Stories of change

Te Korowai Hinengaro Oranga ki Waitaha

What:A collective forum of Maori mental health and addiction service providers.

Why:To improve kaupapa Maori mental health services.

How:By providing coordinated approach to and ensuring quality provision of kaupapa Maori mental health and addiction services.

Target:Planners, funders, tāngata whaiora and their whanau.

Where:Waitaha/Canterbury.

Canterbury maori mental health provider network

"It is about ... collegial support and opportunity to meet each other and share some of those challenges and celebrate some of those successes, when working within the Maori mental health sector.", Cazna Luke, coordinator TKHOW.

The profile

Canterbury region has a population of about 33,000 Maori, representing approximately 9 per cent of the total population in the region. Te Korowai Hinengaro Oranga Ki Waitaha (TKHOW) is a network of all kaupapa Maori organisations that provide mental health and addition services for Maori in the Canterbury region.

The network comprises Canterbury District health Board (CDHB) Maori mental health services and non-governmental organisations, (NGOs) - see network members' under the ‘more information' section of this story. The services provided range from child and youth to adult mental health, drug and alcohol, needs assessment, residential services and community-based programme for youth and adult offenders.

The aim of the network is to ensure better quality services and a sustainable workforce that meets the needs of tāngata whaiora and whanau in the region. It does so by sharing information, identifying issues of concern and developing ways to reflect national Maori mental health and addiction strategies like Te Waipounamu (Maori research symposium) or organisations like Te Rau Matatini - Aotearoa Maori mental health workforce development, at a district and/or regional level. The coordination of TKHOW is funded by Canterbury DHB.

"For Maori, which is always very important, is those relationships, ... it is about that face-to-face with each other, ...what actually strengthens the way in which we work and yet actually crosses and cuts across those boundaries that a lot of people might have with each other.", Te Pora Ehau, Te Pakeke (manager), Te Korowai Atawhai, TKHOW provider member.

The beginnings

In 2001 the Health Funding Authority (HFA) allocated funding for service development of kaupapa Maori mental health care providers. A plan was formulated to develop an infrastructure that would coordinate and encourage the development of Maori mental health services in the Canterbury region.

In 2002 Canterbury DHB tendered out the coordination role to Mokowhiti Consultancy director Cazna Luke, who coordinated the work of TKHOW from 2002 until December 2009. Mokowhiti provided coordination, facilitation and administrative support to TKHOW. Mokowiti has also been able to subcontract experts to support specific TKHOW projects when required.

The first meeting of TKHOW took place in March 2003. The first year of development was devoted mainly to building and strengthening the relationship between different providers. Communication, trust, collaboration and operational functioning were a focus.

The providers gathered together on a monthly basis from 2003 to 2008, when they moved to bi-monthly meetings. TKHOW focused on the areas of strategic influence, workforce development, service and provider development and quality. The coordinator worked with providers on an individual basis on their business or strategic plans, pre and post audit and performance monitoring.

The process

"... it is making use of the resources that we have available and you have got to get that at the one table... sharing of ideas and innovations and resources, without having to go overseas and get speakers in and look at their ideas, when actually it is right in front of us.", Dean Rangihona, consumer advisor, Te Korowai Atawhai, TKHOW provider member.

The network meets on a bi-monthly basis to discuss collective issues. These can range from requests for proposal (RFPs) from the Canterbury DHB to making submissions on national policies. Individual members also raise specific local issues that they wish to discuss. The goal of the meetings is to align strategic thinking and planning of Maori mental health service provision, to provide meaningful engagement with the network and to prevent token representation.

Topics have included developing annual plans, brainstorming new ideas, and developing collaborative projects. Canterbury DHB is invited to participate in at least two meetings per annum, providing their views on the topics, discussing Maori health strategies, and funding and planning. Members of TKHOW are individually supported, depending on their need, to review and develop organisational business plans and workforce.

TKHOW has an agreed annual work plan which describes the network's goals, tasks and action plans. The 2009 core projects have included data utilisation, a human resource workforce development plan, the tāngata whaiora pathways of care and working with providers on an individual basis. Other projects of TKHOW have included the development of strategies for improving cultural responsiveness, review of the policies and business plans of TKHOW members, providing governance training of providers and an orientation programme to integrate new recruits into Maori and mental health sector.

"...when you have the strength of the group that are working together for the best interests of tāngata whaiora, you cant get any better than that...", Dean Rangihona, consumer advisor, Te Korowai Atawhai TKHOW provider member.

After identifying a gap in the provision of services in the region, TKHOW put forward a proposal for Maori specific respite.

Improving the performance of network members is also a goal. Two other projects that are currently well underway are scoping shared management possibilities and performance monitoring data utilisation. The first project was put forward after identifying the need to better align the administrative management practices among the members. A document suggesting possible approaches is being evaluated by the members at the time of writing this story.

TKHOW members provide quarterly performance reviews. The data are used to monitor the overall performance of the network and to consider steps for further improvement. This includes information about the number of tāngata whaiora that have been supported at any given quarter, how the services have been provided, and if there identified needs or venues for additional service provision.

"How are we to project and prepare for an improved future for the next generations coming along if we do not examine and measure what we do - right now? A data collection system and a brave heart to be candid about what's working and what's not working, from the membership of Te Korowai Hinengaro Oranga, puts us in an exciting position to validate our own assumptions, celebrate commonalities and articulate from an evidential base.", Hinerau Jones, manager, Te Awa o Te Ora, TKHOW provider member. (Quoted in the Ministry of Health newsletter, October 2009.)

The unique approach

"We are providing tangible things ... that actually make a difference or that help,
or that are filling a need." , Cazna Luke, Mokowiti Consultancy.

One of the characteristics that make the network unique is its focus on mental health services. The sole focus on mental health care makes TKHOW confined and tight, with shared goals and vision.

Operational management brings smooth communication and saves a lot of time for the network, without imposing limitations on providers' autonomy. For example, the coordinator, Cazna Luke, attends the Canterbury DHB meetings and reports back to the network. Cazna also coordinates presentations and discussions with relevant parties after clarifying the respective needs of the network.

TKHOW provides opportunities for individual providers to apply for funding individually or collectively, on behalf of the network. This strengthens the relationships between network members and provides an aligned approach to the provision of mental health and addiction services for Maori in the region.

This network's structure also provides flexibility in the interactions between providers and the CDHB and models how to connect kaupapa Maori services and main stream mental health service. The latest development in this process includes a two day orientation programme for mainstream workers to come in and get to know Maori mental health providers.

"It is about Maori development and better outcomes for Maori", Te Pora Ehau, Te Pakeke (manager), Te Korowai Atawhai, TKHOW provider member.

The results

"...the aspect of having mainstream come to that table ... that is working in a bi-cultural way, that is valuing the partnerships." , Dean Rangihona, consumer advisor, Te Korowai Atawhai.

TKHOW has proven to be flexible and responsive to the needs of its members. Below are some examples of its activities.

• After identifying governance of the member organisations was an area to further develop and strengthen, two programmes, addressing the issue were run in 2005. The programmes involved 40 participants. Evaluation results suggest most participants were highly satisfied with the relevance, style and clarity of the information, instructor's knowledge and provided illustrative material. All participants rated the governance training as highly useful in assisting them to be a more affective trustee and/or manager.
• There have been eight orientation programmes for new Maori workers employed within TKHOW since the establishment of the network. Of the 70 participants, most reported the orientation met or exceeded their expectations and was effective or very effective for the individual's adjustment to the new work environment. Some of the main benefits participants identified included: getting an in-depth explanation of the different mental health services in Otautahi (Canterbury), learning what other services are out there for whanaungatanga and understanding wellness as Maori whanau.
  

"The benefits of the TKHOW orientation programme are not only to the individual kaimahi involved but also to the provider network. Kaimahi who are familiar with the provider network are far more effective in their mahi and so it will follow that the network as a whole should also be more effective as well." , Winiata Brown, general manager of He Waka Tapu, TKHOW provider member. (Quoted in the Ministry of Health newsletter, October 2009.)

• In September 2009 the first orientation programme for mainstream mental health workers took place, as a result of the strong positive feedback. Feedback is yet to be evaluated.
• A website profiling all members of TKHOW, advertising job vacancies and introducing current projects has been developed and maintained. There is also an intranet, accessible to TKHOW members.
• In response to the need to develop a profile of the regional Maori workforce, outlined in the workforce development plan, employment data from the members has been collated. The project assessed workforce demographics (such as age and gender), current levels of training, and interest in professional development to obtain a baseline for the region. The composition of the TKHOW network is consistent with the national composition of the Maori mental health workforce. The majority of kaimahi in the TKHOW network are women (75 per cent) and the most common age range for kaimahi is 40-49 (39 per cent), and this is closely followed by the 50-59 age group which had 32 per cent. There were no respondents aged under 30. The aim of the project is to guide future planning in the area of Maori mental health workers professional development. At the time of writing results had been partially evaluated with demographic data consistent with national figures for NGOs distribution by age, gender and year of experience.
• TKHOW actively contributes to regional and national policies through collective submissions outlining relevant concerns in a coordinated way. For example, The Werry Centre is leading the workforce development plan for Canterbury and TKHOW is leading the Maori section of the plan.
• Members of the network developed great knowledge of operational management and shaped their leadership role in the region.

"... it is a bridge and we need that bridge between provider arm and NGOs and we need people who can work within those areas and to be able to just consolidate ... because if we don't have those bridges built then our people can't cross.", Dean Rangihona, consumer advisor, Te Korowai Atawhai, TKHOW provider member.

The lessons learnt

• Developing trust, communication and openness were paramount for the establishment and sustainability of the network.
• Working collectively and collaboratively, brought tangible results in the provision of Maori mental health services in Canterbury region.
• The coordinating agency role promoted sense of equity among the providers.

More information

Contact

• Cazna Luke, cazna@mokowhiti.co.nz or by phone 03 329 6975.

Network members

• Purapura Whetu Trust - Maori adult clinical and rangatahi services.
• Te Awa O Te Ora - kaupapa Maori day programme and community support work service.
• Kakakura Health Services - community residential level 3 and community support work service, needs assessment and service coordination.
• Te Tai O Marokura - Alcohol and other drug - rangatahi service.
• Te Korowai Atawhai - DHB provider arm Maori mental health service.
• He Oranga Pounamu - Maori development organisation.
• He Waka Tapu - Alcohol and other drug day treatment and supported accommodation.
• STOP Trust - Maori mental health clinical service.

Website

•  www.tkhow.org.nz

From left: Cazna Luke, Mokowiti Consultancy, Te Pora Ehau,
Te Pakeke (manager) and Dean Rangihona, consumer advisor, Te Korowai Atawhai.

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Te Korowai Hinengaro Oranga Ki Waitaha: Canterbury Maori mental health provider network (PDF, 119KB)

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Page last updated: 7 November 2008