Collaboration with and for Rural Māori with Substance use and Related Problems

Abstract

Collaboration is argued to be a necessary process in the effective treatment of people experiencing substance use and related problems. The process of collaboration is proposed to guide practitioners within services to better work together to meet the needs of service users, and to coordinate and integrate other services in response to related health and social problems that may contribute to a range of further compounding complications. There is evidence that despite these related problems being identified on entry to substance use problem treatment centres, these problems are rarely addressed, and that the problems of poor comprehensive care for people experiencing substance use and related problems are more pronounced for ethnic minorities and people living in rural communities. The lack of collaboration within and across addictions and mental health services, health and social services for Māori, the indigenous population in New Zealand, is of particular concern as Māori are disproportionately affected by substance use and related problems, particularly the social determinants of health. Collaboration is often poorly defined in the literature, and studies primarily take a narrow view of collaboration, that is, viewing collaboration from one perspective, such as between organisations, or between practitioners from different professions. There are very few studies that explore multi-perspective descriptions of what the collaborative process is or practices that support this, or studies that describe experiences of how people address substance use and related problems in their own whānau (family) and communities, or the role of culture in collaboration, such as when Māori and non-Māori organisations or practitioners are seeking to work together. This study utilises Kaupapa Māori Methodology within a case study design to explore collaboration in the context of a rural community for Māori with experiences of substance use and related problems. This includes a qualitative inductive data analysis approach. Three different stakeholder groups were selected in order to contribute to a multi-perspective view of collaboration to explore the different challenges and strategies utilised within and between these stakeholders. Individual interviews were conducted with key community members (KCM; n=10). These participants were involved in the initial forming of services in the area, who also provided an understanding of collaboration across time; Individual and group interviews were conducted with service users and their whānau (SU; n = 20). This involved service users with a self-identified substance use problem and engaging with two or more other health and social services and self-nominated whānau members. This incorporated a discussion of their experiences of addressing substance use and related problems as a whānau collective, and also engaging with a range of health and social service practitioners. The final participant group involved three focus groups with health and social service practitioners (PFG; n= 21). These groups incorporated practitioners form a range of iwi, non-government community groups and statutory services discussing their experiences of collaborating with service users and their whānau, and other practitioners. The study findings provide support for a contextual view of collaboration, where collaboration occurs within and between stakeholders operating at different levels of health and social care. Within a professional practice system, this occurs between government organisations in designing health and social contracts (policy level), between service managers regarding joint projects (organisational level), and between practitioners within and across different organisations and professions when working with the same service user and/or whānau (practitioner level). The study findings also identify a whānau collaborative system that is argued to interact with the professional practice system. The whānau collaborative system incorporates collaboration between community members and organisations to address local needs (community level), whānau members addressing the needs of whānau and the whānau members (whānau/whānui level), and individuals mobilising resources to address their own needs (whānau level). Each collaborative system is argued to have a range of strategies for enabling collaboration and reducing barriers to collaboration. These two systems are incorporated in an overarching model, the ‘Contextual model of whānau centred collaborative practice’. Unique challenges related to substance use and rurality are recognized. One of the unique outcomes of this study is the identification of intergenerational Māori experiences related to colonisation that permeated every level of collaboration across and between both collaborative systems. Based on this, the concept of whakapapa is used to encase the two collaborative systems within the model to represent the cultural values, experiences and practices that are proposed to enhance collaboration, address barriers to collaboration that have continued to repeat across time, and provide traditional pathways to wellbeing.