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 confidence 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 on to 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), Activity Centres and Alternative Education sites (AE) nationally. This means SBHS are available to around 115,000 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 has 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 Documents 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
• care-experienced young people 
• young people with disability.

Our work

Te Whatu Ora, guided by Te Ūkaipō and the advice of Te Tatau Kitenga, and alongside our partners, developed the enhancements work programme with 8 main workstreams: 

1. Partnership and communications. 
2. Te Ūkaipō. 
3. Evaluation. 
4. Workforce development.
5. Data and information. 
6. Commissioning and funding. 
7. Puna ako. 

Who we're working with

We are working with a range of partners, including young people and the youth health sector, for the enhancements programme. Our partnership includes the following groups: 

• 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 –Te Ūkaipō Wānanga Programme 
• Te Aka Whai Ora 
• Ministry of Education 
• Manatū Hauora. 

Te Ūkaipō includes nine interconnected kaupapa Māori whanonga pono (values) with corresponding whakataukī. Together these values form a strong and sturdy kōhanga (nest), a safe space for rangatahi to come into, ask questions, grow and develop. 

Te Ūkaipō is the model of care for SBHS, in the way we work, the mahi we do and the outcomes for young people. It is the foundation for all the workstreams and enhancements to SBHS. 

Te Ūkaipō was developed by Te Rōpū Mātanga o Rangatahi as an expression of Te Ao Māori , Mātauranga Māori and Te Tiriti o Waitangi principles. 

Te Rōpū Mātanga o Rangatahi are the kaitiaki of Te Ūkaipō. The Te Ūkaipō Vision and Values Framework is available in the Documents section below. 

Te Ūkaipō shapes and influences 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. 

The Te Ūkaipō Wānanga Programme has been developed to enable SBHS health practitioners and planners and funders to understand this Māori-centred approach to service delivery, apply Te Ūkaipō in their practice as the model of care and enhance the experience of rangatahi in SBHS. 

The Te Ūkaipō Wānanga Programme includes e-learning on the LearnOnline platform, and kanohi ki te kanohi wānanga that will run until June 2025. The Te Ūkaipō Wānanga Programme is for anyone practising in SBHS, which can include nurses, doctors, counsellors, funders and planners. 

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 SBHS priority groups. 

(see Te Tatau membership list in Documents section below) 

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

Te Rōpū Mātanga o Rangatahi 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 o Rangatahi are also part of Te Tatau Kitenga, recognising the partnership required to embed te Tiriti o Waitangi and equity in this mahi. 

In 2021, Te Tatau Kitenga supported a youth advisory group, known as the National Youth Committee for School Based Health Services (NYC) to develop a report that captured the voice of young people in SBHS. 

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. 

Māngai Whakatipu was formally established in 2022 to focus on quality improvement and enhancement activities for SBHS. The name was developed by the group supported by the Pou Tikanga for the Family and Community Health group. The name reflects their vision to be “representatives of the descendants, voices for generations to come and voices of the future”. 

Our partnership with young people through Māngai Whakatipu means they can be involved in all stages of design, equal with adults. 

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

(see National Youth Committee Report on SBHS 2021 in Documents section below) 

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 discussion 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 

SBHS evaluation framework

The evaluation team has worked closely with Te Rōpū Mātanga o Rangatahi to ensure the SBHS evaluation frameworks are based on Te Ūkaipō and reflect how Te Ūkaipō creates change in the SBHS programme. This change in turn leads to rangatahi experiencing and achieving Te Ūkaipō outcomes. The SBHS evaluation frameworks show how those outcomes link to the outcomes of the Child and Youth Wellbeing Strategy 

The SBHS evaluation frameworks include the evaluation questions and indicators for measuring the changes within SBHS, and the impact of those changes for rangatahi. 

See link to the SBHS evaluation frameworks in the Documents Section below. 

Formative evaluation

The evaluation team completed a formative evaluation of SBHS in 2021 to form a baseline for further evaluation of SBHS as the enhancements come into effect. 

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

See link to the formative evaluation in the Documents section below. 

During 2022, the focus was on improving reporting and monitoring and ensuring youth voice informs quality improvement activities. 

During 2023, the evaluation team continued to support reporting and monitoring and rangatahi voice. The team provided evaluation support for the Te Ūkaipō Wānanga Programme and the workforce development project. 

Workforce development is one of the workstreams in the enhancements programme. The aim is to develop, support and grow the SBHS workforce, so it: 

• can provide a consistently high standard of healthcare delivery, particularly for our priority groups 
• contributes to equitable access and outcomes 
• reflects the diversity of the rangatahi it serves 
• is sustainable 
• is ‘fit for purpose’ 
• can deliver the new model of care. 

The first stage of the project was to gather and review information to describe the current state, including hearing the workforce voice, and form a stocktake and analysis of the characteristics of the existing SBHS workforce. 

The second stage of the project was to prepare a desired state report. This report brings through the rangatahi voice and the kaimahi voice on where workforce transformation is needed and how to achieve that transformation. These proposed areas for action will inform the development of the Career Pipeline and SBHS Workforce Development Plan. 

See link to the current and desired workforce development reports in the Documents section below. 

The Model of Care (MoC) is one of the workstreams in the enhancements programme. The aim of the project was to develop a MoC based on positive models of youth health and development, that works from a holistic perspective, is grounded in Te Ūkaipō and can be embedded in the context of a young person’s life and relationships. The MoC project focused on the existing “Year 9 Health Assessment” within SBHS to address the issues with the current check around quality, capacity and outcomes. 

The first stage of the project was to gather and review information to describe the current state, focusing on the voice of our priority groups. 

The next stage of the project was to seek the voices of the priority groups and make recommendations for the MoC. The report recommends that the MoC should support an interaction that: 

• empowers rangatahi 
• prioritises the needs of those underserved by the current system 
• supports whānau ora and equitable outcomes 
• embeds Te Ūkaipō into SBHS as the model of care. 

See links to the Current State Model of Care report and the report: Meeting the needs of our priority groups within SBHS practice in the Documents section below. 

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

See link to the SBHS Enhancements Programme update August 2022 in the documents section below