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Escalation Ladder for sharing information about vulnerable children

Sharing information involves both the collection and disclosure of personal information. Deciding which laws apply and what information to share can be complicated, but there are some guiding rules.

How to use the Escalation Ladder

Work through from question 1 to question 5 and stop when you can answer ‘yes’. If the answer to all of the five questions is ‘no’, then disclosure should be unnecessary, and should be avoided, at least for now.

Remember that the proportionality principle always applies – you should only provide as much information as is reasonably necessary to achieve your objectives.

Tell us what you think

Is this guidance useful to you? How can we improve it? 

Give us your feedback 

  • 1

    Can we get by without naming names?

    Yes
    No
    • Use anonymous information where practical.
    • Disclosing anonymous information is always OK. (For example, if you have professional supervision, you might be able to discuss a case without referring to any names.)
    • See a scenario
    ×

    Example: Miss S

    Miss S is an 18 year old woman, 16 weeks pregnant, with previous CYF involvement as a child.

    • Her partner is supportive and both are excited about the pregnancy, but lack parenting skills.
    • The couple have no family support and has moved to a new area.
    • Family members are distant.

    Scenario:

    The GP has reasons to believe the couple is not being truthful about their circumstances and wants to know if the circumstances meet the threshold for a referral to a multi-agency team prior to another discussion with Miss S. The GP sought the couple’s consent but they refused.

    Escalation Ladder Step 1:

    Can we get by without naming names? The GP could initially use this Step 1 approach and contact the MAT to find out whether a referral would be appropriate without identifying the family.

    For more scenarios, please download the Escalation ladder booklet.pdf

  • 2

    Have we asked them?

    Yes
    No
    • If information is not able to be used anonymously, the next best thing is consent from the parties concerned.
    • Consent does not need to be written.
    • Always record the fact that parties have agreed. Record any limitation or qualification of consent eg. "please don't involve the church".
    • See a scenario
    ×

    Example: Miss A

    Miss A is 16 years old and 25 weeks pregnant.

    • She has no Lead Maternity Carer but meets with a school nurse.
    • She has had mental health involvement two years ago and attempted suicide.
    • Her 17 year old boyfriend is unsure of becoming a father.
    • She is transient with no fixed address and is temporarily living with friends.

    Scenario:

    The school nurse asks Miss A if her case can be referred to a multi-agency team.

    Escalation Ladder Step 2:

    Have they agreed? If Miss A consents, the referral to the MAT can be made. If consent is refused, the school nurse can explore further steps of the Escalation Ladder.

    For more scenarios, please download the Escalation ladder booklet.pdf

  • 3

    Have we told them?

    Yes
    No
    • If it is not practicable or desirable to obtain consent, the information may be used or disclosed if it is in line with the purpose for which it was obtained.
    • Inform the person affected of this where possible – ideally at the time the information was first collected from them, or soon after that.
    • If informing the person would prejudice the purpose of collection, or would be dangerous to any person, then telling the person concerned may be waived in that instance.
    • See a scenario
    ×

    Example: Miss D

    Miss D is 24 years old and in her fourth pregnancy.

    • She abuses alcohol together with her partner.
    • All previous children have been taken into CYF care.
    • She has suffered from partner violence recently and in the past.
    • Police have attended at least one domestic incident involving physical violence to her.
    • She has not engaged a midwife.

    Scenario:

    A whānau ora provider wants to make a referral to the multi-agency team without Miss D’s consent. To fully assess her case, other services have to be involved including CYF, a midwife, and an addictions clinician. The provider has explained to Miss D that one of the ground rules for participating in their service is that information can be passed on where there are safety concerns and where necessary to conduct an assessment.

    Escalation Ladder Step 3:

    Have we told them? Yes, because Miss D was told that information could be shared if there were safety concerns.

    For more scenarios, please download the Escalation ladder booklet.pdf

  • 4

    Is there a serious threat here?

    Yes
    No
    • Information may be used or disclosed where there is a serious threat.
    • 'Serious' depends on: how soon the threatened event might take place, how likely it is to occur, and how bad the consequences of the threat eventuating would be.
    • See a scenario
    ×

    Example: Boy AB

    Boy AB is an eight year old boy.

    • He was referred to a paediatrician for increasingly violent behaviour and deteriorating learning.
    • There is no relevant medical history and no apparent medical issues.
    • He has mild learning difficulties and normal levels of concentration.

    Scenario:

    Boy AB’s mother reveals current violence towards her on a monthly basis by her partner, who is the boy’s father. The severity of the violence is increasing but she does not believe she will be seriously hurt. Her partner’s behaviour is becoming increasingly unpredictable. He has a history of mental health issues. The children are never hit but they witness the violence towards their mother. She refuses a referral to a family violence agency and says her partner is unlikely to attend a family conference.

    Escalation Ladder Step 4:

    Is there a serious threat here? Yes. The threshold is serious threat which requires consideration of imminence, likelihood and severity. This example would tick all three criteria as it is relatively imminent (monthly), likely (is happening regularly) and relatively severe.

    For more scenarios, please download the Escalation ladder booklet.pdf

  • 5

    Is there another legal provision we can use?

    Yes
    No

    Many different laws allow personal information to be shared. For instance:

    • Information about the health/safety of a child or young person can always be disclosed to a police officer or social worker
    • Health information can be requested by someone who needs it to provide health services
    • Information can be disclosed where necessary to avoid prejudice to the maintenance of the law.
    • See a scenario
    ×

    Example: Baby AJ’s brother

    Baby AJ is a four month old boy.

    • He was admitted to a hospital children’s ward with severely infected, poorly managed eczema.
    • His mother has had considerable advice and support but has been unable to apply the advice.
    • Baby AJ has had poor weight gain and is developmentally delayed but had no injuries or other signs.
    • The mother is suffering from post natal depression and increasing alcohol abuse.
    • She denies that any family violence has occurred, including anyone hitting her children.

    Scenario:

    The mother says Baby AJ’s brother often suffers from minor illnesses but is otherwise doing well. The mother refuses the support that’s offered and refuses to give permission for any agency to contact other agencies about her son.

    Escalation Ladder Step 5:

    Is there another legal provision you can use? For example, can a clinician contact a GP, midwife or a Plunket nurse without the mother’s consent? Yes. Under section 22F of the Health Act, health information can be requested by someone who needs it to provide health services. This includes social workers, care and protection coordinators, police officers, Ministry of Health employees, and district health board employees exercising or performing functions under the New Zealand Public Health and Disability Act 2000.

    For more scenarios, please download the Escalation ladder booklet.pdf

  • If the answer to all of the five questions is ‘no’, then disclosure should be unnecessary, and should be avoided, at least for now.

    The Privacy Commissioner operates a free phone line (0800 803 909) that can be used to help with questions around disclosing information.

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