counties manukau district health board community …€¦ · aroha haggie – director, funding...

‘Aakina to ora, hei oranga mauroa’ – Mahaki Albert, Tumu Tikanga CM Health Look after yourself to preserve health and wellbeing

Counties Manukau District Health Board – Community & Public Health Advisory Committee

COUNTIES MANUKAU DISTRICT HEALTH BOARD COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE (CPHAC)

Wednesday, 27 May 2020

Venue: Ko Awatea, Room 101, Middlemore Hospital Time: 10.00am

Committee Members Vui Mark Gosche (Board Chair) Barry Bublitz (Mana Whenua) Colleen Brown Dianne Glenn Katrina Bungard Lana Perese Paul Young Pierre Tohe Apulu Reece Autagavaia Robert Clark (Mana Whenua) Tipa Mahuta

CMDHB Management Fepulea’i Margie Apa – Chief Executive Aroha Haggie – Director, Funding & Health Equity Dr Campbell Brebner – Chief Medial Advisor, Primary Care Dr Gary Jackson – Director, Population Health Dr Kate Yang – Executive Advisor to the CE Vicky Tafau - Secretariat

AGENDA: PART I – Items to be considered in this public meeting

10.00am 1. AGENDA ORDER AND TIMING Page No.

2. GOVERNANCE

10.05am 2.1 Apologies

2.2 Register of Interests

2.2.1 Does any member have an interest they have not previously disclosed?

2.2.2 Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?

2.3 Confirmation of Public Minutes of the Joint HAC/CPHAC/DiSAC Meeting – 8 April 2020

2.4 Action Items Register

2.5 CPHAC Workplan 2020

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003

005

006

012

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3. BRIEFINGS

10.20am

10.40am

10.50am

11.10am

11.30am

3.1 Ministry of Health Covid-19 Maori Response Action Plan Framework Presentation (Aroha Haggie, Director Funding & Health Equity)

3.2 Covid-19 Maaori & Pacific Response (Sharon McCook, GM Maaori Health & Pelenato Sakalia, Pacific Health Development Consultant)

3.2.1 Pacific Health Response Presentation (Pelenato Sakalia)

3.2.2 Maaori Health Response Presentation (Sharon McCook)

3.3 Start Well Mangere: A prototype for system change? (Presentation from Rochelle Bastion, Programme Manager, Child Youth & Maternity and Summer Hawke, Manager Population Health Programmes)

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027

030

036

044

12.10pm 4. RESOLUTION TO EXCLUDE THE PUBLIC 057

Counties Manukau District Health Board – Community & Public Health Advisory Committee 27 May 2020

CPHAC BOARD MEMBER ATTENDANCE SCHEDULE 2020

Name 26 Feb Mar 8 Apr 27 May June 1 Jul 12 Aug 9 Sept Oct 4 Nov 16 Dec

Colleen Brown (Co-Chair)

No

Mee

tin

g

No

Mee

tin

g

No

Mee

tin

g

Pierre Tohe (Co-Chair)

Barry Bublitz

Dianne Glenn

Katrina Bungard

Lana Perese

Paul Young

Apulu Reece Autagavaia

Robert Clark

Tipa Mahuta

Note: The meeting held on Wednesday, 8 April included all Board Members, including Vui Mark Gosche and Catherine Abel-Pattinson (apologies Garry Boles) as it was a combined HAC, CPHAC, DiSAC meeting due to Covid-19.

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CPHAC MEMBERS

DISCLOSURE OF INTERESTS

27 May 2020

Member Disclosure of Interest

Colleen Brown

(CPHAC Co-Chair)

Chair, Disability Connect (Auckland Metropolitan Area)

Member, Advisory Committee for Disability Programme Manukau Institute of Technology

Member, NZ Down Syndrome Association

Husband, Determination Referee for Department of Building and Housing

Director, Charlie Starling Production Ltd

District Representative, Neighbourhood Support NZ Board

Chair, Rawiri Residents Association

Director and Shareholder, Travers Brown Trustee Limited

Pierre Tohe

(CPHAC Co-Chair)

Senior Executive, Tainui Group Holdings

Trustee, Taniwha Marae

Barry Bublitz Director, International Indigenous Council for Healing Our Spirits Worldwide

Patron - Management Team, Te Mauri Pimatisiwin (A Journal of Aboriginal and Indigenous Community Health)

Chair - Māori Research Review Committee

Chair, Wikitoria King Whānau Trust

Chair, Eva Newa Wallace Whānau Trust

Secretary, Mataitai Farm Trust

Turuki Health Care – Employee

Co – Chair Mana Whenua Kei Tamaki Makaurau Board

Co-Chair Kaitiaki Roopu: Whakangako te Mauri o te Tangata

Dianne Glenn Member, NZ Institute of Directors

Life Member, Business and Professional Women Franklin

Member, UN Women Aotearoa/NZ

Past President, Friends of Auckland Botanic Gardens and Chair of the Friends Trust

Life Member, Ambury Park Centre for Riding Therapy Inc.

Member, National Council of Women of New Zealand

Justice of the Peace

Member, Pacific Women’s Watch (NZ)

Member, Auckland Disabled Women’s Group

Life Member of Business and Professional Women NZ

Interviewer, The Donald Beasley Research Institute for the monitoring of the United Nations Convention on the Rights of Persons with Disabilities.

Katrina Bungard Chairperson MECOSS – Manukau East Council of Social Services.

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Deputy Chair Howick Local Board

Member of Amputee Society

Member of Parafed Disability Sports

Member of NZ National Party

Lana Perese Director & Shareholder, Malatest International & Consulting

Director, Emerge Aotearoa Limited Trust

Trustee, Emerge Aotearoa Housing Turst

Director, Vaka Tautua

Director, Malologa Trust

Paul Young TBC

Apulu Reece Autagavaia Member, Pacific Lawyers’ Association

Member, Labour Party

Trustee, Epiphany Pacific Trust

Trustee, The Good The Bad Trust

Member, Otara-Papatoetoe Local Board

Member, District Licensing Committee of Auckland Council

Member, Pacific Advisory Group for Mapu Maia – Problem Gambling Foundation

Board of Trustees Member, Holy Cross School

Member of the Cadastral Surveyors Board

Assessor of the Creative Communities Scheme South & East Auckland

Robert Clark TBC

Tipa Mahuta Deputy Chair, Te Whakakitenga o Waikato

Councillor, Waikato Regional Council

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Counties Manukau District Health Board –Community & Public Health Advisory Committee 27 May 2020

COMMUNITY and PUBLIC HEALTH ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 8 April 2020

Director having interest Interest in Particulars of interest Disclosure date Board Action Apulu Reece Autagavaia Agenda of 26 February

2020 Mr Autagavia is a member of the District Licensing Committee of Auckland Council

26 February 2020 That Apulu Reece Autagavaia’s specific interest is noted and the Committee agreed that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making, if applicable.

Pierre Tohe Public Excluded Agenda of 8 April 2020

Mr Tohe does work for Waikato/Tainui.

8 April 2020 That PierreTohe’s specific interest is noted and the Committee agreed that he may remain in the room and participate in any deliberations of the Committee but is not permitted to participate in any decision making, if applicable.

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Minutes of Counties Manukau District Health Board Combined meeting of Hospital Advisory Committee (HAC),

Community and Public Health Advisory Committee (CPHAC) and Disability Advisory Committee (DiSAC) Held on Wednesday, 8 April, 2020 at 10.00am – 1.00pm

Ko Awatea, Room 107, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland & Zoom

PART I – Items considered in Public Meeting

BOARD MEMBERS PRESENT

Vui Mark Gosche (Board Chair) Colleen Brown (Co-Chair CPHAC) Catherine Abel-Pattinson (Chair HAC) Pierre Tohe (Co-Chair CPHAC) Barry Bublitz Dianne Glenn Katrina Bungard Dr Lana Perese Paul Young Apulu Reece Autagavaia Robert Clark Tipa Mahuta

ALSO PRESENT

Fepulea’i Margie Apa, Chief Executive Aroha Haggie (Director, Funding & Health Equity) Dr Gary Jackson (Director, Population Health)

Dr Jenny Parr (Chief Nurse and Director of Patient & Whaanau Experience) Dr Kate Yang (Executive Advisor to the CE) Mary Burr (General Manager, Woman’s Health) Dr Peter Watson (Chief Medical Officer) Sanjoy Nand (Chief of Allied Health, Scientific & Technical Professions) Vicky Tafau (Secretariat) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

No public or media were present. WELCOME

The meeting commenced at 9.00am with a mihi and karakia from Barry Bublitz and Robert Clark. Ms Brown advised that it had been agreed she would Chair this meeting and the other meeting Chairs would take subsequent turns if there were to be further joint meetings.

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1. AGENDA ORDER AND TIMING Items were taken in the same order as listed on the agenda.

2. GOVERNANCE (Hospital Advisory Committee)

2.1 Apologies

Apologies were received and accepted from Garry Boles, Christina Mallon and Mary Seddon.


No amendments to the Disclosures of Interest were noted. An amendment to the Disclosure of Specific Interests was noted and will be updated by Ms Tafau.

2.3 Confirmation of the Public Minutes of the Hospital Advisory Committee meeting held on 26 February 2020. Ms Glenn had two queries that were clarified and answered by Margie Apa. Resolution (Moved: Dianne Glenn/Seconded: Paul Young) That the public minutes of the Hospital Advisory Committee meeting held on 26 February 2020 be approved. Carried

2.4 Action Items Register/Response to Action Items Deferring the Action Items was agreed due to the CM Health Covid-19 Response. Resolution (Moved: Catherine Abel-Pattinson/Seconded: Paul Young) Carried

3. GOVERNANCE (Community & Public Health Advisory Committee)

3.1 Apologies

Apologies were received and accepted from Campbell Brebner.


No amendments to the Disclosures of Interest were noted. No amendments to the Disclosure of Specific Interests were noted.

3.3 Confirmation of the Public Minutes of the Community and Public Health Advisory Committee meeting held on 26 February 2020. Resolution (Moved: Lana Perese/Seconded: Robert Clark) That the public minutes of the Community and Public Health Advisory Committee meeting held on 26 February 2020 be approved. Carried

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3.4 Action Items Register/Response to Action Items Deferring the Action Items was agreed due to the CM Health Covid-19 Response. Resolution (Moved: Reece Autagavaia/Seconded: Paul Young) Carried

4. BRIEFING 4.1 Staff Health & Safety, including PPE (Elizabeth Jeffs, Director Human Resources, Peter Watson, Chief

Medical Officer)

CM Health has provided surgical masks into the community, including Front Line workers. The DHB has a secure supply and a close watch is being kept on its distribution. CM Health is confident that supply is available for people when they need it. Training, virtual, online and face to face is being widely undertaken with staff across the board to ensure correct use of PPE gear. Dr Jenny Parr confirmed that with the lower demand for services in the hospital, staff have been taking advantage of the down time to ensure training is undertaken. Health & Safety Team: the flu campaign commenced early. No shortage of vaccinations are available for staff. A new database has been set up and the paperwork is currently being loaded. Data will be released when paper forms have been entered. Vulnerable workers: for 70+, pregnant workers, respiratory compromised staff and automated form has been introduced. 500+ forms have been returned. Data is being entered. There may be a recommendation to expand to include Maaori/Pacific over 60 yrs. Staff will be triaged in terms of their health status. Contact tracing for staff – completed 8 tracings for 100 staff. Continue to meet for security of staff and a psychological well-being group has been set up. 187 calls to staff have been made from the Welfare Centre. There are 450 staff in the 60+ Maaori & Pacific at CM Health. Advice expected in the next few days from the Ministry.

4.2 Patient Safety & Quality, variance reporting only (Mary Seddon, Director, Ko Awatea) Information was taken as read. Dr Perese had a query in terms of being able to provide information with an ethnicity breakdown. Dr Parr advised the committee that the information provided is the national survey results, run every quarter and provided by the Health Quality Safety Commission (HQSC). A link to the site will be sent out so that Board members can delve into the data. Ethnicity data can be provided in future. Maaori & Pacific don’t answer surveys as much as other ethnic groups. We know from our Fundamentals of Care data that Maaori have a worse experience with in-patient care than other ethnicities. Work is being undertaken on this and a deep dive can come to a subsequent HAC meeting. Physical and emotional needs are combined in one question and there are gaps for spiritual and cultural. This is one of the things that the HQSC are attempting to address with the new tool they are using. They are also working with their Maaori Advisory Group to ensure that these types of things are being addressed.

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4.3 Sub-Committee Reporting on Performance Exceptions and Covid-19 Preparedness 4.3.1 Community & Public Health (Aroha Haggie, Director Funding & Health Equity)

CM Health has stood up an incident management team (IMT) ‘Ngaa Amokura Haumaru’ to support Maaori people living in CM Health rohe. This IMT will be liaising closely with the regional Maaori Health IMT and mana whenua to ensure Maaori have access to information and resources during the lockdown. Ngaa Amokura Haumaru is supporting several initiatives, including the Whaanau Guide to Covid-19 (on Social Media and Maaori TV) and Ngaa Kaimanaaki – a new community champion workforce for Covid-19 which will augment current health and social service workforces.

Bulk texting via Primary Care is currently in the planning stage. There are six active Community-Based Assessment Clinics (CBACs) at Airport Oaks, Otara, Wiri, Takanini, Pukekohe and Botany). These clinics are running from 0800 to 1600, seven days per week. Newspaper articles and videos are being loaded to Social Media, including webinars. Positive responses have been received. Current testing criteria for hospitals are if you have any Covid symptoms you will be tested. At CBACs, most people will be tested. If completely well, no swab will be undertaken. CM Health is currently looking into how we might extend our reach into those homes where people may have symptoms but are not coming for a test. Resolution (Moved: Colleen Brown/Seconded: Dianne Glenn) The joint Hospital Advisory Committee, Community & Public Health Advisory Committee and Disability Advisory Committee:

Received this update on the District Health Board’s community and public health response to the Covid-19 pandemic.

Carried

4.3.2 Hospital Advisory Committee (Mary Burr, General Manager Woman’s Health and Dr Peter Watson, Chief Medical Officer) CM Health has established the Incident Management Team (IMT) running the response for the hospital and community. Middlemore Hospital currently has one Covid-19 case in the ward and one in ICU. The hospital is currently well prepared for all possible situations. It was noted that colonoscopy and gastroscopy are achieving the appropriate standards. Emergency Department and KidzFirst attendances are down. There has been a very successful recruitment of new grad midwives and they will commence their employment soon. The Mental Health Primary Care Wellness Team has achieved a national award for their work. It was noted that finances have been impacted by the CM Health White Island response. All patients have now been discharged. Bowel screening is a real success, diagnosing 89 cancers that might have otherwise been missed.

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In the Birthing Unit, it is currently business as usual. In terms of National Health Targets, by February we had still achieved good Measure 1 results but have serious levels of breaching in Measure 2 (FSAs) - elective assessment and treatment. This is mostly related to the White Island Response. We will be severely impacted by Covid-19 in this space. It was advised that the report demonstrates a period of calm before Covid-19 hit. Middlemore Hospital is well prepared for whatever response may be required. Resolution (Moved: Catherine Abel-Pattinson/Seconded: Dianne Glenn) The joint Hospital Advisory Committee, Community & Public Health Advisory Committee and Disability Advisory Committee: Received the Hospital Services Report covering activity in January/February 2020 and noted the shortened format due to Covid-19 activity. Carried

4.3.3 DiSAC (Sanjoy Nand, Chief of Allied Health, Scientific & Technical Professions) The paper was taken as read. The committee was informed that CM Health has taken active steps to improve the ability to communicate important messages to the disability community. The CM Health external webpage includes sections for information that is readily accessible for Easy Read and Sign Language Videos. This is information created by MOH, and CM Health has included clear links to enable people with disabilities to access this easily. We also have been providing messages in simple language and in large font. Where CM Health has created videos to communicate messages, we are including subtitles in English and have been also exploring the translation of the messages in sign language. In terms of ensuring Continuity of Services for People with Disabilities during the Pandemic, our planning includes business continuity for services that we currently provide to the disabled community including services that provide home-based supports. There is regional and national planning that is working to ensure the various providers of disability services have contingency plans for continued support to disabled people. Ms Haggie has connected with Te Roopu Taurima and is comfortable with where they are at. PPE concerns have been resolved. Communications are available to clients and whanau and they are ensuring that there are comms for people with low levels of literacy or hearing/vision impaired. Clients are experiencing burden as is the organisation, due to being disconnected. Resolution (Moved: Colleen Brown/Seconded: Dianne Glenn) The joint Hospital Advisory Committee, Community & Public Health Advisory Committee and Disability Advisory Committee: Received this progress report on the disability action plan and Covid-19 preparedness. Carried

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5. RESOLUTION TO EXCLUDE THE PUBLIC

Resolution (Moved: Katrina Bungard/Seconded: Catherine Abel-Pattinson) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

2.1 Confirmation of Public Excluded Minutes 26 February 2020 for both the Hospital Advisory Committee and the Community & Public Health Advisory Committee.

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes As per the resolution from the public section of the minutes, as per the NZPH&D Act.

4.1 to 4.7 Briefings on Covid-19 Preparedness

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]

Carried This first part of the meeting concluded at 11.00am.

SIGNED AS A CORRECT RECORD OF THE COUNTIES MANUKAU DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE, THE COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEE AND DISABILITY ADVISORY COMMITTEE PUBLIC MEETING OF 8 APRIL 2020.

__________________________________ Colleen Brown CPHAC Committee Co-Chair

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Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


Community & Public Health Advisory Committee Meeting – Action Items/Resolution Register – 8 April 2020

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

Standing Items

Locality Updates: Provide updates for Locality Hubs in general until established enough to provide individual deep dives.

2020 Alan Greenslade, Matt Hannant and Penny Magud

On hold due to the Covid-19 response.

ARPHS – six-monthly update. 12 August Doone Winnard ARPHS will come back to CPHAC with details around the make-up of their staff in relation to the population they are representative of.

Quarterly Non-Financial Summary: Quarterly report. TBC Parekawhia McLean Due to Covid-19 pandemic response, many of these measures have not been reported against and hence cannot be reported. The Planning team will aim to report these alongside Q4 performance data.

17/18 Metro Auckland SLM Improvement Plan – quarterly report.

TBC Robin van Ausdell On hold due to the Covid-19 response.

21.2.2018 3.1 Green Prescriptions in Counties Manukau - Green Prescription is currently undergoing a re-procurement process and will update once this process has concluded.

TBC Ryan Stangroom and Matt Hannant

Work still underway to finalise the service.

19.9.2018 Board 4.3 MoH Letter – Strengthening the DHB Healthy Food & Drink Policy - Doone Winnard and Stella Welsh are looking at what the DHB is currently doing and what this letter means and will report back via HAC and CPHAC.

TBC Doone Winnard Doone Winnard will notify Ms Tafau when there is updated information to report to the committee.

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Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.


DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

26.9.2018 3.1 4.4 Healthy Families New Zealand: Update to CPHAC in 6 months’ time. HFNZ have issued an invitation to host CPHAC at Amersham Way, Manukau.

TBC Carmel Ellis Deferred until a suitable date can be confirmed.

6.11.2019 3.1 Ms Ellis was asked to bring Startwell to a subsequent CPHAC – early 2020 in order to provide CPHAC with an overview of the services they offer to the community.

27 May Carmel Ellis Item 3.3 of this agenda.

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DRAFT CPHAC Committee Work Plan 2020

Meeting Date Strategic Deep Dive Operational Deep dive Site Visit (not necessarily on

the same day) External / regional

presentations Public Excluded

8 April Equity

27 May Performance reporting /

measurement

1 July Maaori Health

te Tiriti o Waitangi Winter Plan update (Vanessa)

Clinical Pathways (Catherine Turner)

Budget 2021 Funder discussion if needed

(Aroha Haggie, Steve Murray)

12 August Primary and Community Health

Strategy Winter demand at urgent Care /

After-hours clinics Urgent Care / After-hours clinic

TBC SLM presentation (MoH

report)

9 September Regional collaboration

New models of Primary Care delivery – Marae-based /

Whaanau based (Matt Hannant, Campbell

Brebner)

4 November Understanding market capacity

and capability

Mental Health and Addiction, including suicide prevention / postvention –Board request

(Tess Ahern)

16 December Provider development Women’s health and birthing

February Intersectoral collaboration Alcohol Harm Minimisation

reflection on their 3 year plan achievements & what's ahead

Hold meeting at Healthy Families South Auckland

premises (Manurewa)

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Date:

CMDHB COVID-19Maaori and Pacific Response Framework

Community & Public Health Advisory Committee

27 May 2020

Aroha Haggie, Director of Funding & Health Equity

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Contents

• Background

• Te Tiriti o Waitangi

• Pandemic Alert Levels

• Action Plan Objectives

• DHB Specific Actions

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Background

• MOH developed the COVID-19 Maaori response action plan in collaboration with Maaori health sector leaders.

– MOH developed an Action Plan given the severe impact of the 1918–19 pandemic on Maaori and the increased susceptibility of Maaori to the 2009 H1N1 influenza A pandemic (both provide rationale to strengthen the Maaori-specific response to COVID-19).

– The Northern region DHBs adopted the action plans framework to guide the Northern region COVID-19 response.

• The Northern Region Pacific Response team developed a COVID-19 action plan with MOH to address the specific risks for Pacific people, families and communities.

• MOH recognised from previous pandemic responses that the business-as-usual model will not yield the greatest benefits for Maaori and Pasifika. It is critical that the specific needs of Maaori, particularly equity and active protection, and equity for Pasifika are integral to the health and disability response to COVID-19.

• It is also recognised that unequal distribution and exposure to the determinants of health increases risk for Maaori and Pasifika. 017

Te Tiriti o Waitangi

The text of Te Tiriti, including the preamble and the three articles, along with the Ritenga Maaori declaration, are the enduring foundations of our CMDHB MaaoriHealth approach. Based on these foundations, each are expressed in terms of mana:

• Mana whakahaere: effective and appropriate stewardship or kaitiakitanga over the health and disability system. This goes beyond the management of assets or resources.

• Mana motuhake: enabling the right for Maaori to be Maaori (Maaori self-determination), to exercise their authority over their lives, and to live on Maaori terms and according to Maaori philosophies, values and practices, including tikanga Maaori.

• Mana tangata: achieving equity in health and disability outcomes for Maaori across the life course and contributing to Maaori wellness.

• Mana Maaori: enabling ritenga Maaori (Maaori customary rituals),which are framed by te ao Maaori (the Maaori world), enacted through tikanga Maaori (Maaori philosophy and customary practices) and encapsulated within maatauranga Maaori (Maaori knowledge).

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Pandemic Response and COVID-19 Alert Levels

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Action Plan Objectives Maaori and Pacific Health

Ensuring Te Tiriti and Maaori

health equity responsibilities are

met in the exercise of

kaitiakitanga and

stewardship over the

national COVID-19

response.

Mana Whakahaere

Ensuring Maaori health equity is prioritised in the COVID-19 national

response planning and implementation, including targeted

information guidance and support to iwi, hapuu, whaanau, and

Maaori communities.

Mana Tangata

Enabling iwi, hapuu, whaanau and Maaori health organisations to utilise

maatauranga Maaori approaches in the design and delivery of appropriate

services for their people in response to COVID-19.

Mana Maaori

Mana MotuhakeEnsuring iwi, hapuu, whaanau and Maaori organisations are supported

to respond directly to the increasing health and other needs of their

people due to COVID-19.

Ensuring Pacific equity is prioritised in the

COVID-19 national response planning

and implementation, including

targeted information

guidance and support to

Pacific people,

families and

communities.

Taua

Enabling Pacific people and communities and Pacific health

organisations to utilise Pacific approaches in the design and

delivery of appropriate services for their people in response to

COVID-19.

Whaka Pahefika

TausigaEnsuring Pacific people and communities are supported to respond

directly to the increasing health and other needs of their people due to

COVID-19.

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Maaori Health Specific Actions

Action Responsibility

Mana Motuhake – Ensuring iwi, hapuu, whaanau and Maaori organisations are supported to respond

directly to the increasing health and other needs of their people due to COVID-19.

1 Provide financial assistance for Maaori provider networks to enable providers to meet increased demand, including through DHB General Managers Maaori (Tumu Whakarae).

MoH/DHBs

2 Support the backfilling and additional workforce capacity arrangements for Maaori providers.

MoH/DHBs

Mana Tangata – Ensuring Maaori health equity is prioritised in the COVID-19 national response planning

and implementation, including targeted information, guidance and support to iwi, hapuu, whaanau, and

Maaori communities.

7 Support Maaori communities (whaanau, hapuu, iwi and marae and Maaori organisations) to provide locally specific support for those self-isolating, unwell, or generally in need of assistance.

MoH/DHBs

9 Provide continuity of care for kuia and koroua – to keep kaumaatua healthy and well (e.g., food parcels, medications, resources).

MoH/DHBs

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Pacific Health Specific Actions

Action Responsibility

1 Saturation of health messaging, monitoring and support for sustaining Pacific community compliance with the Government’s objectives to control COVID-19 spread within Pacific communities to complement the wider regional and national COVID-19 communications.

MOH/DHBs

2 Establish supplementary channels to adapt health messaging to the cultural, socioeconomic demographic, housing and uncertainty in income, low health literacy, bilingual and ethnic specific context of Pacific people and their families (large households, managing resources).

MOH/DHBs

3 Expanded outreach services of non-clinical trained health workers to enable sustained health awareness at a local level raising to achieve coverage of Pacific people by locality, ethnic group, age group for the next 6 months.

MOH/DHBs

4 Port access to healthcare for Pacific people to manage conditions in their own households as both hospital, primary and ambulatory care reduce face to face consultations and prioritise follow up for high risk patient groups.

MOH/DHBs

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Questions & Discussion

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Extra Slides

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Counties Manukau District Health Board Community and Public Health Advisory Committee

COVID-19 Maaori and Pacific Response

Recommendation It is recommended that the Community and Public Health Advisory Committee: Receive this paper which outlines the work of the Maaori and Pacific teams in response to COVID-19 to address the specific needs of Maaori and Pacific communities in Counties Manukau.

Prepared and submitted by: Sharon McCook, GM Maaori Health and Pelenato Sakalia, Pacific Health Development team on behalf of Aroha Haggie Director Funding and Health Equity.

Purpose The purpose of this paper is to present to the Community and Public Health Advisory Committee the work that has been undertaken by the Maaori and Pacific health teams in response to COVID-19. In particular the paper will cover specific actions taken by the teams to mitigate some of the health issues that have arisen in the community during the lockdown period Executive Summary The COVID-19 pandemic has placed greater strain on Maaori and Pacific who are already exposed to negative social determinants of health and experience greater health inequities. In response to this, specific strategies were developed and implemented specifically for our vulnerable Maaori and Pacific Communities. These included:

Community outreach services;

Deployment of additional Maaori and Pacific workers to offer social support to Maaori and Pacific COVID-19 positive families;

Strengthened Maaori and Pacific providers and clinics with high Maaori and Pacific enrollment with additional frontline staff;

Ethnic based communications to ensure Maaori and Pacific people hear COVID-19 information in their language of choice; and

Mobile services utilise Maaori and Pacific staff and have an expansive model of care to both test for COVID-19, and provide GP, social and other supports for families.

Background Inequities in health outcomes for Maaori and Pacific are well recognized. Many of these inequities are long-standing and reflect the unequal distribution in the social determinants of health for Maaori and Pacific compared to non-Maaori and non-Pacific people. These disparities are seen at all ages such as life expectancy, amenable mortality and ambulatory sensitive hospitalisations. A higher proportion of Maaori and Pacific live in deprived communities, struggle with poverty and unemployment, are more likely to live in overcrowded and sub-standard housing, while also suffering from higher rates of chronic conditions, and face inequitable access to, and treatment by, health services. The COVID-19 pandemic poses a number of specific risks for Maaori and Pacific communities. 1. Higher risk of large outbreaks of COVID-19 among Maaori and Pacific communities, due to higher rates of

household crowding.

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2. Higher risk of experiencing complications of COVID-19, including death, due to: a. Higher rates of chronic conditions (diabetes, cardiovascular disease, chronic respiratory disease,

hypertension); b. Poorer access to care (we have seen evidence of this with Pacific people presenting to emergency

departments at a later stage of disease than they would have during business-as-usual); and c. Evidence from other outbreaks, where Pacific people experienced significantly poorer outcomes

compared to non-Māori non-Pacific people. For example, during the H1N1 pandemic in 2009, Māori had 7 times the hospitalisation rate and Pacific people 9 times the hospitalisation rate of the rest of the population. Many Pacific communities are still recovering from the effects of the measles epidemic in 2019 (45% of cases in Auckland were Pacific and it spread to Samoa, where 83 measles-related deaths were reported).

3. Worsening of non-COVID related health outcomes due to well-documented barriers to accessing care (even during business-as-usual).

4. Job redundancies will have a much greater financial impact on Maaori and Pacific families, who have a significantly smaller financial reserve than non-Māori non-Pacific families. Real equivalised median household income in 2016 was $28,000 for Pacific people, $30,000 for Māori and $41,000 for NZ Europeans. Access to welfare and other social supports is crucial.

5. Financial stress may lead to mental distress, higher rates of mental illness, addiction and family violence. Initiatives for Maaori Communities A number of key initiatives were approved and implemented to address the impact of COVID-19 on Maaori whanau and communities. This portfolio of initiatives is designed to reach the most underserved whaanau, households and communities. These approaches align with existing health and social services provided to Maaori and leverage common priorities between Counties Manukau DHB and iwi. Importantly, this work has provided a unique opportunity for engagement of our Maaori community in the development of and management of pandemic response initiatives to ensure that they are appropriate, address inequities and reflect the beliefs, values and aspirations of whaanau. Ngaa Kaimanaaki – a Maaori community led response to COVID-19. This service recognised the existing range of organisations and groups already working with whaanau and the need for a more coordinated and joined-up response during the pandemic. In particular the Kaimanaaki service, focuses on protecting whaanau, allowing for manamotuhake and enhancing whaanau wellbeing during the different alert levels for COVID-19. The first tranche of this initiative is driven by Lead Community Providers who are deploying community response teams to geographic areas they are responsible for. This allows for community leadership and insights to enhance service provision on the ground and ensures that this is not an overly prescriptive service. The second tranche of this work has been developed to support an an iwi-led response to COVID-19. Iwi leadership entails control of resources to understand and respond to whaanau, hapuu and iwi needs, empowering community leaders to innovate at the flax roots, and implementation of new ways of supporting and protecting whaanau. This service facilitates whaanau access to timely and credible information about COVID-19, identify care and resources needs, navigate whaanau to specialist care and support, and build healthy habits while they are isolated in their homes. This model also depends on a trained and focused local community workforce (Kaimanaaki) who will possess a range of skills that can enhance whaanau wellbeing. Community communications – ‘The Whaanau guide to COVID-19’ comprises a range of approaches for regular and consistent COVID-19 communications with Maaori whaanau during the different COVID-19 alert levels. This package includes a Facebook Live series as well as a text message campaign for hard to reach/high and complex needs whaanau. This programme also supports Paerangi; a Maaori-led collaborative designed to meet the communication needs of whaanau hauaa (Maori with a disability).

028


Maaori Mobile Health Service – establishment of mobile units to support influenza vaccination and kaupapa Maaori primary health care and coordination in deprived communities. This model provides comprehensive health and social support that can address immediate issues while engaging whaanau in an empowering and longer term continuum of care. Initiatives for Pacific communities The Northern Region CEs also approved the expansion of the outreach service delivered by Pacific community health workers and social support functions. The response work covered community health workers, trained clinical and non-clinical health workers to reach Pacific groups and subgroups, including focusing on non-English speaking communities and vulnerable households. Functions include:

Redeploying existing workforce and increasing mobility of services;

Strengthening Pacific providers and high enrolled Pacific GP practices, to grow front line staff;

Saturation of health messaging into our communities;

Scaling up Pacific community health workers; and

Support for ARPHS contact tracing teams. In addition, the Pacific IMT has provided:

Substantive social support for ARPHS identified Pacific COVID-positive families in the community (82% of all cases);

Clinical advice Pacific specific responses and option provision in the clinical pathway e.g. overcrowding;

Increasing insight and support to Pacific low paid workers within the Northern Region DHBs;

Increasing the impact of the main pillars of the NRHCC Response for Pacific peoples; and

Pacific dashboard and dissemination of the reach of Pacific data. Mobile Units – additional reach: The mobile services utilise Pacific staff and have an expansive model of care to both test for COVID, and provide GP, social and other supports for families. This approach both strengthens the community outreach model and builds Pacific provider capabilities, aligning with the Pacific MOH policy response. It is also effective in identifying, testing and supporting families facing COVID.

Benefits of Pacific mobile health clinics include:

Delivered directly to Pacific families, in their communities and households;

Focused on caring for our most vulnerable Pacific populations;

Integrated and aligned within the health sector and across sectors – Each service will be aligned to existing services already provided in each community. Referral pathways and joined up outreach will be two key areas of integration;

Clinical quality and safety – the best clinical care will be made available to Pacific families within the current heavily restricted environment. The aim is to support Pacific families through lock downs and ensure their physical and mental wellbeing is being taken care of. Clinical oversight will be a key prerequisite to rolling this service out. Each provider will need to have strong clinical governance already in place to be considered for this service;

Cultural support and trusted providers – we will roll this service out amongst Pacific health providers who have relationships with the selected communities, intimately understand what Pacific families need and what they may present with at these clinics, and have the trust of the community through years of provision to these families; and

Responsive to community needs – although focused on healthcare, the mobile clinics have the ability to include a range of different disciplines, each expanding the services offered at the clinics to ensure it is holistic and, under the current circumstances, comprehensive Planned care.

029

Date:

Fanau Ola ExpansionCOVID-19 Response

Community & Public Health Advisory Committee27 May 2020

030

0

100

200

Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Monthly referrals to Fanau Ola

Pacific peoples with high complex health under Fanau Ola service are more vulnerable to COVID-19

HIGH COMPLEX PACIFIC HEALTHChildren/Youth 0-15yrs

Young Adult/Adult Health 16yrs+

Health• >3 ED presentations in 6 months• >5 ED presentations in 12 months• >2 co-morbidities• Hx multiple DNAs• Lifestyle concerns e.g. smoker,

obesity, poor oral health• Medical/Medication management

uncertaintiesSocial

• Financial concerns impacting on necessities

• History of psychosocial concerns e.g. DV/FV; police, Oranga Tamariki

• Language barrier• Home environment concerns• Not attending ECE/school• Unemployment/Low education

status

Referrals must have 3+ complexities. Other

referrals will be case by case.

Few of the supports provided to patients under FO service

by Nurses and Social WorkersHome visits and consultation in Pacific languages to encourage pt to re-engage with their GP/specialist/provider

Follow up with health and social cares – Pacific approach

Provide training and education on health management – conducted in Pacific

languages and worldview

Coordinate medication and provide education on medication management

Coordinate and support pt with outpatient appointments

Coordinate and support pt with Food parcels and WINZ options

Joint visits with other clinician/services

Finance support

Pacific holistic and clinical assessment conducted and recorded

Transport and housing issues managed

Interpretation and translation offered

Discuss case at MDT for additional support for pt

Establish an agreed care plan

Pacific cultural competency education provided to clinicians

Referrals to appropriate services and follow up

0

500

1000

1500

Jan-20 Feb-20 Mar-20

SAM POLs received by FO (Jan 2020 - Mar 2020)

SAM North

SAM South

Assessment of whole family/household Jan-20 Feb-20 Mar-20

# Family/household members assessed 103 109 82

# Family/household member newly registered with FO 22 42 21

031

Impacts COVID-19 will add to high complex Pacific patients and their families

Impacts of COVID-19:• Decrease home visits and face to face contacts by

health services e.g. outpatient appts, GP appts, NGO providers

• Limited access to essential services e.g. GP, WINZ, social services, library, groceries etc

• Fear of COVID-19

• Confusion/Misunderstanding/Misinterpretation of COVID-19 messages and announcements due to frequent changes

• Enforced isolation of multi generational and crowed homes

• Enforced isolation away from extended families and other supportive community groups e.g. church

• Job losses

• School closures

Underlying stressors are magnified• Increase risk of COVID-19 community spread

• Reduce access and focus to use health services

• Increase health complications

• Increase financial distress / security concerns

• Increase in family violence/harm – increase SAM referrals/tasks

• Increase mental health, anxiety and distress

• Increase education inequities for Pacific students

• Increase inequities and social determinants of health and wellbeing for all ready at-risk Pacific families

032

In response to COVID-19 and the impacts of exacerbated stressors and inequities, Fanau Ola proposes the following…

033

1. Increase staff capacity to help continue Fanau Ola BAU with the intent to be flexible with current criteria Open criteria to Pacific referrals with health

related concerns and social/cultural impacts related to COVID-19 (not limited to 3+

complexities and exclusions).

034

2. Additionally, Fanau Ola will provide welfare supports, emphasize COVID-19 messages; assess crowded households; contact tracing; and offer opportunistic swabbing and flu vaccination.

ENTRY POINTReferrals from services

unable to provide health support to

Pacific vulnerable pts

ARPHS• Welfare• Contact Tracing

CBAC• CMH sites

Hospital e.g.• ED• Wards

Outpatient Care e.g.• MSC modules• District nurses/

allied health

Primary Care e.g.• GP• NGO

Community Central

Other e.g.• Self referral• Police• Oranga Tamariki

Nurse

Social Worker

FO Coordinator

CSW

①Referral

Receives referrals on:[email protected]

②Triage & Planning

③Engage

Pacific cultural approach and 5 C’s

④FO & Welfare Assessment

• Contact tracing• FO Assessment• Case Management• Care plan• Referral• COVID-19 messages• Pacific Cultural

Training for clinicians

Opportunistic• Swabs• Flu

vaccine

⑤Monitor & Follow up cares

• Follow up care plan• Referrals engaged• Self management• Support on Ward

(strict Visitors policy)

⑥Review & Transition

• Review care plan• Self management

results• Referrals engaged• GP/Provider engaged

⑦Discharge

• Pt confirmation• GP informed• Referrer informed• FO Coordinator informed

FANAU OLA

035

mailto:[email protected]

Community-outreach approaches for Maaori

health: COVID-19

036

Context COVID-19 has differential impacts on our whaanau

and communities.

• Ripple effect of decisions made in NZ health and social services to combat COVID-19

• Existing health service access issues for Maaori compounded by COVID-19

• Increased burden of disease on Maaori communities (long-term conditions and mental health)

• Poverty and financial hardship lead to increased exposure of Maaori whaanau to other social determinants of health

• Conversely, pandemic has presented a range of opportunities for Maaori whaanau

• New funding streams based on strengths-based approach

• Agile responses of Maaori providers and other community/grass-roots innovation highlighted

037

Community outreach approaches

Overall approach

• Designed to reach the most underserved whaanau, households and communities via local champions

• Outreach services that coordinate and scale a diverse spectrum of innovative actions within Maaori community

• Alignment with health and social services

• Iwi-led response: alignment with/enhancement of existing actions

• Leverages common priorities between DHB and iwi

• Complementary communications strategy that provides real-time feedback from whaanau

• Feed into other longer-term CMH actions to support our local community

038

Ngaa Kaimanaaki

Phase 1 ($495,509)

• Supporting whaanau wellbeing via deployment of community leaders (kaimanaaki, 25 FTE)

• Utilises lead Maaori Providers and leverages collaborations

• Targets whaanau in underserved areas and spectrum of whaanau members

• Coordinator, Clinical lead (2 FTE) and Kaimanaaki workforce

• Community response teams

• Holistic wellbeing assessment and whaanau plan developed

• Whaanau financial support

Phase 2 (Iwi expansion, $1.003M)

• Agreed between DHB and iwi-partners

• Additional workforce (50 FTE) via hauora provider network

• Northern Region iwi communication centre

• Coordination and Response centre

• Contact centre

• Iwi needs assessment

• Whaanau wellbeing budget

Underpinning key principles and central tenets

039

Ngaa Kaimanaaki workforce

Work alongside health & social support staff

Community leaders/volunteers with key skills

Vulnerable/high needs whaanau

Responsive to the spectrum of whaanau needs (identify pressing needs and best solutions)

Central and coordinated response

Connection to health care providers

Clinical oversight

Leverages key data

040

Community communications

Accompanying communications package for whanau

• a Facebook Live series on Maaori TV (and cross-posted on 7 other Facebook pages)

• Additional videos for sharing

• Text message campaign for hard to reach/high and complex needs whānau.

• Paerangi; a Māori-led collaborative designed to meet the communication needs of whānau hauā

• All of these initiatives support the Ngaa Kaimanaaki workforce currently and over next alert level

• Provide opportunities for ‘real-time’ feedback from whaanau so that we can target most pressing needs

041

Maaori Mobile Health Clinics

Increasing access to health supports through Māori mobile clinics for vulnerable whanau

• Maximum of 14 mobile health services proposed regionally (5 in CMH region)

• Range of options proposed

Supporting influenza vaccinations for eligible Maaori

• Ring-fencing vaccinations

• Priority to Maaori provider requests for vaccines

• Data sharing for Maaori health gain

Providing wrap-around care for vaccinated Maaori and whaanau

• Additional primary health and social support services offered

042

Other support Maaori Provider Support Fund ($5M)

• One-off grant to Maaori Health Providers serving high number of Maaori whaanau

• Established access to Maaori whanau and communities

• Support providers to/with:• Continue to provider essential health and disability services

• Facilitating provider viability going forward

• Enable redeployment of resources to COVID-19 related activity

• Funding for any activity relating to maintaining provider operations and COVID-19 response to whanau

• Large ($68K), medium ($51K) and small ($35K) Maaori providers in CMH rohe

043

Start Well MāngereA prototype for system change?

044

South Auckland Place-Based Initiative (SASWB)

South Auckland SWB (formerly Social Investment Board) was set up in 2016 as one of three ‘Social Investment’ Place-based Initiatives

Initially focused on 0-5 year olds and their whānau in Māngere

Counties Manukau Health (DHB) hosts the SASWB, as well as being one of the 12 representatives on the Board

PBI Structure and Overview

Taking a cross-sector, whānau-centred approach to supporting tamariki

SWB Strategic Management Group

Joint Venture FV/SV Board

SWB Strategic Māori Advisors Group

045

Our Approach

Start Well Māngere

Family Harm & Violence

Mental and Emotional Wellbeing

Housing Support

Early Childhood Education

Vision: All children in Māngere (and South Auckland) are healthy, learning, nurtured, connected to their communities and culture, and

building a positive foundation for the future

System ImprovementTaking a cross-sector & equity view.

Changing how support is provided to tamariki and whānau experiencing multiple stressors – reducing fragmentation, duplication and stress on whānau,

enabling thriving whānau

Improved ‘core business’ and ways of working

New responsive-relational ways of working. Supporting practice that places respectful

relationships at the heart, and is flexible, intensive, whānau-led and enabling. A partnership approach

“Investing for wellbeing” and whānau-centred commissioning

To better meet the needs and aspirations of whānau and improve life-course outcomes,

working with NGOs

Local evidence, insights and cross-cutting themes from focus areas and prototyping informs…

046

Recognition that some whānau in Counties Manukau aren’t getting the type or intensity of support needed to impact on health and social outcomes

Concern about the level of engagement and uptake of universal and targeted services, particularly by families who are considered at risk of poor health and wellbeing outcomes

Lack of flexibility to support whānau through an existing trusted relationship (focus on referral) and ability to focus on what is of value to whānau

Lack of time to build trusted relationship and respond to whānau need, especially for those whānau experiencing multiple life stressors

Stronger focus needed on fostering healthy child development e.g. through reducing parental stress and enabling responsive parenting; ‘serve and return’

Where we started - what were the system/service issues we are trying to solve?

047

Evidence and models we drew on to develop this prototype

A number of models reviewed e.g. Early Start, Family Start, FNP/NFP, Right@Home (Australian model)

Mixed evidence but evidence to support intensive home-visiting approaches such as Family Nurse Partnership, Early Start

Relationships are key Impact of number of visits (i.e. ‘dosage’) and quality of the relationship Skill and experience of staff important Begin in antenatal period vs post natal period “How” interventions / support are delivered are as important as

“what” is delivered Supports need to be based on needs and priorities of families Supports need to be flexible and evolve with needs of the family Non-stigmatising Maintain continuity of care

048

Key worker model (social work and clinical nurse specialist)

Working with Plunket, Family Start, OT, CM Health, MoH

Begins in the antenatal period working alongside and supporting LMC

Spends time developing relationship and identify whānau priorities, needs and aspirations

Working intentionally to address whānau concerns, and issues identified by the key worker, through their professional lens, as important for the wellbeing of whānau

Regular assessment of child’s developmental (including emotional) progress

Whole-of-whānau approach

What is the model?

Work with whānau to reduce emotional distress and social stressors to increase “parental band width” to enable more responsive parenting

Coaching parental responsiveness, “serve and return” Recognises that addressing social determinants is fundamental to positive life

course outcomes for our tamariki Works with (rather than refers) social complexity e.g. Family violence, housing,

financial issues Incorporates Well Child Tamariki Ora framework Incorporates some Family Start Modules (e.g. parenting) Provides intensive navigation for other services (Primary care, mental health)

049

Māngere-based – follows women when possible

Women < 20 years pregnant (or with a child < 5 years)

Clinical Nurse Specialist 2.7 FTE Social Worker 3.4 FTE

Recent addition of responsive psychological support prototype

Iterative, continuous improvement approach – adapting the model as we go based on whānau and frontline insights

Testing a model that is able to “flex up and flex down” to meet the needs of mothers, babies and their whānau

Proportionate universalism

What is the model?

050

At the time of initial assessment, SW mums lived in**:• HNZ home – 48%• Emergency or transitional housing – 38%• In a private rental or own house – 14%

48%

4%

17%

4%

9%

17%

0 moves

1 move

2 moves

3 moves

4 moves

5 moves

Percentage of mums

Number of house moves made by Start Well mums since the beginning of service

Who we are working with (as at July 2019)

31 Mothers38 children in total

4 current pregnanciesApprox. 200 wider whānau members

supported

• 31 mothers aged 20 or under (median age 18, range 13 to 20)

• Four older mothers in wider whānau (median age 36)

• 39 children on the service: including older siblings (1-4 years)

• Gestation at referral range 11 to

40 weeks (average 23 weeks)*

Total response output for 24 mums (therefore totals > 100%)Ethnicity has been outputted at Level 1 to protect the privacy of mothers

Start Well Māngere Evidence and Insights

29%

71%

21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Maaori Pasifika European/Other

Pro

po

rtio

n (

%)

Ethnicity of Mothers

Provisional results

Start Well has a low whānau-to-staff ratio of approximately 1:8 -1:10 for primary clients

As at December 2018

**Based on 21 mums

* First 17 mothers 051

36* referrals

Since 23/11/2017

Takes at least 10-15 hours to engage to build a trusted relationship

Duration of Face to Face contacts was on average 1.2 hours

Longest F2F contact was 8.1 hours with a Social Worker arranging emergency accommodation for a mother and wider whānau

‘Time spent’ analysis (dynamic need) At 6 week WCTO checkpoint, time spent

(combined nurse and social worker) • Minimum: 6 hours• Maximum: 187 hours• Average: 38 hours

At 9-12 month WCTO, time spent: • Minimum time spent: 27 hours• Maximum time spent: 170 hours• Average time across all clients who have

reached this age: 77 hours

“It is not that it hasn’t happened to me before, it is just the first time I have had someone to tell”

Engagement and Practice Insights

“If we visit a home and leave, and the family is not better off then we are not doing it properly”

Start Well model focuses on building the relationship

Client DNAs (‘did not attends’) are viewed in a non-judgmental manner – they are part of the journey to successful engagement

For families dealing with a high amount of toxic stress, relationship-centric support is essential…switching support person / practitioner may be detrimental to engagement

Referrals alone rarely result in engagement

Provisional results

“Start Well practitioners are enabled to start by asking ‘how can we support you today’ (whānau-driven approach) as opposed to going and collecting what we need from them”

052

The Start Well

model combines

social work and

nursing expertise –

both elements are

equally important in

supporting mothers

with high and

complex needs

There has been a

higher need for social

work aspects than

initially expected,

perhaps due to the

particular cohort

- Time spent in the interval between each WCTO visit

Provisional Results

053

Whānau engaged with Start Well for eight months. Significant intergenerational issues with obesity and diabetes across the extended whānau

Through building a trusted relationship with not only the mother but also the wider whānau, the Key Worker has been able to support the wider whānau with obesity and diabetes concerns. Wider family members now travel from their homes to be present when the Key Worker visits.

At one recent visit, five of the adults present were able to discuss their existing diagnosis of Type II diabetes, all with progression of this disease (renal symptoms, eye sight and heart complications, breathlessness). Other members not present that day were undergoing dialysis. The whole whānau report adversity in accessing care, they have limited health literacy, and are fearful of the progression of diabetes.

Key Worker liaised with the family’s primary care provider, and organised new culturally-appropriate primary care input for the whānau.

Key Worker has also arranged an event in the family home for the extended whānau with a Health Promoter / Lifestyle coach e.g. tailored advice, fit-for-purpose exercise, and dietary input.

This is an opportunity to start a change for a group of people who otherwise may have limited life expectancy, who are poorly engaged with health services for a number of reasons, and who are very engaged with the Start Well Key Worker, trust her, and are actively making decisions with her across the whole whānau group.

Start Well: Whānau Case Study

054

Ministry of Health review of a MoH funded health service

A Child Wellbeing service designed and funded by MoH, MoE, Oranga Tamariki

(which reflects the principle of proportionate universalism with the ability to flex up and flex down)

Well Child Review Opportunity

055


Counties Manukau District Health Board 4.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

2.1 Confirmation of Public Excl Minutes of the Joint HAC/CPHAC/DiSAC Meeting 8.4.2020

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i)) of the Official Information Act 1982).

[NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes As per the resolution from the public section of the minutes, as per the NZPH&D Act.

057

counties manukau district health board community …€¦ · aroha haggie – director, funding...

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