This review was undertaken to inform the Primary Healthcare needs assessment as part of the Oranga Tamariki Action Plan, but has wider links across our organisation including to the Disability Strategy.
Oranga Tamariki’s research questions directing this brief were:
• What are the primary healthcare needs of children and young people with disabilities in different age groups (0-4, 5-9, 10-13, 14-17) compared to children and young people who do not have disabilities, with a focus on their health literacy, equity of access to, and engagement with, primary healthcare services?
• What are the strengths, opportunities, gaps, or barriers to meeting these needs of children and young people in care including areas for attention, and including to reduce any disparities between non-Māori and Māori?
This evidence brief examined literature on the primary healthcare needs of disabled tamariki and rangatahi (tamariki whaikaha) in care. This included youth justice and protection facilities.
The brief had a specific focus on equity of access and engagement with primary healthcare services and health literacy.
- large gaps were identified in the available literature. There was no literature on the primary healthcare needs of disabled children in care.
- the rate of disability among tamariki engaged with Oranga Tamariki is much higher than the general population. It is estimated to be between 47% to 87%. This estimate depends on the dataset, age of children, and the definition of disability used.
- the evidence from Oranga Tamariki found that 66% of tamariki whaikaha in out-of-home care were identified as having high or very high support needs.
- evidence on poorer health outcomes for young people with disabilities and young people in care and protection shows that tamariki whaikaha will have much worse health outcomes than their peers.
- of this group the main diagnosis was of intellectual disability (87%). About 11% of these had autism as a primary diagnosis. The remainder (3%) had a physical, sensory or neurological impairment.
A range of support is needed
The evidence suggests a range of components form a best practice response. These include:
- registration with a GP, an initial primary healthcare assessment, early intervention and regular reviews
- addressing barriers to accessing primary care
- supporting transition from paediatric to adult healthcare
- inclusion of disabled voices in planning and strategy
- ensuring health literacy and communication; and
- incorporating indigenous approaches.