The appropriateness of DUNDRUM-3 and DUNDRUM-4 for Maori in forensic mental health services in New Zealand: participatory action research.

BACKGROUND: The Auckland Regional Forensic Psychiatry Services (ARFPS) in New Zealand has introduced structured clinical judgment instruments developed in Ireland (DUNDRUM-3 and DUNDRUM-4) to assist staff decision-making regarding service users' clinical pathways. In New Zealand, Maori (the indigenous people) constitute 43% of the in-patient forensic mental health population. The aim of this study was to determine the face validity of the measures for Maori. METHODS: Participatory Action Research was aligned with a kaupapa Maori (Maori-orientated) research approach, to give full recognition to Maori cultural values. Two hui (gatherings) were held with Maori clinical and cultural experts at the service. The first hui (n = 12), explored the cultural appropriateness of the measures. The second (n = 10) involved a reflection on appropriate adaptions to the measures. Discussions were digitally recorded, transcribed and thematically analysed. RESULTS: Although the usefulness of the measures in enhancing the overall quality of clinical decision-making was confirmed, the DUNDRUM measures were considered to be limited in their ability to fully measure Maori service user progress and recovery. Suggestions were made to develop an additional 'pillar' focused on cultural identity and spirituality for DUNDRUM-3; to use both service user and family ratings for the adapted DUNDRUM-3 and DUNDRUM-4 measures; and to involve cultural expertise at the point of structured clinical judgement when using the measures. CONCLUSIONS: This is the first study to consider the face validity of the DUNDRUM-3 and DUNDRUM-4 for indigenous peoples, who are internationally over-represented in forensic mental health services. Suggested changes would require a negotiated, collaborative process between Maori cultural expertise and the original authors of the measures.

Strategies to reduce the use of seclusion with tangata whai i te ora (Maori mental health service users).

Maori, the indigenous people of New Zealand, have the highest crude population-based rate of seclusion events reported internationally (McLeod et al. ). This qualitative study explored Maori clinical, cultural and consumer perspectives on potential strategies and initiatives considered likely to facilitate prevention of, and reduction in, the use of seclusion, with tangata whai i te ora (Maori mental health service users) in mental health inpatient services. A hui (gathering) over 2 days was held with 16 Maori participants with high levels of clinical, cultural and consumer expertise. The gathering was taped and the tapes transcribed. A thematic analysis of the hui data generated three key categories: Te Ao Maori (access to a Maori worldview); Te Ao Hurihuri (transforming practice); and Rangatiratanga (leadership, power, and control). The findings of this study align with the "six core strategies" for best practice to reduce the use of seclusion (Huckshorn ). A comprehensive approach to the reduction of the use of seclusion with tangata whai i te ora is required, which is clearly based on a Maori model of care and a vision for transformation of practice in mental health inpatient services, which involves Maori leadership.

Caregivers' voices: The experiences of caregivers of children who sustained serious accidental and non-accidental head injury in early childhood.

Head injury is a leading cause of mortality and acquired neurological impairment in children. Head-injured children may have neurobehavioural deficits that persist for years following injury. Head injury can result in significant and persistent caregiver burden, including mental health issues, family stress and disorganisation, and unmet social and healthcare service needs. Few studies have examined the healthcare and social service needs of children and their families following head injury sustained at an early age. This qualitative study aims to describe the experiences of caregivers of children who sustained a serious head injury (particularly non-accidental head injury) before the age of 2 years. Caregivers were interviewed up to 15 years following the initial injury. Semi-structured interviews with 21 caregivers of 15 children (aged 3-15 years at the time of interview) were completed. Thematic analysis of interview data generated three key themes: impact, support and information. The study's findings reveal the broad impact of serious childhood head injury on caregivers, specifically the significant distress and burden brought about through lack of information, challenges in accessing support and inconsistent care. Recommendations for developing a quality 'model of care' and improving ease of access to supports for caregivers are provided.

New Zealand youth that sexually offend: improving outcomes for Maori rangatahi and their whanau.

Maori youth are overrepresented in criminal justice statistics and youth forensic services. Maori youth that engage in sexual offending behaviors have a higher risk of dropping out of treatment than Pakeha(1) youth. Research into Maori mental health is important to inform ongoing service development and is essential to strive for equity in mental health outcomes and offending rates among Maori. In this study, the researchers investigated the coexisting emotional and behavioral problems and victimization histories of an age-matched sample of Maori (n = 75) and Pakeha (n = 75) youth who were referred to a community treatment program for sexual offending in Auckland between 1996 and 2008. The Child Behavior Checklist was used to investigate ethnic differences. After controlling for socioeconomic deprivation, Maori youth scored significantly higher than Pakeha youth on the Delinquent Behaviors syndrome scale. Maori youth were also more likely than Pakeha youth to have a background of physical abuse. Implications of these findings are discussed, with regard to the unique needs of Maori youth and appropriate interventions.