Effective Kaupapa Māori Youth Treatment: Perspectives & Recommendations

1. Critical Success Factors in Kaupapa Māori Youth Alcohol & Drug Residential Treatment: A Māori Youth Perspective Mino’akaKapuaahiwalani- Fitzsimmons National Addiction Research Symposium Massey University Auckland 22 April 2015

2. Nga mihi...Te Runanga o KirikiriroaRongoAteaNgaRangatahi

3. National Addiction Centre • Dr Ria Schroder • Dr Daryle Deering • Dr Kahu McClintock (Te Rau Matatini)

4. Principled Practice with Purpose • Native Hawaiian • Clinical Therapist • Masters Student • Dearth of Literature • AOD Youth Treatment

5. Aim Methodology Findings Summary Implications Future Research Conclusion

6. Aim • Youth Perspective • Critical Success Factors • In Residential AOD Treatment

7. Methodology • Year in Tx - 2009 • 65 Rangatahi Māori • 10 Rangatahi Selected • 5 Wahine & 5 Tane • Qualitative • Kaupapa Māori Framework in Practice • General Inductive • Randomised & Purposive Sampling

8. Findings Themes • Kaupapa (Philosophy of the Treatment Approach of RA) • Te Ao Māori • He Tangata

9. What Rangatahi Had to Say About: Kaupapa • “That’s where I got to learn ... how drugs affect your body ... alcohol ... cigarettes ... this class was important.” • “We could write a song about anything ... it … was a relief for me that class ... I got more things off my chest that I wouldn’t say to other people .” • “sport ... art ... school ... and fun things ... learning, reading, maths, arts, Māori, bilingual ... yeah all that sort of stuff.”

10. What Rangatahi Had to Say About: Kaupapa Rangatahi Recommendations • Gender based treatment • Age difference treatment • More activities offsite • Personal journals • Time for television • More dedicated school hours • More downtime • Less downtime Interventions Mentioned • AOD Classes • Quit Smoking Classes • Music Classes • 12 - Step Meetings • Length of Stay in Treatment • Individualised Programmes • Northern Health Schools • Outings • Tikanga

11. What Rangatahi Had to Say About: Te AoMāori • “It just made me feel a part of my culture, learning Māori everyday. • “ The cultural aspects, the tikanga behind it and everything we do.” • “They (Māori) do it in a different way ...they use their marae ...our rehab had a marae next to it and so you know you’re still in that …tribe thing ...still around Māori stuff ...it’s good …learning about your own culture.” • “If there were no rules…they’d (the young people) rule… they’d take Rongo Atea over… the kaimahi (staff) would get headaches … and they’ll (kaimahi probably kick them out.”

12. What Rangatahi Had to Say About: Te AoMāori • “Pakeha services …ain’t as helpful as Māori …for Māori it’ll be more helpful because they been there …experienced what the taiohi (youth) are going through …so they’ll be more helpful. • Kapa haka and … Koro, he was the man … he’d just come and talk to us about Māori stuff and just life …it relates to the program. He’s different than other old people, some of them are just up themselves .”

13. What Rangatahi Had to Say About: He Tangata • “The kaimahi ...they show interest in what you have to say no matter what it is ...and they’ll take your word ...they’re there to help ...they don’t got sides or anything, every ones ...treated as the same …that’s a rule in there …the kaimahi...treated every one as one ...fair.” • “Being the same culture...they’re (staff) Māori and I’m Māori... It really made a difference.” • “Just knowing they’re Māori... • being around Māori was all good like pretty much family ... I could relate to them.” • “Just made be feel a part of my culture.”

14. What Rangatahi Had to Say About: Marae Based • You won’t see brown people going into a rehab …called …you know …Pakeha name …they’ll go into a rehab and … not feel comfortable …they’ll feel like they can’t fit in.” • “It was nice and fresh… it was beautiful… all nice and Māori designed. It made me feel comfortable.”

15. Integrating Culture and Contemporary Interventions • Another key sucess factor described by many participants was the noho marae. This was a prime example of providing a ‘true’ culture ‘lived’ steeped in cultural protocols such as powhiri, whakawhānaungatanga, waiata, kotahitanga, hakari and poroporoaki. • The significance of the noho marae was seen in the way in which contemporary forms of AOD treatment, such as the 12-step recovery meetings, were interlinked throughout the noho marae experience.

16. Summary • Fulfilling the cultural needs of indigenous youth while in AOD treatment appears to be a critical factor to sucessful treament. • Strengthening cultural identity in conjunction with addressing SUDs are seen as necessary for significant and secure changes to take place for Māori rangatahi. • As emphasised earlier, Māori rangatahi cannot be seen in the narrow context of a SUD, as the evidence is clear that it is essential that they be seen in a broader context of who they are as Māori youth.

17. Success Factors • Culturally significant and holistic approach to AOD treatment worked for Māori rangatahi. • Māori environment, Māori staff, Maori ways of being. • Multifaceted treatment program approach that was strength based and incorporated a positive Māori youth development approach. • Integration of cultural and contemporary treatment interventions. • Importance of having unhindered access to health services in order to begin to address the disparities in Māori health, particularly with Māori rangatahi.

18. Implications • Policies that incorporate easier access for young people and support their continuing care into or back into residential treatment are crucial in order to be more responsive to Māori rangatahi. • Greater flexibility and diversity is offered in terms of treatment options and that interventions are relevant to the particular young person’s needs and support positive Māori youth development. • Overall, a comprehensive review of current practice, policy and funding levels to honor Te Tiriti o Waitangi is essential in order to address and implement the appropriate AOD treatment service needs of Māori rangatahi.

19. Future Research Direction • Research should focus on expanding knowledge about appropriate and acceptable practices in AOD treatment with Māori rangatahi. • Explore in more detail the implications for mental health and addictions policy, planning, and providers, in addressing the holistic needs of indigenous youth and AOD treatment. • Factors associated with treatment retention and completion for Māori rangatahi. • The alignment between current provisions of care for Māori rangatahi in AOD treatment and Te Tiriti o Waitangi. • What are the indicators of a young person’s wellness as an outcome measure in cultural interventions.

20. Conclusion Traditional cultural ways, indigenous models of health, contemporary AOD treatment and positive youth development models combined are necessary to ensure improved AOD treatment services for Māori rangatahi. The findings from this study reinforced the premise that a culturally significant and holistic approach to AOD treatment were success factors for Māori rangatahi.