Who To Refer To:
Welcome What is this book for? Our aim is to create a referral pathways resource for the B4 School Check as it is delivered in the Waikato DHB area. Many of you have asked for a base set of resources that could provide you with some of the key milestones and information connected with four year old development.
Risk Indicators: We’ve always said that the point of B4 School isn’t for the child to have the screen but for the children that require secondary interventions and services, to receive them. Along the way many of you have wanted us to outline a low, medium and high risk scenario. Risk indicators are in blue and are to be used as generic guidelines. When to refer:
Key milestones: Are in yellow and are divided according to subject area. It might have been a while since you last read the Cat in the Hat and laughed along with Kermit the Frog. It might be that a parent simply wants to know - “is this normal”? These milestones aren’t gospel but they will give you a starting point.
The thing that everyone talks about... referrals - how do you know, when should you and who to? Hopefully this book outlines a broad pathway for many of your questions. The quick-guide is in pink and each of the green tables outlines pathways and processes for each risk profile - low, medium and high. Lifelong learning:
Something to think about: We also wanted to provide you with some of the points of view that really made us stop and think as we’ve journeyed around the Waikato. You may not agree with everything written in this section but it is hoped we will add a bit of reflection, debate and discussion to your day.
We know you are busy, we know B4 School isn’t the be-all and end-all of your day but there is a whole internet out there of fantastic resources and research that focus on child health. We’d love to show you, talk to you, teach you and point you in the right direction. If you need ideas or any help getting started, contact the B4SC Coordinator.
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Contents: Dental
Page 3
Immunisations
Page 5
Vision and Hearing
Page 6
Development
Page 7
Speech
Page 9
Growth
Page 11
Mental Health
Page 13
Behaviour
Page 15
Early Childhood Education
Page 17
Safety
Page 19
Parenting
Page 21
Contact Details
Page 23 2
Dental
REFERRAL PATHWAYS
“Children are one third of our population and all of our future” - Select Panel for the Promotion of Child Health.
But I’m not a Dental Therapist - why should I grade their teeth? Early childhood dental caries have been identified as the leading health problem in NZ Under 5s... Not meningitis, not chicken pox, not glue ear - dental caries. Many children miss out on accessing services until they start school. Working together we can ensure all children are receiving the free care they need. The Very Important Project (B4SC) aims to act as a “drafting gate” for Under 5s in having a nurse determine, as part of the B4 School Check, whether the child needs to see a Dental Therapist immediately. The Project also aims to have nurses act as that “drafting gate” as well as promote good oral health as part of the check. Just because a child is enrolled with the
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dental service doesn’t mean they have accessed the care they require. By checking Waikato children’s teeth at four we can refer for dental treatment where it is needed up to a year earlier than it is currently being accessed by our region’s children and their parents. Although almost totally preventable, dental disease is a significant health problem in the Waikato. These disease rates are not acceptable. Children in our community are suffering needlessly. Many may experience delayed speech development, can’t sleep, have difficulty paying attention in school and are at risk of further health problems. Some even end up in the operating theatre because the disease has reached such an advanced stage. Given the scarcity of health care dollars, dental disease prevention is a wise investment for our community. We all benefit when children are healthy. As the saying goes, “you pay now or
you pay later.” We have a responsibility and a financial incentive to provide dental care before a child’s overall health is impaired. Protecting the oral health of our youngest residents will yield both health and financial dividends.
Refer to the resource “Healthy Smile, Healthy Child” which is printed by the Dental service.
Risk indicators Lift the Lip Grades 5 and 6
High
Lift the Lip Grades 3 and 4
Med
Lift the Lip Grade 2
Low
Lift the Lip Grade 1
Nil
Oral health is about much more than having good teeth. Oral health is critical to good health and well-being for children in adulthood. Having clean teeth is important, sure - maintaining good dental health results in fresh breath, a sparkling smile, and a significant savings in the wallet. But good dental health is an indicator of much more than just good brushing habits. A child’s teeth act as a sort of “health barometer” giving outsiders a quick picture of the overall health and wellbeing of a child. Teeth are essential for speaking, eating and guiding adult teeth into the right place. The teeth barometer reflects home care, oral health of the family and diet.
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GOAL: 100% of Very Important Kids enrolled with Dental Service.
Every child
Grade 3&4
Grade 5&6
Enrol:
Refer:
Urgent Referral:
Research has found that an average of 48% of New Zealand five year-olds have experienced dental caries. International Research indicates that this figure should be between 10-20%
Use the Waikato School Dental Service Enrolment Form to register the child. (Nurse to send form through to Dental Service).
Refer to the Waikato School Dental Service. 07 8599160
Refer to the Waikato School Dental Service.
Teach:
Referrals must contain a description of the decay you have observed. Use the Oral Health Assessment and Referral form and post to the Dental Service.
Referrals must contain a description of the decay you have observed.
Spit don’t rinse Full fluoride toothpaste Parent to supervise brushing Water is the best drink Brush for 2 minutes Brush twice daily
Early Childhood Dental Services in the Waikato: Waikato School Dental Service has a range of dental services that both deliver services and promote oral health: -Enrolment from birth. -The Pre-School Oral Health Coordinator. -Oral Health services on selected school sites. -Oral Health checks at Early Childhood Centres. -Oral Health Kaiawhina. -Oral Health in the Holidays. The Dental Service works on a scheduled roster and Dental Therapists and Assistants work on rotation at selected schools in the Waikato DHB area. Dental therapists work out of mobile vans as well as school dental clinics. The schedule for the mobile vans is updated on the DHB website. The number for the local therapist is located under the listing for your local Primary School. You can make a referral to the dental service at any time by calling 07
859 9160 or 0800 TALK TEETH. Brushing Technique? 1)Smear a small amount of toothpaste onto your Very Important Toothbrush. 2)Aim the toothbrush bristles at an angle toward the gum line. 3)Gently jiggle the brush and move it in
small circles over the teeth and gums. 4)Repeat for inside surfaces of all teeth. 5)Spit out the toothpaste after brushing but don’t rinse. 6) Use a soft toothbrush. 7) Brush twice daily. 8)Let the toothbrush and toothpaste be the last things to touch teeth before bed.
Key Tasks: Use the Very Important Toothbrush to demonstrate good brushing technique. Ensure child is enrolled with the dental service. If enrolling at the check, the nurse must post the enrolment form. Grade the teeth 1-6 according to the Lift the Lip Guidelines (err on the side of caution and don’t forget the rear molars)
When to refer: A VERY important number: 0800 TALK TEETH 0800 8255 83384
Post Enrolment form and Oral Health Assessment and Referral form to: Community Oral Health Service, PO Box 1372 Hamilton 3240.
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Err on the side of caution. It is important to refer anything you have concerns about to a Dental Therapist for further assessment. Teeth that have been knocked or bumped in accidents. Dark spots/ areas even when you fear it may just be broccoli. Your notes on the enrolment are important for prioritising what happens next.
Immunisation
REFERRAL PATHWAYS
The importance of the Immunisation Certificate for Parents: All parents will be asked for an Immunisation Certificate when their child is starting an early childhood service, kohanga reo or primary school. The certificate is in the back of the child’s Well Child Book. A separate certificate is also available from Population Health if no Well Child Book is available. The certificate is signed after the four year old immunisations have been given. Parents are still asked to present the Immunisation Certificates even if they have decided not to have their child immunised. Children can still attend an early childhood service if they are not immunised. The information on the certificate is recorded on the early childhood service and school register. The register is held by education so that in the event of an outbreak of disease in an area or community the Medical Officer of Health can check the register
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and offer children who have not been immunised an immunisation. Those who have not been immunised may be asked to stay at home until the disease has gone, to help it stop spreading. The National Immunisation Register is separate from this register and retains a national record of the immunisation status of each child in New Zealand.
outreach services in Waikato towns. Currently, demand outweighs outreach immunisation services capacity therefore the mobile service works as a support mechanism to these.
Mobile Immunisation Service:
(Immunisations Advisory Centre)
The Mobile Immunisation Service consists of two teams, each with an experienced community nurse vaccinator, who is assisted by an experienced community support worker. The service is a hub and spoke model that aligns the National Immunisation Register to a dedicated, centrally based mobile team of vaccinators and support staff. The service primarily focuses on vaccinating children 0-6 years and does not replace current
“Reaching
IMAC: 0800466863
Risk indicators: Incomplete Imms History of catch-ups Recall list for catch ups Complete and up to date
High Med Low Nil
an immunisation target of 95% coverage probably feels like it might take a miracle but if we turn that around and think about working to keep (at least) 95% of our children healthy and free of infectious diseases, to keep on trying just feels so worthwhile. Our children are so worth the effort.” - Hilary Graham-Smith 5
Vision and Hearing
REFERRAL PATHWAYS
“Kids - they dance before they learn there is anything that isn’t music” - William Stafford
Vision & Hearing Screening - transforming the learning experience: “At four you don’t know you can’t see well” Undiagnosed vision problems shape the way a child sees themselves. "If you're four or five and you're sitting there trying to read, you don't know you can't see well. You just can't distinguish between 'a' and 'b'. You're not learning the way other kids are, and it makes you angry. You act out. You get labeled bad or slow, learning disabled or attention deficit disorder. It's a terrible hindrance to any child." Since 70% of classroom learning depends on the visual system, students with uncorrected vision problems are at a tremendous disadvantage before they even enter the classroom. It seems obvious that if a student cannot see clearly, he or she is going to have a very difficult time reading, writing, and even participating in sports.
Something to think about
Comprehensive vision screening is the first opportunity to identify and correct issues before a child starts school. It is well recognized that hearing is critical to speech and language development, communication, and learning. The earlier hearing loss occurs in a child's life, the more serious the effects on the child's development. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact. Hearing loss affects children in multiple ways. It causes delay in the development of receptive and expressive communication skills (speech and language). The language deficit causes learning problems that result in reduced academic achievement. Communication difficulties often lead to social isolation and poor self-esteem and it may have an impact on vocational choices.
Academic Achievement: Children with hearing loss have difficulty with all areas of academic achievement, especially reading and mathematical concepts. Children with mild to moderate hearing losses, on average, achieve one to four levels lower than their peers with normal hearing, unless appropriate management occurs. The gap in academic achievement between children with normal hearing and those with hearing loss usually widens as they progress through school. Social Functioning: Children with severe to profound hearing losses often report feeling isolated, without friends, and unhappy in school, particularly when their socialization with other children with hearing loss is limited. These social problems appear to be more frequent in children with a mild or moderate hearing loss than in those with a severe to profound loss.
Although every one of our senses plays a role in early development, vision and hearing certainly seem to lead the way. A child learns that things and people exist in the world primarily because they see and hear them come and go. They can inspire their parents and friends to linger and play by speaking and making eye contact. They learn about size, shape, color, functions of objects, social interactions, and so much more just by listening and looking at the world at work. Early development has critical links to a child having full use of his/her vision and hearing. When these senses don't work perfectly or not very well, everything is impacted.
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Development
“Children make you want to start life over” - Muhammed Ali
REFERRAL PATHWAYS
Waikato DHB Child Development Centre: CDC is a children's outpatient service based at Waikato Hospital. Children are seen with their families at the centre and sometimes in the ECE or school, or at home. The CDC Team provides assessment and management advice for children with a range of developmental and behavioural disorders. The services CDC provides include: -Comprehensive assessments by a multidisciplinary team for children with multiple developmental and associated behavioural disorders. -Assessment for intellectual disability. -Individual programmes for children with identified developmental needs. -Medical assessment & follow-up of children with suspected or known developmental concerns. -Assessment & management of soiling problems. -Feeding Clinic for children with major eating and swallowing disorders. The CDC team includes: -Social Workers, Psychologists,
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Physiotherapists, Occupational Therapists, Speech Language Therapists, Developmental Paediatricians, and Visiting Neurodevelopmental Therapists. Refer when there are significant parental/caregiver concerns about the child’s development - combined with the evidence from the B4SC.
without even realising. Problem Solving, Language, learning about texture, shape, colour, size, humour, social connectedness, fun, relaxation and confidence all develop as the result of PLAY!
CDC’s contact number: 07) 8398709
The importance of Play in Four year old development: The best thing a parent can do to help their child learn is to spend time with them and encourage them to play in lots of different ways. Play is most valuable when the child gets to ‘make it up’. Encourage parents to help let their child’s imagination go! There are lots of different types of play Active Play Thinking Play Messy Play Making Play Words and Music Play Pretend Play Play means children and their parents learn
Risk indicators: PEDS score 2 or higher and one SDQ individual score of 7+
High
PEDS score 1 and SDQ 17+
Med
Recall list for catch ups
Low
Complete and up to date
Nil
Parents of young children need to realise how crucial these early years are for all future development, and see them as a time of investment with significant rewards. Well nurtured children are less likely to form unhealthy adult relationships arising out of unmet childhood needs. Some of this time needs to be play time - to have fun, to laugh, to do silly things together... become a 4 year old again - go on.... we dare you to!
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GOAL: 100% of concerns about developmental milestones addressed
every child
medium risk
high risk
eyes & ears
identify
identify
Every child should have had their hearing and vision tested by the time they turn five. Return the child on the database ASAP to ensure this can occur.
Family history Peri-natal history Chronic illness Social/Environmental factors Learning stories from ECE
Parental concern Other agency concern Poor social responsiveness Unusual repetitive behaviours Communication problems
encourage
evaluate
evaluate
Enrolment in Early Childhood Education (ECE) if not already
Family history Peri-natal history Chronic illness Social/Environmental factors Learning stories from ECE
Family/Social history Dev/ Medical history Vision & Hearing Screen Previous reports/interventions Learning stories from ECE
refer
refer
-General Paediatrician
-Child Development Centre -General Paediatrician -Nga Ringa Awhina (See contact numbers on last page of this resource).
-Nga Ringa Awhina -GP for secondary screening (See contact numbers on last page of this resource).
PEDS Assessment: MILESTONE QUICKGUIDE Fine Motor Skills Can feed self without a big mess. Can dress self (minus buttons and shoelaces). Can use scissors to cut a line. Looks at puzzle before placing pieces.
Gross motor skills Can walk heel to toe. Can walk down stairs one foot at a time without help. Can hop. Can stand on one foot. Can swing, climb, skip and jump.
Cognitive Can learn, think, reason and solve simple problems. Can focus on a task and finish it. Understands opposites. Understands concepts like under, in front of and behind. Can follow two-step directions such as "close the book and give it to me". Can answer reasoning questions such as, "What do we do when we're cold?" Can tell a short story such as, "two kids played ball."
A method for detecting and addressing developmental and behavioral problems in children. Failure to detect difficulties means that many children do not receive the benefits of early intervention. EARLY INTERVENTION IS IMPORTANT One of the most brief and accurate methods for early detection is Parents' Evaluations of Developmental Status or PEDS. PEDS tells you when parent’s concerns suggest problems requiring referrals and which concerns are best responded to with advice or reassurance. PEDS also reduces ‘oh by the way’ concerns, focuses visits, ensures a ‘teachable moment’, and is known to improve attendance at well visits. PEDS is both an evidence-based surveillance tool and a screening test; it is also a tool for managing a wide range of developmental, behavioural and family issues. With ten short questions to parents, PEDS helps professionals identify children at risk for school problems and those with undetected developmental and behavioural
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disabilities. PEDS helps you decide: Whether a child needs a developmental evaluation or mental health assessment? If so, what kinds of testing are needed? Should a developmental screening test be administered? Do parents simply need advice, and if so, on what topics? Should a child be watched carefully over time to ensure prompt attention for any emerging problems? Are reassurance and monitoring all that is required?
When to refer: Significant caregiver/parent/ teacher concern about child’s development. Your observations of the child’s inability to perform basic milestones. Significant mismatch between yours and parental observations.
Speech
“Grown Ups never understand anything for themselves and it is tiresome for children to be always and forever explaining things to them” - The Little Prince
REFERRAL PATHWAYS
Much More Than Words - Monitoring and encouraging communication: “Much More Than Words” is the foundation text for primary care screening in this field. Much More than Words is a resource developed within Special Education for Early Childhood Educators but with practical applications for Primary Care Nurses working with the B4 School Check. As a document it has been designed to raise awareness of normal communication development and the knowledge of when to reassure parents when there is not a problem. The document includes a series of strategies designed to be photocopied and given to parents to help them work at home with their child to address specific issues.
Learning to talk involves the development and interaction of many different skills. Although all the elements of communication are inextricably linked, they fall into four broad areas and the text “Much More than Words” is divided up accordingly:
Speech Sounds: the sounds and sequences of sounds that are used for talking. The coordination and strength of mouth muscles is an important factor in speech production.
Language: the words and patterns of words that are used to relate meaning and to communicate ideas and thoughts. Language includes things such as sentence length, vocabulary, grammar, understanding of what is said and the social use of language for example greeting, staying on topic, asking and answering questions.
Voice: the sound made by the vocal folds (cords) vibrating. Voice includes volume, pitch, resonance, intonation and overall quality.
Fluency: the smooth, rapid, effortless use of speech and language. Dysfluency is stuttering.
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MILESTONE QUICKGUIDE Speech: Can say all vowel sounds. 90% intelligible and understood by the wider population. Can say p,m,h,n,w,b,k,g,d, f and y sounds.
Language: Answers who, whose and why questions. Asks who, what, where and why questions. Can identify some objects by use. Understands concepts of time. Great increase in the number and type of words used.
“Communication is vital for children to be able to contribute their strengths and interests, to find out what they want to know and to take increasing responsibility for their own learning and care” (Te Whariki)
GOAL: Speech and Language concerns assessed against Much More Than Words norms Consider getting parental consent to discuss specific speech and language strategies with the child’s early childhood centre. Early Childhood Staff have training in this area and may be able to support the family on a day to day basis.
every child
medium risk
high risk
Eyes & ears Every child should have had their hearing tested by the time they turn five. Return the child ASAP to ensure this can occur.
Compare Obtain sample of speech or language and compare with norms in “Much More Than Words” Resource.
Compare conduct speech of language sample and compare with norms in “Much More Than Words” Resource
Encourage Parents to use Much More Than Words resources to develop child’s speech and language.
Monitor Give parents strategies to address issue and monitor for improvement in 3 months
Monitor Give parents strategies to address issue and monitor for improvement in 3 months
Refer Refer to Special Education where there is no or insignificant improvement after three months
Refer Refer to Special Ed where there is no improvement. Refer immediately if there is dysfluency causing the child distress.
Language Development: Four year olds should be talking in simple sentences and will be keen to communicate with you. The average four year old knows more than 1800 words. They should be asking lots of questions and will expect an answer to all of them. They will love to share books and will start looking at the words on the page.
Signs there could be a developmental problem include: Is still speaking unclearly, or is not speaking in complete sentences. Can’t follow instructions you give verbally. Plays silently – he doesn’t talk while he’s playing. Sentences are made up of three or less words.
Speech Sound Development: Four year olds are often great conversationalists and love to talk about the details of all sorts of scientific and important subjects. Four year olds will want to find out about all aspects of life and talking about things is a very important way of understanding how the world works.
Developmental milestones include: Speaking clearly on the whole, but may still not use some sounds correctly ‘th’ for ‘s’ or ‘w’ for ‘r’. Asking about the meaning of words. Telling long stories where reality and
fantasy are intertwined. Asking many, many questions. Arguing a point and offering personal ideas about things. Talking about the future – what they think might happen, or what they hope will happen. Knowing a few songs and rhymes.
Signs there could be a developmental delay include: The child can’t be understood by people other than the parent/caregiver. The child can’t hear things that are said quietly –they need things to be constantly repeated before they understand what has been said.
You will normally have more chance at organising a Speech and Language Therapist if you go through the child’s preschool (discuss with the preschool as they might already have strategies in place).
To refer: Special Education 07)8508890
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When to refer: • You have completed a speech/language sample; given the parent strategies to address the issue; monitored progress for three months and there has been no or insignificant improvement. • If the child has a stutter and there is a family history of stuttering or the child shows signs of anxiety/frustration about speech.
Growth
REFERRAL PATHWAYS
“The test of the morality of a society is what it does for its children” Dietrich Boenhoffer
Brain food - Healthy eating and a healthy lifestyle: Help parents understand the importance of diet and activity for “Under- fives”..... If children and young people are wellnourished and active, their concentration and behaviour are likely to be better, and they have a better chance of learning, in addition to enjoying better overall health. Use the VERY IMPORTANT LUNCHBOXES’ pamphlets to promote the healthy eating message. Help parents to understand what different types of food do for our bodies.
Active Families: The Ministry of Health funds the Green Prescription Active Families programmes, which are community-based health initiatives designed to increase
Something to think about
physical activity. It supports healthier and more active lifestyles through encouragement and education, nutritional guidance and advice, realistic goal setting and ongoing support. Support is given for up to twelve months.
Bodywise:
Risk indicators: Weight in 99th Percentile Weight in 97th Percentile Weight in 85th Percentile Normal range
High Med Low Nil
A free initiative between Waikato DHB and Sport Waikato. It is a family focused weight management programme for children aged 5-12 years. However, it is the adults feeding the child so you can refer the family to get the 4 year old in. Document that in your referral. They work with whole families to help them identify lifestyle habits that they can change to become healthier. If you have concerns refer to: 1) Paediatrician at your local hospital. 2) Community Dietician on 8383565 3) Sport Waikato 8585388
Children begin developing attitudes to food as early as two years of age. Learning relaxed, selfregulated, healthy approaches to food are skills children will be grateful for their whole lives. Parents should encourage children to listen to their tummies, eat a variety of foods and understand nutrition, while limiting their exposure to unhealthy foods. A child’s learning is directly affected by their health and well-being. Parents and caregivers can support their child’s healthy brain development and learning by maintaining the child’s well-being through things like ensuring they get enough rest, eat healthy food, get physical activity, and have regular health checks.
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GOAL: Healthy and active children.
every child
medium
high
teach
evaluate
evaluate
Push Play. Feeding our Futures. No fizzy. Reduce screen time.
Standard history. Psychological factors. BMI rating. Familial factors. Ethnic/Cultural factors.
Standard history. Psychological factors. BMI rating. Familial factors. Ethnic/Cultural factors.
encourage
manage
manage
Family activities outside. Time outside investigating. Get dirty - mud is good!
Dietary advice. Limit portion sizes. Fruit & vegetables. Exercise programmes. Monitor with GP in 3 months.
Community dietitian. Monitor with GP in 3 months.
refer
refer
Community Dietitian. Sport Waikato. Green Prescription for kids. Private Paediatric Dietitian ($) Active Families.
Community Dietitian. Sport Waikato. Private Paediatric Dietitian ($) Bodywise.
Activity: In today’s world, children may not be as physically active as they were in the past. Young children today are carried and travel by car more than any generation before. Opportunities for children to exercise have also been reduced by new technology such as computers, DVDs, and television, different ideas about family time and different leisure activities. TV, videos and computers are very popular with many children. They can be exciting and interesting but can encourage children to remain seated and quiet and not motivated to be active and learn. Encourage parents to try to turn the TV off as much as possible and enjoy active play. Young children need lots of regular physical activity to support their learning and development. Parents can make being active fun for their child and make regular exercise a habit they will keep with them for life. Physical activity is essential for a child’s health and learning. Movement and activity are important to develop: Strong bones and muscles Memory Eyesight Speech and language Self-confidence
MILESTONE QUICK GUIDE • Should gain 2kgs between birthdays • Should grow 2.5 - 5cm between birthdays • Needs 9-12 hours of sleep each night • Might not need naps anymore RECOMMENDED SERVES PER DAY FOR A 4YR OLD Bread, Rice, Pasta, Noodles 3-7 Vegetables/Legumes 2-4 Fruit 1-2 Milk, Yoghurt, Cheese 2-3 Meat, Fish, Poultry, Nuts 5-1 Extra Foods (no more than) 1-2 (A serving is the size of the child’s hand)
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When to refer: • The child is in the 99th percentile for their age and weight • the child stretches across two quartiles for their height and weight • the child is underweight and has lost weight • there is no ethnic factor that would prompt you to use a “manual override scenario”
Mental Health
“A child of five would understand this. Send someone to fetch me a child of five” Groucho Marx
REFERRAL PATHWAYS
Worries and Fears: Child Mental Health: Normal worries don’t last long in childhood. They disappear quickly. In some children worries occur in particular situations like the playground or before going to sleep. Other children get anxious or worried that something bad might happen in any situation from starting daycare or school to being afraid of the dark. Some children react a lot more dramatically to new situations. Even when they know a change in routine is due; when it happens it is met with tears or panic. These children aren’t difficult on purpose it is their inability to cope that brings on such strong reactions. Child Mental Health is something many people find difficult to quantify or put words around. The list below may provide a good conversation starter or reference point: -Worries & Fears -Parental drug/alcohol problems -Bereavement -Disasters & accidents
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-Abuse -Mentally ill parents -Neglect -Harsh discipline -Anger -Troublesome behaviour -Neglect -New partners -Low family supervision
If the primary caregivers are impacted by the same trauma, it is imperative that they get treatment that compliments the work with the child. Indeed, the best intervention for young children is treating the primary caregiving adults. As they become less anxious, fearful and impaired, the more available they are to the child themselves.
Helping children after a traumatic event: Anything that can decrease the intensity and duration of the acute fear response (alarm or dissociative) will decrease the probability of persisting neuropsychiatric symptoms. In general, structure, predictability and nurturing are key elements to a successful early intervention with a traumatized child. The primary source of these key elements is the primary caregiver. Therefore, it is critical to help the caregivers understand as much about posttraumatic responses as possible.
Risk indicators: SDQ individual score 8+ and Prosocial of 0-4
High
SDQ Total 14-16
Med
SDQ Total 8-13
Low
SDQ Total is less than 8
Nil
Contrary to popular belief, even infants and very young children experiencing traumatic events can be affected. Indeed, there is increasing evidence to suggest that the younger a child, the more pervasive are the post-traumatic problems. The child’s world is defined by his or her caregivers. If the caregivers are pre-occupied, depressed, anxious, exhausted or absent due to post-traumatic symptoms, this will adversely impact the child.
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GOAL: Child Mental Health issues are identified and addressed early.
every child
medium risk
high risk
eyes & ears Every child should have had their hearing and vision tested by the time they turn five. Return the child ASAP to ensure this can occur.
identify Parental concern.
identify Parental concern. Other agency concern. Screening concern.
encourage SKIP Parenting strategies. Parenting Literature. Parenting courses.
evaluate Family history. Social/Environmental factors. Learning stories from ECE.
evaluate Family/Social history. Dev/ Medical history. Vision & Hearing Screen. Previous reports/interventions. Learning stories from ECE. Parental mental health.
refer General Paediatrician. Parentline. Barnardos. Family Works. GP for secondary screening.
refer Ngaa Ringa Awhina. General Paediatrician.
Early assessment and intervention is imperative. If a child has had a traumatic event, or if the primary caregiver of young children has been traumatised, early aggressive intervention can be crucial. Take advantage of resources in your community. Each community has agencies, organisations and individuals coping with the same issues. They often have the support you may need.
Advice for caregivers: -Don’t be afraid to talk about the traumatic event. Children do not benefit from 'not thinking about it' or 'putting it out of their minds'. Don't bring it up on your own, but when the child brings it up, don't avoid discussion, listen to the child, answer questions, and provide comfort and support. -Provide a consistent, predictable pattern for the day.
-Watch closely for signs of re-enactment (e.g. in play, drawing, behaviours), avoidance (e.g., being withdrawn, daydreaming, avoiding other children) and physiological hyper-reactivity (e.g. anxiety, a delay in toilet training, sleep problems, behavioural impulsivity). The best thing you can do is to keep some record of the behaviours and emotions you observe (keep a diary) and try to observe patterns in the behaviour. -Protect the child. Do not hesitate to cut short or stop activities that are upsetting or re-traumatizing for the child. Try to restructure or limit activities that cause escalation of symptoms in the traumatized child. -Give the child 'choices' and some sense of control. -If you have questions, ask for help.
-Be nurturing, comforting and affectionate. A good working principle for this is to be physically affectionate when the child seeks it. Further, be aware that many children from chronically distressed settings may have what we call attachment problems. They will have unusual and often inappropriate styles of interacting.
A note on referrals: • In Hamilton all Child Mental Health referrals are handled by Nga Ringa Awhina. • In the North Waikato all referrals are handled by ICAMHs 839 5146. • In the King Country all referrals are handled by ICAMHs 839 5146.
When to refer: • When you have significant concerns that a child’s mental well-being is at risk. • When an educational professional confirms this. • When a traumatic event occurs.
-Discuss your expectations for behavior and your style of 'discipline' with the child. -Talk with the child. Give them age appropriate information.
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Behaviour
“A person’s a person - no matter how small” Dr Seuss
REFERRAL PATHWAYS
Managing Behaviour - Advice from the SKIP Programme: Consistency is the key - Kids want to please and they want to get it right Children explore and experiment to find out about the world and their place in it. They climb, taste, poke, jump, touch and ask a million questions. This helps them make sense of the world around them and to learn where their boundaries are. You can help guide all of this exploration by making sure your child keeps safe and by giving them new things to learn about. By doing this you are helping your child to develop the skills and wisdom they will need as they grow into adults.
What does work? Give lots of love and warmth and praise. Communicate clearly. Tell your child when
they are doing well; they’ll develop the selfconfidence to try new things. Praise your child and they’ll repeat the behaviour you like. Be clear about what you would like your child to do, and what you don’t want them to do. Set clear limits and boundaries. If something does go wrong, talk to them about what happened. They might need help to work things out. If they are very young and you can’t have a chat, think about what happened – they may be tired, hungry or frustrated and not be able to tell you. “Praise them when they’re doing well, keep the momentum going.” If your child is refusing to do something, try to understand why. They could be wanting more attention, be frustrated or feel unsure of themselves. They might just need a hug or
some encouraging words. Talk to your child about consequences. For instance you could tell them that if they hit the cat it might scratch them, or if they throw a toy it might break. Keep things brief and in words they will understand. If you ask them not to do something and they do it, follow through. This might mean saying sorry if they hit someone, not being able to play with a toy or helping you to clean up if they make a mess. Say sorry yourself. This will help your child learn to say it too. Act as you want your child to act. Be patient. It takes time for a child to develop their own self-discipline. “Be firm, fair and friendly.”
Something to think about Clinical Psychologists identify three skills as being essential building blocks for children: developing cooperative behaviour, acquiring basic social skills and solving social problems. Parents can teach these skills and help their children to learn. There will be stumbling blocks along the way and parents need to be reassured (by you!) that the behaviour is normal - as well as a reminder that how they deal with the behaviour is vital in establishing the character of the child.
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GOAL: Behavioural issues addressed early in a collaborative manner.
every child
high risk
medium risk
teach SKIP Resources. 6 SKIP Principles. Parents Inc. Parenting Tips.
parenting help
parenting help
Parents Inc. Incredible Years. Barnardos. Parentline. Family Works. Early Childhood Centre.
Incredible Years. Barnardos. Parentline. Family Works. Mental Health Services.
family issues
family issues
Parenting through Separation. Family Therapy. Family counseling. Incredible Years. Early Childhood Centre.
Parents Inc. Incredible Years. Barnardos. Parentline. Family Works. Counseling.
refer - child only Special Education. General Paediatrician. (Seek learning stories from ECE to support referral).
Plan. Put precious things out of reach. Don’t take your child to the supermarket if they’re tired, and teach your child to cross at the lights. Try not to say “no” and “don’t” all the time. Instead of saying "don’t run in the house" say " walk in the house, you might hurt yourself if you run" or instead of "no we can’t go to the park" say "maybe tomorrow". Have realistic expectations – a small child won’t be able to sit still for a long time or will end up with food all over the place when they first start eating on their own. You can change rules and expectations as they grow and develop more skills. Try to have routines for eating and sleeping. This helps children become organised and feel secure.
Keep your sense of humour. Sometimes you have a split second when you have to decide whether you’re going to get really angry, or whether you’ll see the funny side. If a child has smeared lipstick all over their face, and you laugh, you can still ask them not to do it again and explain why.
What doesn’t work? Don’t withhold love when your child does something wrong. This gives a message that you don’t like them, when what you don’t like is their behaviour. Smacking or hitting doesn’t teach your child what they did wrong. It teaches them that hitting other people is okay. Yelling and screaming can make things build up into major battles. Take a deep breath, walk away for a minute, and be calm.
When to refer:
MILESTONE QUICKGUIDE -Knows how to play with other children. -Can share and take turns. -Can be aggressive. -Will fight to get their own
way. -Can make jokes. -Laughs at things other people say. -Might touch their own genitals. -Doesn’t like going to bed. -Might wet the bed at night.
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When you, the preschool teacher or the Caregiver have significant concerns. When the PEDS and/or SDQ (P) and (T) indicate concerns.
Early Childhood Education
REFERRAL PATHWAYS
“The important thing is not so much that every child be taught, as that every child should be given the wish to learn” John Lubbock
All our children - healthy and ready for learning: The Waikato has many types of early childhood services to choose from. Each type has its own way of working with children and their parents. The first decision for a parent is which type of early childhood service suits a family best. There are two kinds to choose from: Teacher-Led - where teachers provide education and care. Parent-Led - where parents, whanau or caregivers provide the education and care for their children. To find a good early childhood education service it pays to do a bit of research. The Early Childhood Education (ECE) listing is an easy way to find out what services are available in your area. You can find the ECE listing on the Ministry of Education website www.moe.govt.nz It
Something to think about
lists all licensed early childhood education services, plus their contact details in New Zealand, which you can sort by location and service type.
Spotting a Good Programme: A good learning programme will: Have a clear written statement of how the service will educate and care for children (this needs to be based on the curriculum). Keep a record of each child’s learning and development. Set new programmes to extend the child based on these records. Set realistic short term goals that parents and teachers would like the child to achieve based on their needs or interests. Involve teacher discussion. Involve teacher and parent discussion. Be changed as needed.
Slipping through the gaps: Remember that children who are not enrolled with an ECE will have had less of a chance to interact with some of the more formal health milestones such as vision and hearing testing and the oral health programme. Unlike schooling, enrolment with an ECE is not a legal requirement for a parent. Children who are not enrolled do have a right to basic health screening and this needs to be actively managed by all involved in an effort to have every child start school healthy and ready to learn.
Research shows that when children start school behind they stay behind. Children who get a good start are less likely to need expensive special education classes and more likely to complete their schooling career. When those children become adults, they are more likely to hold jobs and earn higher salaries, less likely to commit crime and less likely to receive a benefit. The math works like this: taxpayers receive financial benefits from a stronger, better-educated workforce and gain a higher tax base. There are also direct savings as there is less spending on prisons and welfare. These long term benefits are easy to see for any community.
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GOAL: All the children in our community ready for learning
Teacher-Led
Parent-Led
Home based care
Education and care centres: May include church based, workplace, and a particular focus on language or culture. May be run by community or private owners. Currently, at least half the licensed teachers must hold a Diploma of Teaching.
Playcentres: Offer learning through play for children up to school age. In Playcentre parents, whanau and caregivers meet together to support the child’s learning.
A caregiver/educator provides education and care for small groups of up to four young children in a home setting. The work of the caregiver/ educator is supported by a Coordinator who is a registered teacher.
Kindergartens: Run by a Kindergarten Association and licensed by the Ministry of Ed. Are run by a parent/community committee.
Playgroups: Community based groups giving parents the chance to meet and provide play programmes for their children.
Promoting Participation Referrals: The Promoting Participation workers are contractors whose role is to encourage and engage families in some form of early childhood education. They try to break down any barriers that may be stopping a child from attending preschool. Promoting Participation is available in parts of Hamilton, Ngaruawahia, Huntly, Te Kuiti and Taumarunui. 20 Hours ECE: 20 hours ECE supports children to start or spend regular time in Early Childhood education by reducing the cost to parents and whanau. Spending regular time in Childhood Education helps children develop foundations that will carry them forward in their lives. All teacher led services and some Kohanga Reo are eligible to offer Free ECE, as the policy is not compulsory. Under Free ECE, services cannot charge parents compulsory fees for up to 6 hours a day, up to 20 hours per week. Services can ask parents to pay fees for those hours of enrolment outside of Free ECE.
Kohanga Reo: Build young children’s and parent’s knowledge of te reo Maori and tikanga. Kohanga Reo is a total immersion environment.
For more information, parents can phone the
Free ECE Freephone on 0800 20 44 33. The freephone staff can answer any questions, send you copies of the 20 Hours ECE information and a list of ECE services in your area.
To refer to Promoting Participation: 0272893780
Learning milestones Can copy shapes Can draw squares and circles Can print some letters of the alphabet Can follow three step directions Can probably count to ten Can tell you how old they are Like to play make believe games Know their colours
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When to refer: A child is not enrolled with an ECE and the family would welcome some help in choosing a service. A parent/caregiver says they have concerns about the way a child learns and they are not enrolled in ECE. There are general concerns about development, social, emotional, speech or language development and the child is not enrolled in an ECE.
Safety
REFERRAL PATHWAYS
“Miracles is when nobody ever thought it was going to happen but someone kept trying and eventually broke through”. (Jack aged 5)
Family Violence - It’s not OK: Any behaviour that makes someone else feel controlled and fearful is never OK. Everyone in a family should feel safe and nurtured. It's hard for many of us to make sense of what is OK and what isn't. A healthy relationship is supportive, trusting and warm. But in some relationships one person uses power and fear to control the other. These relationships are emotionally abusive and can become extremely unsafe. People in violent relationships feel frightened. They feel as though they cannot be themselves because their actions, thoughts and choices are determined by the person who is controlling them. No one should be frightened or scared by someone in their family
Something to think about
The Law: In law family violence is known as domestic violence. In the Domestic Violence Act 1995 it is defined as: "Violence against (a) person by any other person with whom that person is, or has been in a domestic relationship". It defines domestic violence as more than physical abuse; it includes sexual or psychological abuse. Psychological or emotional abuse includes threats, intimidation, harassment or damage to property. In addition, psychological abuse is committed against a child if that child witnesses the abuse of a person with whom the child has a domestic relationship.
A single act of violence or a number of acts that form part of a pattern can be regarded as domestic violence. The Act covers people in many different relationships: -married couples -couples in civil unions -de facto couples -gay and lesbian couples -children -family/whanau -anyone in a close personal relationship -flat mates or other people who share accommodation. Work & Income provides financial support for clients who are affected by Family Violence. Non-residents may also be eligible for financial support in this situation.
Resilience can be defined as the ability to thrive, mature, and increase competence in the face of adverse circumstances. Some children who are neglected are able not only to survive the neglect, but also to achieve positive outcomes despite it. What sets these children apart may be a greater number of protective factors related to themselves, their parents, or their environment. Resilience is thought to stem from ordinary human processes, such as parenting, thinking skills, motivation, rituals of family and culture, and other basic systems that foster human adaptation and development. These ordinary processes should be recognized, promoted, and supported so that they work well and can help children thrive.
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Children rely on adults to take action
My eyes stay awake (at night). My dad might kill my mum in the night. He hit
1. Child, Youth & Family: When you suspect a child is at serious risk or a crime against a child has been committed, this must be reported. Ring, state that you are a registered nurse and make a notification. You can do this anonymously. Ph: 0508 FAMILY
her bad before. There was lots of blood” 4 year old boy
2. Family Safety Teams (Police): Family Safety Teams exist in all areas of the Waikato. They are multiagency and an excellent point of contact for health professionals. Ph: 0272147873
Where there is neglect or abuse: A 2002 research study found that while only one third of mothers thought their children were aware of the violence, ALL children knew what had been happening. Although there is no legal requirement to do so, those who work with, or care for children have a responsibility to report suspected child abuse. It is the responsibility of the authorities to conduct an assessment of investigation of the indicators to determine whether the child has been or is being abused.
Children may need help where: There is violence and controlling behaviour from one adult to another. There is known drug taking, drug manufacture or drug dealing. There is an excessive use of alcohol. Animals are neglected or hurt. Children are left alone, appear neglected or uncared for. There is a high focus on keeping the family private or isolated and detached from the community.
Children’s behaviour that could indicate physical abuse: Is wary of adults or a particular individual. May cringe or flinch if touched unexpectedly. May display a vacant stare or frozen
watchfulness. May be extremely aggressive or extremely withdrawn. Goes readily to strangers for nurturing Frequently behaves in a way that provokes punishment. Is dressed inappropriately to hide bruises. May regress e.g. bed wetting. May indicate a general sadness. Could have a vision or hearing delay. Is violent to animals and other children.
Adult’s behaviour that could indicate physical abuse: May appear unconcerned about the child’s well being. May provide an explanation that is not believable given the child’s age. May have little or no knowledge of child development or may have unrealistic expectations for the child. May delay in seeking medical attention for the child. Is aggressive towards the child in front of others. May blame an accident on a sibling, friend or relative.
3. Family Works: Assists families to make lasting positive differences in their lives. Key programmes include “Women against violence” and “Restore” for children who have lived with violence. Ph: 07) 8584413 4. Barnardos: A free, confidential home based support service for families facing issues that are impacting on children. Ph: 07) 8471088 5. Women’s Refuge: To talk to someone about child safety, or for a confidential location where a woman can be safe with her children. Many practices leave safety plans in the women’s toilet. Ph: 07) 8551569 or 0800REFUGE 6. Parentline: Provides options, alternatives and solutions for children and their families. Programmes include KAVE for children who are victims of violence and Positive Changes for Caregivers (reducing family violence). Ph: 07) 8394536
You may be the key person who could make a difference. Take action. Do not look away. Do not assume that someone else has acted. 20
Parenting
REFERRAL PATHWAYS
Better parenting - better lives for our children: but is not confined to them. Carers, teachers, nurses, and others fulfill parenting tasks with children.
Parenting is probably the most important public health issue facing our society. It is the single largest variable implicated in childhood illnesses and accidents; teenage pregnancy and substance misuse; truancy, school disruption and underachievement; child abuse; employability ;juvenile crime; and mental illness. These are serious in themselves but are even more important as precursors of problems in adulthood and the next generation. The importance of parenting arises from its role as a buffer against adversity (such as poverty or delinquent influences) or mediator of damage (as in child abuse). Parenting usually involves biological parents
Something to think about
Parenting has three essential components: 1) Care protects children from harm. Care also encompasses promoting emotional as well as physical health. 2) Control involves setting and enforcing boundaries to ensure children's and others' safety, in ever widening areas of activity. 3) Development involves optimising children's potential and maximising the opportunities for using it. Although a reasonable consensus exists about "bad parenting," there is no agreement about its opposite, particularly in a diverse and rapidly changing society. General Practitioners, community Paediatricians, and primary health teams are in a key position to promote services for the whole child, delivered through supporting better parenting. They are best placed to
identify children at risk--literally before birth--through their knowledge of the parents and to monitor their development and their parents' ability to meet their needs through surgery visits and health visitors. They should insist that the currently fragmented and inefficient services by multiple agencies should be integrated to make the optimum impact on frequently puzzled and fraught parents. Together with social services and education, they can institute programmes that teach and enhance parenting skills so that parents can take a more effective role with their children. All this is based on the premise that health professionals are respected experts in children's health and social development and should use this to promote the wider welfare of children, without which their health will suffer. Above all, this demands an urgent shift of emphasis from reactive intervention to prevention and health promotion.
Families need to be strong and resilient to care for and nurture their members, and to contribute to and participate in society. Participation in paid work can contribute to this resilience. Resilient families are more able to cope with difficulties and change without adverse effects on individual family members, the family as a whole, or society. In addition, the economic circumstances of a family affect its ability to meet the needs of its members and to participate fully in community life. Economic disadvantage is a known risk factor for poor family functioning, and growing up in poverty is associated with poor health, education and employment outcomes.
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What’s Available? HIPPY: Home Interaction Programme for Parents and Youngsters: a homebased programme that helps parents to support their child’s learning. It is a programme for four and five year olds. www.greatpotentials.org.nz
Parents Inc. Practical solutions for parents. This organisation runs a full suite of parenting programmes from “No Sweat Parenting” to Hot Tips for Parents. 0800 535659 ($)
Whanau toko i te ora:
Separation and/or a change in the family situation: Separation and change in families can put stress on everyone involved. Children are affected by changes in their family structure and this can cause changes in their behaviour. Parenting through Separation is a free information programme to help parents help their children when they separate. The information and tips in the programme is highly rated by parents and agencies alike. The content covers: -how separation affects children -what children need during separation -talking with children -talking with ex-partners about arrangements for children -keeping children away from arguments -how the Family Court works Parenting through Separation courses are available through Family Works, Parentline and Barnardos.
Starting a Parents Inc. course for your community: Great kids need great parents and with the right tools anyone can be a great parent! If you are looking for practical strategies, inspiration, encouragement and insight then a Toolbox parenting group is for you. Toolbox parenting groups are a unique and fresh approach to parent education. In an informal, relaxed and friendly environment participants are equipped with practical skills and strategies that can be immediately
put to use. Over six sessions key parenting principles are explored and participants are encouraged in their parenting. Toolbox groups usually meet in someone’s home. There is a comprehensive manual, ‘experts’ on video and lively interaction. The information presented is relevant and insightful. Participants appreciate the opportunity to listen to someone else’s experience and realise that they all face similar issues and challenges. The course is facilitated by trained local volunteers who are friendly and supportive. They keep each session flowing smoothly and help participants to engage with the material. Each session leaves participants with a range of activities and strategies to try at home. The atmosphere of the group is relaxed and informal and there is also a rich vein of humour that runs through the course. Toolbox certainly is positive, practical and fun! Toolbox groups are available throughout the country and are delivered in three age groups – Early Years (0-6), Middle Years (6-12) and Teenage Years (12+). To initiate a toolbox parenting group for your patients or community check out
[email protected]
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This is a parenting programme for whānau delivered by the Māori Women’s Welfare League. This programme is for whānau with children under five years old who have high needs. www.mwa.govt.nz
Family Works: Provide a family assessment which will identify what services the family requires and plan an approach with families from there. Often home based. 07) 8584413
Parentline: Solution focused parenting groups with a therapeutic element. Available to families who have experienced abuse. 07) 8394536
Barnardos: Barnardos is a free, confidential, home based support service for families facing issues impacting on children. Families are appointed a social worker who works one on one to help the family achieve their goals. 07) 8471088
Life Community Services: Free Incredible Years Programme. Nurses can refer. Parents can selfrefer. 07) 8472585
When to refer: When you feel a parent is not coping with the day to day management of their child. When you encounter a family that needs help in a more holistic, wrap around type way. When Early Childhood Centres views correlate strongly with your own. When a family asks for help. If the family has previously been victims of abuse but not accessed support.
Contacts for organisations committed to the Very Important Project: SKIP (Strategies for Kids, Information for Parents) resources 04) 9163385 or
[email protected]
Family Works 07) 858 4413
Community Oral Health Service 07) 859 9160
Sport Waikato Active Families 07 858 5388
Parentline 07) 8394536
Child Development Centre 07) 839 8709
Parenting through Separation 0800 211 211
Child, Youth & Family 0508 FAMILY
M o E Special Education 07 850 8890
ParentsInc. 0800 53 56 59
Public Health Nurses 07 838 3565
Engaging Priority Families 0272893780
Mobile Immunisation Service 0800 466 863
Vision & Hearing/Ear Clinic 07 838 3565
Nga Ringa Awhina 0800 99 99 03
Barnardos 07) 847 1088
Key B4 School Colleagues: Child Development Centre: Services are for children and young people with any condition in which developmental problems, or risk of developmental problems, are central. CDC does not work with children with specific learning difficulties. Ph: 8398709
Mobile Immunisation Service: The mobile immunisation service carries out vaccinations in remote areas of the Waikato Region. The mobile service does not replace outreach services currently operating in Waikato towns. Ph: 0800466863
lasting difference in their lives. Core services are counseling, social work and therapeutic programmes. Ph: 8584413
Ear Clinic:
Barnardos: Barnardos offer a range of child and family services as well as early childhood education in communities throughout New Zealand. Ph: 8471088
Engaging Priority Families:
Provide services to children who have a physical impairment, a learning disability, hearing or vision difficulties, struggle with learning, communicating or getting along with others, and/or have an emotional or behavioural difficulty. Ph: 8508890
Work with families to engage them in Early Childhood Education. Available in Huntly, Ngaruawahia,Te Kuiti and parts of Hamilton. Ph: 0272893780 Footsteps: a learning programme for families who want to arrange their own carer. 0800366878 or www.footsteps.co.nz HIPPY: available only in Huntly and Tokoroa. Helps parents teach their children the skills they need to make a successful start at school. www.greatpotentials.org.nz Correspondence Kindergarten: 07) 8587131 or www.tekura.school.nz/index.php
Sport Waikato:
Parenting through Separation:
Sport Waikato’s programmes and services are available for all communities with a particular focus on young people. They are committed to active and healthy families in the Waikato. Ph: 8585388
A Ministry of Justice funded programme run in over 170 locations around the country once or twice a month. The programme helps parents help their children when they separate. Ph: 0800211211
Parentline:
Child Mental Health:
Parentline is a Child Advocacy Agency. They serve families by providing wraparound healing services and programmes. They are committed to the prevention of family violence, abuse and neglect. They provide a range of therapeutic programmes for children and families who have experienced abuse. Ph: 8394536
Provide free services for children with serious mental health disorders, psychiatric disorders, psychological disorders including severe emotional and behavioural disturbance. See DHB website “referral information” for geographic split of referral locations. 1) Hamilton - Nga Ringa Awhina. 2) Hauraki District - Mental Health and Addictions Services Thames 3) Southern Cluster - Mental Health and Addictions Services Te Awamutu.
MoE Special Education:
Family Works: Family Works work alongside children and their families, supporting them to make
Rural & Community Services:
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The Ear Clinic is open and available for advice on grommets, wax/foreign body removal, treatment of discharging ears and glue ear assessment. Ph: 8581068
Vision & Hearing: Vision & Hearing Technicians visit every Early Childhood Centre in the Waikato DHB Region. They attempt to test every child in the Waikato Region before the age of five. Ph: 8383565
Public Health Nurses: Public Health Nurses form a key part of the delivery of the B4 School Check. Aside from delivery of the check to non-responders and at risk children, they will support families throughout their health journey. Ph: 8383565
Waikato Community Oral Health Service: This service provides free basic care for Waikato children, from 0-17 years of age. Ph: 8599160
B4 SCHOOL COORDINATOR 711 VICTORIA STREET HAMILTON PHONE: 07 839 2888 EMAIL:
[email protected]