School Based Health Services

Improving the well-being and resilience of young people will give them a better sense of connection and help to ensure they are ready to learn and more likely to achieve at school. Young people need to be supported to develop the confidence they need to reach out for help and support when they need it.

School Based Health Services (SBHS) take a holistic approach to supporting young people. The most common presentations include, but are not limited to, trauma-based health impacts particularly family harm, mental health, addictions, and sexual and reproductive health. SBHS nurses provide clinical primary health care and referrals onto required services. They also support health promotion campaigns within the school community.

Students can request to see the nurse, or the nurse may reach out to offer support.

SBHS are available to lower decile (decile 1 to 5) secondary schools, Teen Parent Units (TPUs), and Alternative Education sites (AE) nationally. This means SBHS are available to around 97,000 students across approximately 300 schools.

School health services may also be available in other schools, for example, where schools pay for their own nurse, where the district or primary health organisation have chosen to supplement services with a GP, or in primary and intermediate schools.

The enhancements programme aims to ensure that SBHS are effective and efficient in improving outcomes for young people and achieving equity.

The enhancements programme:

• reflects Te Tiriti o Waitangi (Te Tiriti) principles recommended in the 2019 Hauora report for the health system (See link in Downloads section below.)
• ensures the needs and concerns of young people are central to the measures and indicators and are addressed by the service
• links to the Child and Youth Wellbeing Strategy and other relevant government agency strategies.  

Our focus

The enhancements programme has a focus on populations currently not well served by the system, including:

• rangatahi Māori
• Pacific young people
• rainbow young people
• young people in care
• young people with disability.

Our work

The enhancements programme is focussed on progressing the following enhancements to SBHS:

• commissioning for equity and wellbeing (see below)
• workforce development and support
• improved linkages with other services and sectors
• SBHS model of care.

Commissioning for equity and wellbeing includes:

• the aims and objective of the services
• the quality and workforce expectations
• the reporting and monitoring mechanisms
• quality improvement initiatives alongside an evaluation.

Together with our partners, Te Whatu Ora have considered Te Ūkaipō and the discussion document and developed an enhancements work programme with seven main streams:

1. partnership and communications
2. Te Ūkaipō
3. evaluation
4. workforce development
5. model of care
6. data and information
7. commissioning and funding.

Who we're working with

We are working with a range of partners, including young people, the youth health sector, and the Ministry of Education for the enhancements programme. The following groups make up our partnership for the programme:

• Te Tatau Kitenga
• Māngai Whakatipu
• Te Rōpū Mātanga o Rangatahi
• Malatest International – Evaluation
• Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ) – Workforce Development
• Deloitte – Model of Care
• Te Aka Whai Ora
• Ministry of Education
• Manatū Hauora.

Te Ūkaipō is the foundation for the programme, in the way we work, the mahi we produce and the outcomes for young people. Te Ūkaipō was developed by Te Rōpū Mātanga as an expression of:

• Te Ao Māori values and principles
• Mātauranga Māori
• Te Tiriti o Waitangi principles
• He Korowai Oranga (Māori Health Strategy)
• Whakamaua: Māori Health Action Plan.

Te Ūkaipō includes nine kaupapa Māori whanonga pono (values) with corresponding whakataukī gifted as guiding principles. These values shape and influence practice, commissioning, and delivery of SBHS by enabling a Māori centric approach to enhance the experience of young people in SBHS. 

As we apply Te Ūkaipō we consider the relationship with whānau and the partnerships between services as these are essential to the wellbeing of whānau and their ability to access and engage with services easily.

Te Rōpū Mātanga o Rangatahi hold the  kaitiaki role for Te Ūkaipō.

Te Tatau Kitenga was established in February 2020 through a partnership between the Ministry of Health and the Society of Youth Health Professionals Aotearoa New Zealand (SYHPANZ). The name was gifted by the SYHPANZ Kaumatua, translating as ‘The Doorway to Foresight’ in recognition of the group’s strategic vision for young people and their function as door holders for others.

Te Tatau Kitenga provides expert advice and recommendations to Te Whatu Ora on youth-related topics and services, especially for the School Based Health Services (SBHS) priority groups: rangatahi Māori, Pacific young people, rainbow rangatahi, rangatahi in care and rangatahi with disability. Te Tatau Kitenga is currently focused on quality improvement and enhancement activities of SBHS.

Te Tatau Kitenga includes Te Rōpū Mātanga o Rangatahi (Te Rōpū Mātanga). Te Rōpū Mātanga provides leadership and advice to ensure that the work of Te Tatau Kitenga upholds te Tiriti o Waitangi and is focused on equity.

Te Rōpū Mātanga o Rangatahi (Te Rōpū Mātanga) was established in August 2020 as an advisory rōpū that sits within Te Tatau Kitenga. The name was also gifted by Matua, meaning ‘The Watchmen of Rangatahi’.

Te Rōpū Mātanga provides leadership and advice to ensure that the work of Te Tatau Kitenga upholds te Tiriti o Waitangi and is focused on equity. Members of Te Rōpū Mātanga are also part of Te Tatau Kitenga, recognising the partnership required to embed te Tiriti o Waitangi and equity in this mahi.

Te Tatau Kitenga supported a youth advisory group, known as the National Youth Committee for School Based Health Services (NYC) and focus groups to capture the voice of young people.

The NYC report identified 4 priorities:

1. a supportive culture around accessing SBHS so services are accessible without barriers
2. all rangatahi youth in Aotearoa NZ, no matter what education they’re receiving, or their background have access to all health services
3. the environment which rangatahi receive SBHS should be safe and comforting
4. a system that caters to all and isn’t a “One-Size doesn’t Fit All” approach.

The name was developed by the group supported by the Pou Tikanga, and reflects their vision to be “representatives of the descendants, voices for generations to come and voices of the future”.

Māngai Whakatipu was formally established in 2022 to focus on quality improvement and enhancement activities of SBHS. Māngai Whakatipu includes members of our population groups for the enhancements programme.

Our partnership with young people through Māngai Whakatipu means they can be involved in all stages of design, equal with adults. It also means they can educate and inspire others to act, learn and demonstrate leadership skills, model positive behaviours for peers, and contribute to positive development of young people and their communities.

Māngai Whakatipu bring youth voice, perspectives, knowledge and experience into the enhancements programme and advise the programme partners on tailored communications material and channels for young people.

Te Tatau Kitenga provided a discussion document for Te Whatu Ora with advice and recommendations for improving SBHS (the discussion document).

The discussion document identified 6 priorities for the enhancement of SBHS. The 6 priorities are:

1. improving equity
2. aligning SBHS to te Ao Māori values and principles
3. building young people’s engagement and leadership
4. developing the workforce
5. embedding Te Ūkaipō in SBHS service standards
6. measuring the hard to measure, but important, needs and outcomes.

See link to the document in the Documents section below.

The objectives of the SBHS evaluation are to:

• ensure that SBHS contributes to achieving equity and improving outcomes for young people
• set the standard for equitable, effective, and efficient SBHS
• drive Quality Improvement
• further build the evidence base for investment in and implementation of SBHS
• inform any expansion of SBHS.

The evaluation approach

Malatest International is a New Zealand-based research and evaluation company. The Malatest team have carried out evaluations of health and social sector programmes since 2012.

The evaluation is guided by a kaupapa Māori model. The evaluation team is guided by tikanga Māori values and use indigenous pūrakau to inform an iterative approach. Through this kaupapa Māori lens, our evaluators reflect on the information, knowledge and insights gathered to create a feedback loop and learning cycle. The evaluation is designed to integrate into the wider SBHS enhancement work programme.

The evaluation activities and timeframes

The evaluation team completed a formative evaluation of SBHS in 2021 to form a baseline for further evaluation.

The formative evaluation describes the current state of SBHS, focussing on rangatahi voice, leadership, care delivered for rangatahi, workforce, and rangatahi -centred service and connections with other staff and services.

During 2022, the focus was on reporting and monitoring and youth voice to inform quality improvement activities. In 2023, the evaluation team will support enhancement implementation with a process evaluation.

See links to these documents in the Downloads section below.

For more information or to ask questions about SBHS and the enhancements programme, please email the SBHS inbox at SBHS@health.govt.nz