Specialist Caregiving International Models

Published: November 22, 2023 · Updated: November 22, 2023

This Evidence Brief examines existing evidence to highlight the challenges, strengths, and limitations of different models of care for tamariki with high and complex needs in overseas jurisdictions.


Globally, the development and implementation of different models of specialist caregiving has been driven by 2 key trends:

  1. Increasing complexity in the needs of tamariki requiring care.
  2. Difficulties in recruitment and retention of volunteer carers.

This evidence brief identifies and assesses a range of specialist caregiving models in Australia, Canada, the United Kingdom, and the United States.

In assessing the models, attention was paid to:

  • how the models financially support caregivers and the implications
  • the setting that the care is being delivered within
  • models of care for tamariki with high and complex needs
  • levels of training, support, and development provided
  • how these models of care look in an indigenous context.

Key findings

In addressing the skills and experiences required to care for tamariki with high and complex needs, the evidence brief identified commonalities across models including:

  • elevating the role of the carer and requiring specific qualifications and experience
  • close supervision of the rangatahi 
  • child-centred placements.

In addressing recruitment and retention issues, models included providing intensive training and support, and ensuring caregivers felt valued and respected. This included having a care team approach with a central role for the carer in the team, the tamaiti having a therapist, and a limit of 1 or 2 tamariki per placement.

Identification and assessment of carers was identified as a key part of a specialist caregiving models as well as tailored, 24-7 support for carers. Cross-agency wraparound support services for carers, and tamariki in care, were recognised as needed.

3 models that have been developed from an indigenous lens (from Australia and Canada) were reviewed. Key elements were the use of family-finding and mapping services to locate and recruit appropriate carers and a focus on increasing self-determination and community control. This has parallels with kaupapa Māori approaches, and the value of rangatiratanga.