Child Health Action Plan Phase II Impacting on Child Health Outcomes 2012 - 2017 ‘Five Plans in One’ Access to Primary Care, Family Violence and Child Protection, Mental Health, Disability, Unintentional Injury Prevention Impacting on Child Health Outcomes 2 ‘Tō te kākano, kia tipu tika, kia tipu kaha’ Sow the seeds so they may grow straight and strong. This meaning of this whakataukī (proverb) is that people who have a solid foundation as a child / infant will grow to have strength and success in adulthood. Impacting on Child Health Outcomes 3 TABLE OF CONTENTS Overview Preamble 4 1. Access to Primary Health Care 6 2. Child Protection / Family Violence 14 3. Mental Health 23 4. Disability - Health Services For Those Who Experience Disability 30 5. Unintentional Injury Prevention 38 Appendix 1 42 Appendix 2: Workshop / Engagement Feedback Summary 55 Appendix 3: Governance 59 Appendix 4: Children in Our District 61 Appendix 5: Consultation 63 References 65 Impacting on Child Health Outcomes 4 Overview The Capital and Coast District Health Board (CCDHB) prioritised child health in the Annual Plan for 2011/2012 and will continue this focus in 2012/13. The Board asked the Planning and Funding Directorate to prepare an action plan focussing on what could have the most impact on child health outcomes in the region. Development of targeted action plans has been broken into two Phases. • Phase I: covering Rheumatic Fever, Respiratory Disease and Serious Skin Infection, with a specific focus on Porirua children, was completed and endorsed by the Board in May 2011. Stage II of Phase I involves utilising rheumatic fever, respiratory disease and serious skin infection resources across other high needs areas in the district; and • Phase II: covering Access to Primary Care, Family Violence / Child Protection, Mental Health, Disability and Unintentional Injury Prevention. This paper has been developed for the purposes of identifying the key issues, and prioritised areas for action for Phase II. The Phase II document has been developed effectively as “five plans in one ”. The CCDHB Child Health Integrated Care Collaborative (ICC) [see Governance section for details] will oversee the implementation and development of Phase I and Phase II Action Plans. A key role of the Child Health ICC will be to: • Identify sustainable approaches to address service priorities; • Develop and implement plans for service changes; and • Develop a measures, monitoring and evaluation framework. Appendix 1 contains a Prioritised Areas of Action Summary Table. Preamble The early years of life have a unique and formative impact on child health, development and ongoing relationships throughout adult life. Early environments that include adverse childhood experiences and other risk factors, such as low income, are related to chronic childhood illnesses, and decades later, to adult mental and physical health problems. 1 Poverty in conjunction with other factors such as, having a disability and / or significant health problems can be a risk factor. The 2009 report Organisation for Economic Co- operation and Development (OECD) Doing Better for Children determined that New Zealand needs to take a stronger policy focus on child poverty and child health, especially during the early years when it is easier to make a longterm difference. Many hospitalisations are potentially avoidable, and could be prevented through primary health care interventions and improvement in household conditions. There are currently large disparities in child health status, with Māori and Pacific children and those living in more deprived areas experiencing a disproportionate burden of morbidity and child mortality. Early-life interventions can provide excellent value for money because of their multiple positive consequences. Promotion, prevention and intervention strategies applied early in life are more effective in altering outcomes and reap more economic returns over the 1 Gluckman Dr P, Improving the Transition Reducing Social and Psychological Morbidity During Adolescence May 2011 Impacting on Child Health Outcomes 5 life course than do strategies applied later. This will require long-term commitment to appropriate policies and programmes. Primary health care providers represent a significant and natural point of contact for young children in the first few years of life and offer the opportunity to identify early problems through regular screening of the child and other family members. They have the opportunity to intervene early with family / caregivers of infants and toddlers to promote children’s mental health and well-being. The aim of the Phase II project is to improve the health status of children in the most high needs communities through the strengthening of investment in and integration of child health services across the continuum of care. The current focus is on Access to Primary Care, Family Violence / Child Protection, Mental Health, Disability and Unintentional Injury Prevention. This Plan is intended to better understand the health needs of children in the CCDHB region, identify unmet need and develop a prioritised plan to assist in allocating resources as a focus for future development. While there is some overlap with child and youth health issues, particularly in the disability and mental health work streams, the key focus of this Plan is on children aged 0-14. CCDHB intends to develop a separate youth health work stream in 2012/13. Impacting on Child Health Outcomes 6 1. Access to Primary Health Care Prioritised Areas of Action Better, Sooner, More Convenient, Integrated Family Health Networks and Whanau Ora policy initiatives provide for a range of opportunities for improving child health outcomes. Within this context the prioritised areas of action proposed are: 1. Implement Zero GP Fees for Under Sixes After-hours CCDHB will work with primary care providers to ensure access to free after-hours GP visits for children under six years who need access to acute care. Zero fees for under sixes during after-hours will make it easier for those families / whanau who need to see a GP or nurse outside of business hours for acute care. This is expected to help reduce the numbers of young children presenting at hospital emergency departments. CCDHB will work with primary care providers to ensure access to zero fees for under sixes at after-hours clinics is available from 1 July 2012. Objective Measures Timeframes The Policy Goals for this initiative are: help improve access to services through reducing financial barriers address the national variability in fees for after-hours service provision for this age group reduce the numbers of young children presenting to Emergency Departments (ED) with conditions that might be better treated by primary care providers enhance child health outcomes Financially sustainable service 95 -100% service coverage achieved Reduction of ED attendances for children under six years of age Reduction in acute admissions for children under six years of age From 1 July 2012 2. Zero GP Fees for Under Sixes Extended CCDHB will work with primary care providers to ensure access to free business hours GP visits for children under six years. Zero fees for under sixes during the day are an extension of the free after-hours initiatives and will ensure after-hours and business hours service charges are aligned. This is expected to improve access to all under sixes. CCDHB will work with primary care providers to ensure access to zero fees for under sixes in business hours is available from 1 July 2013. Objective Measures Timeframes The Policy Goals for this initiative are: help improve access to services through reducing financial barriers address the variability in fees for Financially sustainable service 90 -100% service coverage achieved From 1 July 2013 Impacting on Child Health Outcomes 7 after-hours and business hours service provision for this age group 3. Child PHO Enrolment Being enrolled with a PHO is critical to ensuring children are engaged to receive ongoing care. It is particularly important to ensure high need populations and children living in vulnerable communities are enrolled. Future work would assess any gaps in enrolment for children in PHOs. It would ensure that children are enrolled at birth by key services such as Lead Maternity Carers (LMC’s), Well Child / Tamariki Ora providers and hospital neo-natal and maternity services. Objective Measures Timeframes Support PHOs to encourage enrolment of Māori and high need populations (vulnerable communities) Link enrolment to N.I.R, Well child and Immunisation The percentage of children enrolled with a PHO by 8 weeks of age. Target 2012/13 85% [10% of those will be Māori ] July 2013 4. Integrated Family Health Network CCDHB is to work with primary care on the development of Government’s Integrated Family Health Centre (IFHC) policy initiative. CCDHB is exploring the development of Integrated Family Health Networks that have the potential to develop and implement more child friendly models of primary health care. Objective Measures Timeframes CCDHB’s objectives are to: Develop a shared strategic vision for the development of IFHCs and/or Networks and how they might best support the system and service integration work currently underway as part of the Integrated Care Collaborative Programme Engage with primary care and community providers to look at service specific integration models for the development of Integrated Family Health Centres/Networks within the Capital & Coast District Shared Strategic Vision for District Service Integration models identified July 2014 5. Oral Health Hutt Valley DHB, which provides preschool and school aged oral health services for CCDHB, is continuing the rollout of the Oral Health Business case. This involves the construction of new dental clinics, the purchase of new mobile units and new oral health educator roles. Work on improving oral health is a key priority for the DHB. Objective Measures Timeframes For the following population groups: − Māori − Pacific − Other − Total Population The percentage of children under 5 years enrolled in DHB funded dental services The percentage of adolescents Underway Impacting on Child Health Outcomes 8  Enrolment (preschool and primary/intermediate)  Examination (preschool and primary/intermediate)  Completion (preschool and primary/intermediate)  Proportion of children not seen in the planned recall period Provision of an oral health promotion programme Adolescent utilisation rates (by school deciles) Number of adolescent dental providers (both private contractors and other service delivery models) accessing DHB funded dental services The percentage of children 0-12 years not examined according to their planned recall period 6. Māori Health CCDHB priority is to improve the health of children in the most high needs communities. The focus on the health of Māori children is to: • Support PHOs to encourage enrolment of Māori and high need populations (vulnerable communities); • Target funding streams to reduce health inequalities; • Support programmes / initiatives aimed at reducing Ambulatory Sensitive Hospitalisations; • Support the CCDHB Immunisation Programme; • Support the implementation of the Māori Health Action Plan 2011/12; and • Support the development of Whānau Ora initiatives. Objective Measures Timeframes Improve coordination, delivery and investment targeting of child health services in the district Ensure equity of access to services delivered across district Target investment towards high needs and vulnerable communities Reduced incidence of rheumatic fever Reduced incidence of respiratory disorders amongst children Reduced incidence of serious skin infection amongst children Overall improvements in child health in the district Development and monitoring of tamariki health dash board Underway Dash board developed 2012/13 7. Pacific Health Access and affordability are the two most common factors contributing to Pacific children’s poor health and well-being. Strengthening current services is a priority. Primary Care Pacific Support Services have been developed to improve health outcomes for Pacific children. The Service aims to: • Improve access to care and the provision of fanau based wrap-around care; • Achieve measureable improvements for Pacific children in chronic and preventable conditions; and • Reduce the disparity in Pacific children’s health, particularly in localities with the highest ASH rates. Impacting on Child Health Outcomes 9 The service will be delivered through a team of Navigators. Navigators are health workers who will work with Pacific people and their fanau in the community. The Navigators will also work with other providers to enable them to become more responsive to the needs of Pacific people. Objective Measures Timeframes The Service aims to improve health outcomes for Pacific children and those with long term conditions within the primary care environment. The Service aims to: Improve the health of the Pacific populations through improved access to care and the provision of fanau based wrap around care Achieve measureable improvements for Pacific children in chronic and preventable conditions Reduce the disparity for Pacific children’s health and in particular for ASH Achieve improvements in the incidence of Pacific People with long term conditions and support those with long term conditions to live well longer Work with priority practices to develop them to be responsive to Pacific peoples values and health needs The Service will be expected to achieve the following: 5% reduction in the number of children ASH related admissions per annum for Pacific 5% reduction in the number children and total population for ASH related admissions per annum for Pacific in the 10 priority practices In reach and community support for 100% of Pacific children that on discharge have been referred by the CCDHB hospital’s Pacific Health Unit 75% CVR completed by end June 2013 Priority practice DNA rate reduction Development of a practice assessment process to ascertain the responsiveness of the priority practices to the Pacific peoples and the level of patient empowerment that has been achieved by the Service by end July 2012 Improvements in the practice responsiveness to Pacific peoples care as determined by the priority practices and patients 2 Improvements in the level of patient empowerment as determined by patients in the priority practices 1 From 2011/12 Underway What’s in Place? Primary care forms the foundation of an effective health system, with provision of services such as immunisation, Well Child / Tamariki Ora checks, and management of acute illnesses - all important for a child’s long-term health. Ensuring family / whanau have access to care whenever they need it allows for timely treatment and can avoid more costly care being required if health worsens. 2 The method of collecting this information is to be developed by July 2012 as detailed in Section 6 Service Planning & Performance Targets Impacting on Child Health Outcomes 10 Primary and community health care services that provide services to children encompass a wide range of services these include primary health care teams, Māori and Pacific health services, pharmacist services, community pharmaceuticals, child and adolescent oral health services, and mental health services. Access to primary health care is recognised as an important element in maintaining child health and reducing disparities in health. At present, children under five years have two main points of entry into primary health care. They can be enrolled with a Primary Healthcare Organisation (PHO) and / or access child health services delivered through Well Child / Tamariki Ora providers. Key child health stakeholders include Regional Public Health, Lead Maternity Carers (LMCs), Well Child / Tamariki Ora providers, PHOs, primary care and a range of Non Governmental Organisations (NGOs) and local Government. Immunisation services are provided by Primary Care, Well Child / Tamariki Ora providers, and Regional Public Health. Oral Health Services include services provided by Hutt Valley DHB for the CCDHB area. Of the estimated 300,000 people enrolled with PHOs in the district, 54,696 are children aged 0-14 years (January 2012 PHO Register) Under the PHO agreement practices receive a fee for care of children. In addition, if practices offer zero fees for under 6’s a further subsidy is available to all participating PHOs as an incentive to ensure young children have access to timely and adequate primary health care. After hours primary care service delivery is complex and reliant on numerous service elements such as: • Accident & Medical Centres • Emergency Department • Ambulance / Paramedics • Primary care led after hours clinics and telephone support • Telephone Triage and advice service (Healthline, Home Medical Care) • Urgent Community Care (i.e. Kapiti) • District nursing • Access to medication • Palliative care Services to Improve Access (SIA) funding is also available for all PHOs to reduce inequalities among those populations that are known to have the worst health status: Māori, Pacific people and those living in NZDep index 9-10 decile areas. This funding is for new initiatives or innovations that improve access and is additional to the main PHO capitation funding for primary care provision. Additional primary health care services are accessed as children get older through nurses in schools (i.e. School-based health services) or in the community (i.e. Youth one stop shops). Other useful mechanisms to support child health initiatives in the sub-region also include Integrated Care Collaboratives, Porirua Kids Project and Keeping Well Healthy Skin Initiative. [...]... and secondary sector Impacting on Child Health Outcomes 13 2 Child Protection / Family Violence Prioritised Areas of Action Child protection and family violence is a shared responsibility of individuals, families, professionals, community groups, leaders, agencies and government Within this context the prioritised areas of action proposed are: 1 Child Protection Systems Service Design Project Child. .. improving child health Reporting July 2012 Implementation from 2012/ 13 2 National Child Protection Alert System A Memorandum of Agreement for the National Child Protection Alert System was developed in May 2011 The Agreement is to support the consistent and effective implementation of the policies and practises underlying the National Child Protection Alert System Under this work stream the National Child. .. education, Youth One Stop Shops (YOSS), GPs Development 201 2- 13 Implementation 201 3-1 4 Evaluation 201 4-1 5 2 Number of secondary consultations completed Collaborative assessment and intervention for children with suspected Autistic Spectrum Disorder and Aspergers Syndrome The collaborative assessment and intervention for children with suspected Autistic Spectrum Disorder and Aspergers Syndrome action involves... 200 7-0 8 Maori Impacting on Child Health Outcomes 200 8-0 9 200 9-1 0 Pacific Other 201 0-1 1 All Ethnicities 26 Percentage of CCDHB Population Clients aged 10 - 14 years seen by CCDHB 4.0% Blueprint Target 3.9% 3.0% 2.0% 1.0% 0.0% 200 7-0 8 Maori 200 8-0 9 200 9-1 0 Pacific Other 201 0-1 1 All Ethnicities There is generally agreement that there is a significant underspend in infant, child, and youth service provision... Impacting on Child Health Outcomes 29 4 Disability - Health Services For Those Who Experience Disability Prioritised Areas of Action Improving disability responsiveness within health care services is to be achieved by: 1 Improving The Transition From Paediatric To Adult Health Services This action proposes the development of a workforce development plan that has an identified point of co-ordination to:... specialist child protection roles; • Primary care needs to be better linked in; Impacting on Child Health Outcomes 17 • • • • Training for CCDHB staff is variable and inconsistent; CCDHB lacks a dedicated child protection team; There are challenges in maintaining effective intersectoral relationships; and There is a lack of consistent child protection guidelines and policies across three DHBs sub region Family... separation While the highest numbers of deaths are New Zealand European, Māori are overrepresented as both victims and perpetrators Impacting on Child Health Outcomes 22 3 Mental Health Prioritised Areas of Action CCDHB has a commitment to providing Better, Sooner More Convenient mental health services9 in line with the government’s advice and within this context the prioritised areas of action proposed... rate of older children) The leading causes of ASH admissions for the 0-4 age group are dental conditions, gastroenteritis and asthma Impacting on Child Health Outcomes 11 ASH 5-1 4 years, CCDHB, 2010/11 60 Rate per 1000 50 40 30 20 10 0 Kapiti Porirua TLA Wellington Maori Pacific Other Ethnicity The leading causes of ASH admissions for the 5-1 4 age group are dental, asthma and skin infections There have... protection is best achieved when all stakeholders accept responsibility and work together collaboratively to protect children from harm The Child Protection Systems Service Design Project involves developing a phased approach to child protection service development: • Phase I - building a multi-disciplinary team approach within CCDHB; • Phase II - a strategy to support a wider CCDHB Hospital and Health. .. free services for children in areas where they are required; 2 Greater utilisation of nurse-led programmes within PHOs to maximise the skill and experience of a range of health professionals; Impacting on Child Health Outcomes 12 3 4 Better collaboration between primary care and public health in order to prevent, not just cure, illness common in ASH; and Improved health information exchange within . Child Health Action Plan Phase II Impacting on Child Health Outcomes 2012 - 2017 ‘Five Plans in One’ Access to Primary. prepare an action plan focussing on what could have the most impact on child health outcomes in the region. Development of targeted action plans has been