The recommendation made by TRK of the need for investment so that further evidence could be gathered reflects a desire and right by Māori to know what works so that the best Kaupapa Māori programme can be designed, implemented and evaluated. This includes ensuring that current programmes with promising approaches, positive basic evaluation and audit results, and that have never had research investment to demonstrate their ’evidence base‘ are not lost.
Section 2 and 3 of this report referred to components of a Te Ao Māori view that could also be considered in the development of Kaupapa Māori programmes. The use of pūrākau, Te Whare Tapa Wha, powhiri, karakia, mihimihi, whakawhanungatanga etc. could be considered baseline components of Kaupapa Māori programmes that have the potential to be taken to deeper and more meaningful levels of understanding for Māori tamariki, taiohi and whānau in fostering identity and connections.
It is not in the scope of this report to identify specific components that constitute a Kaupapa Māori conduct problem programme. However, principles underlying a Kaupapa Māori programme can be aligned with principles of Kaupapa Māori research. In a review of the wide range of literature about what constituted Kaupapa Māori research, Walker, Eketone and Gibbs (2006) described Kaupapa Māori research as ‘the desire for research to be by Māori for Māori, using Māori cultural perspectives’ (p. 342).
A Kaupapa Māori programme, then, could be viewed as by Māori for Māori using Māori cultural perspectives. Accordingly, to use the kaupapa research principles espoused by the researchers, the following aspects are likely to be reflected in any Kaupapa Māori designed conduct problem programme: it
gives full recognition to Māori cultural values and systems
is a strategic position that challenges dominant Pakeha (non-Māori) constructions of programme design
determines the assumptions; values, key ideas and priorities of programmes
ensures that Māori maintain conceptual, methodological and interpretative control over programme development
is a philosophy that guides Māori programmes and ensures that Māori protocols will be followed during programme implementation and evaluation (based on Walker et al, 2006:333).
While this is a framework for Kaupapa Māori research, the result is to build a body of Māori knowledge (Walker et al, 2006); in essence, indigenous knowledge within a contemporary context. This framework could also one from which to consider Te Ao Māori programmes in the delivery of conduct problem programmes. The content of such Kaupapa Māori programmes will vary according to the level of intervention, targeted group and tika (what is true) of the local hapū or iwi.
There are no dedicated Kaupapa Māori conduct problem programmes designed by Māori for Māori (Robbie Lane, MSD, personal communication, 2009). As noted in the preliminary review of overseas literature, there also appeared to be no purely indigenous programmes for conduct problems. This is an area that will require further investigation in developing and designing Kaupapa Māori specific programmes for conduct problems.
TRK thought there was a wide range of Kaupapa Māori programmes in the community, all of which had the potential to impact on whānau ora and thereby conduct problems for Māori tamariki, taiohi and whānau. Programmes such as Te Pa Atawhainga Harakeke, Tane Whakapiripiri at the Mason Clinic and Te Kawa o te Marae are Kaupapa Māori programmes with the potential for wider effects in conduct problems. As noted, it is not in the scope of this report to identify all potential programmes. This means that TRK will need to identify programmes that may be of use in contributing to a multi-faceted Kaupapa Māori programme for conduct problems, and then to gather evidence from a Kaupapa Māori perspective or research of what components work best.
ACC’s review of injury prevention and health promotion interventions with Māori communities and other indigenous communities identified a number of common themes in relation to what had been identified through the research as being necessary to ensure the success of indigenous programmes (Cherrington & Masters, 2005). These themes included:
the need to incorporate holistic frameworks representing the indigenous worldview into the programmes
the ability for co-coordinators of intervention programmes to have or build strong networks with the community to which the programme is to be delivered.
In beginning the process of gathering evidence a first step would be to conduct a literature review about what services exist within sectors relevant to the conduct problems area. From this, programmes deemed of high applicability to the design and implementation of a Kaupapa Māori programme could be identified to find specific success factors. It is necessary to know what exists, to avoid ‘reinventing the wheel’ when there may well be solid foundations already in place.
As well as reviewing which Kaupapa Māori programmes are applicable to the conduct problem arena, it would be beneficial to gather information about funding levels for Māori and generic programmes. Such transparency of information will likely contribute towards equity of funding for Māori programmes.
Adapting generic programmes: Issues
To enhance identity and connections among Māori tamariki, taiohi and whānau in the delivery of generic conduct problem programmes, the major recommendation has been to have Māori consultation and participation in the development and delivery of generic programmes. At the same time, generic programmes, such as IYBPP, have clear guidelines around maintaining programme fidelity. In essence, there appears to be a desire to maintain the fidelity of generic programmes as well as a need to adapt generic programmes to be culturally responsive. These issues are discussed and an overseas example of a generic programme being adapted is provided.
Another issue is around the responsiveness of generic programmes to Māori, and the lack of evidence-based research to substantiate the implementation among Māori in the first place.
An example of a generic programme being adapted is presented by Bridge, Massie and Mills (2008). The authors highlight the challenge of implementing an evidence-based intervention and maintaining the integrity of the model while ensuring cultural responsiveness. The authors note that due to external pressures such as funding, agencies are now ‘taking evidence-based practice models off the shelf and implementing them without consideration of cultural and community nuances’.19 The need for compliance to a model and programme for it to be effective and ethically responsive in line with cultural competency requires that the model may also require adaptations (Bridge et al, 2008). In order to be responsive the authors noted:
Indisputably, cultural appropriateness is a critical consideration in the selection of any evidence-based practice model or approach. It is the agency’s responsibility to ensure that the model fits with their mission and service delivery, and is fully congruent with the culture of their consumers and the community. This fit may allow for total compliance and adherence to the original model, however it may also require adaptations to be both effective and ethically responsive. (Bridge et al, 2008) 20 In this research (Bridge et al, 2008), a generic model titled ‘Family Connections’ was to be implemented in an African-American population. This intervention was aimed at reducing the level of child abuse and neglect. The design and core components of the model were reviewed to determine cultural relevance and responsiveness to the particular consumer base. This was a collaborative effort with input from clinicians, an advisory board and experts in the field. An ‘implementation model’, which integrated required changes necessary for cultural congruence, was developed. Cultural characteristics included:
culture specific topics including ‘the helping tradition,’ the extended family, race consciousness, respect and strong spiritual life
worker training focused heavily on a culturally appropriate manner
the need for a highly skilled social worker to conduct assessment and engage family system.
The researchers noted that:
Successful implementation of the evidence based practice model was fully dependent on the prioritization of cultural competence.’ (Bridge et al, 2008)21 In summary, the adaptation of a generic programme involved major consultation on the content of programme, subsequent implementation of culture-specific topics, training about behaving in a culturally appropriate manner and the need for skilled practitioners who could engage family.
Huey and Polo (2008) conducted a review of evidence-based psychosocial treatments for ethnic minority youth. They identified that multi-systemic therapy (MST) was the only treatment to reduce criminal offending among African-American delinquent youth in randomised trials. The researchers concluded:
clinicians should utilise evidence-based treatments (EBT) when treating minority youth
family systems treatments such as BSFT (Brief Strategic Family Therapy), MDFT (Multidimensional Family Therapy) and MST (Multi-systemic Family Therapy) are supported in the EBT literature as being probably and/ or possibly efficacious for ethnic minority youth with conduct problems and drug related disorders.
However, the authors concluded there was mixed evidence in relation to the efficacy of culture-responsive strategies with EBTs. They said two strategies were available when utilising EBTs with minority youth:
maintain the EBTs in their original form and apply only those culture-responsive elements that are already incorporated into the EBT protocols
tailor treatments for ethnic minority youth but only to the extent justified by client needs.
In considering these points, it is useful to identify from this review what the cultural-responsive strategies were. The number of studies identified as EBTs with cultural responsive elements was 16. Eleven of these were identified as dealing with conduct-type problems. The types of culture-responsive elements of EBTs ranged from:
1. Therapist being the same ethnicity as the clientgroup
A total of 6 of the 11 studies had the same ethnicity as the culturally responsive element. For example, in one programme, two thirds of the counsellors were African-American.
2. Holistic/ multifaceted approach
Two studies described the therapists using a holistic approach. For example, in one study:
therapists used client strengths across multiple life domains including cultural/ ethnic/ spiritual interests and involvement. (Huey & Polo, 2008:288) 3. Use of family and peers
Two studies referred to the use of family. For example:
Treatment was ‘culturally appropriate in its use of family volunteers and socially high functioning peers with common cultural backgrounds and experiences. (Huey & Polo, 2008: 287) In addition, one study utilised a family resource specialist to help families develop indigenous social supports. This person was used also to assist the clinical team understand the culture and context from which the families came.
4. Programme content/ resources
In four programmes specific mention was made in relation to cultural issues and culturally appropriate resources.
In essence, the degree and variance of what constituted a culture-responsive element varied considerably. In six of the conduct-type studies, the only cultural-responsive element was the fact that the facilitator was the same ethnicity as the group. It could be argued that this by itself does not constitute a cultural-responsive element. For example, ethnicity does not necessarily mean an adherence or knowledge of cultural values and ways of interacting that are important to engaging and working with indigenous groups. This may well have been why there was mixed evidence as to the efficacy of cultural-responsive adaptations to generic programmes. Also, it was noted by the reviewers that the major limitation of all the reviews on the efficacy of cultural adaptations to EBTs was in relation to the cultural validity of the outcome measures which the authors described as Eurocentric.
In summary, the review found mixed evidence in relation to the efficacy of cultural-responsive strategies in EBTs. This could be viewed in two ways. First, there is no need to adapt generic programmes to be more culturally responsive because there is mixed evidenced to support that it works. Second, in the research, rather than the cultural-responsive strategies being of little reported use there is mixed evidence supporting the implementation of culture-responsive strategies into generic programmes. Trying to make generic programmes culturally responsive for minority groups may just not work; they may not be effective with minority youth. This requires further investigation.
It could also be argued that what is required are programmes for minority youth designed and evaluated based on their own cultural values and beliefs. While the review conducted by Heuy and Polo (2008) is extensive, it highlights the seemingly total lack of literature on a purely indigenous treatment approaches to conduct problems.
New Zealand research
Significant concerns at the appropriateness of overseas parenting programmes aimed at reducing prevalence of conduct problems with Māori have been voiced (Cargo, 2008; Elder, 2009), and indicate that consultation and review of programme content is needed. For example, in 2008 a national hui of Māori facilitators was held to discuss their experiences delivering the Incredible Years –Basic Parenting Programme (IYBPP) and to formulate responses to a publication by Webster-Stratton (2007, cited in Cargo, 2008) advocating for a generic IYBPP but culturally sensitive programme rather then one that was culturally adapted, thereby reducing risks of programme fidelity.
Māori facilitators noted that the resources were not relevant to a New Zealand context. For example, the DVD showed people with American accents. The facilitators felt that resources needed to be relevant, reflective and realistic. This is similar to Elder’s criticism (2009) of some American resources used by some IYBPPs that they would not be responsive to Māori and do not promote a positive Māori identity.
Māori facilitators also felt that the IYBPP was being implemented with ‘double standards’. It was noted that the IYBPP was advocated because of an evidence base, yet there was no evidence to support that the programme was effective with Māori whānau. As noted by one facilitator:
I am just so frustrated that there isn’t equity in delivering programmes. Māori want evidence based programmes as well, but we want ones that are based on our beliefs and values. Because I know that there is no evidence that this programme works with Māori, yet here we are all being trained in it. (Cargo, 2008)22 Cargo (2008) further states there is no Māori-designed, kaupapa-based research in New Zealand that shows IYBPP is effective for Māori. It was recommended that the IYBPP be culturally adapted to include key Māori processes and that Te Whare Tapa Wha be incorporated into the training of all facilitators. It was seen as important that Māori whānau had a choice about which types of programmes to attend (that is, a generic culturally-adapted programme) in addition to Kaupapa Māori programmes. Kauapapa Māori programmes needed to be afforded the same respect and value in Aotearoa New Zealand (Cargo, 2008).
As discussed earlier, one study that reported on the efficacy and cultural acceptability of the IYBPP also had limitations (Fergusson et al, 2009). In essence, their research has been used as evidence of a generic programme being identified as culturally acceptable to the 41 Māori people who took part in the programme. While the authors noted limitations in the programme, especially around a lack of data on the number of Māori who did not complete it, Elder (2009) queried why the limitations were not more widely publicised or considered before the widespread implementation of the programme.
The importance of maintaining programme fidelity is such that the AGCP recommended a specialist advisory group be established to ensure this occurs. Based on TRK’s recommendation for effective cultural consultation at all stages of development, implementation and evaluation of new services, it will be imperative there is adequate Māori representation on such a group.
As identified previously from AGCP and TRK, determining the cultural appropriateness of programmes needs to include:
consultation with key cultural groups
inspection of programme content to determine cultural appropriateness
client satisfactions surveys
statistical comparison of rates of participation.
TRK also recommended a whānau ora approach to any intervention or programme design, which should include:
Māori participation in planning and delivery of programmes