Polly Atatoa Carr, Sneha Sadani, Jesse Whitehead, Deanne McManus-Emery, Tanya Parsonson and Jolanda Roe

Supporting Child Wellbeing a health assessment tool for the Hamilton Children’s Team Abstract The Hamilton Children’s Team received its first referral in 2015, with dedicated lead professionals appointed for each child referred. The role of these lead professionals is to assess need, develop a plan for each child, and coordinate a cross-sector Child Action Network to improve care and wellbeing. Challenges were identified in Hamilton for the assessment, identification and coordination of health need within the Children’s Team, particularly for lead professionals from outside the health sector. Therefore, a health assessment package was developed in partnership with the Hamilton Children’s Team, the Waikato District Health Board and other relevant agencies. The use of a standardised and systematic approach, with training and relationship development, resources and referral pathways, resulted in identification of significant unmet need. A number of referrals to the health sector resulted from this assessment and there are implications that such a process can support ongoing attendance at health appointments, monitoring of outcomes from the Children’s Team process, and improvements to physical, emotional and mental wellbeing for families. This approach was well received by lead professionals and families, and future use is likely to enhance the Children’s Team programme and service delivery, and improve wellbeing outcomes. Keywords child health, child wellbeing, health, health assessment, social sector support

Page 10 – Policy Quarterly – Volume 16, Issue 1 – February 2020 round 230,000 children under the Children’s Teams are designed to identify age of 18 in Aotearoa New Zealand at One key early risk and assess the cross-sectoral Asome point during their childhood component of needs of children and their families, as well may experience harm as a consequence of as their strengths, and support the receipt their family environment and/or complex the Oranga of services to achieve improved outcomes. contexts and needs (Expert Advisory Panel The Children’s Team approach is on Modernising Child, Youth and Family, Tamariki reform intended to involve strengthened regional 2015a). The Children, Young Persons and (and national) governance with joint Their Families Act (now Oranga Tamariki process has responsibility and prioritisation; cross- Act) 1989 governs child protection in sector practitioners and professionals Aotearoa New Zealand and is noted for its been the operating together to address the needs of emphasis on family orientation and family children; and improved capability of the participation (Connolly, 1994). Since this development children’s workforce to work in a child- act was passed, however, several social policy centred way, in partnership with families changes have occurred, with detrimental of Children’s (Oranga Tamariki, 2019b). influence on family environments and Teams in order Ten Children’s Teams were established support structures for children and youth. from 2013, including in Rotorua, These have included the scaling back of to support early Whangärei, Counties Manukau, Hamilton, social and economic supports, a reduction Tairäwhiti, Eastern Bay of Plenty, of non-governmental organisation funding intervention Horowhenua/Ötaki, Marlborough and for preventative child welfare services, and Canterbury. Hamilton was announced as increasingly unaffordable housing leading or secondary a Children’s Team site in 2014, and the first to high child poverty rates (Hyslop, 2017; referrals (which come from across agencies, Keddell, 2018). Additional pressures on the prevention of including from Oranga Tamariki, education child and youth protection system have services and health services) to the resulted from: increased costs for children Oranga Hamilton Children’s Team were received in out-of-home care; inability to continue in September 2015. When a Children’s care for those beyond the age of 18; criticism Tamariki Team referral is accepted, a ‘lead of structural disadvantage for Mäori; involvement ... professional’ is appointed as the main point workforce concerns, including capacity and of contact for the child. The core roles of professional tensions; poor collaboration the Children’s Team lead professional are between government agencies; unequal to engage with children and families, assess distribution of responsibility between Plan 2012, the Vulnerable Children’s Act the current needs of the referred child, and government and non-government sectors; 2014, and the review of the Child, Youth develop a single multi-service plan for and attention to data for evidence-informed and Family Service (now Oranga Tamariki children and families that consent to the practice and evaluation (Katz et al., 2016; – Ministry for Children) (Keddell, 2018). process. All the community services and Keddell, 2018; Rouland et al., 2019). agencies that are needed to provide support Reforms of the child welfare system in Children’s Teams (described as the Child Action Network or Aotearoa New Zealand have attempted to One key component of the Oranga CAN) are then coordinated to respond and address such challenges, and most recent Tamariki reform process has been the deliver on the plan by the lead professional. reforms have been wide-ranging. The green development of Children’s Teams in and white papers for vulnerable children order to support early intervention or Health assessment in Children’s Teams (Ministry of Social Development, 2011, secondary prevention of Oranga Tamariki The current tool utilised by lead professionals 2012) and reports of the Expert Advisory involvement (Oranga Tamariki, 2019a). to assess need, and to demonstrate Panel on Modernising Child, Youth and The aim of Children’s Teams is to work improvement within the Children’s Family (Expert Panel Advisory on with children and youth (up to 18 years Team process, is the Tuituia Assessment Modernising Child, Youth and Family, old) who are at significant risk of harm Framework (Oranga Tamariki, 2013), which 2015a, 2015b) were key components of to their wellbeing, but who do not meet records the areas of need, strength and risk three recent reforms: the Children’s Action the statutory intervention threshold. for a child or young person, their parents

Dr Polly Atatoa Carr is a public health medicine specialist in child and Team. Jesse Whitehead is a PhD candidate and health geographer at youth health at Waikato District Health Board, and an Associate Professor the National Institute of Demographic and Economic Analysis (NIDEA) at of Population Health at the National Institute of Demographic and Economic the University of Waikato. Tanya Parsonson was team coordinator of the Analysis (NIDEA) at the University of Waikato. Dr Sneha Sadani is a Hamilton Children’s Team during the health assessment pilot and is currently paediatrician at Waikato Hospital and a Senior Lecturer in Paediatrics, Child the support manager for the Hamilton Children’s Team. Jolanda Roe was the and Youth Health, University of Auckland. Deanne McManus-Emery is the children’s team coordinator of the Hamilton Children’s Team, Services for Regional Manager, South Auckland Services to Children and Families for Children and Families, Oranga Tamariki during the health assessment pilot. Oranga Tamariki. Prior to this she was the director of the Hamilton Children’s

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Table 1: Areas of health need included in the pilot assessment with the priorities to improve outcomes for Hamilton Children’s Team vulnerable children and families in Domain: Healthcare Housing Education and Broader Hamilton; and development wha-nau • establish whether a standardised tool experience for health need assessment improves Health General Practice Whare ora* Developmental Community lead professional capacity and supports need access and engage- eligibility and behavioural services card – the Children’s Team model of care. area ment; Well Child Housing tenure concerns eligibility and This article describes the health needs Tamariki Ora (WCTO) Perception of Early childhood access assessment tool which was piloted with access; Before School housing quality education and Material selected lead professionals involved in the Check access Oral Perception of care – access and resources – Hamilton Children’s Team in 2018-19. health; Vision; Hearing housing security enrolment NZiDep** Descriptive analysis of the health need Immunisation Experience(s) School attendance Financial that was identified during the piloting of Cigarette smoking of residential Education support support – this needs assessment is also provided. Pregnancy support mobility services and eligibility and Finally, recommendations for the future Other specific, Safe sleep funding – access access use of health assessment tools within a common health issues Home safety Children’s Team approach are outlined, *Whare Ora is Waikato District Health Board’s programme to support whänau to create healthier, warmer, drier, and safer homes. and the policy implications of this **NZiDep is an index of socio-economic deprivation for individuals (Salmond et al., 2005). research are discussed. Table 2: Levels of individual deprivation among children referred to the Hamilton Children’s Team Methods Number of Percentage of HCT The pilot health assessment tool was NZiDep Index HCT children children developed in August 2018 in partnership with the Hamilton Children’s Team No NZiDep characteristics described 2 4.3 director, Children’s Team support staff, One NZiDep characteristics described 2 4.3 lead professionals, and key experts at Two NZiDep characteristics described 6 12.8 Waikato District Health Board. The Three or four NZiDep characteristics described 13 27.7 lead professionals involved in this pilot Five or more NZiDep characteristics described 17 36.2 were those from agencies outside the Missing data 7 14.9 health sector (such as Kirikiriroa Family Services Trust). These lead professionals and/or caregivers across three dimensions: ultimately barriers to improving child and were predominantly full-time, and they Mokopuna Ora, Kaitiaki Mokopuna, Te Ao family outcomes. represented approximately 40-50% of Hurihuri (Oranga Tamariki, 2019c). This the full-time equivalent capacity of assessment framework is broad, with little The current study the Hamilton Children’s Team lead specific information gathered or recorded Through the establishment and evaluation professionals, providing the opportunity regarding health, and no opportunity to of the Hamilton Children’s Team, to involve up to 50 children in the health monitor access to eligible health services. In partnerships were established between the assessment pilot. the Hamilton Children’s Team, the majority University of Waikato, Oranga Tamariki and This tool was developed through an of lead professionals are employed in social the Hamilton Children’s Team, the Waikato iterative process involving subject matter sector organisations without specific health District Health Board, and community experts in child health and child assessment competencies, or health sector agencies involved in supporting children development, and was built from the connections. A recent evaluation of the role and families. Having identified the gaps in Harti Hauora Assessment Tool – a of lead professionals within the Hamilton health assessment competencies and health Whänau Ora-based assessment instrument Children’s Team (Atatoa Carr, 2017) found sector connections for lead professionals, designed to reduce health inequities for that Hamilton lead professionals were this project intended to develop and pilot inpatient children and families at Waikato requesting a specific, standardised health a standardised tool for non-health-sector hospital (Masters-Awatere and Graham, needs assessment as an add-on to the lead professionals to assess the health need 2019). Criteria for the inclusion of Tuituia framework that could be completed of children within the Hamilton Children’s assessment questions were determined in and monitored consistently. Without this Team. The objectives of this project were to: the development of the pilot assessment specific and standardised assessment of • build lead professional capability to tool. These criteria included: a suitable health need, lead professionals in Hamilton assess unmet health need, and support question can be asked by lead professionals described difficulties with determining the health system access for Children’s of children and families to gain service and resource requirements for their Team children and families; information about the particular health families, challenges with advocacy and • identify specific areas of health, and need; the area of health need is known to CAN engagement in the health sector, and broader wellbeing, that are likely have an important impact on child and

Page 12 – Policy Quarterly – Volume 16, Issue 1 – February 2020 whänau health outcomes; there are Results appropriate services available that can Training address the need identified. The tool The two-day training programme was an included questions to identify areas of Taking a important component of the support for potential need across four domains (see the lead professionals involved in this pilot. Table 1): healthcare access; housing; systematic and It was attended by the lead professionals, education and development; and broader standardised the Hamilton Children’s Team director whänau experience (including aspects of and support staff. The training focused on the Tuituia assessment which are not approach each specific aspect of the assessment tool, further discussed in this article). and was delivered by the referral partners The tool was developed as a paper- allowed lead from within the health sector. This based questionnaire so that lead provided the lead professionals with not professionals could complete it over several professionals only an improved understanding of the visits with the children and their families, measurement of health need, but also an and during the pilot period it replaced the without specific understanding of the services in Hamilton Tuituia assessment for those lead where they would be able to refer children, professionals involved in this project. health sector young people and their families, as well as Immunisation information for children an opportunity to foster relationships with was also confirmed using the National knowledge to people in those services. Complexities of Immunisation Register, where available. identify the eligibility criteria for each service and Children’s demographic information the relevant referral paths were described, and household composition were also unrealised gaps in addition to aspects of child development collected and recorded, and the following and health across the early years. additional resources were developed for the in service Hamilton Children’s Team to support the Pilot assessment of health need assessment tool: delivery (‘we The standard processes were followed • a two-day training package for the lead regarding referral of children to the professionals, involving relevant local don’t know what Hamilton Children’s Team in 2018. Of agencies; the children referred and accepted, 59 • referral pathways for each aspect of the we don’t know’). children were assigned to one of the lead assessment tool, including forms for This was professionals involved in this pilot and referral to further health services; were therefore eligible for an adapted • lead professional resources and particularly assessment utilising the health assessment information about health need and tool. All caregivers consented to the use health services in the Hamilton area; and evident in areas of the health assessment tool to identify • resource kits for families. specific health need, and consent for All the caregivers/parents of the of health need researchers to access anonymous data children who were referred to the lead from this assessment was obtained for 47 professionals during this health assessment that had typically children (80% of eligible children) from pilot period provided their written 29 households. informed consent to undertake this health not been assessment, and consent was also requested Sociodemographic information for their anonymous information on identified utilising Most households (66%) had a single child health need to be collated for research the broader referred to the Hamilton Children’s Team, purposes. Throughout the duration of this with the remaining households having pilot (including during training), the lead Tuituia approach, up to six children referred. At the time of researcher met regularly with the lead the study, 17% of children were five years professionals and Children’s Team staff to such as oral old or younger, 38% were aged 6–10 years discuss the utility of the tool, challenges and 45% were aged 11–18 years. Sixty per and barriers, and opportunities for health, housing cent of children were male. Thirty-eight improvement. per cent of children identified as äM ori, Ethical approval for this research was safety and health 34% as European/New Zealand European obtained from the University of Waikato and 13% as Middle Eastern. Other ethnic Human Research Ethics Committee service access. groups represented include Columbian, (Health) in January 2018. Afghani and Cook Islands. English was the most common first language spoken

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Figure 1: The health needs of children referred to the Hamilton Children’s Team partially immunised. Just over half of all households (52%) contained smokers. Sore throats Other health issues among the children Scabies raised by their caregivers with their lead Head lice Soiling or wetting issues professional included mental health Concerns about hearing issues (23%), eczema (17%), other skin Skin conditions conditions (15%), issues with soiling or Eczema wetting (13%), head lice (6%), scabies Concerns about vision (4%) and sore throats (2%) (Figure 1). Mental health Not enrolled with a GP Not had recent health assessment Health outcomes Not fully immunised As a result of this assessment tool pilot, Not enrolled with WCTO lead professionals made several referrals Not enrolled with oral health service to health services for the families Smoking in household involved (Figure 2), representing various No recent oral health assessment proportions of the health need identified Not had B4SC (if eligible) 0 10 20 30 40 50 60 (Figure 3). Proportion of children involved in Children's Team health assessment pilot Two-thirds (65%) of children in need of oral health assessments were referred for Figure 2: Child and family health outcomes and referrals enrolment and treatment. Other services 12 with high levels of referrals included GP, vision and hearing services. These referrals 10 also addressed a very high proportion (more than 80%) of the need identified. 8 Referrals were made for all children not yet enrolled with a WCTO provider, and 6 one of the two children aged 4–5 years old who had not yet received the B4SC. There 4 were two homes with pregnant household Number of children referred members, and one was referred to the 2 Waikato-based kaupapa Mäori antenatal programme, Hapü Wänanga. 0 Although non-immunisation and Vision Hearing Oral health Wänanga Whare Ora GP enrolmenWCTO/B4SCt Immunisation ü smoking were relatively common health Smoking cessationHap Home safety checklist issues, the number of referrals to address these needs was low. Referrals were made (64%), followed by Arabic (13%) and with a primary care practice or general for 27% of unimmunised children, and Spanish (6%). practitioner (GP), and 66% had recently 27% of caregivers in smoking households The majority of children referred to had an assessment with their GP. Sixty were given advice or referrals. The majority the Hamilton Children’s Team experienced per cent of children eligible (by age) for of smoking caregivers and household one or more indicators of individual socio- Well Child Tamariki Ora (WCTO) services members of the Children’s Team children economic deprivation as measured by the were enrolled with a WCTO provider and indicated that they were not interested in NZiDep Index (Salmond et al., 2005) (see had completed their WCTO checks, up or yet ready to engage with smoking Table 2). Nearly two-thirds of children to (but not including) the Before School cessation services. (64%) experienced high levels of material Check (B4SC). One child aged four or Over half of households (55%) were deprivation (i.e., answering ‘yes’ to three five years of age (out of three in this age eligible for the Waikato District Health or more NZiDep questions), and a third of group) had received their B4SC. More Board’s housing assessment and children had very high levels of material than half (55%) of children were enrolled management programme, Whare Ora, and deprivation (answering ‘yes’ to five or more with oral health services, and only 47% 43% of eligible households were referred. NZiDep questions). had received an oral health assessment Home safety checklists were completed by or treatment in the last year. Caregivers the lead professionals for all houses that Health need, enrolment and access to health described concerns regarding their child/ were not eligible for referral to Whare Ora. services young person’s vision and/or hearing in Most children (77%) involved in the 19% and 15% of children respectively. Housing Hamilton Children’s Team health Nearly two-thirds of children (64%) were Twenty-eight per cent of households had assessment pilot were already enrolled fully immunised, with an additional 4% been living in their current accommodation

Page 14 – Policy Quarterly – Volume 16, Issue 1 – February 2020 for less than 12 months or were moving Figure 3: Percentage of child health need addressed through referrals between homes, and 48% of households were in private rental accommodation, 100% with a further 31% in social housing. Most families (59%) rated the condition of their 80% accommodation as excellent; considered their accommodation to be either very, or 60% quite stable and secure (79%); and thought that their current housing met their 40% needs (75%). However, 24% of families considered their accommodation to be in an average, poor or very poor state of 20% repair, and 10% of housing had obviously hazardous physical conditions noted by 0% the lead professional. Vision Hearing änanga Oral health Whare Ora GP enrolmentWCTO/B4SC Immunisation ü W Smoking cessationHap Home safety checklist Education and development More than 60% of caregivers highlighted Table 3: Health needs of Hamilton Children’s Team children compared to children in the developmental or behavioural concerns Waikato DHB region for their children. Common concerns were described as educational (32%), related to Health need HCT Waikato DHB disorders (32%) or intellectual disabilities Not had B4SC (eligible age) 66% 8% (16%), and behavioural (21%). Almost No recent oral health assessment or treatment* 53% 14% half (43%) of 0–5-year-olds were enrolled with an early childhood education Not enrolled with oral health service** 51% 25% provider, and most children (84%) aged Not fully immunised at five years old 36% 16% over five years were attending school, with No recent health assessment* 34% 24% one child stood down from school at the time of the study. Not enrolled with a GP*** 23% 30% Many children were already engaged *Waikato DHB indicator is for 0–14-year-olds, while HCT includes all children aged 0–18 years ** Waikato DHB indicator is for 4–5-year-olds, while HCT includes all children aged 0–18 years with services to support educational and ***Waikato DHB indicator is for newborn children, while HCT includes all children aged 0–18 years developmental needs, and a further nine referrals were made by the lead Taking a systematic and standardised Children’s Team would have complex needs, professionals as a result of this assessment. approach allowed lead professionals including in the health sector, the level of The most commonly used educational and without specific health sector knowledge need and the prioritisation of services developmental service was resource to identify unrealised gaps in service required has not previously been teachers learning and behaviour (RTLB) delivery (‘we don’t know what we don’t documented. Prior research nationally and support, for eight children, followed by know’). This was particularly evident in internationally is uncommon, and, when Ministry of Education behavioural areas of health need that had typically not conducted, has typically focused on the specialists, English as a second language been identified utilising the broader Tuituia health needs of children in ‘out-of-home’ support, teacher aides, speech and language approach, such as oral health, housing or state care (Duncanson, 2017; Szilagyi et therapy and educational support for high safety and health service access. Simple al., 2015). The four most common health health needs, each of which had two referral pathway information facilitated needs found in this pilot assessment of children using their services. better understanding of health service vulnerable children still in the care of their eligibility and access opportunities. Health families were each present in more than Discussion and implications needs in the families were indeed found to half of referred children: no B4SC (for The opportunity for lead professionals be common, and many of these needs those eligible by age); non-enrolment in from outside the health sector to assess and would have potentially remained oral health services; smoking in the support health needs for families referred unaddressed without the opportunity for household; and no recent oral health to the Hamilton Children’s Team was well lead professionals to ask specific and assessment or treatment. Noting the received. Families engaged in the pilot were standardised questions, and refer families different age ranges and eligibility, where happy to work through the process with the to health services that they had engaged it is possible to compare this level of need lead professionals, and lead professionals with through the training process of this to the total child population in the Waikato described the assessment as a very useful study. District Health Board region (Ministry of ‘conversation starter’ to ask about key health While it was not unexpected that the Health, 2018; Waikato District Health needs in early life and adolescence. families engaged with the Hamilton Board, 2017), it is clear that the Children’s

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Team families are significantly underserved needed to support attendance at services (see Table 3). Every contact (such as clinics) and remain family Other healthcare needs were highlighted advocates throughout service delivery. The in the free text quotes collected on the with a supportive poor health sector engagement in the assessment questionnaire from families. professional Children’s Team process is also reflected in For example, while enrolment with GP the low proportion of referrals to the services was common, many described should be an Children’s Team from the health sector, and poor engagement with GPs, inconsistent has been previously described for other care provision, and a lack of preventative opportunity to work with Child, Youth and Family services care opportunities. Many families relied on (Rankin, 2011). a secondary care provider (rather than a enhance the This pilot demonstrated that a GP service) for the coordination of comprehensive assessment tool, with healthcare, such as child development health system so prescribed referral pathways, resources and services, paediatric services or mental training processes, provided an improved health services. This poor engagement with that we can approach to vulnerable children and GP services was also a challenge for lead deliver equitable families involved with the Hamilton professionals and there were a number of Children’s Team, particularly for health families where needs identified, such as and appropriate need. Understanding and recognising the immunisation, could be better addressed health need of these children and their through comprehensive and preventative care, and families is important in order to ensure that primary care. Previous collation of appropriate care is received and that our assessments conducted for children in the ultimately health services are reviewed for their care of Child, Youth and Family Services accessibility and appropriate service also found a high level of health need, improve family delivery. The tool provided an opportunity particularly with respect to learning to highlight some of the challenges in the support needs, emotional needs, wellbeing. health sector (such as appointment developmental support, mental health and arrangements and eligibility criteria) for oral health (Duncanson, 2017). Ongoing complex children and families needing to engagement and support of the health three or more NZiDep characteristics, engage and access resources. The tool also sector throughout service delivery within compared to 8.7% of children in the New supported lead professionals to have the Children’s Team is important to ensure Zealand population (Gunasekara and increased knowledge and trust in the health sustained improved outcomes for children Carter, 2012). Over one third of children sector and develop clear and specific action and effective early intervention. in this pilot experienced severe material points to remove barriers and improve The significant inequities in access to hardship, and insecure housing (including health outcomes. Health need for these healthcare experienced by families engaged emergency and motel accommodation) families are also cross-sectoral, and with the Hamilton Children’s Team is also was common. managing needs across the education, in part a consequence of the inequities in An important success of this pilot was housing, health and welfare sectors requires the determinants of wellbeing. Families the ability of this assessment tool to provide a complex local understanding of eligibility were more likely to have experienced high specific networks for the lead professionals, criteria, access systems and siloed structural levels of long-term disadvantage, such as knowledge of local services and their approaches. The funding framework for unemployment, low income, caregiver eligibility criteria, and key clinical and Children’s Team work needs to recognise health needs and constrained environments, service relationships. This success was the continuous involvement and as previously described for children in New described by the lead professionals and also commitment of lead professionals in child Zealand in out-of-home care (Duncanson, demonstrated through the high proportion advocacy and service engagement, over and 2017). Socio-economic strains on family of need that was able to be addressed above coordination, and the future use of stability and resources were significant, and through referrals to health and wellbeing a similar approach, with enhanced health in turn these would have an impact on the services. While the role of the lead sector engagement in the Children’s Team ability to access and engage with health professionals is intended to focus on the work, is recommended. services. Approximately 77% of the coordination of care through the Child Ongoing development of the tool children in this pilot experienced two or Action Network, in reality this pilot includes the possibility of support for more deprivation characteristics according demonstrated the need for the lead monitoring health outcomes of families to the NZiDep index, while Gunasekara professionals themselves to be able to involved with the Children’s Team, such as and Carter (2012) found the same level of engage with and navigate the health sector ongoing healthcare delivery (including any material deprivation in 17.6% of the child in order to get concerns met. Challenges waiting list delays and barriers that arise) population in New Zealand. Further, 64% were found relating to access criteria for and improvements to child and family of the children in this pilot had experienced different services, and lead professionals physical, emotional and mental wellbeing.

Page 16 – Policy Quarterly – Volume 16, Issue 1 – February 2020 Further recommended modifications share) information to support families particularly Kirikiriroa Family Services include: opportunities to better address the who have ongoing complex needs that may Trust and the Ministry of Education. We needs of the adolescent population engaged require a lengthy intervention. Every also thank everyone who participated in with the Hamilton Children’s Team; contact with a supportive professional the lead professional training processes addressing specific gaps identified (such as should be an opportunity to enhance the involved, and the Harti Hauora Research mental health, kaupapa Mäori support and health system so that we can deliver Team for the support with the modification services for new migrants); online supports equitable and appropriate care, and and utilisation of the assessment tool for e-referrals and pathway management; ultimately improve family wellbeing. (particularly Drs Nina Scott and Amy better integration with other services and Jones). approaches such as Whänau Ora and the Acknowledgements Tuituia assessment; and a more ‘living’ We would like to acknowledge the lead document, particularly to document (and professionals and their home agencies,

References Atatoa Carr, P. (2017) Evaluation of Health Sector Lead Professional Ministry of Health (2018) ‘Regional results 2014–17: New Zealand Health Participation in Hamilton Children’s Team, Hamilton: National Survey’, https://www.health.govt.nz/publication/regional-results-2014- Institute of Demographic and Economic Analysis, University of Waikato 2017-new-zealand-health-survey Connolly, M. (1994) ‘An act of empowerment: the Children, Young Persons Ministry of Social Development (2011) Every Child Thrives, Belongs, and their Families Act (1989)’, British Journal of Social Work, 24 (1), Achieves: the green paper for vulnerable children, Wellington: pp.87–100, doi:10.1093/oxfordjournals.bjsw.a056042 Ministry of Social Development Duncanson, M. (2017) ‘Health needs of children in state care’, in J. Ministry of Social Development (2012) The White Paper for Vulnerable Simpson, M. Duncanson, G. Oben, J. Adams, A. Wicken, S. Morris and Children, Wellington: Ministry of Social Development, https://www. S. Gallagher (eds), The Health of Children and Young People with orangatamariki.govt.nz/assets/Uploads/white-paper-for-vulnerable- Chronic Conditions and Disabilities in the Northern District Health children-volume-1.pdf Boards 2016, Dunedin: New Zealand Child and Youth Epidemiology Oranga Tamariki (2013) ‘The Tuituia Assessment Framework’, https:// Service, University of Otago practice.orangatamariki.govt.nz/our-work/practice-tools/the-tuituia- Expert Advisory Panel on Modernising Child, Youth and Family (2015a) framework-and-tools/the-tuituia-framework-and-domains/ Investing in New Zealand’s Children and their Families: expert panel Oranga Tamariki (2019a) ‘Children’s Teams’, https://www.orangatamariki. final report, Wellington: Ministry of Social Development, https://www. govt.nz/working-with-children/childrens-teams/ msd.govt.nz/about-msd-and-our-work/work-programmes/investing-in- Oranga Tamariki (2019b) Oranga Tamariki Quarterly Performance Report: children/eap-report.html June 2019, Wellington: Oranga Tamariki Expert Advisory Panel on Modernising Child, Youth and Family (2015b) Oranga Tamariki (2019c) ‘Tuituia framework and tools’, https://practice. Investing in New Zealand’s Children and their Families: expert panel: orangatamariki.govt.nz/our-work/practice-tools/the-tuituia-framework- interim report, Wellington: Ministry of Social Development, https:// and-tools/the-tuituia-framework-and-domains/ www.msd.govt.nz/about-msd-and-our-work/publications-resources/ Rankin, D. (2011) ‘Meeting the needs of New Zealand children and young evaluation/modernising-cyf/modernising-child-youth-and-family.html people who have been abused and neglected’, Best Practice Journal, Gunasekara, F.I. and K. Carter (2012) ‘Persistent deprivation in New 37, pp.4–9 Zealand children: results from longitudinal survey data’, New Zealand Rouland, B., R. Vaithianathan, D. Wilson and E. Putnam-Hornstein (2019) Medical Journal, 125 (1362), pp.101–6 ‘Ethnic disparities in childhood prevalence of maltreatment: evidence Hyslop, I. (2017) ‘Child protection in New Zealand: a history of the future’, from a New Zealand birth cohort’, American Journal of Public Health, British Journal of Social Work, 47 (6), pp.1800–17 109, pp.1255–7 Katz, I., N. Cortis, A. Shlonsky and R. Mildon (2016) Modernising Child Salmond, C., P. King, P. Crampton and C. Waldegrave (2005) NZiDep: a Protection in New Zealand: learning from system reforms in other New Zealand index of socioeconomic deprivation for individuals, jurisdictions, Wellington: Superu Wellington: Department of Public Health, University of Otago Keddell, E. (2018) ‘The vulnerable child in neoliberal contexts: the Szilagyi, M.A., D.S. Rosen, D. Rubin and S. Zlotnik (2015) ‘Health care construction of children in the Aotearoa New Zealand child protection issues for children and adolescents in foster care and kinship care’, reform’, Childhood, 25 (1), pp.93–108 Pediatrics, 136 (4), e1142–66 Masters-Awatere, B. and R. Graham (2019) ‘Whänau Mäori explain how Waikato District Health Board (2017) ‘Early childhood health profile’, the Harti Hauora Tool assists with better access to health services’, Waikato DHB, https://www.waikatodhb.health.nz/assets/Docs/ Australian Journal of Primary Health, 25, pp.471–7 About-Us/Key-Publications/Health-Profiles/0fca8ba2a0/ECE-Health- Profile-2017.pdf

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