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Cultural Assessment for Suicide
    Prevention with Māori
       Dr Nicole Coupe
            Kāi Tahu
Whakapapa Rangahau
                       Past Research

Maori Suicide
  – ~80-100 /year
  – Males
  – 15-35 years
  – Hanging 67%
Maori Attempted Suicide
  –   ~700 / year
  –   Females
  –   Median age 30 years
  –   Overdose
Roopu
                        Te Ira Tangata Team

Investigation Team
– Simon Hatcher, Nicole Coupe, Mason Durie, Rees
  Tapsell, Hinemoa Elder
Advisory Group (past and present)
– Maria Baker, Sharon Baillie, Tuwhakairiori Williams, Phyllis
  Tangitu, Materoa Mar, Mel Robson, Ministry of
  Health, Counties Manukau, Northland and Waitemata
  (DHB reps)
Project Team (past and present)
– Nicole Coupe, Ruth Herd, Karen Wikiriwhi, Alice
  Walker, Moana Pene-Prokopis, Te Ami Henare-
  Toka, Mihiteria King, Waiora Pene-Hare
Evaluation
– Tania Wolfgramm
Huarahi –
                       Methodology

Recruitment
– Counties Manukau, Northland and Waitemata
  DHBs
Eligibility
– >17, not at school and cognitively able to
  consent, Maori
Randomisation
– Treatment as Usual (controls) and Powhiri: Model
  of Engagement (intervention)
Person Identified Presenting To Emergency Department with an Episode of Deliberate
                                                                       Self Harm


                       Project Staff determine eligibility and ethnicity from psychosocial assessment and discharge summary

              Eligible Non Maori                                            INELIGIBLE                                       Eligible Maori
  Project staff gathers information required          Unable To Give Informed Consent or Still At School Collect   (Age, Gender, Ethnicity, DSH details)
              Person randomised                                  information from DHB and NZHIS                            Person randomised


  Control Group                Experimental Group


                               Consent Form                                                  Control Group                  Intervention Group
Consent Form                   Rating Scales
Rating Scales                  Patient Support
Treatment as Usual             Problem Solving Therapy
                               Vouchers GP visit                             •Consent Form                           • Consent Form
                               Cultural Assessment
                               Risk Assessment                               •Rating Scales                          • Rating Scales
                                                                             •Treatment as Usual                     • Patient support
 3 and 12 months post index
        presentation                                                                                                 • Problem Solving Therapy
rating scales
 telephone interview
                                                                                                                     • Vouchers GP visit
 DHB Records interrogated
 NZHIS information collected                                                                                         • Cultural Assessment
                                                                                                                     • Risk Assessment

 3 and 12 months post index                       Postcards             3 and 12 months post index presentation                         Postcards
        presentation                           1, 2, 3, 4, 6, 8,
                                               10 & 12 months           • Rating scales                                           1, 2, 3, 4, 6, 8, 10 &
rating scales                                     post index
 telephone interview                                                    • Telephone interview                                       12 months post
                                                presentation
 DHB Records interrogated
 NZHIS information collected                                            • DHB Records interrogated                                index presentation
                                                                        • NZHIS information collected
Tukunga Iho
                              Outcome measures

The primary outcome is:
1. Beck Hopelessness Scale.
Secondary outcomes are:
1. Repetition self harm (3 months and one year).
2. Anxiety and depression (HADS)
3. Cultural Identity Profile & Sense of Belonging (SOBI)
4. Quality of life measures (EQ-5D; SF36)
5. Overall mortality at 3 months, one year, five years and ten years
6. Health service use at three months, one year, five years and ten years
Powhiri – Process of
                   Engagement

– Taki/Wero      Consent
– Karanga        Patient support
– Karakia        Prayer (coming together)
– Whaikorero     Problem solving therapy
– Waiata         PST homework
– Koha           Reciprocity
– Hongi          End of Patient support
– Hakari         Food & drink closure
– Poroporoaki    Dissemination
Taki / Wero
            (challenge - consent)
• Consent
Karanga (Call –
Patient support)
Karakia (Prayer)
Whaikorero
(Speech – Problem Solving
        Therapy)
Waiata (Song -
 Workbook)
Koha (Gift)
Hongi
(coming together)
Hakari (Feast)
Poroporoaki
(Farewell – Dissemination)
Nā Reira
                                    So far

Te Ira Tangata has:
• Recruitment 3 November 2009
    – N=167, 5 withdraws,
    – 582 Māori presented to ED for self harm,
    – 365 meet inclusion criteria & randomised
        • intervention, 95 consented
        • control group, 72 consented
• Three month follow ups: 97 of the 166 All Forms (58%)
• Twelve month follow ups: 116 of the 162 All forms (71%)
Nā Reira
                              Findings!


• Significantly decreased hopelessness




• Significantly increased time before re-presentation
Whoatu
                               What you can do!

Keep
• Improving Māori cultural identity through problem
  solving therapy that addresses access to
      •   te reo Māori
      •   Whakapapa
      •   Whanau
      •   Whenua
      •   Marae
      •   Those things Māori

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Dr Nicole Coupe - Preventing Māori suicide: Improving care and intervention

  • 1. Cultural Assessment for Suicide Prevention with Māori Dr Nicole Coupe Kāi Tahu
  • 2. Whakapapa Rangahau Past Research Maori Suicide – ~80-100 /year – Males – 15-35 years – Hanging 67% Maori Attempted Suicide – ~700 / year – Females – Median age 30 years – Overdose
  • 3. Roopu Te Ira Tangata Team Investigation Team – Simon Hatcher, Nicole Coupe, Mason Durie, Rees Tapsell, Hinemoa Elder Advisory Group (past and present) – Maria Baker, Sharon Baillie, Tuwhakairiori Williams, Phyllis Tangitu, Materoa Mar, Mel Robson, Ministry of Health, Counties Manukau, Northland and Waitemata (DHB reps) Project Team (past and present) – Nicole Coupe, Ruth Herd, Karen Wikiriwhi, Alice Walker, Moana Pene-Prokopis, Te Ami Henare- Toka, Mihiteria King, Waiora Pene-Hare Evaluation – Tania Wolfgramm
  • 4. Huarahi – Methodology Recruitment – Counties Manukau, Northland and Waitemata DHBs Eligibility – >17, not at school and cognitively able to consent, Maori Randomisation – Treatment as Usual (controls) and Powhiri: Model of Engagement (intervention)
  • 5. Person Identified Presenting To Emergency Department with an Episode of Deliberate Self Harm Project Staff determine eligibility and ethnicity from psychosocial assessment and discharge summary Eligible Non Maori INELIGIBLE Eligible Maori Project staff gathers information required Unable To Give Informed Consent or Still At School Collect (Age, Gender, Ethnicity, DSH details) Person randomised information from DHB and NZHIS Person randomised Control Group Experimental Group Consent Form Control Group Intervention Group Consent Form Rating Scales Rating Scales Patient Support Treatment as Usual Problem Solving Therapy Vouchers GP visit •Consent Form • Consent Form Cultural Assessment Risk Assessment •Rating Scales • Rating Scales •Treatment as Usual • Patient support 3 and 12 months post index presentation • Problem Solving Therapy rating scales telephone interview • Vouchers GP visit DHB Records interrogated NZHIS information collected • Cultural Assessment • Risk Assessment 3 and 12 months post index Postcards 3 and 12 months post index presentation Postcards presentation 1, 2, 3, 4, 6, 8, 10 & 12 months • Rating scales 1, 2, 3, 4, 6, 8, 10 & rating scales post index telephone interview • Telephone interview 12 months post presentation DHB Records interrogated NZHIS information collected • DHB Records interrogated index presentation • NZHIS information collected
  • 6. Tukunga Iho Outcome measures The primary outcome is: 1. Beck Hopelessness Scale. Secondary outcomes are: 1. Repetition self harm (3 months and one year). 2. Anxiety and depression (HADS) 3. Cultural Identity Profile & Sense of Belonging (SOBI) 4. Quality of life measures (EQ-5D; SF36) 5. Overall mortality at 3 months, one year, five years and ten years 6. Health service use at three months, one year, five years and ten years
  • 7. Powhiri – Process of Engagement – Taki/Wero Consent – Karanga Patient support – Karakia Prayer (coming together) – Whaikorero Problem solving therapy – Waiata PST homework – Koha Reciprocity – Hongi End of Patient support – Hakari Food & drink closure – Poroporoaki Dissemination
  • 8. Taki / Wero (challenge - consent) • Consent
  • 11. Whaikorero (Speech – Problem Solving Therapy)
  • 12. Waiata (Song - Workbook)
  • 17. Nā Reira So far Te Ira Tangata has: • Recruitment 3 November 2009 – N=167, 5 withdraws, – 582 Māori presented to ED for self harm, – 365 meet inclusion criteria & randomised • intervention, 95 consented • control group, 72 consented • Three month follow ups: 97 of the 166 All Forms (58%) • Twelve month follow ups: 116 of the 162 All forms (71%)
  • 18. Nā Reira Findings! • Significantly decreased hopelessness • Significantly increased time before re-presentation
  • 19. Whoatu What you can do! Keep • Improving Māori cultural identity through problem solving therapy that addresses access to • te reo Māori • Whakapapa • Whanau • Whenua • Marae • Those things Māori