The Werry Centre: 2009

The werry centre map

Whakatauaki-Proverb

He aha te mea nui o te ao?
He tangata! He tangata! He tangata!

What is the most important thing in the world?
It is people! It is people! It is people!

Service description

New Zealand Population: 4 million Capital: Wellington Major languages: English, Maori

CAMHS or Community Child Adolescent and Family Services (CCAFS) as they are also known, were established by the Ministry of Health to provide specialist, accessible and culturally sensitive services to children, young people and their families, who are experiencing significant mental health difficulties. They are free services found in all 21 District Health Boards (DHBs) throughout New Zealand/Aotearoa.

CAMHS provide services to children and young people up to, and including, 19 years of age. Multidisciplinary teams are predominantly community based with inpatient units in Auckland (Child and Family Unit), Wellington (Rangitahi Unit) and Christchurch (Child and Family Inpatient Unit) at the Princess Margaret Hospital, Canterbury DHB.

CAMHS are secondary mental health services, accepting referrals from other health professionals, educational and community organisations. In addition to direct clinical interventions CAMHS also offer specialist consultation and liaison services to other agencies and maintain strong links with the communities they serve.

Child and adolescent mental health services are also provided by DHB funded Non Government Organisations (NGOs). These NGOs include independent community and iwi/Māori organisations. The function of these NGOs varies considerably, however most offer a broad range of primary and secondary mental health services, including residential care, community support and consumer and family support services.

Chris Haddock is the project Leader for The Seven Helpful Habits and The Choice and Partnership Approach (CAPA) in New Zealand. He works for the Werry Centre (www.Werrycentre.org.nz) who are the National providers for workforce initiatives for the CAMHS sector. We (Ann and Steve) asked Chris to give an overview on how CAPA has been adapted to NZ since being introduced in March 2007. Below is Chris’s account:

CAPA experience

Ann and Steve back visited Christchurch in March 2007 and then returned in the November to the North Island to run CAPA workshops. My post as Project Leader was established in October 2007 to help organize the North Island workshops and support CAMHS nationwide who wanted to learn more about CAPA and implement ideas from the workshops after Ann and Steve returned to the UK. I have now travelled around NZ providing further CAPA workshops tailored to each CAMHS requirements, consulted around the planning stages of implementation and attended several CAMHS post implementation evaluations.

In 2008 the Werry centre hosted a regional CAPA workshop giving the opportunity to 6 DHB CAMHS to share their sticking points, ideas and solutions around introducing CAPA into their services.

Although we have yet to implement CAPA in a Maori Kaupapa Service we have identified that the values and processes this model embraces are aligned with Maori customs and traditions. For Maori, the experience of being welcomed (Powhiri) into a service strengthens engagement and connectedness. The establishment of new relationships or whakawhanaungatatanga sets the foundation for collaboration and partnership. From a Maori perspective this newly formed relationship would subsequently be cemented by values such as manaakitanga (reciprocity and caring) and kotahitanaga (collective unity).

Impact

Half of the DHB’s in NZ have now either implemented CAPA, are in the planning stages of doing so or have requested training workshops and support. Other teams have chosen not to implement CAPA but have realigned their services through 7 HELPFUL Habits.

From those CAMHS who have implemented CAPA two teams have entered their DHB’s quality improvement awards on the basis of the service improvements they have made. In addition to CAMHS, one DHB has now implemented CAPA into their adult service and interest has been expressed by two Maternal Mental Health Services.

What do we like?

Is CAPA assisting the Strategic goals of Whakamarama te Huarahi (NZ national workforce Development Framework) to be met? Clinicians are now talking more about what constitutes Core and Specific work and ways to extend their Skills.

Feedback from those services employing CAPA report waiting lists have gone and those services without waiting lists, client wait time has been further reduced.

Clients are reported to be happy with CAPA and staff report feeling less pressured.

What helped us?

Some teams have spent months meeting regularly discussing how to go about it whilst others have introduced CAPA piecemeal. A couple of DHB’s created positions for a CAMHS development project leader whose role was to facilitate the implementation. This helped coordinate the work and took some pressure off service leaders.

In June 2008, I came to England for the national CAPA Troubleshooting workshop and visited Ann and Steve’s services, CAMHS in Gloucester [see their story in this book] and Kingston, Surrey with colleagues from Australia. This gave me a deeper understanding of CAPA and I have been able to offer similar Troubleshooting workshops in NZ.

Any problems and advice?

CAPA in NZ must be viewed in its NZ context. NZ is a South Pacific Nation with a unique, rich and diverse cultural heritage. All of this must be respected and CAPA can only be adapted to the cultural principles, which already exist here including Maori as Tangata Whenua. It is very helpful that CAPA is a model that can be adapted to suit individual service and population needs.

And finally

I would very much like to thank Te Rau Matitini, Maori Workforce Development Organization for their support in the initial phase of this Project and sincere thanks to the Werry Centre for the opportunity to do this work and the support they have given me.

Chris Haddock, Project Leader, Werry Centre, Auckland, NZ

Werry centre photo