The Lower North Island Severe Conduct Disorder Unit is a bicultural unit operating under the frameworks of Puao-te-ata-tu (Department of Social Welfare, 1988) and Te Whare Tapa Wha. As discussed earlier, the aim of the service is to provide an inclusive bicultural approach that uses both clinically and culturally relevant treatment, interventions and specialist care for young people/ rangatahi experiencing severe conduct disorder and a co-existing mental health difficulty.
The programme manager, Peta Ruha, identified the approaches that have been positive when working with Māori whānau:
whānau therapy from a range of sectors and disciplines
working with immediate issues the whānau is presenting with
utilising a range of interventions and different mediums (ie, talking, writing, hui) at any given time
resourcing the whānau with access to a range of expertise and experience.
In identifying the approaches that appeared to have a positive impact on Māori whānau, it was stressed there were workforce issues, in that practitioners needed both clinical and cultural experience. These practitioners also needed skills, knowledge and experience in working effectively with whānau and the wider whānau network.
The concept of whakawhanaungatanga was essential but the unit also needed extensive collaboration with other sectors, who needed to acknowledge that all involved had a collective responsibility to the whānau in question (P.Ruha, personal communication, 2009). The kaupapa whānau or interagency linkages were also identified by Durie (2005) as potential barriers to successful outcomes. While this was in reference to early intervention and conduct problems, it is also relevant to tertiary services:
Linkages between schools, whānau, health services, the courts, statutory welfare agencies and community family services are not well established and are often complicated by quite different philosophies and modes of practice. Research in NZ and abroad has confirmed the importance of inter-agency and inter-disciplinary collaboration especially for child and adolescent externalising disorders and where early intervention is the goal. (Durie, 2005:6) This bicultural service does not currently undertake any outcome evaluation, but there has been an initial meeting with the creator of Hua Oranga, Dr Te Kani Kingi, about adapting Hua Oranga for use within the unit.
It has been hypothesised that being able to effectively engage and support Māori whānau in conduct problem programmes will result in better retention and ultimately better outcomes for tamariki, taiohi and whānau. The issue of engagement is essentially related to the connections and whakawhaungatanga (relationships) that have been established. Two generic programmes administered to Māori participants are reviewed; they highlight the importance of establishing connections and using Māori processes to engage and retain Māori.
Tips and Ideals on Parenting Skills (TIPS)
Gifford & Pirikahu (2008) implemented a generic parenting programme (TIPS) within a Māori community and identified a number of challenges in developing and implementing the programme. The researchers recommended engagement as a priority when working with Māori whānau (Gifford & Pirikahu, 2008). Recruitment of whānau was a major issue for the researchers, and it was suggested that people who already had rapport and whanaungatanga (connection) with whānau were the most appropriate first point of contact for recruitment of whānau to parenting programmes. It was further recommended that potential and existing providers needed to allow sufficient time and resources for recruitment and retention of whānau. In addition, the barriers they identified to effective engagement included:
delays in starting programme
social and health issues that took precedence
apprehension by Māori whānau about parenting programmes generally (Gifford & Pirikahu, 2008).
The Incredible Years – Basic Parenting Programme (IYBPP) is an overseas programme that has been implemented in New Zealand to assist in working with children and families with conduct problems. Such parenting programmes have been demonstrated in randomised control trials overseas as being useful in reducing the rates of childhood conduct problems. Fergusson, Stanley and Horwood (2009) undertook preliminary research evaluating the efficacy and cultural acceptability of the IYBPP in New Zealand. Based on their preliminary evaluation, the authors concluded that IYBPP is an effective and culturally appropriate programme. However, the authors did not present any data on the number of Māori parents who dropped out of the programme. As the authors acknowledged, there was no data on those who declined to attend or who dropped out of the programme and the results may give an ‘overly optimistic view of the efficacy and acceptability of the programme’ (Fergusson et al, 2009:79). The issues of generic programmes, programme fidelity and cultural responsiveness are discussed in Section 4.
Herewini and Altena (2009) evaluated a Māori whānau group completing a generic programme, the IYBPP. Measuring programme effectiveness was not a part of their research, but rather the utility and applicability of a Māori context in the delivery of the programme with Māori whānau. Their evaluation was conducted using Te Whare Tapa Wha, and evaluation questions were based on Hua Oranga (Kingi and Durie, 2000). While their cohort was small (n = 10), they had an 80% retention rate. Key differences in the delivery of the programme included the use of tikanga, a powhiri and poroporoaki process and the delivery of the programme on a marae. The authors concluded that these factors, in conjunction with the programme and the ‘right facilitators’, likely contributed to the high retention rate.
In their evaluation process, the authors identified what worked well. This included:
…a lengthy and culturally appropriate engagement process, taking our time, bringing kai and listening to the whānau concerns regarding their tamariki. (Herewini & Altena, 2009)17
The facilitators highlighted a number of areas for improvement. Those that may impact directly on whānau engagement and support included:
the need for closer relationships with parents’ case managers (half the