The Innovation: Te Ao Auahatanga Whānau Ora Programme (TAAWOP)
This programme was specifically developed for Māori registered with the Runanga’s General Practitioner (GP) service who were identified as ‘vulnerable’ and ‘most at risk’, descriptors which equate to inter-generational health and social issues.
The programme, delivered by two full-time staff, empowered and supported clients to find their way back to wellbeing and to independent living. Staff accessed a range of agencies and providers to support client-centred goal planning. Important features of the programme, such as workshops delivered in clients’ homes, were developed in response to an identified need that emerged as the programme began operating. Once a mutual agreement had been reached in terms of completing goal plans, clients were then discharged from the service.
Te Ao Auahatanga Whanau Ora Programme Te Runanga o Ngati Pikiao Trust
Te Ao Auahatanga Whanau Ora programme was set up to provide a wraparound service for Maori registered with Ngati Pikiao GP services.
The programme offered support for Maori with chronic health conditions. Whanau were only enrolled if the met the following criteria.
Whanau with two or more generations in the household,
Two risk factors in health, education, employment, housing and justice,
Working with more than two agencies.
The programme was about supporting
Training and Employment,
Advocacy with Agencies.
And to drive this programme we secured two awesome kaimahi, Kim Richards and Ange Tipu – see these beautiful wahine in the video clip at the end.
Implementing the Innovation – Demographics.
As part of the programme we collected some demographics to tell us who was using this service and what areas they needed support in.
(Bar Graph) Most whanau accessing our programme were between the ages of 26-34 years of age.
(Pie Graph) There were 39 wahine and 10 tane enrolled in the programme.
(Side Bar Graph) On average there were 4-7 dependents in each whanau.
While developing whanau plans, the top three areas of support were identified:
Whanau Support – commonly included social support, repairing relationships, and building healthy positive environments;
Employment Health – this involved benefit advocacy, developing CVs and budgeting support.
Mental Health – support in this area related to working with agencies and linking whanau with services.
Whanau links to other Agencies – Pie Graph.
There appeared to be significant demand for connections to community networks, budgeting advice and housing as you can see in this pie graph.
Documenting The Journey.
We included and external evaluator as part of implementing the programme. This was to help us document the journey but more importantly help us identify areas of improvement so that whanau could achieve their goals. The evaluation process sort answers to the following questions.
What were the key strengths and challenges of the programme?
These were the activities involved in the Evaluation. Overall these steps ensured the roll out in recording of what worked and what didn’t. We learnt that planning for success at the front end of the programme was the best way to keep the focus on whanau outcomes.
Monitor and review progress
Reporting on outcomes
How did the programme contribute to improved outcomes for whanau accessing the service?
Building Strengths and mapping the plan.
With all the planning in place our Kaimahi were ready to get work. Referrals were slow at first but increased steadily as word got out into the community.
We ensured the focus of the kaupapa was always going to be about quality of outcomes and not quantity.
Introduce the program
First step was introducing the kaupapa and letting the whanau know what the programme was set up to do. A service pathway and whanau plan template was developed and this is in the handbook.
Developing a whanau plan
From there we enrolled whanau and set up a time to meet. Whanau plans generally took three weeks to develop and included aspirations and goals that the whanau wanted to achieve.
Working with the whiteboard
Kaimahi introduced planning concepts to whanau while working with the whiteboard in their homes. This technique worked wonders right across the board and brought out the best of them and our kaimahi.
Reconnecting with whanau
This was another key activity in supporting whanau plans towards completion. It included things like kaimahi dropping in for catch ups or calling them on the phone to see how they were doing.
Equip whanau with skills to address barriers and challenges.
This was another key component. Our programme believed whanau had the solutions and sometimes they just needed a little extra support in bringing them out.
Celebrating the Strengths.
There were some common strengths’ identified by whanau, kaimahi and stakeholders who were involved in the programme. This included things like:
Personal and Professional skills of the kaimahi. The team were seen as resourceful, engaging and able to use their skills to support the whanau positively.
Whanau Ora: “…the love and support we received from Kim and Ange was a great blessing, when you believe you are a failure it’s awesome to have someone come in and say “the only way is up..” I warmed to that approach…” Whanau participant.
Whanau also appreciated having the kaimahi to guide and share their journey with them. The kaimahi shared their knowledge and skills about how the support services can work and this helped to reduce the barriers for whanau. …”the greatest strength in this programme was the networks and skills that the staffing of this programme had. They were straight up with the whanau and developed their pan and asked them to commit to being responsible for it…they were the same way the agencies too” Whanau Participant. “…..they have helped link whanau to services that whanau wouldn’t normally access due to barriers, such as whakamaa and mistrust of professionals, and they system….” Ngati Pikiao Manager.
Alongside the participants, key informants also gave the kaimahi recognition for their commitment to whanau and the goals they had set. “ those two have years in the community delivering to our people, we know they know how to deliver interventions and enable whanau to set and achieve goals as managers we needed to support that and license the team to do whatever it takes to support our whanau..” Ngati Pikiao Manager.
Our Kaimahi’s time and effort was recognised by the New Zealand Herald and covered their amazing work. Recognition in an article showed the level of success our kaimahi had supporting whanau to reach their goals. Te Rauaroha kindly shared her experience on the programme – see her in the video.
Utilising a ‘Maori to Maori’ approach
In the design and delivery of the programme was also strength. Whanau and stakeholder felt that being a Maori to Maori service gave the mahi strength and purpose.
“I think being a Maori to Maori programme was a core strength, because the whanau are Maori and the support is Maori, there is a connection there that you didn’t have when the whanau is say visiting WINZ or the doctor…” Ngati Pikiao Manager. “First and foremost I was happy to be receiving support from someone who knew what I valued, knew what it was like to be Maori…that made me feel I was at home and not being seen as a bad person…” Whanau Particpant.
Whanau also identified they were spoken to and engaged with as an important element as a Maori to Maori service. Whanau responded to this approach as they felt safe and supported to reach their goals. “…Kim and Ange made me believe again in what I was taught, that Maori are generous and kind to one another. I had lost that in the hard times of my life but they bought it back. I wish I could keep them or have more people like them in my life….”
Collaboration & Common Purpose
The third key strength for our programme was:
The commitment and focus of the team to enable whanau to navigate services, for their improved health and wellbeing, was a key success. The evaluation findings indicated the programme achieved positive outcomes for whanau by enhancing knowledge, skills and awareness by appropriate services for support. “…They made sure I was on track and believed in me, made me feel good about myself…I have started the certificate in Iwi Maori Social Services and already passed 2 units. I’m stoked….” Whanau Participant.
The provider’s match of service values with whanau values was a key strength and success of our programme. Skilled kaimahi working outside traditional scopes of practice, achieved many outcomes for whanau. The focus from this strength was the need to work to a kaupapa not a contract. “the programme is a kaupapa, they are doing what they know to do and this is supported at all levels in our organisation…That’s the difference for me…it was delivered like a kuapap not a contract…” Ngati Pikiao Manager.
Whanauora in all communities…These strengths are an important consideration for future service delivery platforms. It reminds providers that the relationships formed with whanau, is critical in growing whanauora in all communities. Stephen talks about his time with our kaimahi, in the video clip at the end of this presentation.
Reflecting on the challenges.
The biggest challenge in this programme was:
Whanau Schedules: Kaimahi had mixed rates of success with whanau keeping appointments, but for some it just meant the kaimahi had to be flexible.
Level of participation from agencies Strength & Challenge: Kaimahi felt that the level of participation from services or agencies in the programme, was both a strength and a challenge. A common purpose mobilised some service and agencies, however persistent challenges meant that things like entitlements and housing related support, was difficult to obtain for some whanau. Kaimahi worked hard to collaborate and create opportunities that would result in the best outcomes for whanau.
Extend the scope of the support: At times the programme had to extend the scope of the support, especially for whanau not formally referred to the programme. And as these requests became more frequent, a log was initiated to monitor that contact.
The personal and professional networks of the two kaimahi were extensive, and these were a benefit to whanau outside of the programme. Working in a responsive and reflexive way, meant the kaimahi were able to assist whanau who asked for help but weren’t on the programme. “We are constantly getting people coming up to us in the street or car asking us if we can support them at WINZ or Housing New Zealand because they had heard that we can do that but because they weren’t registered with the programme we can only do so much like give them tips, and tell them the right words to use..” Ngati Pikiao Kaimahi.
Overall the programme successes outweighed the challenges, and whanau of the programme made significant gains towards their goals. A multidisciplinary approach to whanau plans and skilled kaimahi ensured positive outcomes for whanau.
On the way toward Whanau Ora, there were some key things we learned:
Innovation in the face of adversity: Whanau who came into this programme needed some support. They were facing challenges and regular responses were not working for them. They needed someone willing to work with them in a different way and someone who thought outside the box. “Some people can get it straight off but I need a bout more support and this programme gave me the support. It was hard going but I got there and accomplishing my goals was so awesome” Whanau Participant. “..the whiteboard gave a lot of mana to what we were doing…Whanau were used to being given this korero and pamphlets but the whiteboard gave them the opportunity to share in the solutions” Ngati Pikiao Kaimahi.
Unbreakable faith & Support for Whanau Aspirations: Whanau also needed someone to believe in them and not see them as a problem. They needed someone to empower them and to trust their capacity to make things better for themselves. “…we believed the solutions were within the whanau we were seeing and the whiteboard gave us the tool to bring that out..it was empowering for us as well as them” Ngati Pikiao Kaimahi.
“Maori to Maori” can be best practice but it starts with skilled kaimahi: We learnt that whanau will trust and work with Maori to Maori service if they trusted the kaimahi. “They supported me and my husband at a really stressful time, stuck with us till the end. I don’t know if I would have taken the support if they weren’t Maori” Whanau Participant. “..being Maori for Maori worked for me, they were choice. It was unconditional and we are grateful…” Whanau Participant.
Whanau deserve the very best….Everyone is valuable: Supporting someone to overcome adversity starts with believing that everyone is valuable. This learning reminds health professionals that not one size fits all and everyone can contribute something. “…because I never felt judged, the support was awesome and my family have come right now. We were encouraged to never give up or feel insecure about our decision making” Whanau Participant.
Quality of relationships will determine your success: Taking time and investing in relationships always pays off. Success with whanau requires the skills of many not a few. “Watching my family grow and achieve their goals they set in place for themselves with the encouragement and support of the kaimahi was awesome…” Whanau Particpant. “They gave me and whanau 100% full support and commitment to ensure we achieve all goals…” Whanau Participant.
Focus on the future ‘Progress not perfection’
Dedication and commitment to the whanau plan was achieved in small steps making those steps valuable no matter how small, is what will keep whanau on track to long term goals. “It was the ongoing support, non-judgemental approach that gave me back the power to be independent, to believe all things are possible if you are willing to take it one step at a time…” Whanau Participant. “Being able to see how all things were connected was strength, it was neat for us to draw the big picture but know what we could take small steps…” Whanau Participant.
Kim Richards, Paearahi: No time frame, because everybody works in different stages. You know, some families just need a quick fix – just a bit of plaster here and there. But then we’ve got a lot of deep stuff going on within families, so that can go on and on and on.
Te Rauaroha Karakia, Whanau: I just got blown away by it. I couldn’t get over what they did. And knowing I was very sick – I’m very sick. You know, I’ve never had anybody give me that help before.
Ange Tipu, Paearahi: What we’re looking for is “What are the issues? How can be best support them? What care plan are we going to put into place for them, with the support of the family?” And we go from there.
Steven Kohunui, Whanau: At the age of about 46-47, I became mentally unwell. I just wanted to… just let life go by.
Te Rauaroha Karakia: I had my daughter and my grandchildren. And at the time I brought them in, I was very sick. And I was making sure my grandchildren got their immunisation and everything. And knowing I had a bad heart at the same time, the nurse here felt that I needed help with my daughter and my grandchildren. So I was introduced to Whanau Ora, which I didn’t know at the time existed. And I was going, “Well, what’s this organisation? I’ve never heard of it before.”
Ange Tipu: Well there’s three ways of our referral process. There’s internally, which will come through our GP services; or there’s external services that refer their people down to us; and there’s self-referral where people just walk off the streets. But for Te Rauaroha the support was about us being ourselves, building that relationship with her, ensuring she’s gonna trust us because our families – and I talk about our Maori families – are not the easy people to pull out of their doorway.
Part of her plan was WINZ for her daughter. We would attend that appointment with the family for the first appointment. We would even offer a ride for their first appointment. After that we would allow them to make their appointments and attend them. We must ensure that we’re there to empower our people.
Kim Richards: When we work with the whanau, it’s building that rapport with the families. It’s a skill. If you don’t get that at the beginning, you’re had it.
With Tipene, it was his daughter. She come to talk to me because she knew I worked within Whanau Ora. And she came to talk to me because his daughter has seven children of her own, and she was struggling trying to look after herself and her children plus her father. So she came to speak with me to ask me if I can support her dad. Is there any way that Ngati Pikiao can support?
So I ended up ringing up Steven, letting him know what service we run, and how we can support him, and if he would like our support. And from there we made an appointment with him. And it was really sad because he didn’t even come and open the door. He just yelled out “come in”. And he was just swinging on his chair. I dunno, and Ange and I looked at each other and just had a few tears, you know.
Steven Kohunui: There was help out there but I didn’t know how to go enquire about it. Then Whanau Ora came, and when they came they gave me some sort of um… energise myself, to be able to pick myself up again. Like getting out, really socialising with people.
I was able to go to a place – grateful now – which is called Beverly House, which is a recovery programme. And we used to have a kaumatua programme running as well. But it was really good just socialising.
Kim Richards: After sitting with him, talking to him he says that he’s the type of man that didn’t want to burden anybody. From there we got a mental health needs assessment. And part of that came out that Steven was able to have supports like Beverly House in place which supported him around his tikanga, cooking, cleaning, computers, the gym. And it was trying to motivate him. And then another referral went out to Healthcare New Zealand, and their support person would pick him up and take him shopping and just go around each aisle and identify healthy foods for him because Steven was having takeaways seven days a week.
Steven Kohunui: Coming on with Whanau Ora, I do cooking for myself. I was also being reminded of by my family – Kimi and them – to keep myself clean, have showers, doing circuit training and doing te reo classes. What I got out of that was to actually rebuild myself, being able to get myself together, get more active.
Te Rauaroha Karakia: My home was too small, far too small. But I wasn’t going to see them on the road. So I agreed there and then to hop on board with Whanau Ora. And from there they organised everything for me because they knew I didn’t know much about the organisation and what I had to do, so they did everything for me from there.
Kim Richards: We found when we were talking to the families that it was easier to do something visual. So we started doing the whiteboard and then putting it down. So you tell us you know, “What are the areas that we might need to support you in?” And a lot of them will say “Oh look my health, that’s really important. I’m feeling really sick. I need support in that area.”
So what we do is we put them on the whiteboard, and like we might put them under health, housing. And then the more they look at it on the whiteboard, the more they see “Wow, it’s not really my health, the most important bit.” And then they identify once those are all fixed, their health becomes better.
Te Rauaroha Karakia: It was a hard journey but me, like any Maori grandparent or any grandparent, they will awhi their children and grandchildren and try and get any help they can.
Ange Tipu: To see her daughter and her children move forward and find their own whare, that was a release for her. No more stress. She was able to focus on her own health. It was beautiful to see aunty do that. It just boosted her right up when we were able to support the family to move forward. It was fabulous.
Te Rauaroha Karakia: So I hope all the whanau out there just come to Whanau Ora for that help because that’s what they’re there for. And believe me they got the loving people there for all that. They’ll understand you, love you, guide you, everything. All the support / tautoko you need. Nothing to be frightened of.
Ange Tipu: Our doors were always open for any support, any advice, any guidance.
Steven Kohunui: I think they done their job (laughs). For me, I think they’ve done their job. Every now and again I would call my cousins, but I would just call them just to see – just for something to korero about. But for me they’ve done their job. They’ve actually helped me to put my feet on the ground and rebuild myself. But to me I know where I should be now.
About Te Runanga ō Ngāti Pikiao Trust
Te Runanga ō Ngāti Pikiao Trust was mandated by its Iwi in 1987, to provide services and programmes that promote the well-being of Ngāti Pikiao and Iwi Māori. The Runanga primarily offers services and programmes to whānau who reside in the Rotorua Lakes District area. It also has strategic relationships with Iwi throughout the motu in common areas of interest.
Te Runanga ō Ngāti Pikiao Trust
1274 Fenton Street
P O Box 2241
Disclaimer: This page and the innovation it accompanies do not represent the views of the Ministry of Health. The views represented are those of Te Runanga ō Ngāti Pikiao Trust and the innovation piloted.