Dr Russell WillsPaediatrician

HBDHB

Kia ora!• Ngātahi whakapapa: Soleil, Jessica, James, Victoria, Huia, me, NZ• Tikanga & values• Theory of change• The competency framework• Progress so far

• Survey• 3 work streams

• Engaging effectively with Māori• Mental Health and Addictions• Trauma-Informed Practice

• Evaluation• How adults learn: knowledge online -> based workshops ->

learning circles/ peer review groups + portfolios• What we need from you in this afternoon’s learning circles.

Ngātahi Whakapapa• House surgeon Napier Hospital, Christmas 1987• Child Death Reviews - Soleil and Jessica Aplin, James Whakaruru, Victoria

Climbie. Common features: failure of systems, information not shared, staff lacked skills.

• Expert Panel final report 2015• “If the re-design of the system continues to fail Māori children, then it fails

us all.”• “…the need for a shift from rules, compliance and timeframe-driven

practice to professional judgement based on an evidence-based understanding of the impact of trauma on children and young people, the science of child development and attachment, and best practice approaches”.

• Māori over-representation in child protection• Colonisation, loss of language, culture and resource, TOW, iwi

empowerment, HB “uplift’ and subsequent fallout

Huia

Teacher6 year old girl, mid year 2. Unable to sit still, pokes, hits out, disturbs other students, runs out of class, hides under desk or in corner. Learning pre-new entrant level.Unable to engage mother, doesn’t pick up, or return calls or notes.

But wait, there’s more…

TeacherDrug and alcoholcounsellor

Social WorkerPaediatrician

• Mother depression, heavy alcohol, many violent boyfriends. Physical and sexual abuse suspected, but unproven

• Removed by Oranga Tamariki, placed with grandparents• Frequent night waking, acting-out• GF regularly violent to GM, works intermittently, trauma from

violent childhood• GM aged care caregiver, now home with Huia, depressed,

drinks, guilt, estranged from whanau• 2nd daughter also DV, notified to OT. 3 children delayed and

disturbed• 2nd daughter reveals she is pregnant.

What skills, relationships, values and practices do we need to make a difference for Huia and her whānau?

Work & Income case manager

DV programme

Questions1. What are the values, clinical and cultural skills

(competencies) required to support Huia and her whanau:

2. How can the system support practitioners to a) Identify the skills they need but don’t yet haveb) Learn those skills and deeply embed them into

everyday practice?c) Establish the relationships they need to work

collaboratively across sectors?3. How will we know we have made a difference?

Ngātahi tikanga and values- evolving• Thanks to Ngāti Kahungunu Iwi, Māori Relationship Board, Kaupapa Māori

providers, HBDHB Māori Health Unit & kaumatua

• Privilege Māori voice and values

• He Kauanuanu, Ākina, Raranga te Tira, Tauwhiro• Respect, Improvement, Partnership, Care

• Pou: He Taonga te Tamaiti, Kaitiakitanga, Rangatiratanga, Tikanga, Tūhonohono, Whānaungatanga

• Constitutional platform: whānaungatanga, whakamanatanga, kaitiakitanga, manaakitanga, tika, pono, wānanga, kanohi ki te kanohi

• Tuakana - Teina• Most of us will be both!

• Bringing health to culture• clinical and cultural competency, equally valued

• Strengths-based – mana-enhancing practice• Theory: Collective Impact, Appreciative Inquiry, Adaptive Leadership

• Choice to be involved, acknowledges existing competencies

• Language: “Mapping” vs “Appraisal”, “Additional competencies” vs “deficits/ gaps”.

Ngātahi Core Competency FrameworkSix domains, 12 sub-domains:1. Act in the best interests of tamariki2. Be culturally competent3. Identify needs and respond to vulnerability 4. Engage Tamariki 5. Work collaboratively, share information, lead and

sustain transformational change6. Engage parents, family, whānau and caregivers

System 1: Collective Impact

System 2: Appreciative Inquiry

System 3: Theory of change

What did we do? 1Established our tikanga, values & pou. All wānanga and hui now • Delivered on marae, with clear tikanga –pōwhiri,

whakawhanaungatanga, karakia• Co-designed and co-facilitated by experts in practice and tikanga• Tikanga (ngā pou, Māori models of health) woven throughout the

day from start to finish• Quality improvement: evaluations dis-aggregated by ethnicity of

practitionerAnd• Collective decision-making for all major decisions• Strengths based

• Theory: collective impact, appreciative inquiry• Language: “Mapping” vs “Appraisal”, “Additional

competencies” vs “deficits/ gaps”. • Partner: with experts in teaching tikanga and practice, and online

delivery• Independent evaluation – EIT Professors Kay Morris Matthews and

David Tipene-Leach

What did we do? 2Hui 1• 70 leaders from 25 agencies• Discussed and agreed the

• Purpose and approach to of Ngātahi• Core competency framework:

• 12 domains, 13 sub-domains, 289 competencies in 3 tiers

• Definitions the same across all disciplines

• Levels (tiers) required within each discipline

• How we would survey and map the competencies

What did we do? 3441 staff from 25 agencies completed the survey. 3 priorities identified:• Engaging effectively with Maori – has oversight over all other

work streams• Trauma-Informed Practice

• Self-care the first priority• Mental Health and Addictions

Hui 2:• 3 priorities agreed• 3 work streams formed to agree

• what would be taught• by whom and • how

Work streams agreed on pedagogy• Experienced practitioners identify their

own learning needs, in partnership with their leaders

• Knowledge: online learning with credible leader in the field

• Skills: learnt best kanohi ki te kanohi in one-day wānanga

• Embedded in wānanga ita/ learning circles using the TGROW coaching tool

• Inter-sectoral relationships enhanced by inter-sectoral wānanga and wānanga ita

What did we do? 3

What has been delivered?• Now a “team of 500” practitioners across 31 social, education and

health services• Co-constructed and co-delivered

• Self care in trauma-informed organisations: 13 one-day wānanga to 82 leaders and 156 practitioners from 25 organisations

• Mental Health: nine one-day wānanga to 122 practitioners from 20 organisations

• Trauma-informed practice: three one-day wānanga to 51 practitioners from 24 organisations

• In total 25 wānanga delivered to 411 leaders & practitioners• Wānanga ita/ learning circles: 58 established• CAFS: delivered core skill training in attachment & trauma, Dialectical

Behaviour Therapy, Acceptance and Commitment Training (ACT) for teens, assessment & formulation, and family therapy.

What lessons did we learn?

High engagement of most services

Workforce under enormous pressure - increasing volume and complexity of social, cultural and practice issues in our population has to be factored into programme design:

• High need for self-care in a highly stressed and burnt out workforce

• Turnover of leaders and staff

• Capacity issues in services working with high volume and complexity impacts on attendance and ability to release leaders to teach

Importance of

• a bottom up and voluntary process with a high level of buy-in from participating agencies

• regular, face to face communication (email & newsletters are not enough)

• impartial, trusted, credible project leaders

• having access to frontline practitioners to ensure consistent messages

What difference did we make?

• Tikanga successfully woven throughout wānanga, e.g., whakawhanaungatanga, karakia, pōwhiripoutama model, whāriki assessment framework.

• Multi-agency peer review groups (wānanga ita) valuable to embed learning into practice and grew relationships, e.g., pick up the phone to talk to a friend

• Using new tools in practice – practical, helpful

• Staff and practitioners report improved outcomes for whanau, specific examples given.

What’s next?4th leaders’ hui 21st July – questions:• How can we better connect practitioners for

collaborative practice?• How can we release facilitators skilled in tikanga to

co-facilitate with senor practitioners?• What will be the next wānanga?

Ngātahi Website

CAFS’ next training• Motivational Interviewing for Māori / He Puna

Whakaata, Engaging Pasifika, Assessment & Formulation, Solution Focused Brief Therapy.

“”

Me ka moemoeā au, ko au anake; Me ka moemoeā tātou, ka taeatātou (Princess Te Puea Herangi)

If I dream alone only I would benefit; if we were to dream together we would all benefit.