Appropriate Child and Adolescent Mental Health Service (CAMHS): Māori Caregiver’s Perspectives

The development of Child and Adolescent Mental Health Services (CAMHS) that meet the needs of Maori (indigenous people of Aotearoa/ New Zealand) is critical. This study, Te Tomokanga, investigated the acceptability of mainstream1, bicultural,2 and kaupapa Māori3 CAMHS access and delivery to young Māori and their whānau.4 Detailed factors contributing to potential areas for improvement are identified in this examination. This includes, most specifically, a cultural framework based on the traditional Māori Pōwhiri process of access and engagement provided by a culturally relevant workforce. Method A kaupapa Māori (Māori driven) research paradigm, based on the traditional Pōwhiri process of engagement and participation guided this qualitative research approach, particularly the components of karanga, mihimihi, whaikōrero and koha. These components are discussed in more detail in this article. 1. Mainstream services in this study had no dedicated Māori positions available. 2. Bicultural services in this study had a/some dedicated Māori positions available. 3. Kaupapa Māori services in this study had dedicated Māori positions available. 4. Whānau, parents and caregivers are used interchangeably in this thesis. 388 © Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health 9(2) 2011 Participants were invited from the six District Health Boards (DHBs) CAMHS of the Midland health region.5 Semistructured questions were utilized to collect the data from two groups: 1. Whaia te Ara Whanui; a whānau, interview-based phase that involved 25 self-selected participants, some of whom had also completed a quantitative phase (McClintock et al., 2012) and 2. Te Hononga; a whānau, interview-based phase that involved another 25 self-chosen participants who had not consented to completing a quantitative phase. A thematic analysis was conducted on the narrative data from the 50 participants who completed face-to-face interviews Results The 25 whānau in the Whaia te Ara Whanui phase who had completed the survey in a quantitative phase were generally satisfied with what the CAMHS provided. This acceptance was based on respectful partnerships and the development of appropriate cultural support. This assistance was offered by both non-Māori and Māori workforce. The participants in the Te Hononga phase, who declined to complete the study survey but agreed to be interviewed, reported less positive experiences. They generally believed that the non-Māori CAMHS workforce they came in contact with struggled to provide appropriate cultural support. These participants were also frustrated by the lack of information on medication and its benefits. Conclusion Results from both the Whaia te Ara Whānui and Te Hononga phases identified the importance of cultural support for Māori referrals who access CAMHS. However these two cohorts held distinct views on the ability of CAMHS with largely a non-Māori workforce to deliver culturally appropriate services. Their opinions were influenced by their own expectations and experiences with CAMHS. Despite these differences, the views are useful contributions to a conceptual development of a CAMHS best practice model. When aligned with the traditional Pōwhiri process of engagement and participation such a framework values respectful relationships, commitment and reciprocity. The challenge for CAMHS is therefore to provide a 5. Midlands health region includes Waikato, Taranaki, Lakes, Bay of Plenty and Tai Rawhiti DHBs Appropriate Child and Adolescent Mental Health Services (CAMHS) 389 collaborative workforce with culturally appropriate responses to the needs of a diverse range of Māori whānau.