/ 20 District Health Boards
whanau ora – rangatahi health services
STATUS:These service specifications may be amended to meet local agreement needs. / NON-MANDATORY
Review History / Date
Published on NSFL / July 2002
Amendments
changed to non-mandatory / June 2012

Note: Contact the Service Specification Programme Manager, National Health Board Business Unit, Ministry of Health to discuss the process and guidance available in developing new or updating and revising existing service specifications.

Web site address of the Nationwide Service Framework Library:

Whanau Ora – Rangatahi Health ServicesService SpecificationPU:

1Kaupapa/Definition

The Rangatahi service provides a range of general health education and promotion, advisory, liaison and co-ordination activities specifically targeted at Rangatahi. A key objective of the service is to ensure that the activities of existing health professionals are co-ordinated and effectively targeted for Maori, and that Maori are assisted to better utilise those services, however the services will be available to the whole community.

These services will be delivered through:

  • the development of health plans of specific conditions and the development of targets for improvements in health status as agreed with each client
  • face-to-face sessions with individuals to specifically discuss and develop strategies to address their needs
  • face-to-face sessions with whanau to specifically discuss and develop strategies to address their needs
  • hauora wananga – health education and information from a Maori perspective promoting and understanding the Maori view of health in terms of:

–taha tinana (physical wellbeing)

–taha wairua (spiritual wellbeing)

–taha hinengaro (mental wellbeing)

–taha whanau (family wellbeing).

2.Maori Health

The service is expected to contribute to the reduction in health inequalities, the 13 priority Population Health Objectives, as well as the Maori health gain objectives, in particular, targeting services to impact on asthma, diabetes, injury prevention, smoking, hearing, mental health, oral health and immunisation, including violence prevention.

The Maori Health Strategy: He Korowai Oranga is referred to and Maori Health requirements are outlined in the General Terms and Conditions and Provider Quality Specifications. In addition the provider arm of the DHB is to develop and implement a Maori Health Plan that outlines how it will contribute to improving outcomes for Maori for the services contained in this service specification.

The Plan should include the following objectives as a minimum:

  • How you will ensure that Maori utilisation is at least equal to the Maori population in the provider's catchment.
  • How you will ensure your effectiveness and the acceptability and accessibility of services to Maori
  • How links with primary care - general practice, community providers and Maori providers will be effective for improved outcomes in Maori health;
  • How discharge planning and rehabilitation processes will meet the needs of Maori;
  • Links with the DHB provider arm's Maori Health Plan and other contractual quality specifications, especially consultation with Maori.
  • How these objectives will be monitored and measured for Maori health outcomes.
2.1Client Group

The service will be available to all eligible persons resident in the (1)and the surrounding area, with the target group being Maori. Latest data identifies that (2) people in the area are Maori. The numbers that are shown in brackets( ) are the numbers referred to in the targets schedule attached at the end of this service description.

The services provided by you are primarily for Maori but do not exclude people of other cultures. However, and as a priority, the services delivered will focus specifically on the needs of Maori in the service boundaries.

Known Health Status of Target Group

Main causes of hospitalisation and death:

  • death and injury from motor vehicle crashes
  • death from suicide
  • other injuries and fractures
  • respiratory problems
  • pregnancy complications and genital disorders in young women.

2.2Service Components Required
Service Components
Targeted Group: General
Positive outcomes sought / Action required / Performance measures
Improved health status / Utilisation of checklists of service priority areas to develop individual profiles.
Development of needs analysis.
Development of a Health Action Plan which includes:
  • identifies agreed strategies for improved health status for the client
  • identifies positive areas of health status (eg, level of non-smokers, amount of weekly exercise)
  • Identifies priorities for the client and the service provider
  • sets targets for improvement in these priority areas
  • develops specific strategies to make these improvements
  • develops a simple way of assessing whether these improvements have occurred.
/ Summary needs analysis based on.
Profile of the target group in the specified service area.
A Health Action Plan is developed in which:
  • current health status for the client are identified
  • areas that have been agreed to be improved are identified
  • priorities are identified
  • targets for improvement in these priority areas are set
  • specific strategies to ensure these improvements are developed
  • develops a simple way of assessing whether these improvements have occurred.

Key Health Factors for Rangatahi
  • Sexual health promotion and education
  • Alcohol and drug information and education
  • Smoking
  • Mental health

Targeted Group: Rangatahi (15–24)
(approximate number in target population (3))
Positive outcomes sought / Action required / Performance measures
Health planning
Decision making
Increased self- esteem and confidence to self manage health care / Assist rangatahi to formulate health plans.
Assist rangatahi on making decisions related to health issues.
Assist individuals with strengthening whanau, hapü and Iwi links. / Number of health plans written and agreed to (4).
Number of health plans reviewed within six months (target 90%)
How client rate this programme and specific aspects of it (positive and negative).
The number of individuals assisted with identifying whakapapa.
Auahi Kore
Preventing rangatahi uptake of smoking
Encouraging smoking cessation in rangatahi / To provide information and activities about effects of smoking to enable rangatahi to make positive choices about smoking cessation. / The development of a strategy to reduce the number of rangatahi who take up smoking.
The number of promotional activities addressed to provide information about problems caused by smoking and ways to stop it (5).
A survey is done within 12months to assess change in smoking rates by rangatahi registered with the provider (rates per whanau health plan).
Promotion of healthy lifestyles / Providing information about good nutrition and the benefits of exercise.
Provide support for rangatahi to enable them to make positive choices and decisions. / The provision of information to rangatahi about practising good nutrition and exercise.
The number of promotional activities addressing the need for good nutrition and exercise (6).
Promoting mental health and wellbeing / Assist rangatahi and whanau to recognise early signs of stress.
Assist rangatahi to develop individual strategies relating to interpersonal relationships, dealing with stress, depression and personal crisis.
Provide health education programmes to promote positive ways to manage anger.
Provide support for rangatahi to improve their skills resulting in raised self-esteem and self responsibility. / Referral to counsellors and support networks.
Provision of information to promote mental well being and stress management.
The number of rangatahi and their whanau who have been assisted in these cases.
Whakapapa linkages (see whanau section).
Preventing self-harm (suicide) / Use the best available knowledge and resources to prevent self-harm of rangatahi.
Provide information about support networks available. / The number of rangatahi and whanau who have been assisted after suicide threats and/or attempts.
Sexual health and promoting wellbeing / Promotion of safe-sex messages in promotional activities to ensure good access to rangatahi for support service.
Use of peer educators as support for rangatahi. / The development of a plan to assist rangatahi taking responsibility for their sexual health.
The number of promotional activities that addressed positive sexual health responsibility by rangatahi (7).
Use the number of rangatahi assisted in this way.
Promotion of safe use of alcohol and drug use / Providing information on the effects of alcohol and drug use to enable rangatahi to make positive choices and decisions.
Providing support for rangatahi to develop skills to deal effectively with the safe use of alcohol. / The provision of information to assist rangatahi taking responsibility in alcohol and drug use.
The number of promotional activities addressed about the need for responsibility in alcohol and drug use by rangatahi (8).
Management of asthma / Provide specialist support for client with asthma.
Assist in identifying asthma for at risk or potential clients.
Assessment of asthma status and development of an asthma management plan. / Client with asthma who have had specialised advice given to them (9).
The number of asthma health education and promotional activities that have been held.
The number of asthma management plans written and agreed to (10).
Key Health Factors for Wahine
  • Maternity services
  • Cervical screening
  • Sexual health services
  • Mental health services

Targeted Group: Wahine (15 years plus)
(Approximate number in target population (21))
Positive outcomes sought / Action required / Performance measures
Promoting appropriate and relevant use of contraception (for 15–35 year olds) / Give information at promotional activities and to whanau and wahine about family planning.
Provide contraception information to wahine and refer for medical advise where necessary. / The number of promotional activities at which information is given about family planning (11).
Feedback from wahine is that information and education was appropriate and sensitive.
Promoting healthy pregnancies and positive birth outcomes (for 15–45 year olds) / Give advice at promotional activities to wahine about the importance of good maternity care.
Provide information about choices of LMC.
Encourage wahine to have regular check-ups for maternity care. / The number of promotional activities at which advice is given to wahine about the importance of good maternity care (12).
Number of referrals to LMCs.
Feedback from women and providers that attendance rates at maternity care have improved.
Prevention of and awareness about screening for breast cancer / Give information at promotional activities and to whanau and women about breast cancer.
Promote or raise awareness of the breast cancer screening programme (50+ years). / The number of promotional activities at which information is given about breast cancer (13).
The specific ways in which the breast cancer screening programme has been promoted.
Feedback from wahine that the promotion has helped in their knowledge about the importance of this service.
Health promotion and awareness of cervical screening and wellness / Give information at promotional activities and to whanau and wahine about cervical screening.
Register consenting clients / The number of promotional activities at which information is given about cervical cancer (14).
The specific ways in which the importance of cervical screening has been promoted.
Links to other educators of cervical screening and to services.
2.3Key components of the service include:
  • Assessment of self referred conditions, advice and minor treatment with referral as necessary to appropriate health providers.
  • Support and assistance to clients referred by other health providers including general practitioners.
  • Health advice, follow-up, treatment and monitoring of acute and ongoing health care conditions as referred by other health providers.
  • Co-ordination with other health care providers.
  • Co-ordination of health related activities, eg, health education sessions.
  • Services should be culturally appropriate and sensitive to individual needs. These include age, ethnicity*, gender, sexual orientation and any disabilities.
2.4Provision and Level of Service

Services will be available between the hours of 8.30 am and 5.00 pm, or as applicable to the client group. Services will be provided in a range of settings including, marae, schools, TeKohanga Reo and in private homes where appropriate.

2.5Key Linkages

The service is required to demonstrate good linkages with:

  • Maori providers and Maori organisations such as MWWL, Runanga a Iwi
  • local general practitioners, practice nurses and their staff
  • other local health care providers including ambulance services, community nurses such as Plunket, public health and district nurses and midwives
  • local providers of social and community services, eg, schools, kura kaupapa Maori and Te Kohanga Reo
  • hospital providers in respect to community health and public health programmes and hospital services.

You will have written protocols and systems in place to facilitate these linkages.

2.6Service Coverage Area

Services will be provided in the following areas (insert coverage area).

The services provided by you are primarily for Maori but do not exclude people of other cultures. However, and as a priority, the services delivered will focus specifically on the needs of Maori in the service boundaries.

2.7Outputs

Refer to the Annual Targets Schedule page.

2.7.1Reporting Requirements
  • Provide a brief quarterly narrative report on your performance against the quality standards listed in the service specification and the Maori Standard Terms and Conditions.
  • Provide a brief quarterly narrative report on the service, including the following:

–number of full time equivalent staff

–staff training undertaken

–highlights, issues or concerns and any trends within the quarter.

  • Provide the following quarterly financial reports:

–Income and Expenditure Account (accrued)

–Balance Sheet

–Cashflow Statement (not accrued).

  • A quarterly narrative summary report on each promotional activity held including discussion on:

–brief description of the promotional activity (eg, type of programme/s and types of activities or specific health education/promotion programmes that focus on health and wellness undertaken at each promotional activity)

–brief description of target group/clients

–brief description of the benefit to the clients/target group

–summary of client/target group feedback.

2.7.2Performance Measures
  • All service and financial reports will be submitted by the due date required.
  • All information/data requested in the reporting requirements of the service specification will be forwarded to the Monitoring Team – Ministry of Health, Dunedin Office.
  • If for any reason you are unable to meet the reporting timeframes, you are required to contact the Monitoring Team – Ministry of Health, Dunedin to request an extension.
  • Establishment and the maintenance of a client register (by age, sex, ethnicity* and by service type, etc) including:

–Total number of clients on register by age, gender and *ethnicity

–Number of new client registered for the quarter

–Number of clients exiting the service for the quarter

*Ethnicity is recorded as perceived by the family/whanau. People may therefore perceive themselves as belonging to /ore than one ethnic group. Ethnicity is to be reported according to the following priority system: if perceived ethnicity includes:

  • Maori, report as Maori
  • Pacific, report as Pacific
  • otherwise, report as Other

3.Quality Requirements

3.1Philosophy

The Ministry of Health wishes to purchase health services for people that meet the needs of the communities served. In doing so, particular attention must be paid to health gain priority areas of:

  • Maori health
  • child health
  • mental health
  • asthma
  • diabetes
  • dental health
  • injury prevention
  • tobacco control
  • sexual health
  • alcohol and drug.

In regard to Maori health services specifically, the Ministry of Health sees this service as meeting the following Government and Ministry of Health objectives:

  • ensuring purchasing arrangements enable greater participation by Iwi and Maori groups
  • ensuring services provided for Maori are culturally appropriate
  • being responsive to aspirations and interests of Maori
  • recognising the tikanga and mana of each Iwi in the region
  • being aware that Iwi have their own vision for health.
  • In addition to the general quality requirements, the following quality requirements apply to this service:
  • provision of information to eligible people about hours of availability and ways of making contact in an emergency
  • assessment of effectiveness and acceptability through promotional activities or public meetings, which are held at least six-monthly
  • seek feedback from rangatahi that the service is meeting their needs and that knowledge about health has improved or increased.

3.2Staff Training – Disability, Violence and Abuse

Staff training must be given specifically in:

  1. disability awareness to ensure disabled children/adults and disabled carers are given appropriate access and support
  2. specific issues in the patterns and identification of abuse and interpersonal violence for these groups.

Violence/Abuse

Staff must have training in how to identify, support and refer victims of child/adult abuse and interpersonal violence. The agency must have protocols in place to support staff in this intervention.

The above targets are only indicative and provide a guideline for the provider regarding Ministry of Health expectations.

4.Target Schedule

  1. City/region or location of service
/ (insert coverage area)
  1. Total Maori population
/ (Insert Maori population) / Percentage of population / (Insert percentage of population)
Promotional activities
Rangatahi
  1. Number of clienthealth plans to be achieved
  2. Target number of promotional activities held to discuss smoking
  3. Target number of promotional activities held to discuss nurtirion and exercise
  4. Target number of promotional activities held to discuss sexual health issues
  5. Target number of promotional activities held to discuss alcohol and drug issues
  6. Target number of clients assisted with asthma
  7. Number of asthma management plans to be achieved

Wahine
  1. Total number of Maori wahine in population (15-25 years)
  2. Target number of promotional activities held to discuss contraception/ family planning
  3. Target number of promotional activities held to discuss maternity care
  4. Target number of promotional activities held to discuss breast cancer/self-examination
  5. Target number of promotional activities to discuss cervical cancer/smears

The above targets are only indicative and provide a guideline for the provider regarding Ministry of Health expectations