He Kākano ahau i ruia mai i Rangiātea e kore ahau e ngaro: Engaging Māori in culturally responsive Child and Adolescent Mental Health Services

Abstract

Meeting the mental health needs of Māori children and adolescents and their whānau in Child and Adolescent Mental Health Services (CAMHS) is a priority in Aotearoa/New Zealand. Māori living in urban areas are vulnerable to psychological distress due to compounding effects of colonisation, discrimination and socio-­‐economic adversity, which is reflected in negative statistics around Māori health generally as well as mental ill health. Despite this need, engagement of Māori in CAMHS has traditionally been poor. One solution has been the development of Kaupapa Māori services. This research was undertaken with He Kākano, an urban based Kaupapa Māori team in Auckland, to investigate Māori perceptions of engaging whānau in CAMHS. A Kaupapa Māori methodology was used to conduct semi-­‐structured interviews with 20 service users consisting of eight rangatahi (youth) participants (aged 13-­‐18 years old) and 12 whānau member participants (parents, caregivers). He Kākano perceptions of engagement were also gathered through a focus group conducted with 11 staff members. Thematic analysis of interviews identified the importance of addressing barriers and initial concerns as well as building therapeutic relationships via whakawhanaungatanga during the initial assessment. Rangatahi and whānau identified specific clinician/practitioner characteristics and skills that helped ongoing engagement: Aroha (empathy and compassion), awareness of professional power dynamics, and regular consistent contact. Culturally congruent interventions and practical coping skills were also imperative for ongoing engagement. The main barriers for ongoing whānau engagement were communication (language, interpersonal skills) and medication. Challenges of operating as a Māori team within a mainstream service were expressed by He Kākano team members. Finally, whānau pathways to wellbeing including whānau strengths, resiliencies and future aspirations for services were described. This research demonstrates the therapeutic value of tikanga (Māori practices) and mātauranga Māori (Māori knowledge) for engagement of Māori within CAMHS. It also contributes to understanding of factors that facilitate and inhibit engagement and offers recommendations on how to best align services and clinical practices with needs and aspirations of Māori in CAMHS.