Training, Recruitment and Retention Strategies for Psychologists in Child and Adolescent Mental Health Services: Hilda Hemopo October 2004

Transcription

1 Training, Recruitment and Retention Strategies for Psychologists in Child and Adolescent Mental Health Services: A Maori Perspective Hilda Hemopo October 2004 The Werry Centre for Child and Adolescent Mental Health The University of Auckland Auckland New Zealand

2 ISBN The Werry Centre for Child and Adolescent Mental Health Workforce Development Department of Psychiatry The University of Auckland Private Bag Auckland New Zealand The Workforce Development Initiative is funded by: The Ministry of Health, Wellington, New Zealand. This document is available on the website of The Werry Centre: 2

3 Contents Acknowledgements... 4 Executive Summary Background The Treaty of Waitangi A Maori perspective Method Results Participants Maori registered psychologists Maori psychology interns Demographics Child and adolescent mental health training in psychology programmes Adequacy of training Future training topics for all child and adolescent psychologists Cultural Knowledge Specific child, adolescent and family assessment and therapy topics Training initiatives and recruitment issues for Maori Inclusion of Maori content taught by Maori staff Provision of scholarships for Maori students Inclusion of child, adolescent as a specialist area of training What attracts Maori psychologists with experience in the area to work in CAMHS Desire to help Maori children and their whanau Complexity, prevention and use of psychological processes What attracts Maori psychologists with no experience in the area to work in CAMHS Training Opportunity for Early intervention/prevention Deterrents to Maori psychologists working in the area of child and adolescent mental health Lack of cultural resources and support Lack of other resources Complex nature of the work Training programme deterrents Retention issues and deterrents for Maori psychologists continuing to work in CAMHS Cultural factors Other factors Workforce development initiatives Integration, support and valuing of Maori knowledge Professional development training topics Recommendations References

4 Acknowledgements Ko Whangatauatia me Kapa Wairua nga maunga Ko Kāririkura me Parengarenga nga moana Ko Te Uri O Hina me Te Ringa-a-Maui nga hapu Ko Te Rarawa me Ngati Kuri nga iwi Tihei mauriora Tena koutou katoa "Me mahi ngā mahi o waho, me mahi ngā mahi o roto, Hei painga mo te tinana, hei painga mo te wairua, Maa te Matua Nui rawa tātou katoa e manāki Tātau Tātau" (Nina Römana-Subritzky) I would like to thank The Werry Centre for providing the opportunity to undertake this research, their Kaumatua (Rawiri Wharemate) for his support and Tania Cargo (Maori Senior Clinical Advisor) for her assistance in preparing the final document. Thanks also to Te Rau Matatini and Paul Hirini for participating in the design of the initial questionnaire. Special thanks to Dr Ian Lambie, Monique Faleafa, and my colleagues, Ainsleigh Cribb, and Erana Cooper from the Department of Psychology, University of Auckland for their knowledge and support in compiling this report. Finally, I would like to extend my thanks and appreciation to the Maori psychology interns and psychologists who made this project possible by taking the time to participate. Hilda Te Pania-Hemopo Executive Summary This document outlines research undertaken to identify both the incentives for, and barriers to Maori psychologists (clinical and educational) and psychology interns entering mainstream Child and Adolescent Mental Health Services (CAMHS). It also seeks to inform planning and future initiatives for the workforce development of Maori psychologists in mainstream CAMHS in New Zealand. All respondents identified as Maori and responded to a pencil-and-paper survey, distributed as part of a larger mainstream survey of psychologists in CAMHS, conducted by Dr Ian Lambie and Dr Malcolm Stewart for The Werry Centre. The mainstream report is also available from The Werry Centre website ( 4

5 Initially Te Rau Matatini (the national Maori mental health workforce development organisation funded by the Ministry of Health) was involved in designing Maori specific questions that were included alongside the mainstream survey. The data was then analysed by a Maori Clinical Psychology Intern. Results This survey reports the key views of 16 registered Maori Psychologists (40% of all Maori registered psychologists living in New Zealand in 2003) and four Maori psychology interns (30% of all Maori interns in New Zealand in 2003), as they relate to the training, recruitment and retention of Maori psychologists in mainstream CAMHS. Key findings are presented below. Key findings relating to child and adolescent mental health training in psychology programmes : The majority of Maori respondents held a very negative opinion of the adequacy of the training in child and adolescent mental health they received as trainee psychologists; o Over half (11/20) rated their training in child and adolescent mental health as 'poor'; o Seven felt it was 'adequate' ; o Only two respondents rated their training as either good or excellent. Maori respondents rated two topics as very important in the training of child, adolescent and family psychologists.; o Cultural knowledge (9/20); o Specialist assessment and therapy topics (11/20); Key findings related to training initiatives and recruitment issues for Maori Maori identified three initiatives that would assist recruitment of Maori psychologists in child and adolescent mental health: o inclusion of Maori content taught by Maori staff; o provision of scholarships for Maori students; o inclusion of child and adolescent mental health as a specialist discipline in professional psychology training programmes. Key findings related to attraction to work in CAMHS For Maori psychologists with experience in this area the main attraction was their desire to help Maori children and their whanau (85%). Secondary attractions included: o complexity of issues; o use of psychological processes; 5

6 o and the opportunity to work preventively with children. For Maori psychologists with no experience in this area, over half the respondents (60%) identified two things that may have helped attract them into CAMHS: o more training in the area of child and adolescent mental health; o the opportunity to intervene early with children and their whanau. Key findings related to what deters Maori psychologists from working in the area of child and adolescent mental health Maori identified four key deterrents: o the lack of cultural resources and supports; o the lack of agency resources; o the complex nature of the work; o training programme deficits which act as barriers for Maori psychologists entering CAMHS. Key findings related to retention issues and deterrents for Maori psychologists continuing to work in CAMHS Retention of Maori psychologists in CAMHS is a major concern given the experience reported by this group. Of the 12 registered psychologists who had worked in CAMHS, only 3 psychologists (25%) were still in CAMHS. Such a high attrition rate (75%) is of grave concern given the population figures which show that by % of all school-age children will be Maori (Durie, 2001). Maori respondents identified specific cultural factors as significant deterrents to continuing to work in CAMHS including: o cultural inadequacies of agencies; o burnout; o cultural isolation. Like non-maori psychologists, respondents also identified other deterrents such heavy workloads and too much paperwork. Key findings related to workforce development initiatives Maori clearly and strongly identified that cultural workforce development initiatives were needed in order to attract more Maori psychologists into CAMHS. Areas considered essential were: o cultural integration and valuing of Maori knowledge; o cultural support within agencies and; o training of staff in working in a cultural appropriate manner ; Like non-maori psychologists, Maori felt that specific training in specialist psychological practises were also important. Recommendations Based on the these findings, recommendations are: 6

7 1. that psychology training programmes target the needs of Maori trainees; 2. ensure that all trainees are taught to work in a cultural competent manner; 3. that workforce development programmes focus on the needs of professional Maori psychologists within all psychological sectors; 4. that agencies and non-maori staff are supported to become culturally competent. Recommendations require active participation, support and cultural integrity of a number of stakeholders and relevant organisations such as (but not limited to) training institutions, District Health Boards, agency managers, senior Maori clinicians and other interested Maori groups. For the recruitment and retention of Maori in psychology training programmes there is a need to create culturally supportive environments for Maori students. This may include: Academic support provided by affirmative recruitment policies of training institutions to increase the number of Maori academic staff; Secondment of Maori professionals working within the child, adolescent and family mental health services to lecture/supervise and be involved actively in the training programmes; Cultural support through Maori supervisors, mentors kaumatua/kuia or mentoring programmes (e.g., Tuakana Programme) for students and Maori staff; Financial support through scholarships and/or internship bonding. To improve the recruitment and retention of Maori psychologists working in the child, adolescent mental health sector, the following should be considered: The provision of a culturally supportive cultural environment for Maori psychologists as part of agency policies; The support of on-going training for Maori and non- Maori psychologists in cultural competencies with appropriate certification; Support for Maori to have regular hui/wananga to focus on issues related to the mental health of Maori children and adolescents; Support for Maori psychologists to gain and maintain clinical competence in child, adolescent and family mental health; The provision of scholarships for Maori psychologists to increase their clinical skill and competence in cultural issues; Recognition of levels of competencies (i.e., clinical and/or cultural) through competitive remuneration, or working conditions; 7

8 The provision of internal or external cultural support in the form of Maori supervisors and mentors Background The Ministry of Health (MOH) has contracted the Werry Centre (University of Auckland) to develop part of the mental health workforce strategy signalled in the Health Funding Authority s Tuutahitia te wero, Meeting the Challenges: Mental Health Workforce Development Plan The Werry Centre was established in 2002 within the Department of Psychiatry, University of Auckland. The aim of The Werry Centre is to improve the mental health of children and adolescents in New Zealand by: Providing or facilitating first-class training and support to the workforce nationally; Promoting research of a high quality into child and youth mental health; Advocating for the mental health needs of children and adolescents; Supporting the child and adolescent mental health workforce to provide high quality care. The Werry Centre s workforce development project is one of a number of initiatives that supports the education and training of a specialist child and adolescent mental health workforce and includes: An analysis of relevant workforce needs; The determination of appropriate education and training goals, modalities and materials; The delivery, or arranging for delivery, of education and training; Monitoring and evaluation of the impact of training and unmet training needs. This piece of research focuses exclusively on the opinions of Maori psychologists and psychology interns, but is also part of a larger project undertaken by The Werry Centre, to identify recruitment and retention issues for all psychologists working in CAMHS. The objectives for this part of the project are specifically Maori focussed. The research objectives are to: Identify key training needs in child and adolescent psychology programmes for Maori trainees; Identify the barriers and incentives to working in mainstream child and adolescent mental health services for Maori psychologists; 8

9 Identify recruitment and retention issues for Maori psychologists working in mainstream CAMHS; Identify workforce development issues for Maori psychologists working in mainstream services. It is envisaged that these findings will inform workforce development initiatives as they specifically apply to Maori psychologists training, recruitment and retention in mainstream CAMHS The Treaty of Waitangi For Maori as tangata whenua (indigenous people of the land) of Aotearoa/New Zealand, the signing of the Treaty of Waitangi in 1840 epitomised the framework for the establishment of a 'partnership' between Maori tribes and the British Crown (Durie, 1995; Renwick, 1990; Walker, 1990). While in the past Treaty principles have been repeatedly breached, in the last four decades Maori have attempted to challenge successive governments to become accountable to such principles (Evans & Paewai, 1999). Although the process has been slow, in more recent years the Treaty is now being recognised as a blueprint for developing a model of biculturalism with Aotearoa/New Zealand. This includes the practice of clinical psychology and professional services (Evans & Paewai, 1999; Herbert, 1977). Maori, as indigenous people, affirmed in the Treaty, also hold international rights for self-determination endorsed by the United Nations covenants (Smith, 1998; Magallanes, 1998; cited in Robson & Reid, 2001). Trask (1999; cited in Robson & Reid, 2001) states these "indigenous rights are strictly distinguished from [those of other] 'minority rights'" (p. 33). This research acknowledges the significance of the Treaty of Waitangi and that Maori have rights pertaining to their status as indigenous people that are unique from those of other ethnic minorities within Aotearoa/New Zealand, regardless of Maori being only 15 percent of the total population (Robson & Reid, 2001) A Maori perspective The early effects of colonisation in Aotearoa/New Zealand continue to impact on Maori today. In particular, Maori ethnic identity has undergone severe cultural change resulting in diverse Maori realities. This dynamic process exists as Maori, both as individuals and collectively, (i.e., whanau, hapu and iwi) continue to undergo changes in response to societal changes (Vaughan, 1986). The opinions of Maori within this study represent the heterogeneity and richness of Maori who have traditionally been treated as a homogeneous group (Hemopo, 2000). 2. Method The method of the study has been described in the mainstream report (Lambie and Stewart 2003). Questions specific to Maori respondents were developed by a psychologist working at Te Rau Matatini (the national Maori mental health workforce development organisation funded by the Ministry of Health). These were included 9

10 alongside the mainstream survey. The data were then analysed by a Maori Clinical Psychology Intern. Quantitative data were gathered using rating scales, whist qualitative data were gathered as written responses to open-ended questions included in the surveys. These were examined and analysed using thematic analysis where common methods/themes and propositions are generated from the data. This report describes the responses of the Maori respondents 3. Results 3.1. Participants Maori registered psychologists Responses were received from 20 Maori participants including 16 Maori registered psychologists; 15 registered clinical psychologists; 1 registered educational psychologist; 4 Maori psychology interns (i.e., psychology students in their final year of training); 2 clinical psychology interns; 2 educational psychology interns. The 16 Maori registered psychologists surveyed for the present study represents 40% of all Maori registered psychologists living in New Zealand in 2003 (Ministry of Health, 2004). Of this sample, twelve psychologists (75%) had experience working in a specialist child and adolescent mental health service, although only three (20%) were still currently working in this area. The remaining four psychologists were either in adult services, managerial positions or teaching positions Maori psychology interns The four Maori psychology interns represent 30% of all Maori psychology interns studying in New Zealand in All four interns stated that they had been in a placement setting where children and adolescents were clients, although only one intern identified as currently working in a specialist child and adolescent service Demographics Maori psychologists make-up less than 4.7% of all psychologists in New Zealand. They are therefore a very visible population, in order to protect the anonymity of the Maori participants only very basic demographic information is included in this report. There were 13 female and 7 male participants. 10

11 Participants came from four North Island centres and one South Island centre. 11 participants identified solely as Maori, whilst the remaining nine also identified as being Pakeha. Thus although the numbers in the study appear relatively small they do in fact represent a significant proportion of Maori psychologists working in New Zealand Child and adolescent mental health training in psychology programmes Adequacy of training Respondents were asked their perspectives on the adequacy of the training they received in child, adolescent and family mental health as trainee psychologists. Figure1. The Adequacy of Child, Adolescent and Family Training (n=20) The majority of respondents held a very negative opinion of the adequacy of the Poor Adequate Good Excellent training they received as trainee psychologists. Over half the respondents rated their training in child and adolescent mental health as 'poor', seven respondents felt it was 'adequate' but only two respondents rated their training as either good or excellent Future training topics for all child and adolescent psychologists Respondents identified topics that they rated as very important to be included in the training of child, adolescent and family psychologists. Two main themes emerged: the integration of cultural knowledge and specialist assessment/therapy topics. 11

12 Cultural Knowledge Nine respondents rated the need to integrate Maori cultural knowledge in child and adolescent mental health training programmes as very important. In particular the inclusion of Maori cultural assessment and family therapy models to increase clinicians cultural awareness and skill level for working with Maori children and their whanau was considered important. Comments from respondents included: Culturally appropriate assessment and treatment within the youth sector - with an additional emphasis on family and culture (within all youth topic sectors). Cultural awareness [and] developing models for working with Maori. Practice issues [and] implications of working with Maori children, adolescents and their whanau Specific child, adolescent and family assessment and therapy topics Like other psychologists, 11 Maori respondents identified specialist areas that focus on child, adolescent and family psychological assessment and therapy as being very important for inclusion in training programmes. Child and youth cognitive behavioural therapy model, family therapy, parent management training and developmental psychology, are all important.. Assessment of children and adolescents [and] specific treatment strategies for children [and] adolescents and ethics when working with this population are important specialist topics for this population Training initiatives and recruitment issues for Maori Respondents were asked to identify their perceptions of training needs and support initiatives that would assist Maori psychologists in child and adolescent mental health. Three themes emerged. Two had a specifically Maori focus there was the inclusion of Maori content taught by Maori staff and the provision of scholarships for Maori students. The third was a general theme of the need to include child and adolescent mental health as a specialist discipline in professional psychology training programmes Inclusion of Maori content taught by Maori staff Respondents reported the need for training to include more Maori content and for psychology programmes to employ more Maori staff to support Maori students. 12

13 These measures were identified as the most crucial in terms of making programmes culturally safe and therefore attractive and relevant for Maori students. Make programmes more culturally safe/relevant to attract suitable applicants. Incorporate culturally relevant concepts in training. Maori lecturers/ mentors and supervisors imparting principals/understanding in the training program... More appropriate situations for interns to support placements. Respondents also identified the need to be trained in culturally appropriate whanau therapy so they could actively engage the whole whanau in the child or adolescent s therapy. The importance of whanau in children and adolescents therapy was also noted as respondents wrote statements where the word whanau or family was always included when ever they wrote their responses Provision of scholarships for Maori students Respondents acknowledged the fact that few Maori students engage in tertiary level education. Of those that do, many face financial hardship during training because Maori, tend to come from a lower socio-economic group. Therefore as an incentive to train in the area of child and adolescent mental health, respondents suggested that there should be scholarships and/or financial support for Maori students, who would then be bonded to a mainstream CAMHS. However, as the comment below reflects, this on its own is not enough. To recruit Maori students into the area, the other issues discussed above also need to be addressed. For me there is a need to employ more Maori psychologists, so you need to provide scholarships for Maori students. Create an atmosphere of whanau support and manaaki. [The] use of reo in prominent places. Employ kuia and kaumatua as support and Maori as ringawera, kaitiaki. This is too minimal really [and] only serves to marginalise the importance of Maori issues to an add-on approach Inclusion of child, adolescent as a specialist area of training Like other psychologists, Maori felt that the area of child and adolescent mental health needed to have a greater profile during training. Some suggested that it may require its own speciality stream in clinical psychology training programmes. For Maori psychologists the desire to work with Maori children and their whanau is seen as important factors in their choice of profession areas. Finally, as in other areas of psychology, training in areas such as psychometric testing, cognitive behavioural therapy, parenting, family therapy and developmental psychology are important in child and adolescent mental health. 13

14 In training they need to increase the profile of this work (child and adolescent mental health), so trainees are more knowledgeable and less prejudiced about the work What attracts Maori psychologists with experience in the area to work in CAMHS Although16 respondents identified that they had at least some experience in working with children and adolescents and their families, only 13 had actually worked in CAMHS. These 13 respondents were asked to identify what attracted them into CAMHS. The main attraction was their desire to help Maori children and their whanau (85%). Secondary attractions were associated with the challenges of working with this population such as the complexity of the work, use of psychological processes in therapy and the opportunity to work preventively with children Desire to help Maori children and their whanau The desire as Maori psychologists to help Maori children and their whanau was identified by 11 of the 13 respondents (85%) as the predominant reason they went to work in CAMHS. Love the kids!! Very rewarding. Recruited into Specialist Educational Services and felt I'd found my place. As well as a desire to help Maori, respondents also felt a sense of duty to work with Maori. They felt they wanted to help support the increasing numbers of Maori children and their whanau being referred to mainstream CAMHS. Maori children are in need of appropriate Maori support and as Maori numbers [are] increasing, I wanted to work in an area with Maori children and whanau. Particularly interested in [the] needs of Maori youth. Finally all respondents reported that CAMHS philosophy of working with the whole whanau is culturally appropriate and is a reason they would be attracted to work in a CAMHS Complexity, prevention and use of psychological processes Complexity of issues, use of psychological processes and the opportunity to work preventively were further reasons Maori psychologists were attracted into mainstream CAMHS. Enjoy the cognitive/behavioural side of intervention, and the ability to work ecologically for best practise development. 14

15 Enjoy assessing youth vulnerability and the prevention of complex problems/behavioural problems What attracts Maori psychologists with no experience in the area to work in CAMHS Training Seven respondents reported little or no experience working in mainstream CAMHS. However, four of the seven respondents (60%) reported that they would have been at least somewhat likely to choose to work in this field if they had received more training in the area. Lack of focus in training courses on child and adolescent mental health and an over focus on adult needs Opportunity for Early intervention/prevention Four of the seven respondents reported that the opportunity to intervene early with children and their whanau was a key reason they would have been attracted to work in CAMHS. Respondents comments reflected their ideas that by working in CAMHS, clinicians had the chance to work proactively. Preventing children from graduating on to become users of adult mental health services Deterrents to Maori psychologists working in the area of child and adolescent mental health Respondents were asked to identify barriers that deter psychologists from working in mainstream CAMHS. They identified four key deterrent which act as barriers for Maori psychologists entering CAMHS: the lack of cultural resources and supports; the lack of agency resources; the complex nature of the work and training programme deficits; Lack of cultural resources and support Maori psychologists identified the lack of cultural resources as a key deterrent to working in mainstream CAMHS. The lack of Maori staff in agencies, the lack of cultural supervisors and the lack of non-maori who could relate to Maori worldviews were specifically identified as key deterrents which left Maori psychologists feeling isolated within mainstream services. The dominance of the medical model in clinical practice further helped to alienate Maori staff. 15

16 Real lack of people who think the way we as Maori think. No cultural clinical supervisors... sense of isolation. Medical model dominates assessment and treatment Lack of other resources Lack of funding, managerial and interagency collaboration and specialist psychological tools were identified by Maori psychologists as further deterrents to working in child and adolescent mental health. The crap pay; the crappy office space; the unavailability of necessary materials (e.g., tests); the overloading of case loads; the sheer ineptitude of health managers; the idiosyncracy of government guidelines - I like a challenge. The lack of suitable resources to assist i.e., beds/ appropriate daytime programmes. Lack of resources i.e., funding for programmes and psychometrics. Lack of cohesiveness between agencies i.e., CYFS, DHB, SES, which often leads to obstructiveness rather than co-operation Complex nature of the work. Respondents identified factors such as interagency liaison, legality issues and working with parents with their own mental health issues as examples of how complex working in the area of child and adolescent mental health can be. This perpetuates the idea that children and their families are a difficult population to work with. It's more complicated than adult - often there are mental health issues with the parents, routinely we liaise with schools, teachers, guidance counsellors, SES or C-SE and [you] have to collect a lot of collateral information, issues of consent and privacy for minors; dealing with CYFS; issues re: who is child's legal guardian; liaising with paediatric services (plus the long wait to do so). Perceptions of working with children (e.g., limited ability to respond to therapy) and adolescents (e.g., hard, unpleasant group to work with) plus, difficult to work with family dynamics. Child, adolescent and family work is part of a wider picture. We can do the best job in the world but if, for example, the parents become severely mentally unwell, and our work is often undone Training programme deterrents 16

17 Maori psychologists also identified several deficits rooted in training which act as deterrents to working in CAMHS. Given the perceived complexities of working in the child and adolescent sector it is not surprising that the lack of specialised training in child and adolescent mental health, limited child training placements and a lack of child focus during training were seen as barriers to working in this area. Lack of training - lack of confidence. First year post-registration students commencing first jobs tend to select jobs where they've recently had a placement and most often they will have had placements in adult settings. Lack of focus in training courses and over focus in adult needs. Indeed from the four interns who had previous CAMHS experience only one (25%) was in a CAMHS placement. A lack of positive experience during training led one intern to believe that working in child and adolescent mental health is not a good career option. Not recognised as career advancement as a specialised area Retention issues and deterrents for Maori psychologists continuing to work in CAMHS. Retention of Maori psychologists in CAMHS is a major concern given the reports from this sample group. Although 12 registered psychologists had experience working in the child and adolescent mental health area, nine psychologists (75%) were no longer working in the area. Such a high attrition rate is of grave concern because of the increasing numbers of Maori children and whanau who are currently accessing CAMHS and because the population statistics which shows that by % of all school-age children will be Maori 1. Respondents identified several factors that deter them from continuing to work in CAMHS. Specific factors identified included cultural inadequacies of agencies, burnout and cultural isolation resulting from being the only Maori psychologist in an agency. Like non-maori psychologists, respondents also identified other factors with the services as deterrents to continuing in CAMHS Cultural factors Respondents identified cultural inadequacies of agencies, cultural isolation and burnout as a consequence of being the only Maori psychologist in services as major deterrents to continuing work in mainstream services. For me the service did not adequately address the importance of culture and the service's obligations to the Treaty of Waitangi. 1 Durie, M (2002) Cultural Competency, A paper presented at 17

18 Burn out. High case loads. For me, only Maori psychologist in office - got 'over' utilised, got very tired. Having a break - but hope to go back within the next couple of months. Burnout; seeing other family members (or [the] same client) of initial client later on because recommendations not acted upon (by parents/school/cyfs usually) leading to a sense of futility with heavy workload Other factors A heavy workload, low pay, a business model and too much paperwork are among other reasons Maori psychologist reported for not continuing to work in CAMHS. Don't know apart from the usual over worked and under paid and too much paperwork, bureaucracy, business model management Workforce development initiatives Respondents were asked to identify workforce development initiatives that would attract more Maori psychologists to work in mainstream CAMHS. Cultural integration, support and valuing of Maori knowledge, as well as an ongoing professional development which incorporated training in working in a cultural appropriate manner were seen as essential. Like non-maori psychologists, Maori felt that specific training in specialist psychological practises, relevant to children and adolescent were also important Integration, support and valuing of Maori knowledge The integration, support, and valuing of Maori knowledge was identified as being essential when considering recruitment and retention issues for Maori psychologists in mainstream CAMHS. Respondents described their negative experiences of having to justify Maori modalities and practices, and felt that Maori knowledge was undervalued in mainstream services, leaving Maori staff feeling unsupported. A greater acceptance of Maori ways of seeing the world. Most psychologists would likely agree that Maori models and worldviews are valid but only if they meet scientist practitioner criteria. This is debatable no doubt, but for Maori working in the mainstream it seems that we have to prove that our way of being is valid. It seems that the criterion to measure validity is beyond our control. I believe that this is a factor in why Maori can struggle with clinical training. Development of a credible service, which recruits trained personal [sic]. Establishment of a comprehensive service offering effective interventions... Maori advice should be incorporated into this, which can support Maori psychologists becoming involved. 18

19 Whatever is done needs to be generated and controlled by appropriately knowledgeable and experienced Maori. One respondent stated that it could be helpful to have a Maori staff member to assist and train non-maori colleagues in cultural competency issues so that Maori psychologists did not have to do this training, thereby freeing them to do other clinical work. Another respondent felt that greater flexibility to work using Maori health models and non-maori staff who both accepted and respected these practices was important if mainstream services really valued their Maori staff Professional development training topics. On-going professional development was also seen as important for Maori psychologists but respondents reported that this was only likely to occur if case loads were lowered to allow the time required for training. Again the key topic identified for in-service training was working in a culturally appropriate manner that incorporates the whole whanau of the child or adolescent. Further training was also wanted in; CBT, parenting and family therapy, adolescent substance abuse, youth offending and neuropsychological testing. 4. Recommendations Based on these findings recommendations are directed toward the need for: psychology training programmes to support Maori trainees who wish to work in CAMHS; workforce development for professional Maori psychologists both within the child, adolescent and family mental health sector and in other mental health or educational settings; the active participation and support from a number of stakeholders including (but not limited to) training institutions, District Health Boards, Senior Maori clinicians and interested Maori groups. To increase Maori participation in psychology training programmes there is a need to create culturally supportive environments for Maori students. This may include: Academic support with Maori lecturers and supervisors who can provide specialised training that incorporates Maori practices of mental health and wellbeing; Clinical psychology programmes and/or postgraduate programmes should fund an academic "Maori presence within their programmes; Maori professionals working in child, adolescent and family mental health services should be contracted to present/lecture on Maori models of mental health and well-being as well as 19

20 teaching specialist knowledge of the work with Maori children and their whanau. Cultural support characterised by the presence of Maori supervisors, mentors, kaumatua, and kuia; Clinical psychology programmes should consider funding community Maori cultural advisors/ mentors to their programmes; Psychology Departments should fund mentoring programmes to provide cultural support for Maori psychology students (e.g., Tuakana programmes, Kaupapa Maori Student Advisors); All Maori postgraduate psychology students should be informed that there is a grant exclusively to support mentoring valued at $1,000 per annum for three years. While mentors should be 'approved', individuals can have the right to nominate those whom they consider culturally appropriate. Financial support through scholarships and / or internship bonding; Annual scholarships for Child, Adolescent Mental Health should be offered to Maori students when accepted into clinical psychology programmes and/or postgraduate programmes. Scholarships should be for two or three years (dependent on the type of degree e.g., Doctorate in Clinical Psychology) valued at a minimum of $10,000 per annum that bonds the student in their final year to an internship at a child, adolescent mental health service provider. To recruit and retain Maori psychologists in child, adolescent mental health services, the following recommendations need to be considered: A policy of providing a supportive cultural environment for Maori clinical psychologists; Training for Maori and non-maori clinical psychologists in cultural competence working with Maori whanau and children using Maori models of mental health and wellbeing. Training can be in the form of Maori mental health forums/ workshops inviting Maori psychologists and / or cultural Advisors specialised in the child, adolescent mental health services to facilitate such learning. Attained levels of competencies should be recognised in competitive remuneration; Training for Maori clinical psychologists in clinical skills and knowledge in child, adolescent and family mental health; The provision of cultural support using Maori supervisors, mentors; Child and adolescent mental health agencies need to fund Maori clinical psychologists to have internal or external cultural supervision; Maori clinical psychologists should be informed of grants/ scholarships that are available for mentorship. 20

21 References Durie, M. H. (1995). Mental health perspectives for the New Zealand Maori: In Inhsan Al-Issa (Ed). Handbook of Culture and Mental Illness: An International Perspective. Connecticut: International Universities Press. Durie, M. H. (2001). Cultural Competence and Medical Practice in New Zealand. A paper presented at the Australian and New Zealand Boards Council Conference, Wellington, Nov 22 nd. Evans, I., & Paewai, M. (1999). Functional Analysis in a Bicultural Context. Behaviour Change, 16, (1) Training for Maori and non-maori clinical psychologists in Maori models of health and wellbeing and the application of this in working with Maori, children and whanau Health Funding Authority. (2000b). Tuutahitia te Wero, Meeting the Challenges: Mental Health Workforce Development Plan Wellington: Health Funding Authority. Hemopo, H. T. (2000). Impact of Acculturation on Maori Mental Health in Aotearoa/New Zealand: Theory and Applied. Unpublished Honours thesis, University of Auckland. Herbert, A. (1997). Maori Visibility: The Treaty of Waitangi in Clinical Psychology Training at The University of Waikato. Paper presented at the annual conference of the New Zealand Psychological Society, Massey University, Palmerston North, and New Zealand. Ministry of Health, (2004). Psychologists Workforce in New Zealand 2003, Wellington: Ministry of Health. Renwick, W. (1990). The Treaty Now. Wellington, New Zealand: Huia. Robson, B., & Reid, P. (2001). Ethnicity Matters: Maori Perspectives. Te Roopuu Rangahau Hauora a Eru Pomare, Wellington. Vaughan, G. M. (1986). A social psychological model of ethnic development. In J. S. Phinney and M. J. Rotherman (Eds), Children's Ethnic Socialization: Pluralism and Development. (pp.73-91), Newbury Park, California: Sage. 21

22 Walker, R. (1990). Ka Whawhai Tonu Matou: Struggle Without End. New Zealand: Penguin. 22