With your food basket and my food basket, the guests will be fed.
Your knowledge and my knowledge, the goal will be achieved. The purpose of this section is to identify the ways identity and connections are currently being addressed or can be further enhanced to ensure whānau ora for Māori tamariki, taiohi and whānau experiencing conduct problems. The ways identity and connections can be enhanced and honoured is discussed at the following levels:
Haumia, hui e, taiki e
Let us unite as one, unite in conscious thought
PRACTIONER: ENHANCING IDENTITY AND CONNECTIONS
The Health Practitioners Competence Assurance Act (HPCAA) 2003 requires all professional registration bodies to establish standards of clinical and cultural competence. As a result, registration bodies across all sectors have developed cultural competencies. There appears to be no universally accepted definition of cultural competence; however most definitions have a common element which requires an adjustment and acknowledgement of one’s own culture in order to understand the client’s culture (Tiatia, 2008). Durie (2001) cited in Bacal, Jansen & Smith states:
Cultural competency is about the acquisition of skills to achieve a better understanding of members of other cultures so that the patient/doctor relationship is close and productive as possible and the best possible clinical outcome can be achieved for the patient. (2006: 306) Cultural competency has been described as a process that is ongoing and pertains to the acquisition of knowledge and skills about different cultural groups including the cultural group of the practitioner. For example, the New Zealand Psychologists Board (NZPB) considers cultural competence to be:
focused on the understanding of self as culture bearer; the historical, social and political influences on health, in particular psychological health and wellbeing, whether pertaining to individuals, peoples, organisations or communities and the development of relationships that engender trust and respect. Cultural competence includes an informed appreciation of the cultural basis of psychological theories, models and practices and a commitment to modify practice accordingly. (NZPB, 2006:5) In the education sector, generic competencies are defined as well as Māori competencies, he tikanga whakaaro (Grace, 2005, cited in Macfarlane et al, 2008). Macfarlane et al have combined the Ministry of Education (MoE) competencies of thinking, making meaning, relating to others and managing self with Māori competencies of tataritanga (thinking and making meaning), manaakitanga (context of caring relationships), whanaungatanga (building and maintaining relationships), rangatiratanga (taking responsibility for and control over, one’s own learning) and whaiwahitanga (inclusion: participating and contributing). Macfarlane notes that while we cannot expect to understand the full complexity of these forces, we can come to understand some of the elementary dynamics that are more or less likely to motivate or impede an individual’s learning and behaviour. These competencies orient the individual in a variety of situations and should not be seen in isolation; indeed, as Rogoff (2003, cited in Macfarlane, 2007) declares, they vary together in patterned ways (A.Macfarlane, email communication, 2009).
’Lets get real‘ is a Ministry of Health (2008) driven framework that describes the essential skills, knowledge and attitudes required to deliver effective mental health and addiction treatment services. Many of the skills and knowledge are akin to cultural competencies. The seven identified areas with which practitioners were expected to have skills and knowledge included:
working with service-users
working with Māori
working with families/ whānau
working within communities
challenging stigma and discrimination
law, policy and practice
professional and personal development (MOH, 2008:4).
In working with Māori it is expected that every person working in a mental health and addiction treatment service be able to contribute to whānau ora for Māori. Clinicians will be able to demonstrate effective communication and engagement that promote early service access for Māori. Other examples of performance indicators include the ability of a clinician to recognise that Māori clients may want to use waiata, karakia and te reo, the ability to see Māori as contributors to their recovery, familiarity with local Māori groups and understanding how Māori clients may nominate someone in whānau to speak on their behalf.
The following Māori concepts were identified as important when working with Māori:
whakawhanaunga (including being able to recognise the different roles and responsibilities within whānau and the nature of relationships with tāngata whaiora, awareness of Māori methods of interaction that support relationships; that is, no hea koe? (where are you from?)
hauora Māori (understanding of Māori models, using traditional practices, use of whenua, moana and ngahere in support of whānau ora, tino rangatiratanga
wairua – acknowledges different spiritual practices
tuakiri tāngata – acknowledges how Māori identity is important to recovery and whānau ora
manaaki – acknowledges the significance of manaaki to the processes of engagement and whakamana which contribute to whānau ora.
In essence, these concepts highlight the importance of clinicians’ understanding of whānau ora, a holistic approach, identity and the processes of connection.
TRK has strongly recommended that practitioners have dual clinical and cultural competencies (TRK, cited in AGCP, 2009a). Culturally relevant best practice is needed to take a holistic approach and a whānau ora approach. Principles of best practice for the practitioner are centred on promoting identity, connections and a holistic approach. For example, principles of best practice included being able to:
support the development of a secure and positive identity with Māori whānau
facilitate cultural matching between whānau and programme delivery
reinforce being Māori through the re-establishment of links with whānau and Māori communities where Māori values, beliefs and practices are the norm
actively assist applied practice of tikanga Māori and Māori models of wellbeing
conduct a comprehensive assessment process that integrates cultural, clinical, educational and social dimensions
demonstrate whānau inclusive practice (TRK, cited in AGCP, 2009b).
TRK noted that by adhering to these principles, a culturally relevant and effective response to tamariki, taiohi and whānau experiencing the effects of conduct problems would evolve.
It has been postulated that increasing levels of cultural competence in Māori and non-Māori clinicians, implementing dedicated Kaupapa Māori services and increasing the Māori content in generic programmes will ensure better engagement and retention of Māori in clinical services (Huriwai, Roberston, Armstrong, Kingi & Huata, 2001). Culturally competent practitioners and services are vital for solid engagement and assessment and extend into service delivery (Bridge, Massie & Mills, 2008).
It is important to note that cultural competencies may also vary depending on job description and where a person works. For example, the competencies for a person working in a Kaupapa Māori Mental health service or employed to conduct cultural assessments may vary greatly from a person working in a generic mainstream organisation.
The same issue could apply to a person working in a Kaupapa Māori conduct problem programme compared to a person working with Māori in a generic programme. The content and process may differ; however, to enhance identity and connections, understanding of certain values and the ability to engage Māori through the process of powhiri would be cultural competencies relevant for both generic and Kaupapa Māori practitioners and programmes.
The cultural competencies for New Zealand psychologists are based on the cultural safety guidelines developed by the Nursing Council of New Zealand and on overseas research regarding multicultural counselling competencies (NZPB, 2006). Their cultural competencies are outlined under awareness, knowledge and skills. In relation to enhancing identity and connections, certain knowledge and skills are required by both Māori and non-Māori practitioners and are outlined below.