Kei te whetewhete mai ki ngā matua - Parent Whispering. PCIT the art of empowering parents to change to improve tamariki behaviour

Abstract

Research has shown that significant behavioural problems in early childhood that are left untreated are linked to conduct disorder, and a range of poor outcomes later in life including academic, social, emotional and employment problems. In New Zealand, Māori are diagnosed with conduct disorders at almost twice the rate of non-Māori. However there are gaps in our current understanding of how best to support Māori who have tamariki with conduct problems and there are currently no kaupapa Māori interventions. One effective programme (Parent-Child Interaction Therapy, PCIT) was developed and tested in the USA. It has not been tested by and for Māori. To address these gaps in our understanding and develop effective treatment for Māori, this doctoral research used a mixed methods approach. This consisted of a pre-post trial of PCIT-Māori that was conducted across two tertiary services (a residential parenting service and an infant mental health service) to see if it improved tamariki and parenting behaviour. A qualitative study followed and investigated the acceptability of PCIT-Māori. Participants in the pre-post study were 24 Māori parents (n=24; aged 22-50, 96% wahine) and their tamariki (n=24; aged 2-6; 54% kotiro), with severe behaviour problems (92%) and history of abuse (83%). Parents had multiple and significant challenges (83% lived in areas with a social deprivation index of 10; 60% had no school qualifications; 83% reported mental health problems; 100% had a mean yearly income below $31,000). Results from the pre-post test, showed whānau could be retained in therapy (88%) and that tamariki behaviour significantly improved on the ECBI-I (t (23) =10.45, p<0.001) with a large effect size (d=2.63), maintained at 4-month follow-up. Secondary outcomes indicated high treatment satisfaction on the TAI (49 out of 50), significant improvement on the Hua Oranga-Child (t (23) = 8.30, p < 0.001) and Hua Oranga-Parent (t (23) = 8.95, p < 0.001), both showing a large pre- to post- overall effect size (d= -1.82). Results from the qualitative study indicated that PCIT-Māori was acceptable to Māori parents and that this approach facilitated a useful therapeutic journey from hopelessness pre-treatment to hopefulness post-treatment. The current study led to three important outcomes. Firstly, a “by and for Māori” approach can lead to excellent engagement and good outcomes for whānau who have major challenges and are typically hard to engage, in evidence-based interventions. Secondly, programmes that are culturally tailored (PCIT-Māori) are successful and welcomed by Māori parents. Thirdly, adapting evidence-based programmes from non-indigenous frameworks is a useful step and providing indigenous programmes are also important so that whānau who have challenges also have choice in the types of parenting support programmes they would like to engage in.