1. Resilience and Whānau Ora: Amohia Boulton, Jennifer Tamehana, Traditional Knowledge Conference, 7 June 2010 Seeking Understanding Beyond Our First Impression

2. Overview Introduction Research hypothesis, questions, methods Conceptualising resilience in the New Zealand context Preliminary findings Conclusions

3. Introduction Research in response to a Request for Proposals Theme of “resilience and whānau ora” Formation of a research collaboration –Iwi research centre: WRMHD –Inter-iwi primary health care provider: Te Oranganui Iwi Health Authority (TOIHA) –Academic research centre: Health Services Research Centre (HSRC)

4. Research Hypothesis Notions of resilience underpin Māori primary health and health promotion activities in New Zealand Māori primary health approaches have the ability to assist whānau to increase their resilience, by supporting individuals and their whānau to find resources that sustain their wellbeing in culturally meaningful ways

5. Research Questions Is “resilience” a relevant or useful concept for Māori whānau? hapū? Iwi? Is the concept of “resilience” relevant in Māori primary health? Can Māori health providers contribute to enhancing individual and whānau resilience?

6. Research Methods A single case study approach –Two phases of data gathering Construction of the initial conceptual framework through literature review –Academic: resilience, primary health care whānau ora –Grey: District Health Board (DHB) and Primary Health Care Organisation (PHO) documents, TOIHA internal policies, contracts, strategic documents and practice manuals

7. Research Methods Key informant interviews –TOIHA staff, managers and governance board members Series of in-depth focus groups with TOIHA consumers –6-8 whānau meeting regularly over four weeks Small survey of whānau consumers

8. Conceptualising Resilience Approach 1 –origins in psychology and particularly in social cognitive theory –unless people believe they can produce the desired effects in their lives they have little incentive to act –individuals as agents, personal efficacy –limited for understanding the impact history, culture and environment have on resilience

9. Conceptualising Resilience Approach 2 –underpinned by a social, contextual perspective –not simply an internal psychological state of wellbeing –“ecologically fluid, historically sensitive and culturally anchored” –holistic understanding of wellbeing

10. Our Working Definition “an individual’s capacity to navigate health resources and a condition of the individual’s family, community and culture to provide those resources in a culturally meaningful way” International Resiliency Project (undated)

11. Our Study Testing the initial conceptual framework “Mapping” resilience in a Māori primary health care context Four principles identified for further testing –Whānau Ora Approach –Focus on Wellness –Cultural Accountability –Empowerment

12. The Body of Knowledge /Literature on Resilience (includes international and NZ indigenous literature) NZ Context and Specific Case Study Material (TOIHA Documents Whanau ora Documents Maori Worldview) Key Informant Interviews List of Principles distilled from the two sources above Whanau Interviews Validation of literature Extending knowledge Confirming and consolidating practice

13. Findings From Phase One Practitioners perform a range of functions for individuals and whānau which can contribute to their becoming more “resilient” –Navigators (literally of the health system) –Advocates –Educators –Brokers –Support

14. Findings From Phase One Individuals and families exist that are considered more “naturally resilient” –Extended families –Friends –Links to marae and institutions of culture –Educated –Understand their rights

15. Findings From Phase One Te Oranganui works with individuals and their whānau to access resources which sustain their wellbeing “I think it starts of with us, because they [consumer] plant the seed and then it just grows and we’ve got to…nurture it” Yeah, support their confidence and self- esteem, once you’ve built that, well we know we’ve done a good job because (they’ll) ring up and say “oh, don’t need your support anymore” KI 06 and 07

16. Findings From Phase One Primary healthcare providers must be ready to assist and support whānau when whānau determine they are ready “We can’t, you know, actually help them unless they want to be helped…it’s that individual’s choice, you know? When that individual is ready to make that choice, then the services are there to give and assist” KI11

17. Findings From Phase One Resilience as a “facade of deeper incongruence” “Adults may seem resilient, but this may have been built by a series of setbacks, from which they survive, but they have not exactly bounced back, but are weakened by constant pressure” KI05

18. Findings from Phase One Mapping exercise in and of itself an early finding –Teased out the concept of resilience in more depth –Examined the concept with a critical eye –Methodological challenge of drawing out information from key informants without “leading” the interview

19. Findings from Phase One Conceptually very demanding, linking distinct two concepts into a cohesive framework for analysis –Resilience: focus on adversity and the need to overcome adversity and deficit –Whānau ora: strengths-based, about realising potential, does not assume a state of adversity as the norm, being Māori in a contemporary context

20. Research Hypothesis Notions of resilience underpin Māori primary health and health promotion activities in New Zealand Māori primary health approaches have the ability to assist whānau to increase their resilience, by supporting individuals and their whānau to find resources that sustain their wellbeing in culturally meaningful ways

21. Early Conclusions? Very difficult concept for people to consider “cold” Some evidence that Māori primary health care providers can support whānau to be more resilient Implications for the new Whānau Ora programme which calls for greater collaboration and cooperation amongst providers

22. Challenges Our challenge is to translate “academic” theory and theory testing into meaningful practice and lessons for service improvement –what can we contribute to the academy in the way of new knowledge? –what will be useful to research funders? –to our provider partner?

23. Challenges Are we simply attempting to ‘fit’ Māori into a Western framework of resilience - is conceptual adaptation enough? Identifying kaupapa Māori concepts, ways of being and doing that are meaningful for Māori in attaining and/or sustaining whānau ora

24. Acknowledgements The research participants –TOIHA Board Members –TOIHA Managers and Staff –Whanganui Whānau The research funders (Ngā Pae o te Maramatanga, the Families Commission, Health Research Council of NZ, ACC) HSRC

25. Contact Details Amohia Boulton Whakauae Research for Māori Health and Development amohia.whakauae@xtra.co.nz Website: www.whakauae.co.nz