Suchergebnisse

Background
The acceptability of Child and Adolescent Mental Health Services (CAMHS) to Indigenous peoples is little studied. There has been a lack of evaluation tools able to take account of the more holistic approach to the attainment of mental health that characterises Māori, the Indigenous population of Aotearoa (New Zealand). This study aimed to develop such an instrument and establish some of its psychometric properties. Then, to use the measure to establish whānau (family or caregiver) views on desirable CAMHS characteristics.
Method
A self-administered survey, Te Tomokanga, was developed by modifying a North American questionnaire, the Youth Services Survey for Families (YSS-F). The intent of the tool was to record whānau experiences and views on service acceptability.
The Te Tomokanga survey is unique in that it incorporates questions designed to examine CAMHS delivery in light of the Whare Tapa Whā[1], a Māori comprehensive model of health with a focus on whānau involvement and culturally responsive services. This mail or telephone survey was completed by a cohort of 168 Māori whānau. Their children had been referred to one of the three types of CAMHS, mainstream, bicultural, and kaupapa Māori[2], of the District Health Board (DHBs) in the Midland health region, Aotearoa. The Midland health region is an area with a large Māori population with high levels of social deprivation.
Results
The Te Tomokanga instrument was shown to have a similar factor structure to the North American questionnaire from which it had been derived. It identified issues relevant to Māori whānau satisfaction with CAMHS. The work supports the concept that Māori desire therapeutic methods consistent with the Whare Tapa Whā, such as whānau involvement and the importance of recognising culture and spirituality.
The participants were generally positive about the services they received from the three different CAMHS types, which shows good acceptability of CAMHS for Māori. Results found satisfaction with CAMHS was related to whānau involvement and culturally delivered services.
Conclusion
The Te Tomokanga instrument should prove useful in Aotearoa or other similar cultural settings. It is a means of determining the cultural acceptability or improving CAMHS delivery for Indigenous populations.
[1] The Whare Tapa Whā framework relies on a Māori worldview of health, a holistic approach advocating a balance between the four dimensions of the Taha Whānau (family), the Taha Tinana (physical), the Taha Hinengaro (cognitive or intellectual) and the Taha Wairua (spiritual). It is believed if one aspect is in distress then it impacts on the others causing tension and increased risk of poor health. Optimal health requires balance between all four dimensions.
[2] Kaupapa Māori mental health services provide Māori dedicated clinical and cultural workforce for Māori service users.

Within the health research context, indigenous people globally have a commitment to provide their own solutions. Māori, the indigenous people of Aotearoa (New Zealand) value the traditional Pōwhiri process of engagement and participation in mental health research. The practices and protocols within the Pōwhiri process (use in the Doctorate of Philosophy (2010) and Auckland University) are premised on the notion of respect and positive relationships between the tangata whenua (hosts or research participants) and manuwhiri (guests or researchers). This paper briefly describes the Pōwhiri process, which may be a model applicable to research with other indigenous cultures.

New Zealand responded swiftly to the Covid-19 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) to prevent the spread of sickness and prevent unnecessary deaths. The government initiated a four-level social distancing alert system with specified measures at each level to manage and minimise the risk of COVID-19. By late March 2020, Alert Level 4 required people to stay in their homes in their 'bubbles' or family units. Social contact was restricted other than for essential personal movement and travel was severely limited. The Ministry of Health (2020) produced tangihanga (funeral rituals) policy guidelines for Māori, requiring the immediate collection of the deceased's body by a funeral director. Gatherings to do with death and post-death customs were severely restricted and all marae (indigenous gathering places, land, buildings) were closed and burials could only include the immediate family bubble. In this autoethnographic paper, we draw on one Māori family's experience of the birth and death of a baby with an anticipated life-limiting illness, during the most restrictive lockdown phase, level 4. We describe the impact COVID-19 tangihanga policy restrictions had on the family. The guidelines prevented them from conducting timely customary internment rituals with support from kaumātua (older men and women) and whānau (family including extended family and friends) in accordance with their cultural preferences. To prepare for future pandemics we recommend mana whenua (local Māori who have authority over their lands and marae) have autonomy to plan and manage tangihanga to avoid unnecessary distress, particularly where there is a known palliative condition.

Purpose
Is collaborative story production (CSP) a useful method to collaborate with bereaved families to record their reflections on the end of life circumstances and care of people of advanced age? The paper aims to discuss this issue.


Design/methodology/approach
Drawing from Te Pākeketanga, a bicultural study involving 58 bereaved Māori and non-Māori families on behalf of 52 older relatives, the authors describe the CSP method. Researchers and participants co-created personalised written stories about the older person and their end of life experiences, supported with photographs of family, friends and memorabilia. The authors aimed to uplift the status of the older person and their family by tangibly reflecting the significance and magnitude of what had been shared and to strengthen the research analysis.


Findings
CSP supported member checking, promoted a robust understanding of participants' narratives and increased the trustworthiness of data and strengthened the Kaupapa Māori and social constructivist analysis. However, some participants experienced difficulty revisiting painful memories when reading their story. CSP took longer than anticipated, was labour intensive and required a highly skilled and resourced team to ensure participants benefitted.


Originality/value
Using the CSP method with a bicultural cohort of bereaved families who had provided care to someone over the age of 80 was very helpful in assisting the researchers to gather narrative information and present it back to participants in a story format for their comment and feedback. The method contributed a useful way to partner with bereaved family caregivers following the death of an older family member. The authors needed a way to record the participants' narratives of the older person's end of life circumstances and end of life care experiences. This was very important, particularly for grieving families and indigenous families who may have felt vulnerable engaging with research, and with the research processes. The approach provided a helpful and non-intrusive member-checking process. The unique bicultural study approach deliberately utilised the CSP method to assist the researchers to work safely with bereaved families as the participants reflected upon and explored not only the end of life circumstances of the older person, but they also focused on the "death" and their own bereavement experiences. CSP also provided a helpful member-checking method; the authors were working with highly sensitive information and wanted to ensure that the authors as researchers understood and interpreted the families' narrative data correctly, according to their perspectives.

Social policy is often constructed and implemented by people who have little experience of its impact as a service user, but there has been a growing interest in greater public, patient and service user involvement in social policy as both political activity and academic discipline. Social Policy First Hand is the first comprehensive international social policy text from a participatory perspective and presents a new service user-led social policy that addresses the current challenges in welfare provision. A companion volume to Peter Beresford's bestselling All our welfare, it introduces the voices of different groups of service users, starting from their lived experience. With an impressive list of contributors, this important volume fills a gap in looking at social policy using participatory and inclusive approaches and the use of experiential knowledge in its construction. It will challenge traditional state and market-led approaches to welfare