​The way parents speak to children about making mistakes shapes whether they view failure as part of learning or something unsafe, according to a new University of Auckland study.

As a parent, psychology professor Elizabeth Peterson found the "gold" of the study was its identification of three 'conversational features' that are crucial in such conversations - a collaborative action plan, the mention of cognitive tools, and emotional support.

"The sense of 'we' in [these conversations] is really important. It's [giving the child] this  idea that 'I have an emotion, I have a plan, and there's support behind me.'"

The study - which analysed recorded conversations between more than 200 mothers and their 8-year-old children after a recent setback - was published in the British Journal of Educational Psychology.

Although rates of anxiety among children are high and many are easily overwhelmed by a mistake or instance of failure, many parents in the study didn't mention their child's emotional response at all.

"Going back about it, over a past event, the emotions just weren't discussed. And if they were discussed, they were sometimes dismissed, ie 'Oh, you're a bit silly to think that way'."

Over half of the recorded conversations did not include any discussion of a forward plan for the child, Peterson says, and a lot didn't mention resources such as reframing and cognitive regulatory strategies.

"If they only discussed an action plan without any kind of collaborative resources behind it, those kids tended to fear making mistakes more, probably, because there was that sense of isolation."
There's real value in equipping children, from an early age, with tools they can call on when they hit a setback, Peterson says.

Alongside this, it's helpful that parents convey the message that making mistakes is a normal part of the learning process.

"Mistakes are welcome. Mistakes can often be signals of where we need to go a bit deeper. It's about being curious about them.

"Often we think of learning as this ladder that we have to get better and better and better at something. But actual real learning, I like to think of it more as a tide coming in where we learn some stuff and then we have some struggles and we go backwards."

Education specialist James Nottingham's concept of the 'learning pit' as a place in which you can't avoid getting messy conveys this well for Peterson.

"It's going to be hard, it's going to be emotional, but if we practise and we persist and we work on it, we'll come out of that learning pit better than we were when we started ... We often have to jump in and get a bit mucky."

For many, music is a central part of life, whether it's to help get you motivated to work up a sweat at the gym, focus on your studies, or even remember a loved one - and sometimes we'll do this without noticing the therapeutic benefits of listening to music.
 
It can help people at all stages of their lives and in many circumstances, physiologically and psychologically too, says Daphne Rickson, an adjunct professor at the New Zealand School of Music - Te Koki, where music therapists train.

"We all use music in our lives for various reasons, but there are a lot of people who are unable or find difficulty, have challenges, who need the support of the therapist. So the therapist, the therapeutic process in music therapy, is just as important as the music," Rickson told Saturday Morning.
 
"I think we would really like for music therapy to be a choice for people, a mainstream choice, for people who are experiencing physical, social, and emotional or spiritual challenges in their lives - that there are ways for them to easily access music therapy."
 
She recalls how a boy with autism struggled to communicate, until she found him humming the notes of a prominent car advertisement and replicated that to get him to sing along.
 
"It was an incredible breakthrough moment, his mum was there and she was very moved by his expression, and I think it's a lovely example ... because I think it's a beautiful way to demonstrate how connected young people can be to music and how they can excel and do things that they're not able to do in other contexts."

​Chris O'Connor, drummer for The Phoenix Foundation, has found a new career in music therapy, which has also helped transform his way of thinking too.
 
"I feel like I'm just a bit less angsty," O'Connor tells Music 101. "Although that could just be because I'm a bit older now, but I think music therapy has also helped sort of burnish off some angsty edges that are quite persistent.
 
"Music is high stakes for me. It's high stakes of if I don't feel a gig has gone well, I'm devastated, you know, it's high stakes, and music therapy has just helped me find my way into a zone, where I can keep the stakes high but actually be not undermining it by being too angsty about it.
 
"So I'm actually able to go a bit more 'you know what? I've got this music therapy job during the day, now I'm at this gig, I'm not here to mess about, I'm going to actually play beautifully, it's going to be wonderful and I'm gonna love, and let's go'."

Being able to help people connect with their emotions or trigger a memory for people with dementia, for example, has been hugely rewarding, he says.
​
"It's an incredibly humbling to be able to facilitate a real sparking moment, when you see that light in someone's eyes, and that's real excitement, it's palpable.

​​"I mean that's the thing with musical experiences, it's like a secret in plain sight, you know, like having an enjoyable musical experience is only something that you can know through having one, and that's a part of what I'm hoping to facilitate in music therapy sessions."
 
He also loves seeing the profession grow culturally.
 
"I think music therapy has really benefitted from more and more non-Western practitioners, more languages, more cultures."
 
'To be with other people who understand them'
 
A musician herself, Rickson was worried about how her daughter, who was born profoundly deaf, would be able to engage with music. After seeing how her pre-school programme used music to improve listening and speech, she decided to become a music therapist.
 
"It was just so obvious how music was engaging the little children, it was non-threatening compared with speech, and that's something goes right through music therapy work; where if somebody asks you a question, you have a feeling that you have to answer and it has to be the right answer, but if you are just invited to sing, then you know there's no right or wrong way to do that, so it felt very non-threatening."

Her research into children at a Christchurch school, which used singing each morning for wellbeing after the 2011 earthquakes, found the students reported feeling more settled and able to learn after their sessions.
 
"Singing together, chanting together is a very connecting activity to do.
​
​"One of the important messages to bring in here is that not all music does all things. So music therapists are very careful in terms of what music they might choose for what purpose ... something that might be calming and helpful for one person might actually remind somebody else that's not so calming.
 
"For example … if there's a piece of music on the radio at the time the earthquake struck, regardless of what that music may have meant to somebody before that moment, it may strike terror again when they hear it next time."
 
Several neurological choirs in New Zealand are also supporting people in communication and wellbeing, she says.
 
"They could go there to sing, and through the singing to improve speech but also to be with other people who understand them, to really get support from the music therapist who knows how to choose songs, adapt songs, compose songs, that are appropriate for the group."
 
With huge demand for music therapy, Chris O'Connor hopes to see more people join the profession.
 
"So many musician friends of mine would make such great music therapists, some of them have already been cornered by me."
 
 
Reference:  RNZ
www.rnz.co.nz/news/national/527406/the-power-of-music-a-secret-in-plain-sight-that-helps-bring-breakthroughs

​The ability of New Zealand children to hold a conversation is slipping, according to teachers.
 
Teachers are blaming Covid-19, excessive screen time and limited interaction with books for an increase in five-year-olds struggling to string a four- or five-word sentence together.
 
That is according to a new report from the Education Review Office, published in August.
 
"There is a complete lack of positional language, pronouns, and simple grammar tenses. A 6-year-old might say 'Me go pee' instead of 'I need the toilet'," a new entrant teacher told researchers.
 
"I have been teaching for 24 years and have never seen this low level of oral language."
 
But parents need not panic, at least not too much anyway. There are simple strategies that parents can do to up their children's chatter skills, according to Dr Elizabeth Doell, a speech-language and communication lecturer from Massey University.
 
"If we think about starting early, that would be really good," Doell says, adding that for most kids it is never too late for a parent to start consciously working on their child's language development.
 
Turn taking
 
Even when a baby accidentally smiles and a parent responds with a smile or a kind word, we are practising "turn taking". This strategy can continue with verbal language.
 
"Right throughout the whole of a child's early life, they need to have responsive partners, conversational partners who are aware of what they like to talk about and who can engage them in things that are interesting," Doell says, adding that this could be a parent or even an older sibling.

​Tired, busy parents take heart: it doesn't need to be a long, planned conversation, but small interactions as the day unfolds.
 
An example could be an adult asking a child what they would like for dinner and the child says "Fish and chips." The adult can respond with something like "I like fish and chips too."
 
"[That] is just making it into a slightly longer sentence and that's what we call modelling and expanding," Doell says.
 
Throw out a complex question
 
Home language and communication is typically more simple than what a child will encounter at school. It is also often in the here and now, such as "What do you want to eat?"
 
The questions children encounter at school will likely be more complex and looking into the future, according to Doell.
 
But there is no reason why a parent can't give their child some practice at home. Often this means posing an open-ended question, Doell says. This might be "what do you want to do in the weekend?" or "what do you want to do in the future?
 
"That is quite a big jump from that home language," she says.
 
This is something that children impacted by Covid-19 lockdowns and closed schools might struggle with, but many will likely catch up, she says.
 
"Just because they didn't learn it at the time we expected them to learn the language, doesn't mean they can't learn it."
​
​Interactive reading
 
Being read to might be a passive activity for a child, but parents can turn it into a conversation. Try reading a page or two and asking your child 'What is going to happen next?" or "How might that person be feeling?"
 
"Those nice open questions create a conversation around the story," Doell says.
 
"It's a strategy that we use a lot with children who are needing some more support with their language”
 
While excessive TV has been partly blamed by teachers for poor language skills, parents can use TV as a conversation starter just like they would books, Doell says.
 
Is there a health problem?
 
It is so simple that parents might overlook it, but a constant stream of snotty noses, ear infections or other hearing issues can impact a child's ability to engage in conversation, Doell says.
 
This is something a GP can look at.
 
Children who are neurodivergent, such as those with autism, might also struggle with language.
 
Quality early education
 
Studies show that quality early education can accelerate literacy learning by up to a year.
This is especially the case for children from poor communities and is one of the reasons that New Zealand heavily subsidises early education from age three.
 
When to seek help
 
Parents who are concerned about their child's language and communication can first chat with their child's school or early learning teachers, because you might not have anything to worry about. A GP can also help.
 
"In those [school] contexts, the children will be using quite different language," Doell says.
"The language at home is going to be much more informal and probably not as big a range of vocabulary."
 
 
Reference:  RNZ
https://www.rnz.co.nz/news/national/525929/as-more-children-struggle-to-speak-here-s-how-to-get-yours-talking

​We all have big feelings, but for toddlers especially, it can all get a bit too much sometimes.
But can you stop a tantrum in its tracks?
 
According to some parents, a game that teaches breathing through these big feelings is helping their kids to not throw their toys.
 
The Engage programme - a series of games and activities designed to help kids self-regulate - is rolling out across the nation's early learning services, with the goal of being in more than 2000 centres by June 2027.
 
While parents and teachers say the techniques are working wonders, education experts warn no approach is a silver bullet.
 
Barnardos in central Wellington has been running the Engage (Enhancing Neurobehavioural Gains with the Aid of Games and Exercises) programme since May.
 
Delivery manager Dianne Kabigting said the superhero breathing exercise is a favourite.
The exercise involves mimicking a hero's classic gesture - such as hands on hips for Wonder Woman and shooting webs for Spider-Man - while taking deep breaths.
 
She said it helps the kids work through periods of heightened emotion.
 
"We explain to them that we use this breathing exercise when we have really big emotions, when you're feeling angry, frustrated this is a really good time to do this breathing... and then when it happens in real life we can coach them to do these breathing exercises."
 
It was a helpful technique, kaiako/teacher Tiara Lafeta said - especially before nap and kai time - because it was not uncommon for a room full of children to get "pretty hectic".
The exercises also got a good run in the playground.

"When we notice that they're getting into a bit of a scuffle we ask them, 'What can you do to calm down a little bit?'
 
"The fact that they can talk back to us and say, 'We can do our superhero breathing'... [it] just helps them regulate their emotions."
 
It is not just kids taking deep breaths.
 
A mother - whose two-and-a-half-year-old son attends Barnardos - finds the deep breathing beneficial for her too.
 
She said when it comes to the exercises, her son had a favourite hero.

​"He is obsessed with Spider-Man. We do that every time he needs to calm down or he's having a bit of a tantrum - which he does a lot of these days - and we find it really useful."
 
Psychologist and University of Otago professor Dione Healey created the programme and said it was an approach that had kids learning life skills through play.
 
"If you want them to learn to calm down or slow down if they're getting overly excited, or learn to persist a little bit more, for example getting them to complete a puzzle without having to leave halfway through.
 
"So you pick your skill and then you think about games that would involve that skill."
 
She said decades of research also showed self-regulation played a critical role throughout life.
 
"The [longitudinal] Dunedin Study published a famous paper that's often referred to around the importance of self-regulation development where they showed that poor self-regulation at age three was predictive of a wide array of adverse outcomes in adulthood.
 
"So if you had poorer self-regulation, you had higher rates of unemployment, relationship difficulties, physical health difficulties, mental health difficulties, substance use problems, criminal involvement ... so it was a strong predictor of life course outcome."

​Healey said self-regulation was a core life skill, and one that related specifically to the transition from early childhood education to school.
 
"Being able to sit still focus, concentrate, manage your emotions and behaviours in the classroom for example are really important skills."
 
University of Canterbury psychology professor Lianne Woodward agreed, and maintained the strength of the Engage programme came from its real-world application, which signalled a move away from computer-based teaching methods.
 
"It's play-based and it's fun for children, and so they're learning but they're playing.
 
"Children learn in interactions with other humans."
 
University of Otago education professor Alex Gunn cautions that no technique was a silver bullet, and warned against being too prescriptive about what was and was not 'correct' child behaviour.
 
In her view, the merit of the Engage programme was its ability to foster shared understanding about behavioural expectations and "getting adults to talk to each other".
 
"It really schools the adults more than the children in some ways ... and that's a little bit of magic in the approach."
 
Government funding in April last year, means Engage is now rolling out across early learning centres and according to programme lead, Jimmy McLauchlan, is on track to be in more than 2000 by mid-2027.
 
Walk like a giraffe
 
Healey said for parents wanting to encourage certain behaviours, the key was to explain the skill and the why first.
 
"Sometimes when you walk down to the park with mum, if you run ahead that could be dangerous, so you might need to slow down when she asks you."
 
The next step was to introduce the game that used those skills.
 
Healey said the most important part was to link it all back to real-life scenarios.
She said in the Engage game, 'animal speeds' could be a useful one for indicating a gear change.
 
"A cheetah could be really fast, a giraffe could be moderate, and a sloth could be slow.
"So if you're a parent with a child and they're running around and you want them to slow down you could say, 'Go into sloth mode'.
 
"Or if you want to speed up you could say, 'You're bit of a sloth at the moment, go into giraffe mode, we need to hurry up to get somewhere on time'."
 
Reference: https://www.rnz.co.nz/news/national/529696/how-to-stop-a-tantrum-before-it-starts

How do I prepare my child with disabilities for school?
 
RNZ: Serena Solomon

Beginning school is a major milestone for every child. If that child has a developmental, learning or physical disability, that transition is amplified in its complexity. While support is in place from organisations and the Ministry of Education, the often-exhausting burden of smoothing out that bumpy ride largely falls on parents and guardians to advocate for their child.
 
Here is what to consider when a child with a disability is gearing up for school.

​Choosing a school
 
Every child in New Zealand has the right to attend a public school, but that doesn't mean all schools are equal in how they handle children who have unique needs, Catherine Trezona from disability support organisation Your Way Kia Roha says.
 
"That may depend upon the experience they've had with other children, who is on the [school] board and what sort of specialist teachers there are."
 
Meet with each school's leadership to get a sense of their culture and capabilities. Here is a detailed list of questions you can ask the principal or deputy principal.
"A clued-up principal who knows how to access extra funding is amazing," said Lizi Parlby, a teacher who specialises in students with disabilities.
 
Parents should consider if the school grounds have what your child needs - fences if they tend to abscond or quiet places in the case of over-stimulation (see further down for mobility challenges).
Tangaroa picked her daughter's school largely because of its inclusive culture. School leadership was eager to listen and learn what her daughter needed, whereas the other schools seemed more interested in the additional government funding her daughter may or may not bring to the school, she says.
 
"They treated her like she was a normal student, not like there was something wrong with her," she says of her daughter's school.
 
What about specialist schools and Ongoing Resourcing Scheme (ORS) funding?
 
There are about 36 specialist day and residential schools for children with disabilities in New Zealand. To get a place at one of those schools, children need to qualify for ORS funding, which is only available to those with "the highest levels of ongoing need," according to the Ministry of Education.
Children with additional needs should have been linked with an early intervention service to help parents navigate support and funding. This is available from birth until six years old. The early intervention service puts together a child's ORS funding application.

​School accessibility
 
For students with mobility challenges, parents should aim to contact their preferred school 18 months before their child's first day. That is the length of time it might take to sort out accessibility issues such as ramps or mobility equipment, Frian Wadia from Parent to Parent, an organisation that supports parents whose children have a disability, says.
 
"Physical modification and mobility equipment takes a significant amount of time and there are often delays."
 
The cost of this will be covered by ORS funding if your child qualifies. A school can also apply for property modification funds, which includes occupational therapists accessing the school grounds and what your child needs, Wadia says.
 
Getting ready for day one
 
Transitions can be particularly hard for autistic children, Trezona says. Videos of the child going through their new routine can help.
 
"Get the school's permission - even if it is not during class time - to video the child walking through the gate, walking into the classroom, hanging up their bag, greeting the teacher."
Parlby, the special needs teacher, advises parents to get their child acquainted with the school grounds during weekends and holidays before the first day. Get photos printed of the school staff - not just your child's teacher - and create visual timetables of classes and activities so your child understands their new routine.
 
"Photo books and the visual timetables are things that work really well for children that need that routine."
 
Parents can also request that their child's existing friends be in their class or that the school connects them with a peer support buddy so their child has an additional familiar face, Parlby says.
 
How to complain
 
When you feel a school is not accommodating your child - which they are legally obligated to do - your first step is to follow the school's complaint procedure, Wadia says.
If that does not result in a solution, your next step is to go to the school board. Following this, you can head to New Zealand's Human Rights Commission. Wadia had to do this three different times on behalf of her three sons, who have various disabilities.
If the issue is with an individual teacher, you can go to the Teaching Council of Aotearoa New Zealand.
 
Article sourced from Radio New Zealand:
https://www.rnz.co.nz/news/national/535390/how-do-i-prepare-my-child-with-disabilities-for-school 30 January 2025

​Teachers say more and more new entrants are turning up to school without the language skills they should have for their age group. 
 
Too many five-year-olds start school unable to talk coherently, teachers say, and they blame Covid-19 and excessive screen time.
 
Teachers of new entrant school children and early childhood teachers report seeing more children than ever with poor language skills, research by the Education Review Office published today shows.
 
More than a quarter of teachers in schools in poor neighbourhoods said most of their pupils had oral language below the level expected of them, compared to just 3 percent of new entrant teachers in schools in rich neighbourhoods.
 
School teachers said some children could not talk in sentences of more than four or five words, spent a lot of time on devices and had little interaction with books.
 
"There is a complete lack of positional language, pronouns, and simple grammar tenses. A 6-year-old might say 'Me go pee' instead of 'I need the toilet' …", a new entrant teacher told the study.
 
"I have been teaching for 24 years and have never seen this low level of oral language."
Another said: "They have difficulty both with understanding what is said to them and with formulating responses. They often fail to understand what teachers say, [and] miss important points in class."
 
Early childhood teachers told the study they were spotting problems before children start school.
 
"The children want to communicate and try, however, they will often use the same simple words or incoherent sounds to communicate regardless of different contexts and situations," one early learning teacher told the study.
 
"Some of our 4-year-old tamariki like to tell long stories, but it mostly comes out as gibberish, much like an infant babbling," said another.
 
The ERO study said research showed 80 percent of five-year-olds had good oral language, but a significant group of children were behind and Covid-19 had made this worse.
"Covid-19 has had a significant impact. Nearly two-thirds of teachers (59 percent of ECE teachers and 65 percent of new entrant teachers) report that Covid-19 has impacted children's language development.
 
"Teachers told us that social communication was particularly impacted by Covid-19, particularly language skills for social communication. International studies confirm the significant impact of Covid-19 on language development," the report said.
 
Children's vocabulary at the age of two was strongly linked to their literacy and numeracy at age 12, the ERO report said.
 
"Delays in oral language in the early years are reflected in poor reading comprehension at school," it said.
 
However, it also said children's oral language varied a lot up to the first two years of primary school because children's development varied.
 
Quality early childhood education a solution – report
 
International studies showed quality early childhood education supports language development and could accelerate literacy by up to a year, especially for children from poor communities, the report said.
 
It recommended removing barriers to increase enrolments of children from poor families in early learning and increasing the quality of early education available to them through ERO reviews and Ministry of Education interventions.
 
While most qualified school and early childhood teachers know how to help children improve their oral language, some were not confident, the report said.
 
It recommended ensuring the school and early childhood curriculums provide clear progress indicators for oral language.
 
 
Reference:
 
https://www.rnz.co.nz/news/national/525811/more-5-year-olds-starting-school-with-low-speaking-skills-teachers

Code of Health and Disability Services Consumers’ Rights
 
The Health and Disability Commissioner Act 1994 established a Health and Disability Commissioner to oversee this act.  As part of their role they have developed a code of rights.  The act and the code are currently under review.
 
Health and Disability Commissioner (Code of Health and Disability Services Consumers' Rights) Regulations 1996
 
1. Consumers have rights and providers have duties:​
 
(1)     Every consumer has the rights in this Code.
(2)     Every provider is subject to the duties in this Code.
(3)      Every provider must take action to:
             (a)    inform consumers of their rights; and
             (b)    enable consumers to exercise their rights.
 

2. Rights of consumers and duties of provider

The rights of consumers and the duties of providers under this Code are as follows:
 
Right 1
Right to be treated with respect
 
(1)    Every consumer has the right to be treated with respect.
(2)    Every consumer has the right to have his or her privacy respected.
(3)    Every consumer has the right to be provided with services that take into account                                  the needs, values, and beliefs of different cultural, religious, social, and ethnic                                         groups, including the needs, values, and beliefs of Māori.
 
Right 2
Right to freedom from discrimination, coercion, harassment, and exploitation
 
Every consumer has the right to be free from discrimination, coercion, harassment, and sexual, financial or other exploitation.

Right 3
Right to dignity and independence
 
Every consumer has the right to have services provided in a manner that respects the dignity and independence of the individual.
 
Right 4
Right to services of an appropriate standard

(1)  Every consumer has the right to have services provided with reasonable care and                                 skill.
​
(2) Every consumer has the right to have services provided that comply with legal,                                 
(3) Every consumer has the right to have services provided in a manner that                                               minimises the potential harm to, and optimises the quality of life of, that consumer.                                
(4)  Every consumer has the right to co-operation among providers to ensure quality and                           continuity of services. 
 
 
Right 5
Right to effective communication
 
(1)   Every consumer has the right to effective communication in a form, language, and                 
        manner that enables the consumer to understand the information provided.                                          Where necessary and reasonably practicable, this includes the right to a competent                             interpreter.

 (2)    Every consumer has the right to an environment that enables both consumer and               
​          provider to communicate openly, honestly, and effectively.

 Right 6
Right to be fully informed
 
(1)  Every consumer has the right to the information that a reasonable consumer, in                                     that consumer's circumstances, would expect to receive, including:
        (a)    an explanation of his or her condition; and
        (b)   an explanation of the options available, including an assessment of the expected                                 risks, side effects, benefits, and costs of each option; and
        (c)     advice of the estimated time within which the services will be provided; and
        (d)     notification of any proposed participation in teaching or research, including                                            whether the research requires and has received ethical approval; and
        (e)     any other information required by legal, professional, ethical, and other                                                    relevant standards; and
        (f)      the results of tests; and
        (g)     the results of procedures.
 
(2)     Before making a choice or giving consent, every consumer has the right to the                                      information that a reasonable consumer, in that consumer's circumstances,
          needs to make an informed choice or give informed consent.
 
(3)      Every consumer has the right to honest and accurate answers to questions
           relating to services, including questions about:
             (a)     the identity and qualifications of the provider; and
             (b)     the recommendation of the provider; and
             (c)     how to obtain an opinion from another provider; and
             (d)     the results of research.
 
(4)        Every consumer has the right to receive, on request, a written summary of
             information provided.
 
Right 7
Right to make an informed choice and give informed consent

(1)       Services may be provided to a consumer only if that consumer makes an informed
            choice and gives informed consent, except where any enactment, or the common
            law, or any other provision of this Code provides otherwise.

(2)      Every consumer must be presumed competent to make an informed choice and
           give informed consent, unless there are reasonable grounds for believing that the
           consumer is not competent.

(3)       Where a consumer has diminished competence, that consumer retains the right                                  to make informed choices and give informed consent, to the extent appropriate to                                his or her level of competence.

 (4)      Where a consumer is not competent to make an informed choice and give                                            informed consent, and no person entitled to consent on behalf of the consumer is                                available, the provider may provide services where:
             (a)   it is in the best interests of the consumer; and
             (b)   reasonable steps have been taken to ascertain the views of the consumer;  and
             (c)   either:
                    (i)   if the consumer's views have been ascertained, and having regard to those                                             views, the provider believes, on reasonable grounds, that the provision of 
                           the services is consistent with the informed choice the consumer would                                                 make if he or she were competent; or
                    (ii)  if the consumer's views have not been ascertained, the provider takes into                                             account the views of other suitable persons who are interested in the welfare                                       of the consumer and available to advise the provider.
 
(5)       Every consumer may use an advance directive in accordance with the common law.
 
(6)        Where informed consent to a health care procedure is required, it must be in writing if:
                (a)   the consumer is to participate in any research; or
                (b)   the procedure is experimental; or
                (c)  the consumer will be under general anaesthetic; or
                (d)  there is a significant risk of adverse effects on the consumer.
 
(7)         Every consumer has the right to refuse services and to withdraw consent to                           
              services.
 
(8)          Every consumer has the right to express a preference as to who will provide services                          and have that preference met where practicable.
 
(9)          Every consumer has the right to make a decision about the return or disposal of any                           body parts or bodily substances removed or obtained in the course of a health care                             procedure.
 
(10)        No body part or bodily substance removed or obtained in the course of a health care                           procedure may be stored, preserved, or used otherwise than
               (a)   with the informed consent of the consumer; or
               (b)   for the purposes of research that has received the approval of an ethics committee; or
               (c)    for the purposes of 1 or more of the following activities, being activities that are  each                          undertaken to assure or improve the quality of services:
                         (i)  a professionally recognised quality assurance programme:
                         (ii) an external audit of services:
                         (iii) an external evaluation of services.

Right 8
Right to support
 
Every consumer has the right to have one or more support persons of his or her choice present, except where safety may be compromised or another consumer's rights may be unreasonably infringed.
 
Right 9
Rights in respect of teaching or research
 
The rights in this Code extend to those occasions when a consumer is participating in, or it is proposed that a consumer participate in, teaching or research.
 
 
Right 10
Right to complain
 
(1)   Every consumer has the right to complain about a provider in any form appropriate to the     
         consumer.
(2)    Every consumer may make a complaint to:
           (a)     the individual or individuals who provided the services complained of; and
           (b)     any person authorised to receive complaints about that provider; and
           (c)      any other appropriate person, including:
                      (i)  an independent advocate provided under the Health and Disability                                                            Commissioner Act 1994; and
                       (ii)  the Health and Disability Commissioner.
 
(3)      Every provider must facilitate the fair, simple, speedy, and efficient resolution of
           complaints.
 
(4)      Every provider must inform a consumer about progress on the consumer complaint
            at intervals of not more than 1 month.
 
(5)      Every provider must comply with all the other relevant rights in this Code when dealing with 
           complaints.
 
(6)      Every provider, unless an employee of a provider, must have a complaints procedure                           that ensures that:
           (a)   the complaint is acknowledged in writing within 5 working days of receipt,                       
                    period; and
           (b)    the consumer is informed of any relevant internal and external complaints                                             procedures, including the availability of:
                   (i)  independent advocates provided under the Health and Disability                                                               Commissioner Act 1994; and
                    (ii)  the Health and Disability Commissioner; and
           (c)    the consumer's complaint and the actions of the provider regarding that                                                    complaint are documented; and
            (d)    the consumer receives all information held by the provider that is or may be                                           relevant to the complaint.
 
(7)        Within 10 working days of giving written acknowledgement of a complaint, the                                     provider must:
                (a)  decide whether the provider:
                       (i)   a ccepts that the complaint is justified; or
                       (ii)    does not accept that the complaint is justified; or
                 (b)  if it decides that more time is needed to investigate the complaint:
                       (i)   determine how much additional time is needed; and
                       (ii)  if that additional time is more than 20 working days, inform the consumer of  that
                              determination and of the reasons for it.
 
(8)        As soon as practicable after a provider decides whether or not it accepts that a. complaint
             is justified, the provider must inform the consumer of
              (a)   the reasons for the decision; and
              (b) any actions the provider proposes to take; and
              (c) any appeal procedure the provider has in place.

​My Health Passport

The Commissioner has also developed a Health Passport to assist, those of us with disabilities and those of us who have interactions with health services.
 
My Health Passport is a booklet where you can write down information about how you want people to communicate with you and support you when you receive a health or disability service.  Available in a variety of accessible versions.
 
What is My Health Passport?
 
My Health Passport is a booklet that you can carry with you when you visit health and disability services. The booklet has information about how you want people to communicate with you and support you when you use health or disability services.
My Health Passport is not a tool to help doctors diagnose or monitor patients. It is not a substitute for a patient’s medical records.
 
 
The above information has been sourced from the Health and Disability Commissioner website www.hdc.org.nz December 2024

Why do we get corns or bunions and what can be done about it? Should you tackle your own ingrown toenail? And socks, cotton or wool?
 
Christchurch podiatrist Simon Wheeler is the man in the know about how to look after our feet.
 
Toenails
A little but often is his trimming advice.
 
“Rather than once in a blue moon and trying to cut them right back, aim just to cut them straight across the free edge.”
 
Buying the right shoe
Wearing a properly fitted shoe with support and cushioning, is important, and Wheeler suggests supporting your local shoe shop is the way to go.
 
“The trend at the moment is purchasing online, but it’s quite hard to buy footwear online. I think it’s best to actually be fitted at a shop.”
 
Socks and foot hygiene
They need to be changed daily, he says.
 
“Some people sweat more than others, some people will have to change socks more often than daily, particularly if you have gone out and done some sport or activity.
 
“You want to make sure you've got moisture wicking socks. Thin cotton socks do not move moisture away from the skin. You end up sitting in a pool of sweat or moisture.”
 
Go for woollen socks, he says.
 
Toenails as we age
Toenails, like skin and bone, are living and respond to load or to irritation, he says.
 
“They generally thicken because they suffer from trauma. And obviously the older, the longer we live, the more trauma they suffer.
 
“So that's why they thicken up. The most common reason that could be like a one-off trauma, you dropped a hammer on it a cricket ball or whatever.”
 
 
Toenail fungus
“It's common, it's hard to treat. It gets into the nail bed and then in the nail,” he says.
 
Treatments include prescription medication which can “have some quite harsh side effects.”
 
Laser treatment is also an option, but prevention is the best method, he says.
 
“Foot hygiene, first signs of fungal skin infections, athlete's foot, get onto a fungal cream really quickly.”
 
Over the counter anti-fungal creams are highly effective, he says.
 
“The creams for skin infection are 100 percent very effective. Once it starts to get into the nails the more in depth it is in the nails the harder it is to treat.”
 
In-growing toenails
The condition is often hereditary, he says.
 
“They're quite often present in their early teenage years as we start to sweat a bit and the feet are growing.

“And then again, it can be as a result of trauma. You've got to trim them straight across and the risk of you cutting them back yourself is that you introduce a portal for infection, or you miss some of it and you make it a hell of a lot worse.
 
“If you've got an ingrowing toenail with what looks like a skin infection, I would seek podiatry help immediately, as quick as you can.

 
Listener questions:
 
The soles of my feet are covered in coarse, scaly skin and underneath red weeping skin, it's very itchy. I'm desperate.
 
“That sounds like a skin infection of some sort. And so, you should seek medical attention for that. So, a GP or potentially your local podiatrist.”
 
What do I do about thick, yellowing skin that’s become painful?
 
“This is known as a callus, the skin is a living tissue, it responds to what load you put through, the thickened skin or the calluses is its way of protecting itself.
 
“However, often that goes too far. And that yellow thickened skin becomes quite uncomfortable to stand on so often a podiatrist would debride that and take that skin away, which provides instant comfort.”
 
I have damp skin splits that happen between my toes is that athlete's foot?
 
Yes, skin hygiene; natural fibre socks, so we're getting moisture wicking, and antifungal cream, over the counter from the pharmacist.”
 
 Is it important to wash and dry feet when you're in a shared space like a gym shower?
 
“You probably want to wear some real simple, rubber old-school jandals in the shower. And definitely dry thoroughly. So, they're not damp when you're putting them into footwear particularly in the winter.
 
“Otherwise, they're just moist going into that warm, damp environment.
 
“Some people are prone to it, there's no doubt about that. Like some people just seem to get athlete's foot at the sniff of going to a shared shower
 
“If you’re prone you can use the creams for prevention, use sprays these help and anti-fungal talcum powder that you can pop your socks or shoes.”
 
Another listener suffered from painful cracked heels
 
“People that are prone to heel fissures tend to get them again and again, so if you get them, you're going to get them in the future.
 
A regular moisturiser, and you can get cracked heel balm which is a bit thicker. It’s really good to use regularly, especially at the first sign of the crack.”
 
What's your advice for the management of bunions to reduce pain and prevent worsening?
 
“There's, different types of orthotics. Prefabricated ones, but you can get custom made ones which, are probably significantly dearer. But they do a phenomenal job.”
 
Should I pop my blisters?
 
“Probably not, it does give pain relief, but also potentially leads to infections. So salt-water bathing maybe, you’ve got to keep them clean.”

https://www.rnz.co.nz/news/national/516641/schools-failing-autistic-and-other-neurodivergent-children-report​

​A report warns schools and early childhood centres are failing autistic and other neurodivergent children on an epic scale.
The Education Hub study said devastating testimony from 2400 people showed the education system was broken and heading for a major crisis.
It was calling for more funding and a law change to force the Education Ministry and schools to provide support for all children with disabilities and learning needs.
 
The Education Hub is a non-profit organisation that connects teachers with education research.
Its report said 15-20 percent of the population was neurodivergent, meaning they had conditions including autism, ADHD, dyslexia and anxiety.
The school system was supposedly inclusive, with schools required by law to enrol local children regardless of their abilities, it said.
However, inclusion was not the reality for many neurodivergent children.
"Inclusion is all but an illusion for too many of our young people, with no specific education
legislation in New Zealand regarding specialist provisions or supports for children with special educational needs," it said.
"Many parents gave heart-rending accounts of the mental health impacts they witnessed in their neurodivergent children during the time they attended school, describing trauma responses, clinical depression, anxiety, self-harm and suicidal ideation from as young as the age of six."
​The education system focused more than $600 million a year on children with the highest needs, which meant neurodivergent pupils who did not have challenging behaviours tended to miss out, the report said.
"In addition, at some schools, accommodations for neurodivergent students are being arbitrarily denied or discouraged."
When support was provided, it was often inadequate, the report said.
Education Hub founder Nina Hood said it was clear there were big problems.
"The system is completely broken. There's very little that is working particularly well.
"There are significant issues with funding. It's really, really hard for many neurodivergent students to get access to any publicly funded services and those young people who are getting access to public services, in most cases it's not enough support."
There were too few specialists working with neurodivergent children - and teachers needed more help, Dr Hood said.
"They are having to bear a huge burden trying to support these neurodivergent students and for many teachers they want to be doing the best by their students but it is incredibly hard."
More funding was part of the answer, she said.
But the law needed to change so that all children with disabilities had an absolute right to the support they needed.
"Neurodivergent children ... have the right to attend school but at the moment they don't actually have the right to receive the resourcing and support they need in order to actually succeed and thrive at school," Hood said.
 
Frustrated and exhausted
Tami Harris from Acorn Neurodiversity, a trust helping neurodivergent children and young people in Auckland, said the report accurately reflected what many families were going through.
"Families feel like a burden to their school and, in fact, are often discouraged from enrolling their child at the school directly and feel like they're constantly needing to fight to get the things that their child needs."
The situation was "incredibly bad" and New Zealand's neurodivergent children were much worse off than children in other countries, she said.
"The access that our families would have if they lived across the pond in Australia or really anywhere else, they would be getting a suite of comprehensive services if they had a disability or some form of learning challenge."
Rebecca, the mother of a child with autism and ADHD, said trying to get support for her daughter was exhausting.
"I've been out of work, in work, out of work purely to spend time advocating, ensuring my daughter's needs are met, ensuring I'm at home when she's been sent home. Yes, it's been a real roller-coaster."
Many people tried their best to help, but the system was too difficult to navigate, she said.
"Individuals [are] working within a system that's convoluted, complex and just doesn't have enough to meet the basic needs of children with learning needs."

​University student Annabelle said she teared-up when she read the report.
Going through school with undiagnosed ADHD and autism was tough, because even with supportive teachers, the system made neurodivergent students feel like failures, and seemed to provide help for students only after they had failed, rather than supporting them to succeed, she said.
"It's not acceptable for the students and it's not acceptable for the teachers. It's not acceptable for the leaders, it's not acceptable for anyone working in schools.
"Trying to navigate a system that's built like an ambulance at the bottom of a cliff is ridiculous."
​
Hostile environment
In the report, several respondents said the situation in schools was so bad they would be better off home-schooling their children.
A school's special education coordinator told the study: "If I had a learning support child I would seriously homeschool my child. At times I suggest to parents the same. The New Zealand school system currently cannot support these students."
Many respondents were especially unhappy with so-called modern learning environments, which have large, open, shared spaces for teaching.
Most said teachers' lack of knowledge about neurodivergent children was a big problem.
And schools that did a good job tended to attract more neurodivergent children, a teacher told the researchers.
"It is a concern to me that the schools/staff that have embraced better approaches to supporting neurodiverse students (and others with special needs) often are flooded with those students.
"This is unfair, does not always come with extra funding/resources, and allows those who are deliberately blind to remain that way."
Another respondent said specialists were burnt out and every Education Ministry speech therapist they knew was looking for another job.
 
 
 
Author: John Gerritsen
Sourced from Radio New Zealand website:
https://www.rnz.co.nz/news/national/516641/schools-failing-autistic-and-other-neurodivergent-children-report
 

Type 2 Diabetes prevalance and risks
 
17 per cent of New Zealanders over 65 have Type 2 Diabetes (around 135,221).  This is an alarming statistic due to the complications Type 2 Diabetes can cause for a person’s overall health.  Type 2 Diabetes is a disorder of the endocrine system.  It’s an impairment in the way the body uses and regulates glucose in the blood.  Subsequently too much glucose is circulating in the blood and can lead to disorders of the nervous, immune and circulatory systems.
​Nutrition as a simple intervention in the aged care setting
 
Low carbohydrate nutrition has been researched, with good outcomes, as a therapeutic measure for those with Type 2 Diabetes.  This can be of significant use in the aged care setting, as a simple measure for improving the quality of life for those with Type 2 Diabetes.  Particularly where other lifestyle measures such as exercise may be limited due to mobility, nutrition is a simple daily measure that can be used to treat Type 2 Diabetes and reduce clinical costs.
 
Here is some practical advice around implementing this and monitoring residents.  Individual advice for each resident should be sought from a Registered Clinical Nutritionist trained in low carbohydrate nutrition and the residents medical professional (GP or Diabetic Care Nurse).
 
Positive effects of Low Carbohydrate Nutrition on blood sugar, lipids and body weight reduction
 
Type 2 Diabetes is linked to obesity and elevated blood lipids.  In one study following 64 obese subjects with elevated blood glucose, it is interesting to note that not only a drop in blood glucose has occured but also a drop in body weight and a decrease in blood lipid markers for these patients.  The study was conducted over a period of 56 weeks.  Thus showing a really beneficial effect long term for adherence, blood glucose reduction, body weight reduction and blood lipids.
 
Monitoring in the initial period and ongoing
 
If a resident is prescribed insulin for their Type 2 Diabetes diagnosis it is really important to monitor blood glucose levels closely when embarking on a low carbohydrate lifestyle due to the high risk of hypoglycaemia.  In this instance the care facility staff should moitor blood sugars four times daily (before meals and before bed or as recommended by their registered health professional) and work closely with the resident’s doctor as to when the insulin should be reduced and/or ceased.
 
The risk of hypoglycaemia with diabetic prescription medications is low and whether or not a patient stays on these as blood sugars lower can be discussed with the resident’s doctor on an individual basis.  If a resident is prescribed anti-hypertensives for high blood pressure, then blood pressure should be moitored closely when embarking on a low carbohydrate diet.  The high blood pressure insulin levels can cause sodium retention, and this is often quickly resolved with a low carbohydrate diet.
 
How to implement a low carbohydrate lifestyle
 
From a practical perspective keeping it simple is best.  A diet consisting of 10 per cent carbohydrate, 25 per cent protein and 65 per cent fat across total calories for the day is a good start for most.  Essentially following a low carbohydrate diet is eating eggs, meat, fish, chicken, nuts, seeds, low to no lactose dairy, low sugar fruit and plenty of green vegetables (above ground), and cutting out sugar, highly processed packaged foods, starchy carbohydrates and grains.  Nutrient dense, wholefoods should be consumed predominantly.  Packaged foods tend to be over processed, contain added refined sugar and industrially produced oils that can lead to inflammation.  If you are using any packaged foods check the ingredients first for either of these.  Make sure you know what it is in the food provided.
 
Protein should be prioritised at each meal.  Amino acids contained in protein are the building blocks of the body and increasingly important across the lifespan.  As the aging process occurs the body naturally works against itself by way of a process called sarcopenia (muscle wastage).  You can combat this for residents by ensuring they eat at least 1.8gms of protein per kg (note this is not the weight of the actual food but the weight of the protein content in the food) of bodyweight daily and get at least a little exercise (resistence is best for this and should be appropriate to the resident) daily.

Foods high in protein include eggs, fish, meat, and chicken etc.  Protein powders may also be used where a resident cannot or is struggling to consume enough protein from other sources.  Bone broth and whey protein powders have the best amino acid profile.  Plant based pea protein powders can be used if dairy is not tolerated.  Protein powders are a convenient way to add in protein by way of a smoothie as a snack or a complete meal with the right additions.  Low to no lactose dairy includes full fat yoghurt, butter and cream.  This is of course only appropriate to those who tolerate dairy.
​
In terms of carbohydrates, low sugar fruit consists of berries.  As it is an accumulation of carbohydrate across a day it may be appropriate at times to include a small amount of vegetables such as carrots, pumpkins and onions etc.  Variety will of course improve nutrient consumption also and this should be a priority.  Healthy fats include cold pressed oils, and good quality dairy.
 
 
Ref: Aged Care New Zealand Issue 02 2022
Author:  Rosie James, Registered Clinical Nutritionist