ࡱ> 9 ; & ' ( ) * + , - . / 0 1 2 3 4 5 6 7 8 #`  bjbjmm  ="d ('X8: րѶ @P(xxɤ~G۽ҨԨԨԨԨԨԨ$ehͻq @ɤ<<xxm("""h/<xxҨ"Ҩ""j@:x 4isA n`Ҩ<ѶΞlq q:q :  "5!(ѶրրDd~րր~<#'8<<<i  Te hohounga: Mai i te tirohanga Mori The process of reconciliation: Towards a Mori view The delivery of conduct problem services to Mori Lisa Cherrington, Ngati Hine, Ngapuhi Report prepared for Ministry of Social Development, 30 June 2009 ISBN 978-0-478-33533-0 (online) TABLE OF CONTENTS  TOC \o "1-3" \h \z \u  HYPERLINK \l "_Toc280607246" TABLE OF CONTENTS  PAGEREF _Toc280607246 \h 2  HYPERLINK \l "_Toc280607247" Background  PAGEREF _Toc280607247 \h 8  HYPERLINK \l "_Toc280607248" Purpose of report  PAGEREF _Toc280607248 \h 8  HYPERLINK \l "_Toc280607249" Na wai? Who is this report for?  PAGEREF _Toc280607249 \h 9  HYPERLINK \l "_Toc280607250" SECTION 2: MAI I TE TIROHANGA MORI: TOWARDS A MORI VIEW  PAGEREF _Toc280607250 \h 12  HYPERLINK \l "_Toc280607251" Introduction: Indigenous knowledge  PAGEREF _Toc280607251 \h 12  HYPERLINK \l "_Toc280607252" KMrero pkrkau: Mori mythology  PAGEREF _Toc280607252 \h 13  HYPERLINK \l "_Toc280607253" Te Wehenga: Separation  PAGEREF _Toc280607253 \h 14  HYPERLINK \l "_Toc280607254" Whnau as the focus  PAGEREF _Toc280607254 \h 16  HYPERLINK \l "_Toc280607255" Towards a Mori view  PAGEREF _Toc280607255 \h 19  HYPERLINK \l "_Toc280607256" Te Whare Tapa Wha: A Mori model of health  PAGEREF _Toc280607256 \h 21  HYPERLINK \l "_Toc280607257" Te taha hinengaro  PAGEREF _Toc280607257 \h 25  HYPERLINK \l "_Toc280607258" Te taha tinana  PAGEREF _Toc280607258 \h 26  HYPERLINK \l "_Toc280607259" Te taha wairua  PAGEREF _Toc280607259 \h 27  HYPERLINK \l "_Toc280607260" Wairua  PAGEREF _Toc280607260 \h 27  HYPERLINK \l "_Toc280607261" Whakataunga: Conclusion  PAGEREF _Toc280607261 \h 30  HYPERLINK \l "_Toc280607262" SECTION 3: WHAKAMANA TE TUAKIRI ME TE HONONGA: ENHANCING IDENTITY AND CONNECTIONS  PAGEREF _Toc280607262 \h 31  HYPERLINK \l "_Toc280607263" Introduction  PAGEREF _Toc280607263 \h 31  HYPERLINK \l "_Toc280607264" Identity and connections  PAGEREF _Toc280607264 \h 32  HYPERLINK \l "_Toc280607265" Practitioner, provider and policy considerations  PAGEREF _Toc280607265 \h 35  HYPERLINK \l "_Toc280607266" PRACTIONER: ENHANCING IDENTITY AND CONNECTIONS  PAGEREF _Toc280607266 \h 35  HYPERLINK \l "_Toc280607267" Cultural competencies  PAGEREF _Toc280607267 \h 35  HYPERLINK \l "_Toc280607268" Cultural competence: Awareness  PAGEREF _Toc280607268 \h 39  HYPERLINK \l "_Toc280607269" Cultural competencies: Knowledge and skills  PAGEREF _Toc280607269 \h 40  HYPERLINK \l "_Toc280607271" Summary  PAGEREF _Toc280607271 \h 56  HYPERLINK \l "_Toc280607272" PROVIDER: ENHANCING IDENTITY AND CONNECTIONS  PAGEREF _Toc280607272 \h 56  HYPERLINK \l "_Toc280607273" Kauapapa Mori  PAGEREF _Toc280607273 \h 58  HYPERLINK \l "_Toc280607274" Bicultural  PAGEREF _Toc280607274 \h 59  HYPERLINK \l "_Toc280607275" Generic programmes  PAGEREF _Toc280607275 \h 60  HYPERLINK \l "_Toc280607276" AGCP, CAMHS and TRK  PAGEREF _Toc280607276 \h 63  HYPERLINK \l "_Toc280607277" PROVIDER: CULTURAL SUPPORTS BEYOND PROGRAMME DELIVERY  PAGEREF _Toc280607277 \h 64  HYPERLINK \l "_Toc280607278" Teina/ Tuakana  PAGEREF _Toc280607278 \h 64  HYPERLINK \l "_Toc280607279" Support and connection to a turangawaewae, hapk and iwi  PAGEREF _Toc280607279 \h 65  HYPERLINK \l "_Toc280607280" Support between sessions  PAGEREF _Toc280607280 \h 66  HYPERLINK \l "_Toc280607281" POLICY: ENHANCING IDENTITY AND CONNECTIONS  PAGEREF _Toc280607281 \h 67  HYPERLINK \l "_Toc280607282" SECTION 4: DELIVERY OF CONDUCT PROBLEM PROGRAMMES: ADDITIONAL ISSUES  PAGEREF _Toc280607282 \h 70  HYPERLINK \l "_Toc280607283" Introduction  PAGEREF _Toc280607283 \h 70  HYPERLINK \l "_Toc280607284" THE DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF TE AO MORI PROGRAMMES  PAGEREF _Toc280607284 \h 70  HYPERLINK \l "_Toc280607285" Development and implementation  PAGEREF _Toc280607285 \h 70  HYPERLINK \l "_Toc280607286" Adapting generic programmes: Issues  PAGEREF _Toc280607286 \h 73  HYPERLINK \l "_Toc280607287" Overseas research  PAGEREF _Toc280607287 \h 73  HYPERLINK \l "_Toc280607288" New Zealand research  PAGEREF _Toc280607288 \h 77  HYPERLINK \l "_Toc280607289" Conclusion  PAGEREF _Toc280607289 \h 79  HYPERLINK \l "_Toc280607290" EVALUATION  PAGEREF _Toc280607290 \h 80  HYPERLINK \l "_Toc280607291" Indigenous knowledge  PAGEREF _Toc280607291 \h 80  HYPERLINK \l "_Toc280607292" Evidence-based research  PAGEREF _Toc280607292 \h 82  HYPERLINK \l "_Toc280607293" Practice-based evidence  PAGEREF _Toc280607293 \h 83  HYPERLINK \l "_Toc280607294" Evaluation of whnau ora  PAGEREF _Toc280607294 \h 84  HYPERLINK \l "_Toc280607295" SECTION 5: DISCUSSION/ CONCLUSIONS  PAGEREF _Toc280607295 \h 87  HYPERLINK \l "_Toc280607296" Purpose  PAGEREF _Toc280607296 \h 87  HYPERLINK \l "_Toc280607297" Indigenous knowledge  PAGEREF _Toc280607297 \h 87  HYPERLINK \l "_Toc280607298" Whnau ora  PAGEREF _Toc280607298 \h 88  HYPERLINK \l "_Toc280607299" Mai i te tirohanga: Towards a Mori view  PAGEREF _Toc280607299 \h 88  HYPERLINK \l "_Toc280607300" Te Whare Tapa Wha  PAGEREF _Toc280607300 \h 88  HYPERLINK \l "_Toc280607301" Identity and connections  PAGEREF _Toc280607301 \h 89  HYPERLINK \l "_Toc280607302" Cultural competency  PAGEREF _Toc280607302 \h 89  HYPERLINK \l "_Toc280607303" Programme development  PAGEREF _Toc280607303 \h 89  HYPERLINK \l "_Toc280607304" Kaupapa Mori programmes  PAGEREF _Toc280607304 \h 91  HYPERLINK \l "_Toc280607305" Generic programmes  PAGEREF _Toc280607305 \h 92  HYPERLINK \l "_Toc280607306" Evaluation of whnau ora  PAGEREF _Toc280607306 \h 93  HYPERLINK \l "_Toc280607307" PART 6: RECOMMENDATIONS: TOWARDS RECONCILLIATION  PAGEREF _Toc280607307 \h 94  HYPERLINK \l "_Toc280607308" Indigenous knowledge  PAGEREF _Toc280607308 \h 94  HYPERLINK \l "_Toc280607309" Whnau therapist/ advocate/ liaison worker  PAGEREF _Toc280607309 \h 95  HYPERLINK \l "_Toc280607310" Cultural competency  PAGEREF _Toc280607310 \h 95  HYPERLINK \l "_Toc280607311" Te Whare Tapa Wha  PAGEREF _Toc280607311 \h 96  HYPERLINK \l "_Toc280607312" Kaupapa Mori programmes  PAGEREF _Toc280607312 \h 96  HYPERLINK \l "_Toc280607313" Generic  PAGEREF _Toc280607313 \h 97  HYPERLINK \l "_Toc280607314" Evaluation  PAGEREF _Toc280607314 \h 97  HYPERLINK \l "_Toc280607315" Limitations of report  PAGEREF _Toc280607315 \h 98  HYPERLINK \l "_Toc280607316" Concluding comment  PAGEREF _Toc280607316 \h 98  HYPERLINK \l "_Toc280607317" PART 7: REFERENCES  PAGEREF _Toc280607317 \h 100  EXECUTIVE SUMMARY Ka rere te hue mataati The first shoot of the gourd stretches out & when an action is started it should be followed through until a result is produced (Mead & Grove, 2002: 182). The aim of this report is to gather knowledge and understandings that can contribute towards a Mori view of conduct problems, to ensure that Mori tamariki, taiohi and whnau experiencing conduct problems receive the most effective and culturally enhancing interventions possible. Indigenous knowledge in action will be instrumental in the implementation, development and evaluation of Kaupapa Mori programmes as well as enhancing generic Mori cultural responsiveness. For indigenous knowledge to be effective, it needs to be included and maintained in a meaningful way, such as appropriate consultation and equity of funding for programme development. Mai i te tirohanga: Towards a Mori view is a Mori model developed by Te Roopu Kaitiaki that conceptualises conduct problems. At the centre is whnau ora, which is influenced by: sociological factors (housing, employment, income, incarceration, health, education, identity and connection) the political context (power, funding, legislation, political will and institutionalism) the ability of Kaupapa Mori services and sectors (education, health, social development and justice) to enhance identity and connections. Facilitating access to a secure identity and strong connections is regarded as imperative in a Te Ao Mori view of conduct problem interventions. Interventions with Mori tamariki, taiohi and whnau exhibiting conduct problems need to come from a whnau ora focus. This also requires a holistic approach to understanding, assessing and providing treatment or interventions. To facilitate whnau ora the position of a whnau therapist/ advocate/ liaison worker, whose role is to engage with whnau and work collaboratively across all sectors, must be considered. Given the complexity of issues whnau may present with, such a position requires core specialised cultural and clinical skills. Workforce development issues related to upskilling, training and retaining Mori kaimahi (workers) into such a position need to be identified. Te Whare Tapa Wha (Durie, 1985) is a Mori model of wellbeing that has been used in Kaupapa Mori and generic services and sectors. It is a holistic framework that has the potential to be used in both Kaupapa Mori and generic programmes, addressing conduct problems for Mori tamariki, taiohi and whnau. Cultural competency training and cultural supervision is required to increase awareness, knowledge and skills for Mori and non-Mori practitioners working in the area of conduct problems. In particular, competencies in relation to enhancing Mori identity, facilitating whakawhanaungatanga (relationship building) and utilising Mori models of wellbeing are essential. A review is urgently required to identify what programmes currently exist in the community relevant to Mori and whnau ora that could form a basis for the development of a Kaupapa Mori conduct problem programme in addition to enhancing generic conduct problem programmes. The desire and right by Mori to know what works best so that the best Kaupapa Mori programmes can be designed, implemented and evaluated requires a major investment in terms of funding and workforce development issues. Careful consideration needs to be made about the most effective use of resources. A detailed plan is required for the further development, implementation and evaluation of Kaupapa Mori programmes. This plan will also need to consider funding and timelines. The further development of Kaupapa Mori programmes and cultural responsiveness of generic service providers needs to ensure that programmes: take an integrated and holistic approach involve Mori in design and delivery provide information on participation and outcomes from a Mori perspective. In addition to honouring meaningful consultation, discussion of generic programme content and efficacy issues for Mori, a review of generic programmes relevant to conduct problems and Mori tamariki, taiohi and whnau involved needs to occur. The use of the Hua Oranga (Kingi & Durie, 2000), a Mori mental health outcomes measure, has the potential to assist the assessment of wider outcomes for generic conduct problem programmes and to help establish a framework to assess any developed Kaupapa Mori conduct problem programmes. In order to evaluate whnau ora outcomes, further clarification is required on indicators of whnau ora. More research is needed to identify whnau ora outcome measures, to capture information relating to housing, employment, incarceration, health, education, identity, connection, involvement of Kaupapa Mori services and other sector involvement. At a policy level, the enhancement of identity and connections that ensure Mori tamariki, taiohi and whnau receive the most effective and culturally enhancing interventions possible can be assured by: investment in implementing and/or developing Kaupapa Mori programmes based on indigenous knowledge and best practice evidence from a Mori perspective meaningful consultation about generic programmes including inspection of programme content and adaptations as recommended equity of funding for Kaupapa Mori programmes. SECTION 1: INTRODUCTION Tohu tamariki (Children s gifts) Tamariki: Tama is derived from Tama-te-ra the central sun, the divine spark; ariki refers to senior-most status; and riki on its own can mean smaller version. Tamariki is the word for children. Children are the greatest legacy the world community has. There are many gifts that little children haveThey are: creativity, imagination, innocence, affection, laughter, tears, healing, honesty, facial communication, intuition, energy, mimicry people and anything else only become less than perfect when compared to someone or something else, or when influenced by negative forces. (Pere, 1991: 4) Background In March 2009, the Advisory Group on Conduct Problems (AGCP) published the first of a series of reports, entitled Conduct Problems: Best Practise Report (AGCP, 2009a). Based on the AGCPs response to Treaty of Waitangi obligations, it was recommended that an expert Mori group be set up to provide a Te Ao Mori view on conduct problems and advice regarding responsiveness to Mori in generic services. This group, Te Roopu Kaitiaki (TRK) recommended that further work be undertaken to explore what a Kaupapa Mori response would look like for Mori tamariki, taiohi and whnau experiencing conduct problems. Purpose of report As a result of the recommendations made by AGCP and TRK, this report was commissioned by the Ministry of Social Development (MSD) to better understand a Te Ao Mori perspective when engaging with Mori tamariki, taiohi and whnau experiencing conduct problems. TRK recommended that a major investment be made in gathering and analysing evidence from a Te Ao Mori context and that a report would help start this initiative. MSD requested that the report address the following issues: provide guidance for government and non-government organisations in delivery of conduct problems programmes directed at tamariki, taiohi, whnau, hapk and iwi provide advice on how to engage and support tamariki, taiohi, whnau, hapk and iwi in the delivery of conduct problem programmes outline cultural protocols of engagement and support for whnau identify cultural supports required to encourage Mori whnau beyond programme delivery sessions outline Te Ao Mori principles relevant to the delivery of generic programmes discuss principles of cultural competency for Mori and tauiwi practitioners identify indicators that could measure whnau ora. Na wai? Who is this report for? On 9 June 2009, TRK reconvened discussions focused on a Mori view of conduct problems and issues related to service delivery for Mori tamariki, taiohi, whnau, hapk and iwi. The title of this report was put forward by Moe Milne. The words process and towards signal that this report is a beginning step in identifying a Mori view in relation to conduct problems and delivery of conduct problem programmes. A number of questions were raised by TRK: What do we want for our mokopuna (grandchildren/ young generation)? How do we reduce the degree of separation for our tamariki, taiohi and whnau experiencing conduct problems, conduct disorder and raruraru (unsettledness, turbulence)? What was it like in traditional Te Ao Mori for our children, and how do we get back to that way of valuing and nourishing our tamariki and taiohi? If your child or your niece or nephew exhibited conduct problems, how would you want services to assist you and your whnau? Most importantly, this report is for our Mori tamariki, taiohi and whnau experiencing conduct problems. It is envisaged this report will help ensure they receive the most effective and culturally enhancing interventions possible. It is also envisaged that this report will benefit practitioners, service providers and those in the policy arena. In Section 2, a Mori view of conduct problems is constructed, using both traditional and contemporary indigenous knowledge. Through the use of pkrkau (mythology) an understanding of conduct problems from a Mori view is presented; it highlights the importance of a whnau focus and the effects of separation. A model of how conduct problems may be conceptualised from a Mori view is presented, as well as issues raised by TRK in relation to this model. A Mori model of wellbeing, Te Whare Tapa Wha (Durie, 1985) is also presented, alongside specific examples relevant to Mori tamariki, taiohi and whnau experiencing conduct problems. All of these contribute to the development of a Mori view with the major theme of needing to be holistic and whnau orientated. Section 3 illustrates how identity and connections can be further enhanced in both Kaupapa Mori and generic services. Specific Mori protocols such as powhiri, and values such as aroha and manaaki, highlight ways in which identity and engagement of Mori can be strengthened. The ways identity and connections can be enhanced and honoured is discussed at practitioner, service provider and policy level. Also presented are issues relating to cultural competency and a brief overview of programmes that can influence whnau ora and conduct problems. Section 4 focuses on issues surrounding the implementation of Kaupapa Mori programmes and the enhancement of the cultural responsiveness of generic programmes. A preliminary overview of research conducted in the area of conduct problems and indigenous populations is provided. Additionally, the issues related to evaluating generic programmes (particularly those around evaluating whnau ora) and implementing, developing and evaluating Kaupapa Mori programmes, are discussed. Section 6 presents the major conclusions of the report. Towards reconciliation is the focus of Section 7 and recommends how to ensure Mori tamariki, taiohi and whnau receive the best, and culturally enhancing, interventions possible. Whakatauki: Proverb He kai poutaka me kinikini atua He kai poutaka me horehore atu M te tamaiti te iho. Pinch off a bit of the potted bird, peel off a bit of the potted bird, but have the inside for the child. (Mead & Grove, 2001:81) SECTION 2: MAI I TE TIROHANGA MORI: TOWARDS A MORI VIEW Introduction: Indigenous knowledge N Tne i toko, ka mawehe a Rangi raua ko Papa Nna i tauwehea ai, Ka heuea te PM, ka heuea te Ao. It is by the strength of Tane that Sky and Earth were separated and Light was born. In the Mori creation story, it was Tane, god of forests, who separated Earth and Sky, allowing light to shine on the earth, so freeing the world from darkness. This is often used as a metaphor for the attainment of knowledge or enlightenment. (trad.) (Grace & Grace, 2003:62) Indigenous knowledge can include all areas of Te Ao Mori, both traditional and contemporary. The values and beliefs behind tikanga (customs, meanings, practices) and kawa (protocols, ceremonies) are forms of indigenous knowledge. The reo (language), waiata (songs), whakatauaki and pkrkau are all forms of indigenous knowledge that originally came from the three baskets of knowledge obtained by Tane Mahuta, god of the forests and mankind. As stated by Pere (1991): Proverbs, legends, stories, history and particular knowledge have hidden meanings and symbolic reference for those who understand the mythology and the cultural group to which they belong (p. 10). Contemporary Mori knowledge, which acknowledges that culture is dynamic and evolving, must inevitably combine traditional concepts and understandings within a contemporary context. TRK strongly advocated for indigenous knowledge to have equal standing as a form of evidence when considering the implementation, development and resource allocation for Kaupapa Mori initiatives and enhancing generic programme responsiveness to Mori. Whakatauki: Proverb Te torino haere whakamua, Whakamuri At the same time the spiral is going forward It is going back In order to move forward and formulate a Mori view around conduct problems, there is a need to look backwards. This section, therefore, looks at one form of indigenous knowledge, pkrkau or Mori mythology and its relevance to the conceptualisation of conduct problems today. From the pkrkau, an understanding of the importance of whnau and the effects of separation help guide a Mori view of conduct problems. A model is presented, with the overarching question: How can the degree of separation be reduced for Mori tamariki, taiohi and whnau experiencing conduct problems? Finally, a Mori model of wellbeing, Te Whare Tapa Wha, is outlined and examples relevant to conduct problems presented, to emphasise the need to view conduct problems from a holistic perspective. KMrero pkrkau: Mori mythology There was a time when I was one with Rangi, but now we live far apart. Between us, but not separating us, were our many children to whom we had given life and nourishment and into whose hands had been given future life and growth. But this future life and growth required light and space. So our children set us apart, causing Ranginui the father, and me, Papatuanuku the mother, great pain and anguish. (Kahukiwa & Grace, 2000:22) Dr Ranginui Walker (1978) refers to the myth-messages embedded in Mori mythology, and how in contemporary society these myth-messages need to be more clearly stated for understanding. In addition he writes: The validity of myths was not questioned by the Mori until the post-Christian era when they were displaced by the mythology of a new culture. Today  kMrero pkrkau has the same negative connotation of untruth as it is only a myth. This is unfortunate, since an analysis of Mori myths will show that even today Mori will respond to the myth messages and cultural imperatives embedded in their mythology& The myth-messages now need to be spelled out to the modern Mori. (Walker, 1978: 20) In essence, pkrkau centre on the actions, feelings and behaviours of a whnau. As discussed by Sullivan (2002): A famous English writer, William Shakespeare, once wrote that the whole world is a stage. In the Mori world, the whole world is a story. The world is family of stories, beginning with Ranginui and Papatuanuku. Your own story, your life story, is a part of this great family story. The stories of our gods set examples of how to live our lives, how to live well and to live with each other. The gods werent perfectbut the gods were there to guide us and our ancestors who came after the gods. (Sullivan, 2002:28) Te Wehenga: Separation The kMrero pkrkau highlight the impact of separation. After Ranginui and Papatuanuku were separated, their children all had different reactions. Korero pkrkau show us how our atua coped, adapted and dealt with change, separation and loss. Aspects of tikanga came about from the actions of the atua who were reacting to the changes. In addition, the pkrkau show the capacity for both positive and negative actions. When considering the behaviour of each of the children, the pkrkau reflect a strong, strengths-based focus. This is relevant to viewing conduct problems within a Te Ao Mori perspective. For example, consider Twhirimatea, god of the winds, who reacted angrily against his brothers: After the separation the brothers continued to fight. One particular brother, Twhirimatea who was known as God of the Wind became very angry. He had never agreed to the separation and believed that his mother and father were meant to stay together. He showed his anger by attempting to destroy his brothers. (Cherrington & Rangihuna, 2000:2) Twhirimatea sent great winds and storms to beat upon Tangaroa (god of the ocean) and Tne Mahuta (god of the forest). He destroyed property and caused much devastation. Despite his ability for anger and destruction, he had many strengths. Later he helped Tne obtain the three kete (basket) of knowledge. Whiro, the eldest brother, attacked Tne as he ascended the heavens, and Twhirimatea sent the winds to disperse the hordes of insects Whiro had sent. In his actions Twhirimatea displayed the attributes of aroha (love), tautoko (support) and manaki (caring). Despite Twhirimatea s potential to destroy, we also acknowledge his potential for healing, as evident in the whakatauaki: Hokia ki nga maunga kia purea koe e nga hau Twhirimatea Return to the mountains to be cleansed by the winds of Twhirmatea. As stated by Robyn Kahukiwa in her introduction to Wahine Toa: Women of Mori Myth: Myths provide answers in human terms to the way things are in our world. The characters act as we do but on a grand scale. They can be an important guide to philosophy, values and social behaviour; to correct procedures for certain acts. They can show us the results of certain acts and provide pointers towards social order. (Kahukiwa & Grace, 2000:10) The potential for kMero pkrkau to be used in intervention settings has been advocated for in the past (Cherrington, 1999; Cherrington, 2002; Cherrington & Rangihuna, 2000, O Conner & MacFarlane, 2002; Tapsell, R, cited in Brookbands & Simpson, 2007). It is seen as a taonga tuku iho, a gift handed down from our ancestors, and needs to be treated with respect. Many legends, chants, historical accounts and proverbs have been interpretated and translated from Mori into English. In many instances it was a literal translation with little or no understanding of the depth of information and knowledge from which they project themselves. (Pere, 1991:10) The separation of Ranginui and Papatuanuku prompted change in the way the family functioned. There were both positive and negative consequences. The separation allowed growth and human life to come about: So now Rangi dwells far above, giving space for growth. From his dwelling place he is ever witness to life and death, joy and sorrow, hope, despair, destruction, invention, jealously, treachery, courage, faith and love, and the many earthly happenings. (Grace, 2000:22) While it is acknowledged that the separation allowed space for growth, there is a suggestion, by looking at the words used to describe abnormal reactions or behaviour in Mori society, that too much space of separation has the potential to impact negatively. For example, the word pMrangi is used to describe abnormal behaviour, such as impulsiveness and dis-inhibition. PM refers to the night and rangi is the sky. The mind is thought to be between the surface of sky and darkness (Stewart, 1997). Similarly, the word wairangi is described as a lesser state of mental illness where the mind is seen as being between water and sky (Stewart, 1997). These states also refer to Rangi, the sky and space. If there is too much space, difficulties and confusion may result. Working with Mori who have conduct problems can be viewed as dealing with tamariki, taiohi and whnau whose separation is the greatest. Whnau as the focus One of the most important sign posts pkrkau provide in the area of conduct problems is how the whnau is the focus. Pkrkau centre on whnau dynamics, whnau relationships and whnau separations. The story of our ancestors is all about a family coping with change, loss and grief. All behaviours and feelings have to be considered within this context. In contemporary society, the importance of whnau is reflected in the Mori Health Strategy, He Korowai Oranga. The overall aim is for whnau ora: the ability for Mori families to achieve their maximum health and wellbeing (Ministry of Health, 2002). He Korowai Oranga acknowledges that effective health services for Mori need to be co-ordinated around the needs and realities of whnau and incorporate Mori cultural values, beliefs and practices. The recommendation by TRK that conduct problems be viewed from a whnau perspective (TRK, cited in AGCP, 2009b) and not just from an individual perspective is in line with tikanga Mori, and with recommendations by the AGCP (2009b) about the need for multi-faceted interventions. In many forms of Western family therapies, especially in child and adolescent family therapy, the child/ client who has been referred is often viewed as the symptom bearer for the whole family. The problem behaviours are conceptualised from a family systems perspective rather than at an individual level. Recently the New Zealand Psychological Society (NZPS) was asked to respond to the governments planning sentencing option of sending youth offenders to military-style boot camps. NZPS responded by asking that the government support evidence-based approaches which encompass prevention, rehabilitation and restorative justice. The president, Jack Austin, was quoted as saying, interventions that focus on the individual are much less likely to be effective than interventions that also focus on the family, involve the school and community resources (NZPS, 2009). In working with Mori in the area of addictions, the Kina Families and Addictions Trust (KF&AT) presents a model that highlights the centrality of whnau to the individual and shows how the individual is a part of a bigger system: AU WHNAU WHANAUNGA WHAKAWHANAUNGA WHAKAWHANAUNGATANGA Whakawhanaungatanga is the foundation and refers to practising the principles of whakawhanaunga (acknowledging the interconnectedness and interdependence of an individual and all members of the whnau, immediate and extended family, community and bigger society), whanaunga (relatives), whnau (immediate and extended), and au (me  the individual) (KF&AT, 2005). While this model is presented in relation to working specifically with Mori, their guidelines refer to a general practice when working with all individuals with addictions of  family inclusive practice ; in essence, involving family members as partners in the treatment process of an individual. In Kaupapa Mori services, the inclusion of whnau is standard practice. The related concept of whakawhanaungatanga (making connections) is described by Gilgen (2008) as being  one of the, if not the most important tool in a Kaupapa Mori clinician s toolbox . Durie (2005) also advocated for whnau to be used as an early intervention strategy to the area of conduct disorder. Whnau in this context could include the child, principal caregivers, other family members, the school or early childhood centre and peer groups, primary health care, education sector specialists (special education advisors) and the inclusion of specially trained whnau therapists who work across all sectors. Durie referred to research undertaken on a cohort of Christchurch 18-year-olds. Mori males were the group with the highest rate of disorders (conduct and substance abuse). The strongest predictors of disorders were not socio-economic factors but related to the person s immediate social environment (family, school and peers) (Durie, 2005). In order to reduce the rates of conduct disorder in Mori tamariki and rangatahi, he states that interventions need to focus on: Integrated and multi-compartmental prevention programmes that could address school, family and social factors with culturally appropriate interventions. (Durie, 2005:5) In conclusion, the focus on whnau as highlighted in pkrkau, but also present in health strategies and other programmes working with Mori, has to be considered an essential component of a Mori view of conduct problems. Towards a Mori view Members of Te Roopu Kaitiaki (TRK) met on 9 June 2009 to begin to discuss the issue of conduct problems within a Mori context. From this discussion, the following diagram was designed. It was stressed that this model was a starting point for Mori to further discuss, expand on and refine. Figure 1: Mai i te tirohanga Mori: Towards a Mori view There are four major tenets of the model: Whnau ora is the goal for Mori tamariki, taiohi, whnau, hapk and iwi experiencing conduct problems. At a macro level, whnau ora is influenced by sociological factors such as housing, income, employment, rates of incarceration, health status, educational experiences, identity and connections. At a macro level, whnau ora is also influenced by the political environment, including legislation, funding, sharing of power and resources, political good will and institutionalism. Whnau ora has the potential to be influenced by practitioners, providers and policy makers where the focus is on enhancing identity and connections. Kaupapa Mori services and sectors such as health, education, social development and justice will be responsible for these programmes. In addition the following points were made by members in relation to a Mori view: Conduct problems and raruraru (unsettledness) is a expression of things gone wrong in the child or young person s world. KMrero pkrkau highlight how separation resulted in a state of turbulence and that a state of balance is what is needed today. Disconnection and loss of identity have impacted on whnau ora. It is important not to marginalise Mori tamariki and taiohi by separating them off with the conduct problem. They are a part of a whole system; whnau, hapk, iwi, community and country. Returning to a state of whnau ora is the optimal goal. By achieving whnau ora, Mori tamariki and taiohi are provided with the opportunity to thrive. The political and policy contexts in Aotearoa New Zealand will impact on attaining whnau ora, including past and present issues of colonisation, racism, discrimination and institutionalism. Reducing the degree of separation from where whnau currently are and whnau ora is the role of practitioners, service providers and policy makers. If the issues identified at a macro level are not dealt with, recommendations put forward about enhancing service delivery at a micro level will be less effective in achieving whnau ora. There needs to be shared responsibility in political, policy and provider contexts in addressing conduct problems. Mori want accountability and to know which programmes make a difference for Mori tamariki, taiohi, whnau, hapk and iwi; both Kaupapa Mori and generic programmes. In conclusion, TRK emphasised that a Mori view of conduct problems needed to include both a macro and micro understanding. At the macro level are sociological factors. At the micro level (but related to sociological factors) is the need to enhance identity and connections. This is where service providers and practitioners can influence. However, TRK stated that if the macro levels were not addressed for Mori, issues at a micro level would be rhetoric. Te Whare Tapa Wha: A Mori model of health There are a variety of Mori models related to health and wellbeing, including Te Wheke (Pere, 1991), Nga Pou Mana (Henare, 1988), The Gallery of Life (Te Roopu Awhina o Tokonui, 1988). A consistent theme of these models is the holistic approach and the need to address wairua at some level. In essence, the conceptualisation of conduct problems from a Mori view points to the need to address the issue from a holistic approach. The focus on identity and connections also signifies the importance of wairua and whnau. Te Whare Tapa Wha is presented here as a model of wellbeing, relevant to the development, implementation and evaluation of programmes working with Mori tamariki, taiohi and whnau experiencing conduct problems. Te Whare Tapa Wha was first presented at a Mori Women s Welfare League hui in 1982. In 1985, Mason Durie published a paper called A Mori perspective of health, which outlined differences in perspectives towards health by Western society and Mori. Durie presented a  traditional perspective of Mori health as being a  four sided concept representing four basic tenets of life (Durie, 1985, p. 483). The balance and symmetry with each of these tenets were essential for wellbeing. The four components of wellbeing are; te taha wairua (spiritual wellbeing), te taha hinengaro (mental wellbeing), te taha tinana (physical wellbeing) and te taha whnau (family wellbeing). The essential feature of Te Whare Tapa Wha is that it takes a holistic perspective to wellbeing, and that to achieve wellbeing, or health, each component needs to be in balance. In 1985, Durie noted that the limitation of many contemporary health services was in relation to addressing the spiritual dimension. Twenty years later, ACC commissioned a literature review to explore Mori models, frameworks and strategies that could relate to injury prevention and health promotion and provide a review of evidence-based interventions within Mori communities and other indigenous literature pertaining to injury prevention and health promotion (Cherrington & Masters, 2005). The review found that Te Whare Tapa Wha (Durie, 1985) was being used as a framework for services in a range of sectors including policy, health, mental health, public health, education, justice and Kaupapa Mori health services. The model was also being endorsed as a framework in mental health outcomes with the potential to be used in both generic and Kaupapa Mori mental health services (Kingi & Durie, 2000). In programmes working with Mori tamariki, taiohi and whnau with conduct problems, the use of Te Whare Tapa Wha is dependent on what sector and what service the person and whnau is seeing. In 2003, under the Capital and Coast District Health Board (C&CDHB), a Regional Rangatahi Adolescent Inpatient Unit (RRAIU) was established as a bicultural unit providing inpatient beds for adolescents throughout the North Island requiring hospitalisation for mental health problems. RRAIU assessment processes and treatment plans are based on Te Whare Tapa Wha and ensure all components of a persons wellbeing are addressed (L.Laphen, personal communication, 2005). In 2004, the Lower North Island Severe Conduct Disorder Unit was opened in Epuni. The frameworks of Puao-te-ata-tu (Department of Social Welfare, 1988) and Te Whare Tapa Wha were outlined as the frameworks from which the service was to be delivered. The aim of the service was to provide an inclusive bicultural approach and to develop clinically and culturally relevant treatment, interventions and specialist care to young people/ rangatahi experiencing severe conduct problems and a co-existing mental health difficulty. Although not addressing children and adolescents, Te Whare Tapa Wha has also been used in a criminogenic programme for woman offenders, Kowhiritanga (King & Cherrington, 2004), and at the Montgomery House violence prevention programme. In providing a Mori view around conduct problems, TRK recommended that culturally relevant best practice must include whnau. In addition, programmes required an: Integration of clinical, cultural and social dimensions of interventions to achieve effective outcomes. (TRK, cited in AGCP, 2009:42) In essence, TRK advocated for a holistic approach to assessment and treatment when working with Mori tamariki, taiohi and whnau experiencing conduct problems. Te taha whnau Te taha whnau refers to family wellbeing, as in whnau ora. Durie (1998) describes this component as incorporating the capacity to belong, to care and to share. Te taha whnau also refers to one s relationships in a variety of contexts. In relation to tamariki and taiohi with conduct problems, such relationships would include relationships with peers, relationships within the school system, siblings, immediate whnau, extended whnau, hapk and iwi connections. Family relationships such as the parent unit, siblings, kuia and kaumatua (elders), teina (younger sibling) and tuakana (older sibling) roles are all a part of te taha whnau. In addition, both contemporary and traditional concepts of whnau and the obligations that go along with this may or may not be evident. The concept of whanaungatanga (connectedness) is also important when considering whnau wellbeing, and also a child s and young person s ability to belong, to be a part of and to share within their biological whnau and appointed whnau (that is, peers/ gangs/ romantic relationships). In essence, when there are healthy relationships in different contexts, the individual within the wider system is able to receive appropriate physical, emotional and spiritual nourishment. As highlighted earlier, a Mori perspective of conduct problems needs to be conceptualised from a whnau perspective. Not only do the needs of the young tamariki and/ or taihoi need to be considered, but so do the needs of the whnau when formulating assessment and treatment plans for Mori tamariki and taiohi with conduct problems. Individual and whnau identity are both important and intertwined. As noted in many families with conduct problems, families themselves present with a variety of complex issues (AGCP, 2009b). The families level of criminal activity, homelessness, violence, alcohol and drug use, employment, support, income and adult mental health issues are variables that impact on whnau wellbeing and need to be addressed in interventions focused on the whole unit. Peta Ruha, programme manger of the Lower North Island Severe Conduct Disorder Unit, described the realities of the whnau and young people coming into their service: we are working with mostly gang families there is serious poverty it is mostly the Mums doing the fronting there are multiple layers of issues. A reality for some taiohi is that they are parents or about to become parents. Issues related to whangai (adoption) within the whnau or the whnau s ability to support the taiohi and a mokopuna are important for many Mori whnau. Te taha whnau is about relationships with immediate whnau and whnau where there are whakapapa (genealogical) links, whether or not these links are known and whether or not there is a relationship. Interventions for many Mori youth and whnau may centre on establishing links with whnau, hapk and iwi. Te taha whnau also refers to relationships with persons in their wider social network, including gangs, sports groups, church and other community initiatives. Other very important relationships include those the young tamaiti or taiohi is forming (or in some cases not forming) with professionals who have become involved because of conduct problems. Social workers, youth aid officers, teacher aids, court-appointed psychologists, psychiatrists, cultural workers and doctors are some of the professionals that may be involved. The types of relationships formed with these professionals are important to engagement and retention of whnau in a potentially therapeutic process that could assist in reducing the escalation of problematic behaviours. In essence, te taha whnau as highlighted by Durie has the potential to be used as an intervention strategy. Whnau includes the many systems that the individual and their whnau are involved in. This is not dissimilar to aspects of multi-systemic therapy. However, in line with the intent of Te Whare Tapa Wha, te taha whnau can not be viewed in isolation, and interventions need to address all aspects of wellbeing. Te taha hinengaro Te taha hinengaro refers to mental wellbeing, and includes psychological processes. Thoughts, feelings, cognitive functioning, thinking styles are aspects of te taha hinengaro. Pere (1991) also described te taha hinengaro as a combination of the conscious and subconscious. As a result, te taha hinengaro also refers to mental processes and intuition. Durie (1998) describes te taha hinengaro as the capacity to communicate, to think and to feel. In relation to conduct disorder, additional issues relevant to Mori tamariki and taiohi might include: communication styles of individual and whnau ability for person and whnau to communicate in Mori understanding of what is happening, legal consequences, court processes, comprehension beliefs about why this is occurring mental state/ emotions/ mood whakam (shyness/ embarrassment  individual and whnau) pMuri (depression) anger and expressions of from individual and whnau motivation to make changes individual and whnau engagement with professionals and programmes learning difficulties cognitive abilities strengths and weaknesses of personality attitudes about their own behaviour. Te taha tinana Te taha tinana refers to physical health and can include the physical environment within which a tamariki or taiohi lives. Durie (1998) refers to te taha tinana as the capacity for physical growth and development. Te Roopu Awhina Tautoko (1987), in describing this component, also acknowledges a spiritual connection: Taha tinana is turning to nature for herbal compassion, utilising rituals for physical appeasement, keeping the soul and body intact. (Te Roopu Awhina Tautoko, 1987:7) The concepts of tapu and noa (sacred and not sacred) are also used in relation to the body and, in essence, provided safe, healthy and hygienic practices traditionally. In contemporary society, viewing the body as tapu, and therefore giving the body the appropriate respect by not damaging it through drugs, poor diet and lack of exercise, is a Kaupapa Mori perspective towards hauora (wellbeing) and a healthy life style. Given there are numerous physical health disparities between Mori and non-Mori, physical growth and development is imperative for Mori tamariki and taiohi. Te taha tinana can also refer to the physical environment, and includes variables such as housing, employment, income, schooling and daily activities, all of which can impact on the wellbeing of the individual and whnau. The importance of turangawaewae (place of identity/ belonging), being brought up in the area where you are from, having contact with your turangawaewae and how often etc. are all aspects of te taha tinana that can impact on one s wellbeing. The connection to the physical land highlights how spiritual and whnau components are intertwined with taha tinana. Te taha wairua Te taha wairua is probably the most difficult area to define, assess and understand, yet it is the most important area and is intertwined with every other component of wellbeing. Te taha wairua refers to spiritual wellbeing, and is not just inclusive of religion. Kingi (2002) describes te taha wairua as including beliefs in a non-physical dimension or force. Durie refers to te taha wairua as the capacity for faith and wider communion, and states that health is related to unseen and unspoken energies (Durie, 1998:70). Te taha wairua also acknowledges the relationship a person has with the environment and their ancestors. The following poem highlights the many facets of te taha wairua: Wairua By Heather Delamere Thomson Koro, what is wairua? the child asked, eyes wide Wairua, my moko is what gives us life Handed down to us from a time past At the moment of your beginning You shared with me the wairua of your tipuna: For I am your link with the past And you are my link to the future The aroha of the whnau has wairua And their words, their laughter, their tears The marae, tangi, waiata and whakapapa Have a wairua that strengthens us, gives us pride  So too the sunrise and sunset The soft summer rain, the raging storm, The song of the birds in the trees, The waves on the beach The mist rising from the bush The moonlight on the water And the embracing darkness of the night To sit quietly in the wharenui or the urupa And feel the presence of your tipuna is to feel wairua Your arms around my neck, your breath on my cheek, Fills me with a special wairua For there is wairua in all things that give meaning to life To love, to the future. So moko, open your mind, Let your heart love Your eyes see Your ears hear Your hands feel Give of yourself, my moko For in giving, you receive And the wairua grows. In relation to tamariki, taiohi and whnau experiencing conduct problems, an important goal is to ensure that their taha wairua is in balance. For many deculturated youth and whnau, it is about reconnecting to their sense of wairua and what makes them feel strong spiritually. Te taha wairua also refers to beliefs around tapu (sacred) and noa (safe), makutu (Mori curse), mate Mori (Mori illness), use of rongoa (Mori medicine), karakia (incantation), taonga (treasure) and tangihanga (funeral). These aspects of Te Ao Mori are better left to be assessed by Mori knowledgeable in these areas. However, this does not preclude generic and Kaupapa Mori practitioners gaining an understanding of what te taha wairua may mean for whnau and individuals, without needing to go into an indepth cultural assessment. Simply finding out what makes a person feel centred and uplifted in some way, such as listening to music, going to the ocean, laughing with one s children, is an important component of te taha wairua. Hua Oranga is a Mori mental health outcomes measure developed by Kingi and Durie (2000) and is based on Te Whare Tapa Wha. Through extensive consultation and hui through the country with key stakeholders, the researchers identified components within each taha as a way to evaluate outcomes of interventions. The measure requires a triangulated approach to evaluation where the clinician, whnau and tngata whaiora (client seeking wellbeing) complete the form. In relation to te taha wairua, the questions and components used n Hua Oranga are detailed to expand on an understanding of te taha wairua. Four dimensions are identified under te taha wairua: Dignity and respect feeling valued as a person As a result of this intervention do you feel more valued as a person? Cultural identity  strong as a Mori person As a result of this intervention do you feel stronger in yourself as a Mori person? Personal contentment As a result of this intervention do you feel more content within yourself? Spirituality As a result of this intervention do you feel healthier from a spiritual viewpoint? (Kingi, 2002: 428). These questions highlight the many facets of wairua, including a sense of dignity and respect, cultural identity and personal contentment in conjunction with a persons own sense of spirituality. While many programmes focus on te taha hinengaro or te taha whnau, a Kaupapa Mori approach would ensure that all taha were addressed in a therapeutic intervention, not only for the individual but also for the whnau. The potential and scope for te taha wairua interventions are many and varied and could range from simply having therapy sessions by the moana (sea) or wananga (learning) in a whare nui, to more cultural-specific interventions such as Mau Rakau or Kaupapa Mori activity-based programmes. However, it must be noted that these types of interventions are not just spiritually based but also holistically focused. Whakataunga: Conclusion Te Whare Tapa Wha has been talked about and used in a variety of settings over the last 25 years. It has become a well-known model that is easily understood and has the potential to be useful for Mori and non-Mori. Practitioners and service providers need to consider the use of Te Whare Tapa Wha or a similar model to ensure they take a holistic approach when working with Mori tamariki, taiohi and whnau. By using Te Whare Tapa Wha in the assessment process, a comprehensive treatment plan can be developed. Ideally, if Te Whare Tapa Wha was used across sectors, a more unified approach towards treatment could be obtained. The essential feature of such a framework would be for the whnau as a whole to address each area as well as the identified symptom bearer or tamariki or taiohi with conduct problems. By utilising a holistic approach, the complexities of working with hard-to-reach whnau can be more fully assessed and addressed. SECTION 3: WHAKAMANA TE TUAKIRI ME TE HONONGA: ENHANCING IDENTITY AND CONNECTIONS Introduction Te Roopu Kaitiaki estimates that the prevalence of conduct problems among Mori tamariki and taiohi is approximately 15% of the population. Mori are over-represented in admissions for conduct problems and are more likely to enter the youth justice system (Durie, 2005). In a recent radio release (Radio New Zealand, 9 June 2009) the principal youth court judge, Andrew Becroft, described the latest statistics on crime committed by young Mori as a  national scandal . Figures released from the Ministry of Justice included that: Mori teenagers are three times more likely to be apprehended by the police than their Pkeh or Pacific Island counterparts Mori children are five times more likely to be apprehended by police the national average of Mori as a percentage of all youth appearing in the youth court is 50% with higher percentages in certain areas (75% in Waikato and 90% in Rotorua and Tauranga) 60% of the offenders held in youth custody or police cells are Mori. As noted by Elder (2009): & rates of offending and behavioural disturbance that violates the rights of others are higher in Mori tamariki and rangatahi than non-Mori. Associated information such as Mori being approximately 80% of the Adult Forensic mental health population, the very high proportion of Mori in the prison population and the majority of those facing Youth Court charges being Mori show the severity of the impact of severe behavioural disturbance for Mori whnau. (p. 1) In 2008, a review of social and emotional needs of infantsin South Auckland (highly populated with Mori and Pacific Islanders) estimated that 15% of 0-3 year olds in that area have significant behavioural problems Severe behavioural disturbance early in life has been identified as high risk factor for the development of severe conduct disorder (Merry et al, 2008). The high rates of conduct problems experienced in the Mori community highlights the need for effective engagement of Mori into programmes aimed at reducing the incidence of disorder and improving health outcomes for those tamariki, taiohi and whnau in distress. Because of the prevalence of Mori conduct problems and the fact that Mori are at increased risk of conduct problems and related disorders (AGCP, 2009a), it is imperative that practitioners, providers and policy makers work collaboratively to provide the most effective and culturally enhancing programmes and interventions possible. The ways in which identity and connections can be enhanced at a practitioner, service provider and policy level are discussed. Specific Mori protocols such as powhiri (formal welcome) and values such as aroha (love) and manaaki (support) are presented to highlight ways in which identity and engagement of Mori can be strengthened at a practitioner level. Examples of some programmes and service providers for Mori tamariki, taiohi and whnau experiencing conduct problems are given. Finally, we outline a review of policy that influences the way in which practitioners and service providers work. Identity and connections Whakatauki: Proverb I kore au e ngaro; te kkano i ruia mai i a Rangiatea. I will never be lost for I am a seed sown from Rangiatea. This traditional whakatauki highlights the importance of identity to ones wellbeing. In contemporary society it is postulated that a secure identity can protect against poor health (Durie, 1995; Durie, 1999a). As noted among indigenous populations worldwide: Deculturation has been associated with poor health where as acculturation has been linked to good healthcultural identity is considered to be a critical prerequisite. (Durie, 1999a) The initial findings of Te Hoe Nuku Roa, a longitudinal study of Mori households, indicate that Mori who have a more secure identity experience better health (Durie, 1995). Promoting a secure identity is seen as an essential component of best practice when working with Mori tamariki, taiohi and whnau experiencing conduct problems (TRK, cited in AGCP, 2009a). The importance of hononga (connections) is strongly related to the concept of whakawhanaungatanga (relationships and connections) which in turn relates to a secure identity. As noted: The concepts of whnau and whakawhanaungatanga highlight a sense of belonging and a sense of relating to others within a context of collective identity and responsibility. (Macfarlane, Glynn, Grace, Penetito & Bateman, 2008: 187) In Te Pae Mahutonga, a model for health promotion (Durie, 1999a), one of the main tenants is mauriora; access to te ao Mori, which rests on a secure cultural identity. As noted by Durie;  too many are unable to have meaningful contact with their own language, customs or inheritance& Identity means little if it depends only on a sense of belonging without actually sharing the groups cultural, social and economic resources . Facilitating access to te ao Mori, and thus a secure identity, includes access to language and customs, culture and cultural institutions such as marae, economic resources (land, fisheries and forests), social resources (whnau, Mori services, networks) and societal domains where being Mori is endorsed (Durie, 1999a). TRK were of the view that disconnection from self, whnau, hapk, iwi and lack of identity contributed to poor wellbeing both spiritually, physically and mentally. Elder (2008) summarised research and highlighted how poor mental health stemmed from insecure identity. In addition, a secure identity was seen as a protective factor for Mori youth and suicide attempts (Coupe, 2005). The relationship between connection with culture and reduced rates of offending was noted by the principal youth court judge, Andrew Becroft, who identified recent research suggesting that young Mori who are involved or connected with their culture do not offend at any greater rate than any other person (Radio New Zealand, 9 June 2009). Colonisation and alienation from land initially contributed to disconnection with whnau and identity. The effects of these are seen as key factors that have placed Mori at increased risk of conduct problems (TRK, cited in AGCP, 2009a). In considering the role of identity and connections, Macfarlane (2009) notes: Connecting with culture is actually a means of validating individuals identity and whakapapa - who they are and where they come from. It is a process that values relationship building, and which 'speaks' about providing a safe environment within which individuals can feel a genuine sense of belonging and value for who they are as Mori. It enables individuals to be who they are and to feel safe in doing so. (Angus Macfarlane, email communication, 20 April, 2009) Therefore, enhancing identity and connections is seen as paramount in considering a Mori approach to the delivery of conduct problem programmes for Mori tamariki, taiohi and whnau. The song,  Music has saved me by contemporary Mori artist, Tiki Tane, highlights the importance of connection and changing a way of living. In this song, music was the connection, which is a form of connection for Mori taiohi today. Waiata: Song Lyrics from  Music has saved me by Tiki Tane For me, I know when I heard it, it was like this is a connection here and it was a struggle& I had been this young Mori kid growing up in a white world Music has given me life, away from the streets and strife. Practitioner, provider and policy considerations Nu to rourou, nku te rourou, ka ora te manuhiri 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 whnau ora for Mori tamariki, taiohi and whnau experiencing conduct problems. The ways identity and connections can be enhanced and honoured is discussed at the following levels: practitioner service provider policy. Karakia: Incantation Haumia, hui e, taiki e Let us unite as one, unite in conscious thought PRACTIONER: ENHANCING IDENTITY AND CONNECTIONS Cultural competencies 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 ones own culture in order to understand the clients 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 Mori 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 Mori competencies of tataritanga (thinking and making meaning), manaakitanga (context of caring relationships), whanaungatanga (building and maintaining relationships), rangatiratanga (taking responsibility for and control over, ones 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 individuals 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 Mori working with families/ whnau working within communities challenging stigma and discrimination law, policy and practice professional and personal development (MOH, 2008:4). In working with Mori it is expected that every person working in a mental health and addiction treatment service be able to contribute to whnau ora for Mori. Clinicians will be able to demonstrate effective communication and engagement that promote early service access for Mori. Other examples of performance indicators include the ability of a clinician to recognise that Mori clients may want to use waiata, karakia and te reo, the ability to see Mori as contributors to their recovery, familiarity with local Mori groups and understanding how Mori clients may nominate someone in whnau to speak on their behalf. The following Mori concepts were identified as important when working with Mori: whakawhanaunga (including being able to recognise the different roles and responsibilities within whnau and the nature of relationships with tngata whaiora, awareness of Mori methods of interaction that support relationships; that is, no hea koe? (where are you from?) hauora Mori (understanding of Mori models, using traditional practices, use of whenua, moana and ngahere in support of whnau ora, tino rangatiratanga wairua  acknowledges different spiritual practices tuakiri tngata  acknowledges how Mori identity is important to recovery and whnau ora manaaki  acknowledges the significance of manaaki to the processes of engagement and whakamana which contribute to whnau ora. In essence, these concepts highlight the importance of clinicians understanding of whnau 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 whnau 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 Mori whnau facilitate cultural matching between whnau and programme delivery reinforce being Mori through the re-establishment of links with whnau and Mori communities where Mori values, beliefs and practices are the norm actively assist applied practice of tikanga Mori and Mori models of wellbeing conduct a comprehensive assessment process that integrates cultural, clinical, educational and social dimensions demonstrate whnau 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 whnau experiencing the effects of conduct problems would evolve. It has been postulated that increasing levels of cultural competence in Mori and non-Mori clinicians, implementing dedicated Kaupapa Mori services and increasing the Mori content in generic programmes will ensure better engagement and retention of Mori 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 Mori 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 Mori conduct problem programme compared to a person working with Mori 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 Mori through the process of powhiri would be cultural competencies relevant for both generic and Kaupapa Mori 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 Mori and non-Mori practitioners and are outlined below. Cultural competence: Awareness The following lines are taken from a poem of Tuhoe origin, recounted in 1987 in Ranginui Walkers book, Nga Tau Tohetohe: Years of Anger. It shows one persons awareness of their own culture Being Mori is- Having the greatest grandparents in the world Respecting your elders because they earned it Having 250,000 brothers and sisters Fouling up the government and its statistics Having no where for the kids to go, and getting a visit from the police who want to see them Talking tough Not laughing at your children when they mispronounce your language To miss work because so many of your relations are dying Owning land and not being able to use it Going to school to eat lunch Watching the teacher teach the other kids Belonging to a particular tribe which is the best in the country Having your friends and relatives accuse you of being a traitor if you earn more than $7000, wear a tie and drive a new car Being Mori is hard, being Mori is sad, being Mori is to laugh, being Mori is to cry, being Mori is forever. (Walker, 1987: 136) In developing cultural competence, practitioners both Mori and non-Mori need to be aware of their own cultural background, values and beliefs. Through an examination of their own beliefs, a practitioner can begin to see how this may or may not impact on their interactions with people from other cultures. In teaching practitioners about becoming more aware of their own cultural background, a useful exercise has been to get them to complete their own poem, entitled: Being [however they define their culture] is Such an exercise requires participants to give meaningful consideration at more than just an intellectual level. For many New Zealanders, such an exercise has been an eye opener in beginning to lay the foundations of  Pkehatanga and/ or  Kiwi culture and/ or acknowledgement of their own rich tapestry of ancestry that combines a variety of cultures. As the following whakatauaki suggests, a practitioner needs to have examined their own culture before working with people from other cultural backgrounds: Maatua whakapai i toou marae, ka whakapai ai i te marae o te tangata. First set in order your own courtyard before you clean up anothers. Cultural competencies: Knowledge and skills Te Ao Mori principles and protocols relevant to delivery of conduct problem programmes Knowledge about the intent behind certain protocols can help in the transition of some traditional Mori practices into a contemporary setting. In relation to conduct problem programmes there are protocols and principles that are seen as paramount in enhancing connections and identity for Mori tamariki, taiohi and whnau. Yesterday, Today and Tomorrow (YT&T) (2007) developed a Mori cultural competency framework which is aligned with the powhiri and hui process. Thirteen areas related to Mori cultural competency were identified, ten of which are outlined to give practitioners insight into ways identity and connections can be enhanced. 1. Powhiri  Transactional engagement In considering Te Ao Mori principles and protocols relevant to the delivery of conduct problem programmes, the protocols and beliefs imbedded in the powhiri (welcome) process would appear most applicable in both generic services and Kaupapa Mori programmes. Durie (1999b) described the marae encounter and the resulting tikanga as evidence of a Mori psychology and way of thinking and behaving both in traditional and contemporary times. The powhiri process has also been acknowledged by the Mental Health Commission as an important component to cultural assessment and, as such, needs to be used routinely in district health boards (DHBs) (Mental Health Commission, 2004). The powhiri process has also been identified in therapy contexts as the beginning process to a learning and spiritual journey for whnau that can address feelings of  loss, despair and alienation (KA&AT, 2005). YT&T (2007) describes powhiri as a ritual of encounter that provides an effective process of engagement. They go on further to describe powhiri as a transactional engagement. Traditionally, powhiri occurred on the marae and involved a process of greeting between the tngata whenua (people belonging to that marae) and manuhiri (people visiting the marae). However, the powhiri process has the potential to be utilised on a marae setting and also for a meeting encounter between tamariki, taiohi and whnau and professionals involved in a particular case. Te Ngaru Learning Systems developed the powhiri poutama model which has been used predominately in the alcohol and drug treatment area. While there is no published literature on the specific details of the model, it has been identified as a model that Mori child and adolescent mental health workers wanted more training in as a Mori model of practice (Te Rau Matatini, 2004). The model has also been introduced in Kaupapa Mori mental health services. For example, Turoa Haronga, kaumatua, used this model to provide the framework from which he practiced in Kaupapa Mori mental health settings (T. Haronga, personal communication, 1997). The model is related to the process of powhiri when a clinician meets with a client. The issues of karanga (who has called the meeting), whaikorero (who lays down the kaupapa or purpose of the meeting) and issues related to boundaries, time and space as identified by Durie (1999), are integral to the powhiri process and the subsequent successful engagement of a client. In considering the engagement of Mori whnau through the use of powhiri, it is important to consider the components of powhiri both within a formal setting such as a marae and in a less (culturally) formal setting such as a clinical interview room. The components important in this powhiri process would include the karanga (call), karakia (incantation), whaikMrero (speech), mihimihi (introductions), haruru (shaking of hands) and hakari (feast). This aligns with Durie s proposed Mori psychology framework (Durie 1999b). Karakia and mihimihi are discussed further on. Traditionally, karanga is when the kuia (senior woman) calls the manuhiri (visitors) onto the marae. It is a ritual of encounter and requires that the manuhiri return this call through their kai karanga (caller). The karanga is typically conducted by the kuia, who has a good command of the language. Mihipeka Edwards, a well known kuia, noted that the words issued in karanga are spiritual, like a prayer, issued in love and compassion (Edwards, 2002: 17). The karanga is very much a spiritual process where the deceased are acknowledged and the purpose of coming together on the day identified. It is important to note that in traditional times the manuhiri could not come onto the marae until they had been called by a kai karanga. To do so would have been disrespectful, and more than likely a sign the group was not coming in peace. The karanga as a ritual of encounter could be applied to engaging Mori and trying to make a connection in a modern context. In considering engagement issues, who is the person asking the tamariki, taiohi or whnau to come and meet with them? How is this call made? Is it by letter, telephone call or face to face? Special Education have a form in which it is made clear how whnau want to be contacted, either via mail, phone call or kanohi ki te kanohi (face to face). How is the karanga put to the whnau? Is there acknowledgement of the past as in the traditional karanga? Is there a clear statement of the purpose of the meeting and who will be there? Traditionally, a kuia does the karanga and typically holds a lot of mana. Does this have the same meaning as a letter sent out stating an appointment time? In essence the karanga is the first point of contact with whnau. A karanga in a modern context is the work that is done to invite, to call, to get whanau to the venue to further the process of engagement. How this is done has a huge impact on whether or not whnau turn up. Practitioner and service providers need to consider how they conduct this first point of contact to make a connection and increase chances of effective engagement. 2. Ahu whenua  Use of environment The place where an encounter occurs will affect how Mori processes are conducted. For example, a meeting at the child or young person s own home may have a different process to that conducted on a marae, and possibly to hui conducted in an office or therapeutic room. The environment in which an interaction occurs is important for engagement. The importance of the environment and having a family and whnau friendly environment is referred to in Family Inclusive Practice within the addictions area (KA&FT, 2005). This describes the need for child friendly environments as well as a friendly atmosphere and somewhere for a  cuppa and something to eat . The ability to partake in eating or drinking after powhiri is very important for Mori and is related to the concept whakanoa (making free of tapu). Where a whnau is coming to meet a professional, the waiting area can provide important information about the acceptance of Mori culture and values. Posters depicting positive Mori images can help normalise Mori culture and be culturally appropriate. C&CDHB s tikanga guideline refers to reception as the first point of contact and therefore very important. The guidelines advocate having Mori images in the waiting room or significant landmarks that will give a sense of connectedness with the community and land. Having Mori magazines or te reo books in the waiting area also show a sense of acceptance of Mori as part of the community. Holding hui on marae has been identified as contributing to the engagement of Mori whnau in parenting programmes (Gifford & Pirikahu, 2008; Cargo, 2008). A marae-based rehabilitation programme for Mori youth was successfully trialled in Gisborne and is now being considered in other parts of the country where there are Mori youth court judges (Radio New Zealand, 9 June, 2009).In addition, a number of primary prevention and injury prevention programmes have been conducted on marae (Brewin & Coggan, 2004; Ratima, Fox & Te Karu, 1999; Simmons & Voyle, 2003). Increasingly, the marae is seen as the most culturally appropriate place to conduct meaningful hui and ensure participation and engagement of Mori whnau. Ahu whenua refers to the interconnectedness and relationship Mori have with the natural world. Not only does this incorporate the use of natural rongoa to assist with healing but also the natural environment. The whenua (land), moana (sea), ngahere (forest), awa (river) and maunga (mountain) are important components of wellbeing. When considering development of programmes for Mori tamariki and taiohi, the use of land, sea, forest, rivers and mountains need to be implemented. In training psychology students, the writer has often asked students to consider how a session with a child or adolescent may differ if it occurred in a different environment, such as in the ngahere or at the beach. Alternatively, to undertake a session by a childs own ancestral river or mountain has the potential to enhance identity and connections at all levels; physically, spiritually, and emotionally, both at individual and whnau level. 3. Karakia  Transition YT&T (2007) refer to karakia as a mechanism to support transition for tngata whaiora, whnau and kaimahi. The concept of transition may include the spiritual perspective but also to lay the foundations for a safe and effective engagement with clinicians and whnau. Salmond (1976, cited in Durie, 1999b) describes the purpose of karakia as being to create a sense of unity with ancestors, the environment and spiritual powers. The concept of interconnectedness and finding commonalities are also components inherent within the use of karakia. Kaumatua in Mori mental health settings advocate the use of karakia in every clinical encounter, whether this is done formally in a session or in private before a session. However, not every Mori patient will expect a karakia. Mori culture is dynamic: Like those of all other populations, will have their own preferences and beliefs. Just as not every male patient likes to talk about sports during his examination and not every female patient worries about her weight, not every Mori patient will expect a blessing (karakia) before a medical procedure. It is up to the provider to learn the preferences of each patient, Mori or non-Mori, and to strive to put them at ease, in order to create and sustain a respectful, trusting and therapeutic relationship. (Mauri Ora Associates (MOA), 2008:3) This is in line with Ministry of Health guidelines for the process of a Mori cultural assessment where flexibility is also recommended by the assessor. It is advocated that the assessor establish the protocol needs before any meeting. For example a whnau may prefer mihimihi rather than the more formal process of powhiri. By ascertaining the cultural needs of the whnau before a meeting takes place the assessor will be able to carry out the appropriate karakia and mihi when required (MOH, 2004). It is important to note that these guidelines and recommendations are centred on hui and encounters that do not occur on the marae or typically in a Kaupapa Mori setting. Some clinicians have argued that the use of traditional or Christian karakia have served to further alienate Mori, especially those who do not have traditional or Christian belief systems. In teaching tauiwi and Mori psychology students about the use of karakia with tngata whaiora, the writer has advocated the need for identifying what is meaningful to the client and what they connect with at a spiritual level. First, the clinician needs to model to the whnau the use of karakia. It is important that the whnau and tngata whaiora hear what and why this has been done. This whakamarama (explanation) helps to further engage whnau who have had less exposure to these processes. In addition, by later identifying what is meaningful to the whnau they can also participate in the process of karakia. This is especially relevant for tamariki and taiohi. The intent of the karakia whether it be through a poem, a song or a video clip is the same: safety and unity. While as Mori, our first option is to refer to our kaumatua to begin and end our sessions with karakia, this is not always available. Within Mori mental health services, when working individually with Mori tamariki and taiohi, the writer has assisted them in writing their own karakia about acknowledging those things in their life that uplift them and that they wish to acknowledge. In essence, the intent of karakia is to create a safe environment for all concerned so that further rituals of engagement can occur. Milne (2005) relates the story of a kaumatua and tohunga working together under ACC. She notes: This tohunga went on to explain about the tikanga Mori process of creating a safe place between people who meet. This he likened to the process engaged in powhiri and whakawatea or clearing spiritual pathways which creates the safe environment. Aroha, tautoko and manaaki needed to exist before the trauma could be addressed. This he explained as the difference between Mori process and thinking as compared to Pkeh. (Milne, 2005: 13) 4. Te reo : Effective communication Tangohia te reo o te tangata ka tu tahanga. Tangohia te tikanga o te tangata ka noho ngoikore. Take away a peoples language and you take away their identity. Take away a peoples culture and you take away their dignity. The greatest value of cultural competence is to enhance communication between clinician and client, and to ensure the desired outcome is achieved (MOA, 2008). In communicating with Mori and whnau, clinicians need to be aware of differences. For example: Mori whnau will at times agree with what a doctor is saying to avoid small disagreements. This does not necessarily mean they agree with a clinician or that they will adhere to what has been recommended silence by Mori whnau does not necessarily mean agreement it is important to be guided by the patient and whnau about the need for customary Mori practises such as hongi and karakia (MOA, 2008). Correct pronunciation of Mori names is identified as the best way to show respect to Mori patients (MOA, 2008). The following poem highlights how such an issue can impact immediately on the relationship between people. Barriers Kia ora Hinewairangi speaking Who? Hinewairangi Can you spell that? I reckon I can, can you? No Will you spell it please? H I N E W A I R A N G I Oh, yes High knee we rah gee No Hinewairangi Will high knee do? No Call me Rose (Kohu, 1993: 56) The words used in an interaction between whnau and a kaimahi are also important. The use of Mori words helps to model the acceptability and promotion of te reo Mori within that particular setting. This would be expected If, for example, the interaction was on the marae. There are fewer expectations for this to occur in a clinical interview room. However, the use of te reo may assist the whnau in feeling more comfortable and engaged with the practitioner. Some clinicians have argued that the use of te reo Mori by tauiwi might be seen as condescending and intimidating by whnau who are not able to speak Mori. The same care may need to be taken when a clinician is using Western psychological jargon. For a Mori clinician, it is about assessing their level of comfort with te reo and continuing to model the use of te reo with them. For Mori, the reo is at the base of identity and therefore needs to be modelled and promoted in a sensitive and appropriate manner by Mori. The use of te reo by tauiwi shows a normality and acceptance of te reo within the therapeutic setting. It is also important to consider the number of tamariki, taiohi and whnau who have gone through kohanga reo (preschool Mori immersion), kura kaupapa (Mori immersion primary) and whare kura (secondary school immersion). While knowledge of te reo and culture is a indicator of a secure identity and is seen as a protective factor against conduct problems, that alone can not prevent the prevalence of conduct problems. Therefore it is important that interventions for bilingual tamariki, taiohi and/ or whnau reflect their preferences in language. The ability for practitioners to talk in te reo with a child, young person and or whnau members who speak Mori will assist greatly with engagement and connections. 5. Mihimihi  Structured communication The purpose of mihimihi in a powhiri process or less formal process (mihi whakatau) is to identify each person present by where they are from and their whakapapa connections. Bennett (2009) discusses the need for a clinician and client to establish a relationship. For this to occur, Mori need to get to know the other person. It is important to know who the person is, where they come from and who their family is. Thus time needs to be set aside for the clinician, the patient and whnau/ support person to get to know each other. (Bennett, 2009: 64) Mihimihi typically involves each person stating where they are from and who they are. Facilitating this process in a meaningful way is a definite skill. The purpose is so connections can be made with all people present at a hui or meeting. For many, these connections can be made through whakapapa making whnau, hapk and iwi connections. Sometimes the process of mihimihi can be used to disclose other information that might connect participants, especially if it is a mixed group. For example a clinician may begin a mihimihi process and include whakapapa information as well as disclosing information such as where he/ she was raised, current interests, a landsite in New Zealand that he or she identifies with, etc. By then asking the people at a hui to disclose this information, connections are able to be made with participants without necessarily needing to be a whakapapa connection. If the intent is to ensure connections are made, then at times it may require a facilitator to provide information, or to ask the appropriate questions that can ensure this occurs at the beginning of hui. This is an essential tool in engaging and working with Mori whnau. It would be very useful in making connections with non-Mori participants as well. Pepeha are proverbs that pertain to a specific iwi, and the use of them tells where that person is from. In many cases, pepeha refer to a maunga, awa, marae, tkpuna (ancestor), hapk and iwi. Each pepeha is unique to the area from which that person identifies with. Some Mori, as the following poem highlights, do not know of their traditional pepeha. Sad Joke on a Marae Tihei Mauriora I called Kupe, Paikea, Te Kooto Rewi and Te Rauparaha I saw them Grim death and wooden ghosts Carved on the meeting house wall In the only Mori I knew I called Tihei Mauriora Above me the tekoteko raged He ripped his tongue from his mouth And threw it my feet Then I spoke My name is Tu the freezing worker Ngati DB is my tribe The pub is my marae My fist is my taiaha Jail is my home Tihei Mauriora I cried They understood the tekoteko and the ghosts though I said nothing but Tihei Mauriora for thats all I knew. (Taylor, 1993:277) This example highlights disconnection, whakam (shame) and connection of the person all at once. The process of mihimihi would work to establish what other commonalities could be established. For many Mori youths, a commonality could be not knowing their tribal pepeha. Mihimihi is an essential tool to establish connections. Often it requires the practitioner to skilfully identify where one is going to make a connection. 6. Whakawhanaunga  Multiple system dynamics The concept of whnau and its wider applicability in relation to the many systems that an individual and whnau are involved in has already been discussed. Whakawhanaunga refers to the connections and relationships that exist and that need to be established for optimal wellbeing. In relation to engagement in programmes, whakawhanaunga is vital in ensuring meaningful connections. It is a continuing process, not a one-off event. Embedded in whakawhanaunga are concepts such as aroha, manaaki and tautoko (support). Moreover, whakawhanaunga contributes to a persons sense of belonging and can improve outcomes for Mori, strong identity and healing and recovery (YT&T, 2007). Immediate whnau relationships refer to the sense of connection and relationships with kuia and kaumatua, in addition to tkpuna and ha a kuia ma a koro ma (aspects of tikanga that have been passed down from ancestors) to whnau (Pere, 1991). The potential use of the teina/ tuakana (youngest/ oldest) model as a mentoring and buddying system when working with Mori tamariki, taiohi and whnau is an important consideration for whakawhanaunga and establishing connections. As highlighted by Durie (2005) the whnau can also take a much wider approach. Whakawhanaunga also acknowledges the promotion of intersectoral working and a multi-systemic approach to working with whnau (YT&T, 2007). A tatau mahi kia kaha United effort The processes and protocols used within Special Education services highlights the importance placed on whakawhanaunga and the importance of the first point of contact as discussed earlier (that is, karanga). There are clear protocols that occur when a Mori child is referred to the service. These protocols include the involvement of a kaitakawaenga at the outset of a referral and, if agreed on with the whnau, a manakitia te whnau form (cultural profile) being completed. These processes help identify the cultural needs of the whnau and with engagement and connection of whnau within specialist education services. The role of the kaitakewaenga, being the first point of contact with a whnau coming into the service, may be a critical factor in the engagement and ongoing support of the whnau in Special Education and also the conduct problem arena. As discussed by Berryman and Bateman (2008): Kaitaiawaenga expertise and knowledge is an integral component to the service delivery process, as they are able to draw from Kaupapa Mori ways of knowing and engaging, enabling whnau to bring their own cultural realities and preferences to interactions. There are also clear review protocols for working with the bicultural service and involvement of the kaitakawaenga and lead worker service agreement forms (that is, working with the wider whnau or kaupapa whnau). In Pikinga ki Runga, Macfarlane (2008) maps the processes of partnership, protection and participation for whnau, tamaiti and the classroom, referring to the concept of huakina mai (opening doorways; that is, engagement), mana motohake (based on te whare tapa wha) and he tikanga whakaaro. Much emphasis is placed on how GSE will engage and collaborate with whnau during programme planning. Engagement is described as an ongoing process. Listed are ways in which Special Education workers and teachers can increase this engagement. This includes: negotiating meeting times and venues with whnau whakawhanaungatanga  investing time in establishing and maintaining quality relationships whakarongo  actively listening to whnau, leaving a draft copy of notes taken in the session with whnau awhi mai, awhi atu  sharing knowledge and information about one another whakapapa  making family connections and increasing knowledge and awareness of connectedness whenua  making links with mana whenua through connections with the land service negotiation  involving whnau, child, and key and co-workers. In the Department of Corrections Mori Strategic Plan, the engagement and inclusion of whnau is highlighted as one way to improve responsiveness to Mori. It is noted that other agencies have whnau-inclusive services and that the department s service to Mori can be improved by incorporating whnau involvement. The appointment of whnau liaison workers in all Mori focus units was one way this was being addressed. In addition, the department was to explore the feasibility of appointing whnau liaison workers to all the youth units and women s prisons. 7. Manaaki  Honouring and supporting The concept of manaaki is also connected to the process of powhiri. It is also an ongoing process. Manaaki refers to nurturing relationships, looking after people and being careful about how others are treated. Manaakitanga is a key component of Mori culture. Manaakitanga is about positive human behaviour and  encourages people to rise above their personal attitudes and feelings towards others. The aim is to nurture relationships and to respect the mana of other people no matter what their standing in society may be.  Treating people with dignity and respect, acknowledging mana tngata (respect for human kind) and kaitiakitanga (guardianship) are aspects of manaaki. Manaaki can be seen in both clinical and cultural encounters. It can be expressed at an individual level and at a service level, in the way a service promotes  active hosting and support of tangata whaiora and whnau (YT&T, 2007). Hospitality, a component of manaaki can range from the type of reception whnau may receive in a waiting room and being offered a drink while waiting to be seen, to being greeted by kaumatua in a formal powhiri process and partaking in shared eating afterwards. 8. Aro matawai Assessment The process of powhiri, mihimihi and whakawhanaunga, if implemented appropriately, can lay the groundwork for a meaningful assessment where rapport and trust have been established with tamariki, taiohi and whnau and the assessor. Bennett (2009) emphasises the importance of ascertaining the  self-defined cultural identity of a client from the start. The importance of determining a person and whnau sits along the identity continuum (Stevenson, 2004), and will influence the assessment process as to how a clinician sensitively promotes a positive Mori identity. The assessment process needs to be holistic. As discussed, Te Whare Tapa Wha is a model that can be used in both generic and Kaupapa Mori services. As recommended by TRK, the assessment process with Mori tamariki, taiohi and whnau needs to integrate cultural, clinical, educational and social dimensions. From this thorough assessment, comes a personalised treatment plan that addresses cultural, clinical and whnau needs (TRK, cited in AGCP, 2009a). In outlining the guidelines for a cultural assessment for Mori under the Intellectual Disability Compulsory Care and Rehabilitation Act 2003, it is noted that the  process of engagement is one of the ways of determining whether a Mori cultural assessment might take place. In addition, it states that: The assessment process validates Mori healing methodologies, such as karakia, rongoa, spiritual assistance, tikanga, whanaungatanga, te watea, awhi, manaakitanga, whakapapa, whakawhanaungatanga, moemoea, matauranga Mori, taha wairua and mauiuitanga. (MOH, 2004:6) While many generic services may not have the skills to conduct a cultural assessment or have extensive knowledge in the above concepts, the process of engagement may help identify whether a cultural assessment is necessary. It is important, therefore, that generic services have a minimum level of knowledge, understanding and exposure to components of whanaunga, whakawhanaungatanga, karakia, taha wairua, manaakitanga and tikanga. 9. Ohaoha Partnership The concept of ohaoha refers to aspects of generosity and reciprocity between clients, whnau and professionals. The therapeutic relationship can be viewed as a reflection of ohaoha (YT&T, 2007). Being able to acknowledge that each person brings with them their own mana and knowledge is important in facilitating the concept of partnership. For example, a tauiwi clinician with very little te reo knowledge may be working with a whnau who speak te reo. The clinician can bridge the gap and power imbalance by acknowledging whnau expertise in this area and having the whnau assist the clinician in learning phrases. The clinician can provide advice and knowledge about his or her own area of expertise. In essence, the acts of giving and receiving, mai and atu are a part of ohaoha. It has the potential to bridge the power imbalance sometimes felt by Mori when being assessed by professionals both Mori and tauiwi. 10. Aroha  Strength and encouragement The word aroha has a range of meanings depending on the context in which it is used. Love, sorrow, sympathy, compassion, encouragement are all words its meaning encompasses. In a clinical setting, aroha can be expressed in practical actions, such as having positive Mori media images around the service, access to water and ensuring there are appropriate times for hui (YT&T, 2007). Aroha is related to the concepts of tautoko, manaaki and awhi (embracing). Being compassionate as a clinician and being able to see when aroha is  running low in other whnau is also important in implementing interventions that can help a whnau to reconnect, feel aroha and subsequently begin to heal (YT&T, 2007). Macfarlane (2007) describes aroha as being fundamental to the Hikairo Rationale, a culturally responsive approach when working with students with learning and behavioural difficulties. He says: Aroha does not mean a soft approach. In the context of discipline, aroha connotes co-operation, understanding, reciprocity, and warmth (p. 118). Given that aroha is a fundamental concept within Te Ao Mori (Macfarlane, 2007), it deserves consideration in clinical and cultural supervision. Aroha in action can mean, at times, that practitioners have to make difficult decisions a tamariki, tamaiti and whnau may not agree with; for example, a CYFS notification. For some Mori practitioners the concept of aroha in action can have non-Mori practitioners questioning boundary issues etc. Maintaining aroha requires supervision. For kaimahi Mori there are particular issues around shared grief and loss and hopelessness in working with our own that need to be attended to (H. Elder, personal communication, 2009). Summary In summary, there are a number of Mori protocols and concepts of which practitioners need to have an understanding. Issues related to the context and environment where encounters occur and the processes involved, such as karanga, karakia, mihimihi and te reo, are vital when looking at engagement issues with Mori whnau. A holistic perspective has been highlighted as important in the assessment process (aro matawai, as is to exhibit the ability to manaaki (support), whakawhanaunga (make connections), ohaoha (a partnership and approach) and provide aroha (strength and encouragement). Cultural competency incorporates awareness, knowledge and skills. This section provides information to increase awareness and knowledge. The next step is for practitioners to use these processes and concepts in a meaningful and respectful manner in order to enhance a positive identity and connections when working with Mori tamariki, taiohi and whnau experiencing conduct problems. Being able to work with these processes and concepts will require both cultural and clinical supervision. PROVIDER: ENHANCING IDENTITY AND CONNECTIONS As noted earlier, it has been postulated that implementing dedicated Kaupapa Mori services and increasing the Mori content in generic programmes will result in better engagement and retention of Mori in clinical services (Huriwai et al, 2001). This section discusses issues surrounding service delivery and the potential to further enhance identity and connections. In 2001, the Te Puni Kokiri (TPK) published a report, Whanake Rangatahi Programmes and Services to Address Youth Offending (Owen, 2001). A major conclusion was that there was a lack of well-resourced, Mori-developed and Mori-focussed programmes for Mori youth offenders: Young people and whnau are clear about the issues and many of the solutions. They need to be involved in an ongoing basis  in deciding what is needed in their communities. (Owen, 2001:186) The review recommended that: government agencies must adopt an integrated and holistic approach Mori must be involved in programme and service design and delivery government agencies must collect robust information on participation and outcomes government agencies need to provide Mori youth and whnau with better information on programmes and services. The conclusion noted that: & the little information we do have indicates that Mori approaches to addressing offending are very successful and deserving of greater government support. (Owen, 2001:189) A key recommendation of the TRK, is the imperative of sound research being conducted to identify what programmes are working for Mori tamariki, taiohi and whnau experiencing conduct problems. In particular TRK advocates that this gathering of evidence needs to be formulated from a Kaupapa Mori approach: A major investment is needed to support the gathering and analysis of evidence from a Te Ao Mori context to sit as part of the evidence base in NZ to full inform the delivery of effective programmes for conduct problems. (TRK, cited in AGCP, 2009a:43) In relation to generic programmes, TRK recommended: With generic services effective cultural consultation and participation by Mori should take place at all stages of the development and evaluation of new services (ibid). In order to provide robust information about which programmes are working for Mori tamariki, taiohi and whnau with conduct problems, it is necessary to first identify the programmes available. It is not within the scope of this preliminary report to review all currently available programmes; however, we present five different programmes to highlight differences in scope, values and practice. Kauapapa Mori Te Atawhaingia Te Harakeke Te Atawhaingia Te P Harakeke is a programme with a  by Mori for Mori with Mori values approach  in essence, a Kaupapa Mori approach. It does not deal directly with tamariki, taiohi and whnau, but with the kaupapa whnau. 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#hh|}hn|6OJQJ^JmH sH h{OJQJ^JmH sH hjOJQJ^JmH sH  hh|}hjOJQJ^JmH sH h<*OJQJ^JmH sH h cOJQJ^JmH sH  hh|}hn|OJQJ^JmH sH  hh|}hOJQJ^JmH sH hOJQJ^JmH sH RHJ~DL ʻܭ܋}o^ܭܭܭܭPܭhjOJQJ^JmH sH  hh|}h2OJQJ^JmH sH h2OJQJ^JmH sH h{OJQJ^JmH sH  hh|}h{OJQJ^JmH sH  hh|}h<*OJQJ^JmH sH h<*OJQJ^JmH sH h]C6OJQJ^JmH sH #hh|}hn|6OJQJ^JmH sH  hh|}hn|OJQJ^JmH sH #hh|}h6OJQJ^JmH sH   >D`02JT>H>N>??űᕇyhhfYhh|}hn|OJQJ^JU hh|}h2OJQJ^JmH sH h8OJQJ^JmH sH hjOJQJ^JmH sH h2OJQJ^JmH sH h cOJQJ^JmH sH &hh|}hn|56OJQJ^JmHsHhh|}hn|mHsH hh|}h<*OJQJ^JmH sH  hh|}hn|OJQJ^JmH sH h<*OJQJ^JmH sH  programme is to address the impact of domestic violence on whnau, hapk and iwi and their development, based on a Mori cultural framework. Atawhaingia Te P Harakeke is a whnau development training and support programme for Mori and iwi education, health and social service organisations. The programme is delivered by the Ministry of Education training unit, Te KMmako to more than 200 providers over 10 ten years. The parenting programme is called Hkuitanga / Hkorotanga, whose aim is to upskill facilitators of Mori parenting programmes based on Mori cultural frameworks. As noted by Elder (2009): The strengths of the Atawhaingia Te P Harakeke programme come from the understanding that the acquisition of effective parenting skills for Mori are optimised by the use of a Mori cultural framework. The development of the programme from its earliest application in prisons with efficacy in working with Mori fathers has led to current capacity to train providers to build connections with Mori who may be initially dismissive, avoidant or actively refusing input and support. The programmes have demonstrated efficacy with extremely complex cases. (p. 1) Elder advocates that increased investment into programmes such as Atawhaingia Te P Harakeke is a better investment strategy than limiting the spend on generic programmes that have little or no robust evidence base for Mori participants. Te Kawa o te Marae Another example of training that assists practitioners in a range of sectors to work more effectively with whnau is Te Kawa o te Marae. This training is based on rituals and protocols that occur on the marae. It was initially developed and refined by the team at Te Whare Ruruhau o Meri in Otahuhu, Auckland, in 2000. The model of practice promotes whnau engagement, motivates change and allows for safety, transformation and healing. Facilitators describe the framework as: a safe and effective pathway for transformational work alongside whnau (individually and collectively). Within this context practitioners can apply any of their existing skills in the way they decide it is most helpful to assist the whnau member/s with their engagement, understanding, sense of responsibility and/or accountability, change, healing and restorative processes. (Clarke, 2009) Bicultural Lower North Island Severe Conduct Disorder Unit The Lower North Island Severe Conduct Disorder Unit is a bicultural unit operating under the frameworks of Puao-te-ata-tu (Department of Social Welfare, 1988) and Te Whare Tapa Wha. As discussed earlier, the aim of the service is to provide an inclusive bicultural approach that uses both clinically and culturally relevant treatment, interventions and specialist care for young people/ rangatahi experiencing severe conduct disorder and a co-existing mental health difficulty. The programme manager, Peta Ruha, identified the approaches that have been positive when working with Mori whnau: whnau therapy from a range of sectors and disciplines working with immediate issues the whnau is presenting with utilising a range of interventions and different mediums (ie, talking, writing, hui) at any given time resourcing the whnau with access to a range of expertise and experience. In identifying the approaches that appeared to have a positive impact on Mori whnau, it was stressed there were workforce issues, in that practitioners needed both clinical and cultural experience. These practitioners also needed skills, knowledge and experience in working effectively with whnau and the wider whnau network. The concept of whakawhanaungatanga was essential but the unit also needed extensive collaboration with other sectors, who needed to acknowledge that all involved had a collective responsibility to the whnau in question (P.Ruha, personal communication, 2009). The kaupapa whnau or interagency linkages were also identified by Durie (2005) as potential barriers to successful outcomes. While this was in reference to early intervention and conduct problems, it is also relevant to tertiary services: Linkages between schools, whnau, health services, the courts, statutory welfare agencies and community family services are not well established and are often complicated by quite different philosophies and modes of practice. Research in NZ and abroad has confirmed the importance of inter-agency and inter-disciplinary collaboration especially for child and adolescent externalising disorders and where early intervention is the goal. (Durie, 2005:6) This bicultural service does not currently undertake any outcome evaluation, but there has been an initial meeting with the creator of Hua Oranga, Dr Te Kani Kingi, about adapting Hua Oranga for use within the unit. Generic programmes It has been hypothesised that being able to effectively engage and support Mori whnau in conduct problem programmes will result in better retention and ultimately better outcomes for tamariki, taiohi and whnau. The issue of engagement is essentially related to the connections and whakawhaungatanga (relationships) that have been established. Two generic programmes administered to Mori participants are reviewed; they highlight the importance of establishing connections and using Mori processes to engage and retain Mori. Tips and Ideals on Parenting Skills (TIPS) Gifford & Pirikahu (2008) implemented a generic parenting programme (TIPS) within a Mori community and identified a number of challenges in developing and implementing the programme. The researchers recommended engagement as a priority when working with Mori whnau (Gifford & Pirikahu, 2008). Recruitment of whnau was a major issue for the researchers, and it was suggested that people who already had rapport and whanaungatanga (connection) with whnau were the most appropriate first point of contact for recruitment of whnau to parenting programmes. It was further recommended that potential and existing providers needed to allow sufficient time and resources for recruitment and retention of whnau. In addition, the barriers they identified to effective engagement included: programme timetabling delays in starting programme social and health issues that took precedence apprehension by Mori whnau about parenting programmes generally (Gifford & Pirikahu, 2008). Incredible Years Basic Parenting Programme The Incredible Years  Basic Parenting Programme (IYBPP) is an overseas programme that has been implemented in New Zealand to assist in working with children and families with conduct problems. Such parenting programmes have been demonstrated in randomised control trials overseas as being useful in reducing the rates of childhood conduct problems. Fergusson, Stanley and Horwood (2009) undertook preliminary research evaluating the efficacy and cultural acceptability of the IYBPP in New Zealand. Based on their preliminary evaluation, the authors concluded that IYBPP is an effective and culturally appropriate programme. However, the authors did not present any data on the number of Mori parents who dropped out of the programme. As the authors acknowledged, there was no data on those who declined to attend or who dropped out of the programme and the results may give an  overly optimistic view of the efficacy and acceptability of the programme (Fergusson et al, 2009:79). The issues of generic programmes, programme fidelity and cultural responsiveness are discussed in Section 4. Herewini and Altena (2009) evaluated a Mori whnau group completing a generic programme, the IYBPP. Measuring programme effectiveness was not a part of their research, but rather the utility and applicability of a Mori context in the delivery of the programme with Mori whnau. Their evaluation was conducted using Te Whare Tapa Wha, and evaluation questions were based on Hua Oranga (Kingi and Durie, 2000). While their cohort was small (n = 10), they had an 80% retention rate. Key differences in the delivery of the programme included the use of tikanga, a powhiri and poroporoaki process and the delivery of the programme on a marae. The authors concluded that these factors, in conjunction with the programme and the  right facilitators , likely contributed to the high retention rate. In their evaluation process, the authors identified what worked well. This included: & a lengthy and culturally appropriate engagement process, taking our time, bringing kai and listening to the whnau concerns regarding their tamariki. (Herewini & Altena, 2009) The facilitators highlighted a number of areas for improvement. Those that may impact directly on whnau engagement and support included: the need for closer relationships with parents case managers (half the participants had mental health issues) transport for parents and wider transport options giveaways to parents to encourage self-care and modelling providing tangible rewards having support workers attend the programme and assist with implementing strategies in the home setting having additional access to kaumatua to further talk about traditional and contemporary views of parenting. AGCP, CAMHS and TRK In the Conduct Problems: Effective Programmes for 3-7 Year Olds (AGCP, 2009b) report strategies when working with hard-to-engage clients were identified, and included ensuring generic programmes were delivered in culturally appropriate ways by culturally competent practitioners (AGCP, 2009b). To ensure a programme was culturally appropriate, there needed to be: consultation with key cultural groups inspection of programme context to determine cultural appropriateness client satisfactions surveys statistical comparison of rates of participation, drop out, programme completeness and programme outcomes for different cultural groups (AGCP, 2009b). In discussing strategies to reach hard-to-engage clients (not only for Mori whnau) it was highlighted that timing of programmes was important, as was providing financial support, ensuring that clients (the family) had other supports and providing families with incentives for completing the programmes (AGCP, 2009b). Mori children and adolescents experiencing conduct problems can also be seen by local child and adolescent mental health services. The Child and Adolescent Mental Health Services (CAMHS) contract specifications exclude those with conduct disorder alone. In practice this poses a number of problems; a reluctance to assess young people who have a referral suggestive of conduct disorder and to make the diagnosis of conduct disorder as this may compromise service provision (H. Elder, personal communication 2009). In 2005, Ramage et al (TRK, cited in AGCP, 2009a) conducted research into identifying the barriers for Mori to mental health services. TRK were of the opinion that these barriers generalised to Mori with conduct problems. These barriers centred on: lack of services and specialised staff whnau lack of knowledge of services criteria for referral length of delay in being seen lack of feedback. In essence, service delivery issues such as the referral process leading up to being seen, and communication issues once involved, were barriers for Mori being seen by generic child and adolescent mental health services. TRK (cited in AGCP, 2009b) identified principles of best practice as a way of ensuring service providers promote identity and enhance connections when working with Mori tamariki, taiohi and whnau experiencing conduct problems. The holistic approach required of programmes and a focus on whnau ora were essential requirements of both generic and Kaupapa Mori programmes. In order to achieve this, TRK recommended there be an increase in Mori participation in the planning and delivery of conduct problem programmes as well as promoting workforce development issues for Mori practitioners and providers. PROVIDER: CULTURAL SUPPORTS BEYOND PROGRAMME DELIVERY Providing ongoing support to Mori whnau attending programmes reflects the concepts of manaaki, aroha and ohaoha. Cargo (2008) identified actions that could enhance the support provided to Mori whnau attending parenting programmes: This included: providing a buddy and mentoring system support and connection to a turangawaewae, hapk and iwi support between sessions. Teina/ Tuakana The issue of a buddy or teina/ tuakana (younger/ older) system was identified by Mori facilitators (Cargo, 2008) as being another factor that would assist with retention of whnau and providing ongoing support. In particular they advocated that participants from previous courses come and talk with the new group. The teina/ tuakana system dates back to pkrkau and utilises a whnau concept where one who is older, or more knowledgeable or more experienced supports the younger, less knowledgeable or less experienced person. This system of responsibilities again highlights the values of manaaki and aroha. From a whnau ora approach, attendance at parenting programmes may not be just for the matua (parents) of a tamaiti or taiohi, but also for the rest of the whnau who have contact or care for the child. It could be of benefit to have an older brother or sister attend with parents as support, and who have accountability to each other during and after programme attendance. Support and connection to a turangawaewae, hapk and iwi Lyrics from  Stronger by Scribe And I made it through the rain and cold, through the dark all alone. My life hit rock bottom, I had no where to go and if I could change back time and change the road that I chose, all the mistakes I made that burnt a hole in my soul, and it took all that I had to get out of the hole& It took the love of my family and friends to show me the truth I ve lived a life time of pain and I am only a youth& And even the strongest trees must grow from the roots See a house without love aint a home, it s a roof, a shelter without warmth, man you know its true. This song highlights the importance of connections, whnau and the depth and meaning of relationships. Knowledge alone of one s turangawaewae requires the establishment of a connection and relationship, a sense of whanaungatanga. The concept of turangawaewae, knowing and connecting with the place you are from is a vital component of Mori identity. However, having knowledge is one component; having a connection and ongoing relationship is also of vital importance. Many Mori whnau are unaware of their connections to hapk and iwi. Programmes that want to enhance identity and connections need to make sure the beginning steps are in place for a relationship to exist with the whnau and their turangawaewae, hapk and iwi. The reality of urban Mori raises challenges in terms of turangawaewae, but this does not mean that connections with people from their own hapk and iwi cannot occur. Connecting whnau with taura here roopu (iwi groups that are not local) and kaumatua living in the locality has the potential for positive outcomes in terms of identity and a sense of belonging and connection. Additionally, connection with hapk and iwi is forever and does not end on completion of a programme. This reality can have a significant impact on whnau ora if initiated in a meaningful way. Support between sessions An emphasis on programmes would be to make sure participants established a strong sense of whanaungatanga with each other so there was ongoing support for each other after programme completion. As identified by Cargo (2008), based on the parenting programme they implemented, factors to increase success included  keeping to Mori kawa, karakia, whakawatea and whakawhanaungatanga in every session (Cargo, 2008). The role of facilitators would be to ensure this occurred by encouraging the exchange of contact numbers (with the agreement of group members) and possibly setting up a formalised system of manaaki where members contacted one another, particularly if they appeared to be struggling with issues. It would be clear that this contact was not to provide counselling or therapy but to provide contact with another parent facing similar difficulties. As noted by Cargo (2008), regular out-of-session contact and support was also considered important. This could occur through texting or phone calls by group members to each other and, in some cases, the facilitator making contact. The role of the whnau therapist (Durie, 2005) or advocate would be important to ensure ongoing contact after attendance at a programme. In essence, the whnau worker needs to be in contact throughout attendance at programmes and after completion to provide ongoing follow-up. POLICY: ENHANCING IDENTITY AND CONNECTIONS Given that conduct disorder is recognised as largely sociologically driven, the role of social policy in challenging the prevalence of the disorder is significant. At a macro level this requires consideration of health, housing, education, welfare, justice and employment policies and how they actively contribute to wellbeing. When the social policies align to the needs and aspirations of Mori wellbeing there will be an improvement in the prevalence of the disorder for Aotearoa New Zealand. In He Korowai Oranga, (MOH, 2002), it is clearly stated as a strategic direction that to ensure accessible and appropriate services, improve whnau ora and reduce inequalities, whnau receive timely, high quality, effective and culturally appropriate health and disability services (MOH, 2002:9). Some of the access barriers identified included: availability of quality services cost travel referral patterns assumptions health professionals make about the behaviour of Mori culturally appropriate services (MOH, 2002). The cultural appropriateness of programmes has been identified as including: consultation with key cultural groups inspection of programme context to determine cultural appropriateness client satisfaction surveys statistical comparison of rates of participation, drop out, programme completeness and programme outcomes for different cultural groups (AGCP, 2009a). As noted by AGCP (2009a) in section 1.2, acknowledgement of article two of the Treaty of Waitangi guarantees that Mori have control of their cultural and social destiny. In honouring this principle, the AGCP recommended that an expert Mori committee be set up to advise and make recommendations on conduct problem policy from a Te Ao Mori view. The review of programmes and services to address Mori youth offending identified a lack of well-resourced Mori-developed and Mori-focussed programmes (Owen, 2001). Recommendations of the review included that: government agencies must adopt an integrated and holistic approach Mori must be involved in programme and service design and delivery government agencies must collect robust information on participation and outcomes government agencies need to provide Mori youth and whnau with better information on programmes and services. It was noted: the little information we do have indicates that Mori approaches to addressing offending are very successful and deserving of greater government support. (Owen, 2001:189) The policy recommendations made by TRK in relation to generic services were: 4.2.1 Service planning should be targeted to a minimum of 15 per cent of Mori 3-17 year olds. 4.2.2 Effective cultural consultation and participation by Mori should take place at all stages of development and evaluation of new services under the Treaty-based relationship described in section 1.2. The policy recommendations made in relation to Te Ao Mori programmes were: 4.2.3 The evidence-based approach needs to recognise indigenous knowledge and experience as a valid contribution to the analysis and critique of programmes for conduct problems. 4.2.3 A major investment is required to support the gathering and analysis of evidence from a Te Ao Mori context to sit as part of the evidence base in Aotearoa/ New Zealand and to fully inform the delivery of effective programmes for conduct problems. 4.2.5 Effective cultural consultation and participation by Mori should take place at all stages of development and evaluation of new services under the Treaty-based relationship described in section 1.2. These policy recommendations advocate the need to develop culturally appropriate services and ensure effective cultural consultation and participation by Mori when developing new services, and also evaluating services currently in place. While not stated explicitly, such policy recommendations are focused on doing what works with Mori. From a Te Ao Mori view, this is centred on enhancing identity and connections. SECTION 4: DELIVERY OF CONDUCT PROBLEM PROGRAMMES: ADDITIONAL ISSUES Introduction Based on recommendations made by the AGCP and TRK, the delivery of conduct programmes for Mori tamariki, taiohi, whnau, hapu and iwi will involve further input in two main areas: development, implementation and evaluation of Kaupapa Mori programmes from a Kaupapa Mori perspective adaptation of generic programmes to be more culturally relevant. The following discussion highlights research issues related to these two areas. THE DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF TE AO MORI PROGRAMMES Development and implementation The recommendation made by TRK of the need for investment so that further evidence could be gathered reflects a desire and right by Mori to know what works so that the best Kaupapa Mori programme can be designed, implemented and evaluated. This includes ensuring that current programmes with promising approaches, positive basic evaluation and audit results, and that have never had research investment to demonstrate their  evidence base are not lost. Section 2 and 3 of this report referred to components of a Te Ao Mori view that could also be considered in the development of Kaupapa Mori programmes. The use of pkrkau, Te Whare Tapa Wha, powhiri, karakia, mihimihi, whakawhanungatanga etc. could be considered baseline components of Kaupapa Mori programmes that have the potential to be taken to deeper and more meaningful levels of understanding for Mori tamariki, taiohi and whnau in fostering identity and connections. It is not in the scope of this report to identify specific components that constitute a Kaupapa Mori conduct problem programme. However, principles underlying a Kaupapa Mori programme can be aligned with principles of Kaupapa Mori research. In a review of the wide range of literature about what constituted Kaupapa Mori research, Walker, Eketone and Gibbs (2006) described Kaupapa Mori research as  the desire for research to be by Mori for Mori, using Mori cultural perspectives (p. 342). A Kaupapa Mori programme, then, could be viewed as by Mori for Mori using Mori cultural perspectives. Accordingly, to use the kaupapa research principles espoused by the researchers, the following aspects are likely to be reflected in any Kaupapa Mori designed conduct problem programme: it gives full recognition to Mori cultural values and systems is a strategic position that challenges dominant Pakeha (non-Mori) constructions of programme design determines the assumptions; values, key ideas and priorities of programmes ensures that Mori maintain conceptual, methodological and interpretative control over programme development is a philosophy that guides Mori programmes and ensures that Mori protocols will be followed during programme implementation and evaluation (based on Walker et al, 2006:333). While this is a framework for Kaupapa Mori research, the result is to build a body of Mori knowledge (Walker et al, 2006); in essence, indigenous knowledge within a contemporary context. This framework could also one from which to consider Te Ao Mori programmes in the delivery of conduct problem programmes. The content of such Kaupapa Mori programmes will vary according to the level of intervention, targeted group and tika (what is true) of the local hapk or iwi. There are no dedicated Kaupapa Mori conduct problem programmes designed by Mori for Mori (Robbie Lane, MSD, personal communication, 2009). As noted in the preliminary review of overseas literature, there also appeared to be no purely indigenous programmes for conduct problems. This is an area that will require further investigation in developing and designing Kaupapa Mori specific programmes for conduct problems. TRK thought there was a wide range of Kaupapa Mori programmes in the community, all of which had the potential to impact on whnau ora and thereby conduct problems for Mori tamariki, taiohi and whnau. Programmes such as Te Pa Atawhainga Harakeke, Tane Whakapiripiri at the Mason Clinic and Te Kawa o te Marae are Kaupapa Mori programmes with the potential for wider effects in conduct problems. As noted, it is not in the scope of this report to identify all potential programmes. This means that TRK will need to identify programmes that may be of use in contributing to a multi-faceted Kaupapa Mori programme for conduct problems, and then to gather evidence from a Kaupapa Mori perspective or research of what components work best. ACC s review of injury prevention and health promotion interventions with Mori communities and other indigenous communities identified a number of common themes in relation to what had been identified through the research as being necessary to ensure the success of indigenous programmes (Cherrington & Masters, 2005). These themes included: the need for consultation and intervention programmes to be community driven the need to incorporate holistic frameworks representing the indigenous worldview into the programmes the ability for co-coordinators of intervention programmes to have or build strong networks with the community to which the programme is to be delivered. In beginning the process of gathering evidence a first step would be to conduct a literature review about what services exist within sectors relevant to the conduct problems area. From this, programmes deemed of high applicability to the design and implementation of a Kaupapa Mori programme could be identified to find specific success factors. It is necessary to know what exists, to avoid  reinventing the wheel when there may well be solid foundations already in place. As well as reviewing which Kaupapa Mori programmes are applicable to the conduct problem arena, it would be beneficial to gather information about funding levels for Mori and generic programmes. Such transparency of information will likely contribute towards equity of funding for Mori programmes. Adapting generic programmes: Issues To enhance identity and connections among Mori tamariki, taiohi and whnau in the delivery of generic conduct problem programmes, the major recommendation has been to have Mori consultation and participation in the development and delivery of generic programmes. At the same time, generic programmes, such as IYBPP, have clear guidelines around maintaining programme fidelity. In essence, there appears to be a desire to maintain the fidelity of generic programmes as well as a need to adapt generic programmes to be culturally responsive. These issues are discussed and an overseas example of a generic programme being adapted is provided. Another issue is around the responsiveness of generic programmes to Mori, and the lack of evidence-based research to substantiate the implementation among Mori in the first place. Overseas research An example of a generic programme being adapted is presented by Bridge, Massie and Mills (2008). The authors highlight the challenge of implementing an evidence-based intervention and maintaining the integrity of the model while ensuring cultural responsiveness. The authors note that due to external pressures such as funding, agencies are now  taking evidence-based practice models off the shelf and implementing them without consideration of cultural and community nuances . The need for compliance to a model and programme for it to be effective and ethically responsive in line with cultural competency requires that the model may also require adaptations (Bridge et al, 2008). In order to be responsive the authors noted: Indisputably, cultural appropriateness is a critical consideration in the selection of any evidence-based practice model or approach. It is the agency s responsibility to ensure that the model fits with their mission and service delivery, and is fully congruent with the culture of their consumers and the community. This fit may allow for total compliance and adherence to the original model, however it may also require adaptations to be both effective and ethically responsive. (Bridge et al, 2008)  In this research (Bridge et al, 2008), a generic model titled  Family Connections was to be implemented in an African-American population. This intervention was aimed at reducing the level of child abuse and neglect. The design and core components of the model were reviewed to determine cultural relevance and responsiveness to the particular consumer base. This was a collaborative effort with input from clinicians, an advisory board and experts in the field. An  implementation model , which integrated required changes necessary for cultural congruence, was developed. Cultural characteristics included: culture specific topics including  the helping tradition, the extended family, race consciousness, respect and strong spiritual life worker training focused heavily on a culturally appropriate manner the need for a highly skilled social worker to conduct assessment and engage family system. The researchers noted that: Successful implementation of the evidence based practice model was fully dependent on the prioritization of cultural competence. (Bridge et al, 2008) In summary, the adaptation of a generic programme involved major consultation on the content of programme, subsequent implementation of culture-specific topics, training about behaving in a culturally appropriate manner and the need for skilled practitioners who could engage family. Huey and Polo (2008) conducted a review of evidence-based psychosocial treatments for ethnic minority youth. They identified that multi-systemic therapy (MST) was the only treatment to reduce criminal offending among African-American delinquent youth in randomised trials. The researchers concluded: clinicians should utilise evidence-based treatments (EBT) when treating minority youth family systems treatments such as BSFT (Brief Strategic Family Therapy), MDFT (Multidimensional Family Therapy) and MST (Multi-systemic Family Therapy) are supported in the EBT literature as being probably and/ or possibly efficacious for ethnic minority youth with conduct problems and drug related disorders. However, the authors concluded there was mixed evidence in relation to the efficacy of culture-responsive strategies with EBTs. They said two strategies were available when utilising EBTs with minority youth: maintain the EBTs in their original form and apply only those culture-responsive elements that are already incorporated into the EBT protocols tailor treatments for ethnic minority youth but only to the extent justified by client needs. In considering these points, it is useful to identify from this review what the cultural-responsive strategies were. The number of studies identified as EBTs with cultural responsive elements was 16. Eleven of these were identified as dealing with conduct-type problems. The types of culture-responsive elements of EBTs ranged from: 1. Therapist being the same ethnicity as the client group A total of 6 of the 11 studies had the same ethnicity as the culturally responsive element. For example, in one programme, two thirds of the counsellors were African-American. 2. Holistic/ multifaceted approach Two studies described the therapists using a holistic approach. For example, in one study: therapists used client strengths across multiple life domains including cultural/ ethnic/ spiritual interests and involvement. (Huey & Polo, 2008:288) 3. Use of family and peers Two studies referred to the use of family. For example: Treatment was  culturally appropriate in its use of family volunteers and socially high functioning peers with common cultural backgrounds and experiences. (Huey & Polo, 2008: 287) In addition, one study utilised a family resource specialist to help families develop indigenous social supports. This person was used also to assist the clinical team understand the culture and context from which the families came. 4. Programme content/ resources In four programmes specific mention was made in relation to cultural issues and culturally appropriate resources. In essence, the degree and variance of what constituted a culture-responsive element varied considerably. In six of the conduct-type studies, the only cultural-responsive element was the fact that the facilitator was the same ethnicity as the group. It could be argued that this by itself does not constitute a cultural-responsive element. For example, ethnicity does not necessarily mean an adherence or knowledge of cultural values and ways of interacting that are important to engaging and working with indigenous groups. This may well have been why there was mixed evidence as to the efficacy of cultural-responsive adaptations to generic programmes. Also, it was noted by the reviewers that the major limitation of all the reviews on the efficacy of cultural adaptations to EBTs was in relation to the cultural validity of the outcome measures which the authors described as Eurocentric. In summary, the review found mixed evidence in relation to the efficacy of cultural-responsive strategies in EBTs. This could be viewed in two ways. First, there is no need to adapt generic programmes to be more culturally responsive because there is mixed evidenced to support that it works. Second, in the research, rather than the cultural-responsive strategies being of little reported use there is mixed evidence supporting the implementation of culture-responsive strategies into generic programmes. Trying to make generic programmes culturally responsive for minority groups may just not work; they may not be effective with minority youth. This requires further investigation. It could also be argued that what is required are programmes for minority youth designed and evaluated based on their own cultural values and beliefs. While the review conducted by Heuy and Polo (2008) is extensive, it highlights the seemingly total lack of literature on a purely indigenous treatment approaches to conduct problems. New Zealand research Significant concerns at the appropriateness of overseas parenting programmes aimed at reducing prevalence of conduct problems with Mori have been voiced (Cargo, 2008; Elder, 2009), and indicate that consultation and review of programme content is needed. For example, in 2008 a national hui of Mori facilitators was held to discuss their experiences delivering the Incredible Years  Basic Parenting Programme (IYBPP) and to formulate responses to a publication by Webster-Stratton (2007, cited in Cargo, 2008) advocating for a generic IYBPP but culturally sensitive programme rather then one that was culturally adapted, thereby reducing risks of programme fidelity. Mori facilitators noted that the resources were not relevant to a New Zealand context. For example, the DVD showed people with American accents. The facilitators felt that resources needed to be relevant, reflective and realistic. This is similar to Elder s criticism (2009) of some American resources used by some IYBPPs that they would not be responsive to Mori and do not promote a positive Mori identity. Mori facilitators also felt that the IYBPP was being implemented with  double standards . It was noted that the IYBPP was advocated because of an evidence base, yet there was no evidence to support that the programme was effective with Mori whnau. As noted by one facilitator: I am just so frustrated that there isn t equity in delivering programmes. Mori want evidence based programmes as well, but we want ones that are based on our beliefs and values. Because I know that there is no evidence that this programme works with Mori, yet here we are all being trained in it. (Cargo, 2008) Cargo (2008) further states there is no Mori-designed, kaupapa-based research in New Zealand that shows IYBPP is effective for Mori. It was recommended that the IYBPP be culturally adapted to include key Mori processes and that Te Whare Tapa Wha be incorporated into the training of all facilitators. It was seen as important that Mori whnau had a choice about which types of programmes to attend (that is, a generic culturally-adapted programme) in addition to Kaupapa Mori programmes. Kauapapa Mori programmes needed to be afforded the same respect and value in Aotearoa New Zealand (Cargo, 2008). As discussed earlier, one study that reported on the efficacy and cultural acceptability of the IYBPP also had limitations (Fergusson et al, 2009). In essence, their research has been used as evidence of a generic programme being identified as culturally acceptable to the 41 Mori people who took part in the programme. While the authors noted limitations in the programme, especially around a lack of data on the number of Mori who did not complete it, Elder (2009) queried why the limitations were not more widely publicised or considered before the widespread implementation of the programme. The importance of maintaining programme fidelity is such that the AGCP recommended a specialist advisory group be established to ensure this occurs. Based on TRK s recommendation for effective cultural consultation at all stages of development, implementation and evaluation of new services, it will be imperative there is adequate Mori representation on such a group. As identified previously from AGCP and TRK, determining the cultural appropriateness of programmes needs to include: consultation with key cultural groups inspection of programme content to determine cultural appropriateness client satisfactions surveys statistical comparison of rates of participation. TRK also recommended a whnau ora approach to any intervention or programme design, which should include: Mori participation in planning and delivery of programmes being able to demonstrate whnau inclusive practice a holistic approach to treatment plans that addresses cultural, clinical and whnau needs (TRK). Conclusion Based on the recommendations made by TRK, and research conducted here and overseas, the adaptation of generic programmes to be culturally responsive to Mori is required. Doing so prioritises cultural competence in the delivery and content of programmes for Mori tamariki, taiohi and whnau attending generic programmes, and is likely to enhance their efficacy for Mori. Based on this previous section and on research, cultural responsiveness includes: the need for a holistic approach such as Te Whare Tapa Wha a focus on whnau ora incorporating Mori processes and values such as powhiri and aroha into programme content the use of a whnau liaison worker/ advocate/ therapist a Mori facilitator the programme being delivered in an environment that can help enhance identity and connections, such as marae or turangawaewae. EVALUATION TRK (2009) have called for a major investment in the gathering and analysis of evidence from a Te Ao Mori context to sit as a part of the evidence base in Aotearoa New Zealand. Mori need to have opportunity to implement programmes based on indigenous knowledge and best practice that can then be evaluated from a Mori perspective. As discussed by TRK on 9 June 2009, it is vitally important that Mori know what works for Mori tamariki, taiohi and whnau. In the development of Te Ao Mori programmes it is just as important to be able to identify the factors that contribute to successful outcomes so that they can be replicated. The implementation, development and evaluation of Te Ao Mori programmes need to be undertaken within Mori frameworks and values. These aspirations have previously been acknowledged: All the universal risk factors and those specific to conduct disorder are much higher in Mori. It is therefore both equitable and a sensible allocation of investment resources to allocate a higher percentage of resources to Mori. Programmes for Mori need to be acceptable to Mori, and wherever possible owned by Mori within a culturally safe and appropriate kaupapa. However, Mori equally need professional evidence based prevention and intervention as key aspects in programmes, though within a Mori kaupapa. (Werry, ed, 2005, cited in Elder, 2009) Indigenous knowledge TRK have advocated that indigenous knowledge and experiences be recognised as valid contributions to the analysis and critique of programmes for conduct problems. It would appear that while an evidence base is being built around Kaupapa Mori or Te Ao Mori programmes, the indigenous knowledge, understanding and history that exist around tikanga, whakawhanaungatanga, pkrkau, waiata, te reo etc. needs to be accepted as just as valid a contribution to deliver outcomes for Mori. There are many other facets of indigenous knowledge relevant to programme implementation and outcomes. The processes of hui and consultation, for example, should be viewed as having mana within Moridom and just as valid in assisting Mori achieve whnau ora. In other words, the cultural protocols that give mana to Mori identity cannot be separated from sub-components or principles underlying any conduct problem programme as a conduit of whnau ora. Durie (1997) discusses the issues of Mori knowledge and scientific enquiry in the context of the resurgence of traditional healing: & conventional explanations may not only be inadequate to explain traditional knowledge, they might impose inappropriate frameworks which are incapable of encompassing the holistic nature of the understanding& . Full understanding requires the capacity to learn from quite different systems of knowledge and to appreciate that each has its own validity of its own within its own cultural context. Science is one such system. Mori cultural knowledge is another& a challenge will be to accommodate more than one system of knowledge without necessarily attempting to validate one using the criteria of the other. (Durie, 1997:11) Durie is essentially advocating for different knowledge bases having their own standing. In discussing Mori-centred research, Durie (2005a) supports the utilisation of both generic/ scientific and Mori methodologies, rather then discounting one methodology in favour of the other. He calls this interface research and suggests that we need to: Harness the energy from two systems of understanding in order to create new knowledge that can be used to advance understanding in two worlds. (Durie, 2005b, p. 306) Evidence-based research In considering best practice around evidence-based research and indigenous knowledge, it is useful to consider both quantitative and qualitative information. Given the dearth of quantitative information about indigenous programmes, different types of information need to be acknowledged. For example, in looking at the issue of evidence-based purchasing of health promotion initiatives, Rada, Ratima and Howden-Chapman (1999) were required to develop a framework for prioritising 22 health promotion interventions. They used a broad range of evidence which included scientific research, organisational capacity, socio-cultural factors and local community-based knowledge. They concluded that for: & evidence-based medicine, evidence-based health promotion must employ both quantitative and qualitative evidence, and that the final judgement about purchasing of health promotion initiatives is essentially subjective and political. (Rada et al. 2003) The use of qualitative information and what has been endorsed by Mori through the process of hui and consultation is a form of knowledge which has a cultural validity and mana (standing) in the community. For example, Puao-te-ata-tu recommended a number of actions that needed to occur in order for the then Department of Social Welfare to be more responsive to Mori. The document outlined specific actions towards the department becoming bicultural. This specific strategy has not been researched; however the recommendations were based on extensive consultation with Mori and, therefore, the strategy has a type of cultural validity for Mori. Since the 1980s, Mori health hui have repeatedly called for the inclusion of wairuatanga in health practices when working with Mori (Durie, 1998), with the result that health services now acknowledge this component of wellbeing. In devising Hua Oranga, an extensive consultation process was used, whereby the Whare Tapa Wha framework was endorsed (Kingi & Durie, 2000). The qualitative information (ie, hui, consultation and community endorsement) must be given weight in considering best practice and for an evidence base. Practice-based evidence Practice-based evidence is gaining increasing recognition in the clinical arena. It revolves around receiving feedback in each session about effectiveness and engagement that leads a clinician to modify sessions according to the needs of the client. The Outcomes Rating Scale (ORS) is used to monitor progress of therapy and also the usefulness of sessions (Millar et al, 2006, cited in Drury, 2007). The ORS has been researched extensively and has good reliability and validity data. Drury (2007) then developed a Kaupapa Outcomes Rating Scale (KORS) based on the ORS. The four dimensions are based on Te Whare Tapa Wha and appear also to be adapted from Hua Oranga. The KORS requires the client to rate on the line about how well they have been doing in the following areas: wairua  feeling valued, strong and content within yourself as a person, healthy from a spiritual point of view hinengaro  thinking, feeling and acting in a manner that allows you to set goals for yourself tinana  looking after your physical health in a manner which will maximise your ability to move without pain or distress whnau  communication and relating with your whnau in a manner that is confident and clear. Drury notes that: An increasingly dominant voice in mental health would have us colonise clients with empirically validated treatments on the grounds that this is  scientific and  best practice . This form of colonisation can be countered through the development of scientific tools that monitor client progress and the alliance from the client s viewpoint, thus meeting cultural safety standards better and allowing the clinician to employ a wide variety of therapeutic options. The Kaupapa Outcomes Rating Scale is one such tool. (Drury, 2007:21) Drury (2007) argues that using KORS in clinical settings can contribute to a client-directed, outcome-informed (CDOI) approach to therapy; in essence, a way of delivering practice-based evidence. This may be a component that Kaupapa Mori programmes want to consider as a part of building an evidence base. Evaluation of whnau ora The literature pertaining to Mori research on outcomes measurement derives primarily from Kingi and Durie (2000). As discussed earlier, Hua Oranga is a Mori measure of mental health outcome designed to reflect cultural outcomes of mental health care (Kingi & Durie, 2000), and is based on Te Whare Tapa Wha. In line with the holistic approach of Te Whare Tapa Wha, a triangulated approach to the Hua Oranga measure was used where information was obtained from tngata whaiora, caregivers/ whnau and clinicians. The researchers emphasised that Hua Oranga was to be used in addition to other clinical outcome measures or where a culturally relevant outcome was relevant (Kingi & Durie, 2000). While Hua Oranga measures cultural outcomes based on a Mori model of health, the format, administration and process are based on models used in standardised outcomes measurement tools. Hua Oranga has the potential to be used in both generic and Kaupapa Mori services. The questions, used especially under te taha wairua and te taha whnau, have direct applicability in both generic and Kaupapa Mori programmes dealing with conduct problems. The usefulness of using Hua Oranga in a generic programme would be to ensure the programme and practitioners are mindful of and implement content and processes subsumed within Te Whare Tapa Wha. There is also the potential for it to be used to evaluate whnau ora. While ongoing reliability and validity data is still being collected, Hua Oranga has been identified in the Ministry of Health as a Mori outcomes measure. One of the limitations of Hua Oranga was in relation to the applicability of the measure to Mori tamariki and rangatahi. A modified version for tamariki and rangatahi, Tupu Ranga, was advocated for in 2004 (Cherrington, 2004), utilising simplified questions and different processes, such as drawing to gain information from the child and/ or adolescent. However, to date, no further modifications or research has been conducted. Hua Oranga has the potential to be developed within the conduct problems arena for both Mori and generic programmes. In evaluating the achievement of whnau ora for Mori who present to providers with conduct problems in their whnau, there is also the potential for questions to be adapted in relation to whnau outcomes rather than individual outcomes. For example, under te taha wairua, the questions could be adapted to be: does the whnau feel more valued? does the whnau feel more content? does the whnau feel stronger as a Mori whnau? does the whnau feel healthier from a spiritual point of view? However, further consultation is needed by TRK to determine whether Hua Oranga would fit with the concept of whnau ora. In doing so, consideration would need to be given to what might constitute measurement of whnau ora. The Ministry of Health (2002) considered measurement to include: indicators of disability levels of income, housing, education and access to social supports environmental measures measures of participation in society, including Te Ao Mori a secure identity, a sense of belonging, high self-esteem a control over one s destiny (MOH, 2002). In Section 2, the diagram representing a Mori view towards conduct problems was discussed. The focus was on whnau ora, while the surrounding circles were factors that had the potential to influence whnau ora. All these areas would need to be considered if a holistic approach to evaluation of whnau ora was to be pursued. In this case, questions assessing measures of whnau ora could be based on the following areas: housing employment incarceration health education identity connection Kaupapa Mori services other sector involvement. Indicators of whnau ora is an area that requires further consideration by TRK. SECTION 5: DISCUSSION/ CONCLUSIONS Purpose The aim of this report is to gather knowledge and understandings that can contribute towards a Mori view of conduct problems. It is envisaged that gathering this knowledge and evidence will help ensure that Mori tamariki, taiohi and whnau experiencing conduct problems receive the most effective and culturally enhancing interventions possible. Indigenous knowledge Indigenous knowledge includes both traditional and contemporary knowledge and experiences. Examples of indigenous knowledge include waiata, whakatauki, te reo, pkrkau and cultural processes such as powhiri and mihimihi. Indigenous knowledge in action will be instrumental in the implementation, development and evaluation of Kaupapa Mori programmes. Indigenous knowledge in action will enhance Mori cultural responsiveness in a generic programme if included and maintained in a meaningful manner. Key elements defining  meaningful manner include delivery by Mori, with programme elements that reflect and reinforce Mori identity and in settings that enhance Mori participation. Krero pkrkau provide pointers towards a Mori view of conduct problems, highlighting two main areas of importance: whnau separation  how can the degree of separation be reduced for Mori tamariki, taiohi and whnau experiencing conduct problems? Whnau ora The importance of whnau and whnau ora is reflected in pkrkau, Mori culture and in contemporary society through health strategies, recommendations by TRK, Kaupapa Mori services and other generic organisations working with Mori. Whnau ora is an essential component of a Mori view of conduct problems. To facilitate whnau ora, the position of a whnau therapist/ advocate working primarily with whnau to enhance engagement, identity and connections has been advocated by Durie (2005) and supported by TRK. Further discussion is needed about where such a position would be situated and the skills and training required. It is likely that such a position would require dual cultural and clinical skills, as well as knowledge of how the sectors are interrelated in working with a Mori tamaiti, taiohi and their whnau. Mai i te tirohanga: Towards a Mori view Mai i te tirohanga: Towards a Mori view is a Mori model conceptualising conduct problems, developed by TRK on 9 June 2009. At its centre is whnau ora, which is influenced by: sociological factors (housing, employment, income, incarceration, health, education, identity and connection) the political context (power, funding, legislation, political will and institutionalism) the ability of Kaupapa Mori services and sectors (education, health, social development and justice) to enhance identity and connections. TRK strongly advocated for the macro issues facing Mori whnau (health, housing, education, welfare, justice and employment) to be addressed in order to ensure the success of interventions at the micro level. Te Whare Tapa Wha Te Whare Tapa Wha (Durie, 1985) is a Mori model of wellbeing that has been utilised in Kaupapa Mori and generic services and sectors. It is a holistic framework with the potential to be used in both Kaupapa Mori and generic programmes addressing conduct problems for Mori tamariki, taiohi and whnau. Te Whare Tapa Wha will also be a useful model for generic programmes to use in ensuring cultural responsiveness to Mori. Identity and connections The overall aim of effective interventions with Mori tamariki, taiohi and whnau experiencing conduct problems is to achieve whnau ora, in addition to enhancing identity and connections. Facilitating access to a secure identity and strong connections is regarded as imperative in a Te Ao Mori view of conduct problem interventions. Specific Mori protocols and concepts relevant to enhancing identity and connections include: powhiri, ahu whenua, karakia, te reo, mihimihi, whakawhanaunga, manaaki, aro matawai, ohaoha and aroha. Cultural competency Cultural competency training and cultural supervision is required to increase awareness, knowledge and skills for Mori and non-Mori practitioners working in the area of conduct problems. Cultural competencies relevant to practitioners working with Mori tamariki, taiohi and whnau experiencing conduct problems could include awareness, knowledge and skills in: enhancing Mori identity facilitating whakawhanaungatanga using Mori models of wellbeing. Programme development The further development of Kaupapa Mori programmes and cultural responsiveness of generic service providers needs to ensure that programmes: take an integrated and holistic approach involve Mori in programme design and delivery provide information on participation and outcomes from a Mori perspective. A review is urgently required to identify what programmes exist in the community relevant to Mori and whnau ora that could form a basis for the development of a Kaupapa conduct problem programme  and enhance generic conduct problem programmes. From a kaupapa perspective this may include the enhancement of existing Kaupapa Mori programmes. Such a review needs to be driven by Mori and based on Mori perspectives and outcomes. Examples of Kaupapa Mori programmes within the community having a positive effect on and enhancing whnau ora include Te Atawhainga Te Harakeke, Te Kawa o te Marae and the programmes at Tanewhakapiripiri ( Mason Clinic). The kaitakewaenga position in GSE is an example of a bicultural initiative that has the intent of influencing engagement and identity, in line with the whnau therapist/ advocate role. Concerns have been expressed about the implementation of generic programmes without robust evidence of efficacy for Mori. Mori facilitators of generic parenting programmes such as IYBPP and TIPS identified the importance of engagement of whnau and ongoing whanaungatanga. In addition, most analysis does not capture Te Ao Mori perspectives of outcomes. The use of the Hua Oranga tool developed by Kingi and Durie (2000) could assist assessment of wider outcomes for a generic conduct problem programme and help establish a framework to assess any developed Kaupapa Mori conduct problem programmes. Cultural supports for Mori whnau beyond programme delivery include promoting the teina/ tuakana system among group members and ensuring a relationship has been established with turangawaewae. At a policy level, the enhancement of identity and connections can be assured by: investment in implementing and/or developing Kaupapa Mori programmes based on indigenous knowledge and best practice evidence from a Mori perspective meaningful consultation about generic programmes including inspection of programme content and adaptations as recommended equity of funding for Kaupapa Mori programmes. Indigenous knowledge and experiences need to be recognised as a valid contribution to the development, analysis and critique of conduct problem programmes for Mori tamariki, taiohi and whnau. Indigenous and Western-based knowledge has the potential to help identify what works best with Mori tamariki, taiohi and whnau experiencing conduct problems. Kaupapa Mori programmes Currently there are no dedicated Kaupapa Mori conduct problem programmes designed by Mori for Mori. Nor does there appear to be literature or research pertaining to indigenous programmes for conduct problems. Given the overwhelming over-representation of Mori appearing before youth courts, this indicates a crisis, and a failure of the programmes currently funded to prevent and treat conduct problems at the severe level. The lack of information and existence of robust, culturally responsive services for conduct problems contributes to the failure of Mori. Kaupapa Mori programmes must be invested in and implemented in order to comprehensively determine the cultural elements that modify conduct disorder symptoms and enhance whnau ora. A Kaupapa Mori programme can be viewed as by Mori for Mori using Mori cultural perspectives. In addition a Kaupapa Mori programme: is lead by Mori gives full recognition to Mori cultural values and systems is a strategic position that challenges dominant Pkeh (non-Mori) constructions of programme design determines the assumptions, values, key ideas and priorities of programmes ensures that Mori maintain conceptual, methodological and interpretative control over programme development is a philosophy that guides Mori programmes and ensures that Mori protocols will be followed during programme implementation and evaluation (based on Walker et al, 2006:333). The desire and right by Mori to know what works best so that the best Kaupapa Mori programmes can be designed, implemented and evaluated will require a major investment in terms of funding and workforce development issues. Generic programmes Based on the TRK recommendations and previous research, the adaptation of generic programmes to be culturally responsive to Mori is required. This is not without problems. On the one hand generic programmes, having been developed within other cultural worldviews and languages, use meanings derived from those cultural paradigms, which do not necessarily align with a Mori world view. On the other hand Mori have the right to choose and participate in programmes that may be helpful, no matter where they originate, if they have been shown to be effective for other ethnicities including Mori, particularly when there are very few such programmes, if any, available to Mori whnau (H. Elder, email communication, 2009). Ensuring generic programmes are responsive to Mori prioritises cultural competence in the delivery and content of programmes for Mori tamariki, taiohi and whnau attending such programmes and is likely to enhance their efficacy for Mori. A review of generic programmes relevant to conduct problems and Mori tamariki, taiohi and whnau involved needs to be conducted. This will provide a comparison for Kaupapa Mori programmes. Meaningful consultation, discussion of content and efficacy issues for Mori can then occur. Culturally responsive strategies for generic programmes may include: Mori leadership at a governance level major consultation of the content of programme subsequent implementation of culture-specific topics the need for a holistic approach such as Te Whare Tapa Wha a focus on whnau ora incorporation of Mori processes and values, such as powhiri and aroha, into programme content the use of a whnau liaison worker/ advocate/ therapist a Mori facilitator the programme being delivered in an environment that helps to enhance identity and connections such as marae or turangawaewae. Evaluation of whnau ora Hua Oranga (Kingi & Durie, 2000) is a Mori mental health outcomes measure that has the potential to be used in both generic and Kaupapa Mori conduct problem programmes. Practice-based evidence and utilisation of the KORS (Drury, 2007) may be an initiative that Kaupapa Mori programmes want to consider in developing outcomes data from a Mori perspective. In order to evaluate whnau ora outcomes, further clarification is required regarding indicators of whnau ora. Further research is needed, identifying whnau ora outcome measures that capture information relating to housing, employment, incarceration, health, education, identity, connection, involvement of Kaupapa Mori services and other sector involvement. PART 6: RECOMMENDATIONS: TOWARDS RECONCILLIATION Te tapaepae o te rangi See there, to the place Where the sky reaches down Strive to attain the utmost. Look to the furthest horizon. (trad.) (Grace & Grace, 2004: 52) The intent of this report was to gather information that would help ensure Mori tamariki, taiohi and whnau experiencing conduct problems receive the most effective and culturally enhancing interventions possible. The following recommendations are based on making sure this moemoea (aspiration) can come to fruition. The meaning behind the title of this report, Te hononga: Mai te tirohanga Mori: The process of reconciliation: Towards a Mori view, reflects a number of issues: this report is seen as a beginning, a first step, in the process of developing a Mori view on conduct problems the process cannot end with this report the recommendations reflect the desire to achieve the best outcomes for Mori tamariki, taiohi and whnau experiencing conduct problems. Indigenous knowledge It is recommended that indigenous knowledge and experiences in both traditional and contemporary understandings be considered as a valid evidence base. For indigenous knowledge to be effective, it will need to be included and maintained in a meaningful way, such as appropriate consultation and equity of funding. Indigenous knowledge has to be included in the implementation, development and evaluation of Kaupapa Mori programmes. Indigenous knowledge in action will be vital in enhancing generic programmes if included and maintained in a meaningful manner. Interventions with Mori tamariki, taiohi and whnau exhibiting conduct problems need to come from a whnau ora focus. This will require a holistic approach to understanding, assessing and providing treatment or interventions. Facilitating access to a secure identity and strong connections is essential in providing interventions for Mori tamariki, taiohi and whnau experiencing conduct problems. It is recommended that programmes dealing with Mori and conduct problems are able to identify how their programmes assist in promoting identity and connections. Whnau therapist/ advocate/ liaison worker It is recommended that the implementation of a whnau therapist/ advocate/ liaison worker, whose role is to engage with whnau and work collaboratively across all sectors, be considered. Given the complexity of issues whnau may present with, such a position will require core, specialised cultural and clinical skills. Workforce development issues related to upskilling, training and retaining Mori kaimahi (workers) into such a position need to be identified. Cultural competency Training workshops for Mori and non-Mori workers focussed on enhancing identity and connections with Mori would benefit practitioners working in the area of conduct problems. Cultural supervision will be needed in increasing awareness, knowledge and skills for Mori and non-Mori practitioners. Te Whare Tapa Wha Consideration needs to be given to using Te Whare Tapa Wha as a framework when assessing and providing interventions to Mori tamariki, taiohi and whnau experiencing conduct problems. Te Whare Tapa Wha will also be a useful model for generic programmes to consider using in ensuring cultural responsiveness to Mori Kaupapa Mori programmes The desire and right by Mori to know what works best so that the best Kaupapa Mori programmes can be designed, implemented and evaluated will require a major investment of funding and workforce development issues. Given the dearth of dedicated Kaupapa Mori conduct programmes available to Mori, urgent investment is required to further develop, implement and/or modify Kaupapa Mori initiatives for conduct problems. Careful consideration needs to be made about the most effective use of resources. It is recommended that TRK consider developing a plan of what is required for the further development, implementation and evaluation of Kaupapa Mori programmes. This plan needs to consider funding and timelines. As a first step, it is recommended a stocktake be taken of Kaupapa Mori initiatives relevant to conduct problems. Following this, programmes of interest can be further reviewed to identify success factors, and recommendations made about what is required for the best, most effective and culturally enhancing Kaupapa Mori programmes for Mori. There needs to be a degree of urgency about the stocktake and review, given no specific programmes are available from a Kaupapa Mori perspective. Barriers to the success of programmes, such as funding, will also need to be identified. This stocktake and review needs to be completed by Mori and not defined by the wider group. It will be important that information pertaining to a stocktake of services is shared with the community and those people working at the clinical and cultural level. It is important that practitioners are aware of the programmes available for Mori from Kaupapa Mori, bicultural and generic perspectives. Generic It is recommended that a review of generic conduct problem programmes be conducted to identify the cultural responsiveness of programmes to Mori. In line with overseas research this would include an inspection of programme content and processes as well as strategies used to enhance identity and connections among Mori participants. It is further recommended that information be obtained about the funding generic programmes receive, to provide a comparison and ensure funding equity with Kaupapa Mori programmes. Evaluation Investment is needed to assist Mori-focussed programmes in place to gather and provide outcomes data. Measures such as Hua Oranga may be of use; however, investment is needed to ensure appropriate adaptation and implementation. The issue of evaluating and identifying whnau ora indicators warrants further discussion and collection of information. Limitations of report The scope of this report was very large and involved the consideration of two major areas: the development of Kaupapa Mori initiatives and generic programme responsiveness. MSD outlined specific areas they wanted addressed, which corresponded with increasing knowledge and understanding for generic programmes. The writer acknowledges that, as a result, full consideration and time was not made for Kaupapa Mori initiatives. It is therefore recommended that, in the next stage of development, a discussion document based on the recommendations put forward under Kaupapa Mori programmes be produced with Kaupapa Mori as its only focus. The second limitation of this report is in relation to the very tight timeframe in which it was conducted. This may have impacted on the ability to obtain meaningful feedback and consultation with members of TRK. It is recommended that if further reports are to be commissioned for MSD, TRK have the opportunity to meet and discuss report progress on more than one occasion, and that an adequate amount of time be given to provide feedback. Concluding comment Ka rere te hue mataati The first shoot of the gourd stretches out & when an action is started it should be followed through until a result is produced. (Mead and Grove, 2002: 182) This whakatauki is presented last and represents a request. This report has begun the contribution towards a Mori view of conduct problems. Now practical action is required, such as investment of money, time and resources to investigate and implement programmes that will improve whnau ora, identity and connections for Mori tamariki, taiohi and whnau experiencing conduct problems. He mihi mahana ki Te Roopu Kaitiaki (Mere Berryman, Wayne Blisset, Brian Coffey, Hinemoa Elder, Angus Macfarlane, Materoa Mar, Moe Milne and Peta Ruha) me, MSD (aka Robbie Lane) mo o koutou whakaaro, o koutou tautoko, o koutou ihi ki tenei kaupapa. He ao te rangi ka uhia Ma te huruhuru te manu, Ka rere Like clouds adorn the sky So birds need feathers to fly PART 7: REFERENCES Advisory Group on Conduct Problems (2009a). Conduct Problems: Best Practice Report 2009. Ministry of Social Development, Wellington. Advisory Group on Conduct Problems (2009b). Conduct Problems: Effective Programmes for 3 7 Year Olds. Ministry of Social Development, Wellington. Bacal, K., Jansen, P. & Smith, K. (2006). 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Presentation at Taumata Whanonga, Wellington, 16 17 March 2009. Mauri Ora Associates (2008). Best health outcomes for Mori: Practice implications. A resource booklet prepared for the Medical Council of New Zealand by Marui Ora Associates. Mead, H.M., & Grove, N. (2003). Nga Pepeha a nga Tipuna: The Sayings of the Ancestors. Wellington, New Zealand: Victoria University Press. Mental Health Commission. (2004). Delivery of Cultural Assessment for Mori. Mental Health Commission, Wellington. Merry, S.N., Wouldes, T., Elder, H., Guy, D., Faleafa, M. & Cargo, T. (2007). Kua whakawhenua te purapura ka puawai te taonga. Addressing the social and emotional needs of infants in Counties Manukau District Health Board. Report commissioned for Counties Manukau District Health Board, 2007. Milne, M. (2005). Mori perspectives on Kaupapa Mori and Psychology: A discussion document. A report for the New Zealand Psychologists Board. Ministry of Health. (2008). Let s get real: Real Skills for people working in mental health and addiction. Wellington: Ministry of Health. Ministry of Health. (2002). He Korowai Oranga: Mori Health Strategy. Wellington: Ministry of Health. Ministry of Health. (2004). Guidelines for Cultural assessment  Mori Under the Intellectual and Disability (Compulsory Care and Rehabilitation Act 2003), Wellington: Ministry of Health. New Zealand Psychological Society. (March 2009). Society media release focus on access and evidence-based practice. Connections. March 2009. New Zealand Psychologists Board. (May 2006). Cultural competencies: For Psychologists Registered Under the Health Practitioners Competence Assurance Act (2003) and those seeking to be registered. Wellington: NZPB. O Conner, M. & Macfarlane, A. (2002). New Zealand Mori stories and symbols: Family value lessons for western counsellors. International Journal for the Advancement of Counselling. Owen, V. (2001). Whanake rangatahi: Programmes and services to address Mori youth offending. Social Policy Journal of New Zealand, 16, pp. 175 190. Pere, R. (1991). Te Wheke  A celebration of infinite wisdom. Gisborne: Ako Global Learning. Rada, J., Ratima, M. & Howden-Chapman, P. (1999). Evidence-based purchasing of health promotion: Methodology for reviewing evidence. Health Promotion International, 14(2), pp. 177 187. (abstract only cited). Ratima, M.M., Fox, C. & Te Karu,H. (1999). Long-term benefits for Mori of an asthma self-management program in a Mori community which takes a partnership approach. Australian and New Zealand Journal of Public Health, 23(6), pp. 601 605. Simmons, D. & Voyle, J.A. (2003). Reaching hard-to-reach, high-risk populations: piloting a health promotion and diabetes disease prevention programme on an urban marae in New Zealand. Health Promotion International, 18(1), p. 41. Stewart, T. (1997). Historical interfaces between Mori and psychology. In P. Te Whaiti, M.B. McCarthy & A. Durie (Eds). Mai i Rangiatea (pp. 75 95). Auckland, New Zealand: Auckland University Press/ Bridget Williams Books. Sullivan, R. (2002). Weaving earth and sky: Myths and legends of Aotearoa. Auckland, New Zealand: Random House. Taylor, A. (1993). Sad Joke on a Marae. In W. Ihimaera (ed.),Te Ao Marama: Contemporary Mori Writing, Volume 1, pp. 277 279. Auckland, New Zealand: Reed. Te Rau Matatini, The Werry Centre. (2004). The Proceedings of the Te Rau Tipu Mori Mental Health Child & Adolescent Workforce Conference. Palmerston North, New Zealand: Te Rau Matatini. Te Roopu Awhina o Tokonui. (1987). Cultural perspectives in psychiatric nursing: A Mori viewpoint. Community mental health in New Zealand, Vol 3(2), pp. 2 17. Tiatia, J. (2008). Pacific Cultural Competencies: A literature review. Wellington: Ministry of Health. Walker, R. (1978). Relevance of Mori myth and tradition. In M. King (Ed.). Tihei Mauriora: Aspects of Moritanga. Wellington: Methuen. Walker, R. (1987). Nga Tau Tohetohe: Years of Anger. Auckland, New Zealand: Penguin. Yesterday, Today & Tomorrow Ltd. (2007). A Mori Practitioner Competency Framework. Kaupapa Mori Addictions and Mental Health Milieu Report. The welfare of the children ensures the strength of the people  TRK also prefers the terminology of conduct problems rather than the DSMIV diagnosis which is limited in scope and applicability to Mori.  There are a number of Mori roopu such as Te Atawhaingia Pa Harakeke and Kaupapa Mori services who use pkrkau in their wananga and interventions.  Retrieved 6 June 2009 from: http://www.kinatrust.org.nz/myfiles/FIP.pdf.  Retrieved 6 June from: http://waikato.researchgateway.ac.nz/bitstream/10289/1547/1/NMPPS%202007_Gilgen.pdf.  Moe Milne (personal communication, 2009) uses the term Kaupapa whnau to describe this term of organisational whnau.  Retrieved 21 May 2005 from: http://www.corrections.govt.nz/public/research/ effectiveness-treatment/montgomery-house.html.  Retrieved 6 June 2009 from: http://www.pha.org.nz/documents/tepaemahutonga.pdf  ibid The concepts and broader explanations are all derived from the Mori cultural competencies written by YT&T, 2007.  Retrieved 6 June 2009 from :  HYPERLINK "http://www.kinatrust.org.nz/myfiles/FIP.pdf" http://www.kinatrust.org.nz/myfiles/FIP.pdf .  For more detailed description see Durie (1999b).  Retrieved 5 June 2009 from:  HYPERLINK "http://www.matatini.co.nz/careers/lespriest.htm" www.matatini.co.nz/careers/lespriest.htm.  Retrieved 6 June 2009 from : http://www.ccdhb.org.nz/patient/docs/Kitanga_Guidelines_Jan09.pdf.  Retrieved 26 June 2009 from: http://waikato.researchgateway.ac.nz/bitstream/10289/1554/1/NMPSS%202007_Berryman,%20Bateman.pdf.  Retrieved 20 June 2009 from: http://www.corrections.govt.nz/news-and-publications/strategic-documents/archive/strategic-business-plans-contents/maori-strategic-plan-contents/the-maori-strategic-plan.html  Retrieved 20 June 2009 from: http://www.bpac.org.nz/magazine/2008/august/tikanga.asp, 26 June 2009.  Retrieved 12 May 2009 from: http://www.werrycentre.org.nz/site_resources/library/Projects/Parent_Mgt_Trng__Incredible_Years/Articles%20and%20Reports/IY_Whanau_Group_Evaluation_Report_2009.pdf.  Retrieved 10 May 2009 from: http://www.werrycentre.org.nz/site_resources/library/Projects/Parent_Mgt_Trng__Incredible_Years/Articles%20and%20Reports/Maori_Hui_Report_2008.pdf.  Retrieved 20 June 2009 from: http://www.sciencedirect.com/science.  ibid  ibid Retrieved 10 May 2009 from: http://www.werrycentre.org.nz/site_resources/library/Projects/Parent_Mgt_Trng__Incredible_Years/Articles%20and%20Reports/Maori_Hui_Report_2008.pdf.  Retrieved 5 April 2005 from: http://www.healthinfonet.ecu.edu.au/html/html_programs/health_promotion/programs_healthpromotion.htm#summary.     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