Family Start Newsletter November 2018

November 2018 Issue 2

Making Connections Family Start and Universal Health Services

Active Families Family Start National Expansion

Welcome Oranga Tamariki – Ministry for Children (Oranga Tamariki) works to improve the wellbeing and positive long-term outcomes of children and young people. We know that when we invest early, in ways we know will make a difference, we can do better for New Zealand’s most vulnerable children.

Family Start is a nationwide intensive home visiting programme for vulnerable children (aged 0-5) and their families. The programme focuses on improving children’s growth and health, learning and relationships, family circumstances, environment and safety.

The Ministry of Health (Health) and Oranga Tamariki are coordinating across key stakeholders to provide preventative care and improve access to core health services.

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In this newsletter issue we continue to encourage Family Start and health care providers to make connections to improve children’s health.

Contact details for providers to connect with in your region are included with this newsletter.

Healthy Homes initiative -pg 6

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In this issue

Key tips for a warmer, drier home

4 Family Start National Expansion

10 Immunisation Gives Children the Best Start

4 PILLARS Ka Pou Whakahou Family Start Programme

11 Active Families

5 Cheaper GP visits with a Community Service Card 6 Healthy Homes Initiative 7 Zero Fees for Under-14s

11 Active Play Resources for Tamariki

If you follow even just a couple of these tips, your home could be cheaper to heat and more comfortable to live in.

Open your curtains during the day & close them at night.

Stop cold air getting into your home by stopping draughts around doors, windows and fireplaces.

Check you have the best heating option for your home.

Wipe off any water that has collected on walls and on the inside of windows.

Let steam out in the kitchen and bathroom.

Use white vinegar to remove mould from ceilings and walls. (Never mix

Dry your washing outside or in the garage or carport.

Find out if your home is insulated.

You may qualify to have insulation installed for free.

bleach and vinegar.)

www.energywise.govt.nz

Open your windows for at least a few minutes each day.

www.health.govt.nz/warmhomes Aug 2016

12 Start Well Māngere – South Auckland Social Wellbeing Board (SWB)

8 Smokefree whānau

13 Key Tips for a Warmer Drier Home

9 Smokefree Home Support

14 Updated Factsheets

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15 Contact details – use your contacts to make a difference Note 0-5 health services are also commonly described as core health services as they are central to ensuring wellbeing and development.

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Family Start National Expansion We are pleased to announce the establishment of four new Family Start programmes: Nga Mataapuna Oranga Ltd in partnership with Te Manu Toroa Trust (Tauranga/ Western Bay of Plenty), Kowhai Consulting (Waikato), Tuhoe Hauora (Tuhoe Rohe) and Tu Tama Wahine o Taranaki (Taranaki).

The new providers will help us extend Family Start’s reach across New Zealand including into rural and isolated communities, to ensure that all eligible children can access a Family Start service.

We encourage referral services to contact their local Family Start providers to ascertain how many places are available for families; this will also provide an opportunity to refresh contact and strengthen referral networks. You can use the Family Start provider contact list provided with this newsletter to make contact.

The Factsheet also has key information about Family Start that will help to identify families that meet the Family Start enrolment criteria.

PILLARS Ka pou Whakahou Family Start programme PILLARS is another new Family Start provider that will be working specifically with families with an incarcerated parent at the Otago Corrections Facility (OCF).

A special referral process has been developed by PILLARS, OCF and Community Probation. A priority outcome is that when the prisoner/offender is released and becomes one of the caregivers of a child, consistent co-parenting will have been established.

PILLARS will be providing the full Family Start service that includes encouraging families to access health and education services for their children.

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Cheaper GP visits Cheaper GP Visits with a Community Services Card From December 2018 general practices will provide low cost visits during the daytime to all enrolled patients with a Community Services Card (CSC) and their dependent children.

General practices that choose to provide lower fees for CSC card holders will reduce the fees to under $20.

The change to lower fees for enrolled CSC holders does not apply to after-hours or casual patients, and as general practices operate as private businesses, they are able to set their own fees (these will vary between practices).

A person is eligible for a CSC if their family income is below a specified amount which changes for different family sizes. To find out if you might be eligible for a CSC and how to apply, go to www.workandincome. govt.nz and search for ‘Community Services Card’.

You can also phone the call centre on 0800 999 999.

To further support improved access to primary health care services the Government is extending the eligibility of CSC to two additional groups of New Zealanders. People living in public housing with an Income Related Rent Subsidy, and Accommodation Supplement recipients will now qualify to be automatically issued with a CSC.

For further information about the CSC go to https://www.health.govt.nz/our-work/ primary-health-care/primary-healthcare-subsidies-and-services/communityservices-card

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Healthy Homes Initiatives Family Start is working with the Healthy Homes Initiatives (Healthy Homes) to help families keep their homes warm and dry to prevent health problems.

Healthy Homes providers can refer to Family Start and vice versa. The Healthy Homes Initiatives cover 11¹ district health boards (DHBs) with a high incidence of rheumatic fever. Initially, Healthy Homes targeted families with children at risk of getting rheumatic fever who were living in crowded households.

However the programme was expanded to focus on warm, dry and healthy housing for pregnant mothers and at-risk families with children under 5 years old³.

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Healthy Homes identify at-risk families, undertake a comprehensive housing assessment and then facilitate access to a range of interventions to create warmer, drier, healthier homes, such as: insulation, curtains, beds, bedding, floor coverings, heating sources, and moving house (private, community or social relocation). Advice is provided to families on how to keep a house warm and dry, and reduce risks associated with overcrowding.

If you need further assistance establishing this relationship please contact Bronwyn Petrie, Ministry of Health, Senior Project Manager, Communicable Diseases and Healthy Environments (09) 580 9035 or email bronwyn_petrie@moh.govt.nz.

¹ The 11 DHBs are: Auckland DHB, Waitemata DHB, Counties Manukau DHB, Northland, Waikato, Wellington region (Hutt Valley and Capital and Coast), Lakes, Bay of Plenty, Hawkes Bay and Tairawhiti. ³ Expanded eligibility criteria include: 0-5 year olds hospitalised with a specified housing-related indicator condition; families with children aged 0-5 years old for whom at least two of the social investment risk-factors are present; or pregnant women and newborn babies.

Kainga Ora help whānau to find healthy homes.

Kainga Ora, one of two Healthy Homes providers in the wider Auckland region, currently has 40 whānau referred from Family Start providers. Of these families eight to ten have been re-housed in public housing and nine whānau have been referred on to the Minor Repair Service with Habitat for Humanity.

Example of support provided The Feki³ whānau (not their real name) were referred by Family Start. The whānau live in a Housing New Zealand property in an overcrowded environment, a two bedroom property with eight people and a sick baby. The house was also in need of some minor repairs and the whānau needed education about how to maintain a warm and dry home. The whānau also requested a Full and Correct Entitlement assessment from Work and Income.

Kainga Ora supported the whānau with accessing HNZ 0800 minor repair service, assisting the family to move up the public housing wait list (because of support with MSD and through the Rheumatic Fever fast track process) and provided advice on how to maintain a warm and dry home.

The whānau now maintain a healthy new home which meets their needs.

Some top tips and resources for helping to keep your house warm and dry this winter ——See tips for a warmer, drier home on page 13.

——Watch the Key tips for a warmer, drier home videos. The videos are available to watch in English, English and Maori, English and Samoan, and English and Tongan.

——There is a Healthy Homes Initiative page on the Ministry of Health website including contact details for all providers. Go to www.health.govt. nz/our-work/preventative-healthwellness/healthy-homes-initiative for more information.

——Warmer Kiwi Homes: the Energy Efficiency and Conservation Authority has new funding for heating and insulating homes of low income home owners. From 1 July 2018, home owners can apply for grants.

Go to https://www.energywise.govt. nz/funding-and-support/funding-forinsulation/ for further information.

Zero fees for under-14s All children aged under 13, and who are eligible for publicly funded health services, are eligible for zero fee daytime general practice care.

From December 2018, this will include children aged under 14.

Zero fees for children aged under 14 includes general practice after-hours services at participating clinics.

Prescriptions are cheaper with an exemption from the standard $5 charge per prescription item, for daytime and at participating pharmacies during after-hours services.

For further information about zero fees for under-13s go to www.health.govt.nz/yourhealth/services-and-support/health-careservices/visiting-doctor/zero-fee-doctorsvisits-children-aged-under-13

³ Names have been changed to protect privacy.

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Smokefree whānau Smokefree

whānau Most people know of at least some risks of smoking during pregnancy.

These include preterm birth, unhealthy (low) birth weight babies, and an increased risk of Sudden Unexplained Death in Infancy (SUDI).

However, the risks extend further. Children born to mothers who smoke have a greater risk of overweight and obesity, high blood pressure, respiratory problems and are more likely to experience learning difficulties.

Parents (mums and dads) and whānau want the best for their kids, but many who smoke struggle to quit. The last thing that they want is another lecture from a healthcare or social worker about how bad smoking is, and how they must stop for the sake of their baby. For many, smoking is a coping mechanism and you can see how people who smoke may be unwilling to give it up, especially if everyday life is a bit difficult. However, this is not to say that smoking is something we should take lightly.

Encouraging people to make a quit attempt is important, but we need to take a mana enhancing approach and take into account the lived realities of whānau.

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Smokefree Services all provide tailored support for pregnant women and their whānau. Most services now provide financial incentives for pregnant women, and some extend this to post-partum mums, and whānau who are also quitting smoking at the same time.

The Counties Manukau Living Smokefree Service, for example, provides up to $500 in vouchers over 12 weeks if a woman can quit smoking. The smokefree incentives programme is also available for women who are post-partum. Whānau who smoke and quit in support can earn up to $200 in vouchers.

There is good evidence to show that financial incentives can increase quit rates at time of delivery and beyond. In fact, they are probably the best smoking cessation intervention available to help pregnant women quit.

If you don’t know who provides your local smokefree service, or how to refer, check out www.smokefree.org.nz/help-advice/ stop-smoking-services and give the service a call. They will be able to tell you what’s on offer and how to refer. This is also a great opportunity to explain what Family Start can do for Smokefree Service clients, who are eligible for Family Start support. Some areas have good links already, but it’s never a wasted effort to refresh these from time to time.

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Child wellbeing is a Government priority. Helping to ensure that kids grow up without the adverse effects of tobacco smoke, either from exposure during their mother’s pregnancy or from second-hand smoke, (and without their role models smoking) is an important factor in promoting child wellbeing.

When talking with clients about smoking keep your conversation positive and nonjudgemental. Although whānau might find quitting difficult, there is a light at the end of the tunnel. Not only will they be free of the hold of tobacco addiction, there’s a good chance that there will be some extra cash and, eventually, a little less stress in their lives.

Smokefree Home support We all know that our tamariki need smokefree homes, but did you know that smoking during pregnancy has a six-fold increase risk of SUDI than non-smokers? Cutting back is not enough. #truestory

Health Outcomes for Babies Short-term ——Preterm birth ——Fetal growth restriction ——Low birth weight ——Altered brain structure and function in newborns ——Lower fetal heart rate variability

Long-term (childhood and adulthood) ——Increased risk of being overweight or obese ——Higher blood pressure ——Increased risk of wheezing, asthma, airway hyper responsiveness, impaired lung function, bronchitis

——Increased risk of SUDI Banderall et al. Journal of Translation Medicine, 2015, 13:327

We know how hard it is to make changes, so the Ministry of Health has funded face-to-face stop smoking service providers to help make a difference.

Ready Steady Quit provides cessation support to those in the Auckland and Waitemata DHB regions. Part of the service is a specialist maternity incentive programme. This initiative provides behavioural change support and no charge nicotine replacement therapy (QuickMist, patches, gum and lozenges) and vaping information to support hapu mamas and the wider whānau unit become smokefree.

Not pregnant? We still want that smokefree home and we have other options available to support everyone. Quitting unsupported (going it alone) has proven to be less successful than having a one to one connection with a smokefree practitioner, so referral to one of these services helps to make the smokefree commitment work. Kanohi ki te Kanohi works better.

To find out more about Ready Steady Quit go to www.readysteadyquit.org.nz and for information on support services in other regions go to: www.smokefree.org.nz/help-advice/stopsmoking-services

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Immunisation gives children the best start

Even before they are born, babies can be protected from serious illness through immunisation.

The idea of protecting babies by immunising their mums is relatively new, but in the last few years there’s been growing evidence that it’s a safe and effective way to keep serious diseases away from our littlest ones.

Babies get their first antibodies from their mums, passed on through the placenta before they are born, so that they’re protected for a while from the diseases their mums have already fought off. When pregnant mums are immunised, they produce antibodies to the vaccine. Babies get those antibodies from their mums without being exposed to the vaccine itself.

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It’s really important for young babies to be protected against whooping cough, because we have regular outbreaks and the disease is so severe for them. Babies are due for immunisations at six weeks, three months and five months, but they’re still unprotected for their first few weeks unless their mum has been immunised as well. Whooping cough immunisation is recommended and free for pregnant mums at between 28 and 38 weeks’ gestation. Influenza immunisation is recommended and free at any stage of pregnancy.

Once babies are born, they need to be immunised on time to make sure they’re protected when they need it most. Enrolling babies at a general practice as soon as they are born is an important way to make sure they get the care they need. Immunising children on time means that they will be protected against 12 serious diseases before they start school, to get the best start in life.

Active Families Active Families help whānau to lead healthier and more active lives through encouragement and education, nutritional guidance and advice, realistic goal setting and ongoing support.

There are currently 15 Active Family programmes; usually these are for five to 18 year olds and their families. In the 2018 Active Families survey 85 percent of families became more active, 90 percent improved their diet and 98 percent noticed health benefits.

At present, 10 DHBs are funded to provide B4 School Check (B4SC) Active Families for obese four year olds identified in B4SCs. These DHBs have established a range of family programmes that vary from the Active Families approach of group or individual activities, to positive parenting programmes or kaiawhina home visits.

Contacts for B4SC Active Families are attached, please contact your general practice if your family would like to join a programme. GPs or practice nurses can refer overweight children and well child tamariki ora (WCTO) nurses can refer children as long as they contact the child’s general practice.

Active Families contacts (mostly for over five year olds) are attached. Some programmes accept self-referrals just by calling these contacts.

Teara and her whanau riding their scooters

Find out about how Teara and her whānau are healthier and happier with Active Families: www.health.govt.nz/your-health/ healthy-living/food-activity-and-sleep/ green-prescriptions/green-prescriptionsuccess-stories/teara-shares-her-activefamilies-experience

Active play resources for tamariki A package of free Active Play resources has been launched on the Ministry of Health website to help support children aged under five to play regularly and sleep well.

Tamaiti Nohinohi Toddlers 1 2 years SLEEP

11 - 14 hours per day Including at least one daytime sleep

Walking Running Climbing

Play with other children

KIA ITI TE NOHO

PLAY interact, walk and climb reach

p

hold

gras

Sit less

KIA AU TE MOE

Sleep well

No screen time

Hikoi ana e oma ana e piki ana

KIA NUI TE NEKE Move more

A child is represented by the tukutuku pattern ‘maunga’ or mountain.

The pattern demonstrates that all people are made up of many different strands. Strands represent whakapapa (genealogy), whatumanawa (emotional), tinana (biological), wairua (spiritual), whēako (experiences), all of which (and more) represent the very tapestry of who we are. As parents, caregivers, grandparents, aunties and uncles, we have the privilege of influencing the many strands that make up a child.

The resources include: four infographic posters, two videos based on the movements of pūngāwerewere and mokomoko, an oriori (sleep lullaby), a waiata and a karakia.

These resources in Māori and English are colourful, musical and delightful. They were developed to support the Sit Less, Move More, Sleep Well: Active play guidelines for under-fives.

They were designed predominantly for kaiako in kohanga reo, but can be used by anyone who provides advice to parents, caregivers and whānau on active play for tamariki under five years of age.

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Start Well Māngere Start Well Māngere (Start Well) is a home-visiting initiative that has been set up in South Auckland, with a focus on supporting mothers under the age of 20 and their wider whānau from pregnancy through to when the child is aged five. Māngere is a vibrant and diverse community within South Auckland, where the majority of residents identify as Pasifika and Māori.

Start Well started in November 2017 and is an initiative of the South Auckland Social Wellbeing Board (SWB). The SWB was set up in 2016 with a focus on supporting whānau experiencing challenging life circumstances. The particular focus of the SWB is on children aged 0 – 5 years and their whānau, which recognises the importance of the early years in supporting a ‘best start’ in life and the lasting impact that early life experiences have on a child’s future.

The SWB has an independent chair and representatives from 12 agencies including Counties Manukau District Health Board (CMDHB), Ministry of Health, Oranga Tamariki (OT), Ministry of Social Development (MSD), Housing New Zealand (HNZ), Ministry of Education, Te Puni Kōkiri, Ministry for Pacific Peoples, New Zealand Police, Ministry of Justice, Department of Corrections and Auckland Council.

Start Well has been set up with involvement of CMDHB, OT- Partnering for Outcomes, Family Start Māngere, Plunket and the Ministry of Health. It draws on elements of the universal Well Child Tamariki Ora service with additional “unwell child” expertise and the Family Start (social work-led) programme.

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It is using a flexible, combined health and social model of care and is staffed by nurse and social work specialists. Start Well is taking a strengthsbased approach, driven by the reality of the mother and whānau. There is a focus on the style of practice and whānau partnerships. By supporting young mothers and reducing the levels of stress experienced by whānau, the aim is to improve carers’ emotional ‘bandwidth’ for responsive parenting and minimise the impacts of stressors on early brain development and later outcomes.

Some key areas where Start Well has supported mothers include: ——Accessing permanent housing options and increased financial support via MSD and HNZ services ——Working with women antenatally to ensure they are receiving the health and wider social support they need to prepare for the arrival of baby ——Supporting mothers and whānau to build health literacy ——Reducing the use of alcohol and other substances in pregnancy and in the post-natal period ——Empowering whānau to reduce and end family harm and violence in their homes.

Through Start Well, we are further understanding the practice and commissioning requirements to provide effective, flexible support in a timely way to young mothers and whānau requiring high intensity support in the first years of their baby’s life.

Key tips for a warmer, drier home

If you follow even just a couple of these tips, your home could be cheaper to heat and more comfortable to live in.

Open your curtains during the day & close them at night.

Stop cold air getting into your home by stopping draughts around doors, windows and fireplaces.

Check you have the best heating option for your home.

Wipe off any water that has collected on walls and on the inside of windows.

Let steam out in the kitchen and bathroom.

Use white vinegar to remove mould from ceilings and walls. (Never mix

Dry your washing outside or in the garage or carport.

Find out if your home is insulated.

You may qualify to have insulation installed for free.

bleach and vinegar.)

www.energywise.govt.nz

Open your windows for at least a few minutes each day.

www.health.govt.nz/warmhomes Aug 2016

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Factsheet: Family Start and Universal Health Services Family Start

Referring a Family More Than Once

Family Start is an intensive home visiting programme that works with vulnerable 0-5-year-old children and their family/ whānau. It focuses on improving children’s growth and health, learning and relationships, family circumstance, environment and safety.

Health providers can refer a family more than once, provided the whānau meet the criteria and will only be enrolled as one whānau.

Family Start whānau often move, whānau can be transferred from one provider to another. However a whānau cannot be on two Family Start programmes at the same time.

Support from Family Start There are 42 Family Start provider sites and one Early Start4 provider across New Zealand. Family Start has capacity to support around 7,200 children and their whānau.

Criteria for Family Start Whānau with high needs can be referred to Family Start at any time through pregnancy and up until the baby is 12 months old.

Family Start is for families with mental health issues, addiction problems, care and protection history, relationship problems, parenting and child development issues or other issues. Please view this website for detailed criteria: www.ot.govt.nz/assets/ Uploads/Family-Start/Family-Start-referralguide.pdf Older Siblings can benefit from Family Start Family Start is child centred and whānau focused. Older and younger children are able to be supported through Family Start.

Support for siblings and other whānau is important for the development of children in their whānau and environmental context.

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4 Any reference to Family Start is inclusive of Early Start.

Providers That Can Refer to Family Start Midwives, GPs, nurses, Well Child Tamariki Ora, Plunket, Early Childhood Educators and any community agency can refer a family to Family Start; whānau can also self-refer.

The Evidence Base for Family Start A Quasi-Experimental Study was completed in February 2016 that reported on the impact of the Family Start home visiting programme on mothers and children. The most significant finding of the study is robust evidence that Family Start reduced post neonatal infant mortality. Read more here: www.msd.govt.nz/about-msd-and-our-work/ publications-resources/evaluation/familystart-outcomes-study/index.html Further Information on Family Start Please view this website for information on Family Start: www.mvcot.govt.nz/assets/Uploads/FamilyStart/Family-Start-brochure.pdf

The Need for Health Services Young children need access to universal health services to remain healthy, continue to grow and develop, and prevent more serious conditions that require hospitalisation. Young children in difficult circumstances often miss out on the health care they need.

This is why Family Start is working with universal 0-5 (years of age) health service providers.

Universal Health Services Universal health services include general practice, immunisations, Well Child Tamariki Ora, Before School and oral health checks, and newborn hearing screening.

——Dental care is free until children turn 18 years old. Free dental care is provided by the Community Oral Health Service or dentists contracted by DHBs. ——Newborn hearing screening, Well Child Tamariki Ora and Before School checks are also free.

More Information on 0-5 Universal Health Services You can find health service information at: www.health.govt.nz A health and education handbook for families and carers can be found at: www.ot.govt.nz/assets/Uploads/Caregiverresources/Hand-in-Handbook.pdf

Free Health Services ——There is no fee charged for general practice visits for eligible and enrolled children aged under 13, but general practices usually charge a fee for adults and older children. This includes exemption from the standard $5 charge per prescription item. It also applies to after-hours general practice and pharmacy services at participating clinics and pharmacies. From December 2018, zero fees will extend to children aged 13.

Contact Us For further information or to contribute a story or update to the newsletter please contact us: rachael_bayliss@moh.govt.nz or janet.dean@ot.govt.nz for Family Start.

——Youth aged 14-17 years old whose caregivers are CSC cardholders will have reduced general practice fees from December 2018.

——Immunisations provided from the immunisation schedule are free.

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