Abstract

Background

The acceptability of Child and Adolescent Mental Health Services (CAMHS) to Indigenous peoples is little studied. There has been a lack of evaluation tools able to take account of the more holistic approach to the attainment of mental health that characterises Māori, the Indigenous population of Aotearoa (New Zealand). This study aimed to develop such an instrument and establish some of its psychometric properties. Then, to use the measure to establish whānau (family or caregiver) views on desirable CAMHS characteristics.

Method

A self-administered survey, Te Tomokanga, was developed by modifying a North American questionnaire, the Youth Services Survey for Families (YSS-F). The intent of the tool was to record whānau experiences and views on service acceptability.

The Te Tomokanga survey is unique in that it incorporates questions designed to examine CAMHS delivery in light of the Whare Tapa Whā[1], a Māori comprehensive model of health with a focus on whānau involvement and culturally responsive services. This mail or telephone survey was completed by a cohort of 168 Māori whānau. Their children had been referred to one of the three types of CAMHS, mainstream, bicultural, and kaupapa Māori[2], of the District Health Board (DHBs) in the Midland health region, Aotearoa. The Midland health region is an area with a large Māori population with high levels of social deprivation.

Results

The Te Tomokanga instrument was shown to have a similar factor structure to the North American questionnaire from which it had been derived. It identified issues relevant to Māori whānau satisfaction with CAMHS. The work supports the concept that Māori desire therapeutic methods consistent with the Whare Tapa Whā, such as whānau involvement and the importance of recognising culture and spirituality.

The participants were generally positive about the services they received from the three different CAMHS types, which shows good acceptability of CAMHS for Māori. Results found satisfaction with CAMHS was related to whānau involvement and culturally delivered services.

Conclusion

The Te Tomokanga instrument should prove useful in Aotearoa or other similar cultural settings. It is a means of determining the cultural acceptability or improving CAMHS delivery for Indigenous populations.

[1] The Whare Tapa Whā framework relies on a Māori worldview of health, a holistic approach advocating a balance between the four dimensions of the Taha Whānau (family), the Taha Tinana (physical), the Taha Hinengaro (cognitive or intellectual) and the Taha Wairua (spiritual). It is believed if one aspect is in distress then it impacts on the others causing tension and increased risk of poor health. Optimal health requires balance between all four dimensions.

[2] Kaupapa Māori mental health services provide Māori dedicated clinical and cultural workforce for Māori service users.

Acknowledgments

The authors wish to acknowledge the funders of this study, the Health Research Council of Aotearoa and the six participating CAMHS - Taranaki, Waikato, Te Au o Hinetai, Te Puna Hauora Kaupapa Māori services, Voyagers, and Te Whare o te Rito of the DHBs in Midland Health Region, Aotearoa.

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