Te Puaruruhau Referral | What to Expect for Your Child

For Whānau

My child has been referred to Te Puaruruhau. What can I expect?

Te Puaruruhau is a service of Starship Child Health. We are paediatricians, nurses, and social workers who are specially trained in child protection.

We work closely with you and the medical staff caring for your child, who will continue to prioritise your child’s health needs.

We also encourage you to seek support from others, as we understand that some questions can be very upsetting for you. These support people may include ward social workers, Kaiawhina or Kaiatawhai, Pacific Island Family Support, other staff, or individuals you wish to involve.

Initial Referral and Assessment

Your child has been referred to us because they may have an unexplained injury or illness that requires further understanding. Our child protection team take a “safety first” approach to ensure that all children are protected from harm while we consider possible causes for your child’s injury.

We see children where there may be concerns that they have been hurt or harmed. (in any way, ie physically, sexually etc) We take the time to try to understand what has happened for your child. We are a health service and want to ensure children are receiving the care that they need.

When hospital staff are unsure if a child may have been hurt or harmed, they are required to refer the case to us. Our specialist team carefully consider all the information provided. Your child’s safety and wellbeing are paramount to us, and we understand how crucial it is to you as well.

What Can You Expect from a Referral to Te Puaruruhau?

We will introduce our service and explain our assessment process during our first meeting with you. If you are admitted to Starship, a doctor and hospital social worker will visit you together. If your child was admitted in the late afternoon or evening, we may not be able to see you until the following day. If you are meeting us onsite our team see you in our building.

Our assessment process gathers a comprehensive understanding of your child and family, enabling us to make well-informed recommendations about your child’s healthcare needs. Even where harm has occurred, our role is not to consider “who did it.” Our goal is to work with whānau and children to ensure the best outcomes for children where they are safe and protected from harm and have all their needs met including physically, emotionally, culturally and spiritually.

During our assessment, we will ask detailed questions about the symptoms that led to admission, any potential causes of your child’s injuries that you can recall, any relevant medical history of your child or family, and general information about your child and family. The doctor will conduct a thorough examination of your child, which may include documenting injuries with diagrams and photographs.

We will also consult with the doctors and nurses who referred your child to us, and review any tests or X-rays that have been conducted. If necessary, we can arrange for an interpreter. We may need to wait for test results and collaborate with other specialists before reaching conclusions. We may also contact your General Practitioner, midwife, or other relevant professionals. Additionally, we might need to ask if your family is known to Oranga Tamariki or the Police.

This process can sometimes take several days. Throughout, we strive to keep you fully informed. Please feel free to ask questions at any time, and we can arrange additional visits if needed.

In young children, additional tests or X-rays are often necessary before we can reach a definitive conclusion. If this is the case, we will explain these procedures to you.

We will keep you informed of our progress, as your involvement is crucial to ensuring your child’s safety. Following assessments, if we suspect someone has harmed your child (or if we cannot rule it out) we will inform Oranga Tamariki and Police so they can also work with you to keep your child safe. Hospital policy mandates us to inform Oranga Tamariki and the Police. Our team is located adjacent to Starship in a building called Puāwaitahi, which we share with Police and Oranga Tamariki. They may meet with you, typically at the hospital if your child is admitted, to explain their procedures in person. They may also speak with other family members and acquaintances. Please request a card to remember whom you spoke with.

Throughout this process, we emphasise that no conclusions are rushed to. Sometimes involving the hospital, Oranga Tamariki, and the Police is necessary to ensure we have all relevant information to make informed decisions.

Throughout this process, you can expect to be treated with respect. We understand that having a child in the hospital due to illness or injury is incredibly stressful for your entire family. We also ask that you treat our team with respect, as safeguarding children is a collective responsibility. We all share the same hope for your child’s safety.

What Happens Next?

Sometimes we can quickly determine whether there is cause for concern and will inform you as soon as possible. However, more often, it takes time to gather all the necessary information to thoroughly assess the situation.

Your child’s health is our priority, and we strive to offer the best possible service during this challenging time for your family. We are always available to meet with you and your family to address any concerns you may have about the process.

If you have any queries or questions that you would like to discuss with someone other than Te Puaruruhau, please feel free to speak with an advocate of your choice. Pamphlets outlining your rights under the Code of Health and Disability Services Consumers’ Rights are available throughout the hospital.

Tautoko Support Services at Starship Hospital

The information desk at the Level Two entrance to Starship (near the Atrium) is staffed with volunteers from 10:00 am to 4:00 pm, Monday to Friday. There is also a volunteer at a Help Desk stationed at the entrance to Starship from carpark B, just past the lift. Volunteers are also available on Level Five of Auckland City Hospital. They are ready to assist with any general queries and help navigate you around the hospital.

Parking around the hospital is limited; please ask if you need more information. The hospital offers several onsite food options, and you are welcome to use the hospital café on Level Five of the main building.

Parent Lounge/Kitchen:
Most wards provide parent lounges equipped with tea and coffee making facilities, a fridge, toaster, and microwave, available 24 hours a day. Lounge facilities are also available in the Ronald McDonald Family Room on Level Three of Starship.

Chaplaincy:
The chapel for prayer, meditation, or quiet reflection is located on Level Six of Auckland City Hospital. To contact a Chaplain, please ask your nurse or call 307 4949 ext. 25447.

Interpretation and Sign Language Services:
These services can be arranged through your child’s nurse or ward clerk. The Kai Atawhai and Pacific Family Support staff can provide additional cultural support. If you have an outpatient or day stay appointment, please inform the staff in advance if you require an interpreter.

Tautoko Support Services at Starship Hospital

The information desk at the Level Two entrance to Starship (adjacent to the Atrium) is staffed with volunteers from 10:00 am to 4:00 pm, Monday to Friday. There is also a volunteer at a Help Desk stationed at the entrance to Starship from carpark B, just past the lift. Volunteers are also available on Level Five of Auckland City Hospital. They are ready to assist with any general queries and help navigate you around the hospital.

Chaplaincy:
The chapel for prayer, meditation, or quiet reflection is located on Level Six of Auckland City Hospital. To contact a Chaplain, please ask your nurse or call 307 4949 ext. 25447.

Staying in the Hospital and Patient Attenders

When a child is admitted to the hospital due to an unexplained injury or concern that they may have been harmed, a “Patient Attender” may be assigned. Their role is to provide 24-hour support to ensure your child’s safety while they are in our care. Usually, at this stage, even if a child has been harmed, the hospital does not know by whom.

There are several reasons for assigning Patient Attenders. When there are concerns about safety, the hospital has a responsibility to closely monitor your child, which can be challenging for busy nurses. It’s important to note that Patient Attenders are not there to observe you or to take over the care of your child.

Additionally, Patient Attenders serve as a safeguard for caregivers. This ensures that any accidents that might occur in the room (such as a fall from a cot) are not mistakenly attributed to you.

Further Tests

Depending on your child’s needs the doctors may request tests which they will explain to you at the time. The team will discuss tests that may help them understand what has happened for your child and what treatments may be required. Some of the tests that may be requested include:

Skeletal Survey – A skeletal survey istwo sets of X-rays, typically taken a week or two apart. These tests help us assess healing injuries and identify stable ones. They can also reveal previously unknown injuries, which is especially valuable with babies and children who cannot clearly communicate their symptoms. Two of our nurse specialists will assist your child alongside the radiology team. The imaging process requires multiple images and can be upsetting for children. Our team will advise you on how best to support your baby to ensure we obtain the clearest images in the shortest time possible. You may choose to remain present throughout the procedure or step out if you prefer; our team will continue to care for your baby. Please note, we advise against participation in the procedure if there is any possibility you may be pregnant.

CT Head or MRI Brain – A CT Scan or MRI of your child’s head provides doctors with information about what might be causing their symptoms or to exclude injuries if there is a history of possible harmful event. It is necessary for your child to lie completely still during these tests so depending on their age they may require sedation for this to occur; the doctor requesting the CT Head or MRI Brain will explain this to you if needed.

Blood Tests – We often need to check a blood test to look for medical causes of your child’s symptoms or injuries. These may include a full blood count, clotting studies, liver function tests, kidney and electrolyte studies, and nutritional studies; the doctor requesting any blood tests will explain these to you.

Urine Tests – Occasionally we need to check your child’s urine. Urine analysis at the laboratory can tell us a lot about your child’s metabolism and is an important part of ruling out very rare but important medical conditions.