The women are among seven Health Coaches working across the Western Bay of Plenty and Whakatāne as part of the PHO’s Integrated Primary Mental Health and Addiction (IPMHA) services team. The free service provides enrolled patients or whai ora, with support to guide them towards improved mental health and generalHealthwellbeing.coaches work closely with GP teams and Health Improvement Practitioners (HIPs) within a practice, and their non-clinical roles are mobile, enabling them to provide support where and when patients need it.
They might not come with pom poms but Natasha Edhouse and Liz Kriel are the cheerleaders we all need in our lives.
Reducing barriers, such as transport, Mobile support reducing barriers to care
Te Rerenga
August 2022 wboppho.org.nz
time and cost, are fundamental to helping people access the care they need in a timely way, says Natasha. “We visit them at home or meet at a café, or go for a walk up the Pāpāmoa Hills – whatever works best for whai ora. “Not all of our sessions are face to face; we can talk on the phone or on Zoom. A lot of people also work during the day so we can talk to a truckie on the phone hands-free in his cab when he’s driving to Matamata for an hour about his dietary needs. That fits into his day and it means he doesn’t need to park his truck for an hour to talk to us.”
News from the Western Bay of Plenty Primary Health Organisation
Health coaches Liz Kriel and Natasha Edhouse actively support whai ora in the community, where and when they need it.
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Phone conversations also revealed there were barriers to visiting the clinic for some patients. Bookings were made to deliver the flu vaccine to those patients at home. Brent Gilbert-De Rios from Te Whatu Ora, Hauora a Toi Bay of Plenty is proud to tautoko The Doctors Phoenix reaching out to its patients. “We’re working collaboratively with our partners across the health system to make getting immunised easy for whānau – whether that’s the flu jab, COVID-19 booster or measles vaccine. “Winter can be a tough time and the flu jab is the best way we can protect ourselves and our whānau from getting really sick with the flu. “We’re delighted with the success of this collaboration with The Doctors Phoenix. Congratulations to the team and to the community for getting protected against the flu.”
The wrap-around, holistic service has been operating since November last year, with the Bay of Plenty the second-tolast region to roll out the model. In 2019, the Government allocated $445 million to expand primary mental health and addiction services nationally.
Extra administrative support for practices has helped to lift rates for flu jabs in Whakatāne, especially for whānau experiencing barriers to accessing healthcare. Cover story continues ...
Courtney admits the practice team was apprehensive about how the offer of support would work in reality, but the results demonstrate real value in the initiative.
If there is a need to connect whai ora with more clinical support, health coaches can make those introductions. “We’ve got great relationships with Diabetes Tauranga, Sport Bay of Plenty and other community organisations, so we can make referrals if that’s what our whai ora need to get on top of their At The Doctors Phoenix, an administrator spent eight hours across four days working through a list of 600 patients who were eligible for their free influenza shot, resulting in the practice needing to create extra appointment times to accommodate the demand.
Te Whatu Ora, Hauora a Toi Bay of Plenty funded the admin hours as part of an initiative to support general practice teams to reach vulnerable whānau at the start of the winter flu season. Medical Centre Manager Courtney Takawe says the extra admin support made a significant difference to their vaccination rates. “It was a great result for us and our patients. We didn’t think we’d get as many people as we did coming in, so we were pleasantly surprised by the response.”
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Flu jab rates receive healthy boost
“When everyone in the practice is head down and busy, it can be easy to think you don’t have time to try new things. But working collaboratively like this allows us to help reach our vulnerable people, so it’s all worth it.”
The practice had already sent text messages to its enrolled population, informing them that flu jabs were available – and free for certain patients who met the eligibility criteria. Letters were also sent to reach those patients who didn’t have mobile phones. “What we learned from Paula, the administrator, is that many patients she spoke to on the phone had been thinking about getting the flu vaccine, but hadn’t gotten round to booking their appointment. The phone call was a good little push for those people.” health,” says Liz. Both former teachers, Natasha and Liz say they love their new roles in health for the variety and ability to improve the lives of patients.“Wecan see the difference and behavioural changes in people,” says Liz. “It’s wonderful to know the work is having a positive impact. When we see people get excited about an upcoming weigh-in, I get quite emotional because I’ve seen how hard they’re working and I’m just as excited for them.”Theservice is operating at the following practices: Pāpāmoa Pines Medical Centre – Domain Road Clinic, Pāpāmoa Pines Medical Centre – Palm Springs Clinic, Dee Street Medical Centre, Mount Medical Centre, Chadwick HealthCare – Greerton, Chadwick HealthCare – Bethlehem, Chadwick HealthCare – South City, Chadwick HealthCare – Tauriko.
Complementing existing primary health services, Natasha says health coaches provide whai ora with extra motivation and encouragement in relaxed settings to manage their health and wellness. “Whai ora create their own goals and we’re like their cheerleader on the sideline. We’re not running the race but we’re cheering them on.” Not all support relates to mental health, with whai ora also benefiting from discussions relating to lifestyle management, sleep hygiene, weight loss and long-term conditions, such as diabetes, asthma and gout. Liz joined the team in April and says whai ora valued the support to get their health back on track. “When we take people out of a clinical setting and we’re just walking and talking, people feel more relaxed and the conversation often just flows. “We’re actively listening, providing empathy and compassion. There’s no judgement; we’re there to establish a relationship, respond to their needs and keep the kōrero going.”
Tamariki from Merivale School welcomed everyone to the launch with waiata. The event, coinciding with Matariki, also featured the unveiling of a taonga, conceived and carved by artists Pohe Luttenberger (Ngāti Ranginui) and Whare Thompson (Ngāti Whātua, Ngāpuhi). Pohe says the taonga represents the full face of tupuna who looked into the healing waters of Rangiora near Gate Pā, as well as the faces of whānau who can now visit the health hub for advice and wellness.
Ngāti Ranginui Iwi chief executive Mel Tata says the hub aims to be a ‘centre of health’ for whānau by making it easier for eligible people to access free immunisations and general health information. “We aren’t focused on bureaucracy. It doesn’t matter which GP you’re registered with or which area you’re in. If you are visiting Tauranga Moana our doors are open for you. “This co-created immunisation service has a strong foundation with the whenua that it sits on, giving us the confidence to A new walk-in wellness hub operating at Fraser Cove Shopping Centre is improving access to immunisations for whānau in Tauranga Moana. move forward with care that is focussed on access and convenience for whānau.”
The partnership between Iwi and Te Whatu Ora was formed in 2020 to create a “response model” to COVID-19. The pandemic had “emphasised and exacerbated” inequities on whānau at that time, says Mel. The health hub was looking ahead to provide more preventative care services, while still being focussed on responding to COVID-19. “We’re in a time of resilience but COVID-19 is an evolving virus. The health hub is a place where whānau can come for up to date information.”
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Seven day health hub open for whānau
PHO chief executive Lindsey Webber congratulates Ngāti Ranginui and Te Whatu Ora for developing the health hub. “This is an important milestone in our collective efforts to eliminate health inequities and improve health outcomes for those most in need.”
Te Whatu Ora, Hauora a Toi Bay of Plenty chief medical officer Dr Luke Bradford says the sector had taken many lessons from COVID, including the most effective ways to deliver health services. “We need to do things differently to reach whānau and ensure they remain well. The hub is a chance for people to access services in a new way, when they choose them at weekends or when they’re out shopping – without appointments or any rigmarole.”TheBay of Plenty’s childhood immunisation rates had dropped since COVID-19, and he says the health hub is an opportunity to change that.
Pupils from Merivale School welcomed guests to the official hub blessing with waiata.
Rangiora Health Hub was officially blessed on June 22 and is a partnership between Ngāti Ranginui Iwi and Te Whatu Ora, Hauora a Toi Bay of Plenty (formerly Bay of Plenty District Health Board). Providing free vaccinations for eligible, vulnerable populations, it provides whānau with a service they can access at a time that suits them. Appointments are not necessary and it is open seven days a week, including public holidays.
Health and social service providers, including PHO health promotion coordinator Tiana Bennett, attend a facilitation training workshop for Heru & Hapū Māmā. online resources and how they can support wahine to become smokefree. PHO health promotion coordinator Tiana Bennett says the transition from Ūkaipō to the Heru & Hapū Māmā programme reflects a need to engage with pregnant wahine Māori in new ways. “The pilots have been really successful, so we wanted to bring Heru & Hapū Māmā across to the Western Bay,” she says. “Patrick cleverly uses online learning and innovative augmented reality (AR) technology to connect with wahine and motivate them to make positive lifestyle changes for themselves and their whānau.”
Evolving quit smoking support for hapu māmā
A long-running wananga providing support for pregnant wahine Māori in the Western Bay of Plenty has been rebranded with new digital tools available to help them quit smoking. Heru & Hapū Māmā participants receive a range of resources to support and empower them on their quit smoking journey.
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The Ūkaipō programme, funded by Te Whatu Ora, Hauora a Toi Bay of Plenty, has adopted the Heru & Hapū Māmā branding and digital resources following successful pilots in the Waikato and Eastern Bay of Plenty. Delivered over six weeks, the local programme now combines three face-toface sessions providing an opportunity for whānau to weave a wahakura (safe bed) for their baby, plus learn from health and social service providers with a takehome resource pack and digital app for participants to access in their own time. In June a facilitation training workshop, led by programme developer and KaiRua founder Patrick Salmon, was held at Hungahungatoroa Marae in Matapihi for Western Bay of Plenty and Eastern Bay of Plenty providers to learn more about the
While there is a core focus on smoking cessation education, the KaiRua resources also empower hapu māmā to realise their personal strengths so they can have
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Holistic support for whānau
Trish says Te Ahunga Whānau is unique to the Bay of Plenty, but pulls knowledge from similar programmes. “It’s taking into account the social determinants of health, and the physical impacts they have on wellbeing. This also reflects Te Whare Tapa Whā, a Māori health model that explores the four cornerstones of hauora for Māori – taha tinana (physical health), taha wairua (spiritual health), taha whānau (family health), and taha hinengaro (mental health).”
Whānau benefit from the programme for up to six months, allowing sufficient time to provide them with tools for effectiveFormerself-management.PHOnurseTamar Courtney was involved in the pilot, and now, through her role with Ngāti Ranginui, will oversee nurses employed to deliver the service from their base at Rangiora Health Hub.
The online learning complements group sessions held at marae around the Western Bay, says “SimilarTiana.toŪkaipō, these sessions are a chance for wahine to connect with other hapu māmā, health and social service providers that work with whānau, and weave a beautiful wahakura that becomes a safe sleeping device for their pēpi.”
A wananga was held with specialist weaver Jenny Firmin at Hungahungatoroa Marae in Matapihi in July to take more people through the steps to weave a wahakura (safe bed) for pēpi.
A pilot programme that provided support to patients with long-term health conditions and their whānau will roll out across the Bay of Plenty thanks to further PHO funding. be many other things that contribute to that. Kaiāwhina can work with whānau on everything from working with Work and Income or the Ministry of Social Development, to looking at their tenancy agreements, housing issues, or helping them to put food on the table.”
PHO Iwi Network Lead Waimaria Awa will also contribute by strengthening bonds with iwi Networkpartners.Services Development Advisor Trish Anderson says a similar health model operating in the Waikato for many years was lauded internationally. In a previous leadership role, PHO chief executive Lindsey Webber presented the exemplar model to health ministers from various countries at the Commonwealth Fund’s 21st International Symposium on Health Care Policy in the United States.
Te Ahunga Whānau was piloted in the Western and Eastern Bay of Plenty over 12 months, operating in partnership between the PHO, Ngāti Ranginui Iwi in the West and Tūhoe Hauora in the East. The whānaufocussed model of care saw mobile nursing and kaiāwhina teams work with patients from five practices in the pilot stage. An evaluation of the programme was carried out early in 2022, with feedback from participating practices helping to inform the next stage of development.
“In time, we expect more practices will see the value of this and be a part of Te Ahunga Whānau as well,” adds Sarah. confidence to make changes for better maternal wellbeing. In developing the kaupapa Māori programme, Patrick says the aim is to target wahine with education that supports their cultural identity of who they are, so they can achieve their goals. “To build equity for positive Māori health outcomes and wellbeing, services must be culturally responsive and empowering. Heru & Hapū Māmā delivers tikanga and ancestral knowledge in a way that motivates participants to quit smoking.”Using the KaiRua app, wahine can access a three-part online series for education at home. Experts featured in the ‘digi-wā’ cover the philosophy of the heru, dealing with loss, grief and trauma, overcoming cravings with cooking, breathing and meditation techniques, reflective thinking, using kai to counter boredom or idle hands, and using karakia to meditate.
The first step for patients referred to Te Ahunga Whānau involves kaiāwhina building relationships with patients and their whānau. A holistic assessment will identify their individual wellbeing goals and any additional support the patient may need. “For a lot of people who are struggling to stay on top of their health, there can
Team Lead Sarah Johnson says everyone was “fired up” to see the programme permanently adopted, involving three practices in the West (Katikati Medical Centre, Gate Pa Medical Centre and Ngati Kahu Hauora), and The Doctors Total Health and Kopeopeo Health Centre in Whakatāne. Ngāti Ranginui Iwi and Ngāi Tūhoe Iwi in the Eastern Bay of Plenty are partnering with the PHO in the roll out by employing registered nurses and kaiāwhina to work with whānau referred to the programme by their GP. “It’s a co-designed, whānau-centric, holistic model of care that we know can be life-changing for patients,” says Sarah. “It’s not just focussed on responding to the long-term conditions of an individual, such as diabetes, asthma, or heart disease. It also supports people and their whānau to address the social issues that might be getting in the way of them having a healthier life that’s fulfilling for them.”
Equity journey unites team
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Katikati Medical Centre’s equity team (from left): Hayley Robertson, Cushla Money, Navkiran Kaur, Barbara Dunn and Faith Blair. their Māori population is engaging with the practice.“Ten percent of our patients are Māori and most of them have had contact with us over the past year. Now we want to drill down and better understand the barriers for anyone not seeing us,” she says. “That can be taking more time in a recall conversation to find out what’s preventing them from using our services. Is it our opening hours clashing with when they work? We need to ask those questions then use that information to target our resources to better meet their needs.”
Katikati Medical Centre is on a mission to better meet the health and cultural needs of its increasingly diverse community.
Decorated polystyrene balls, multimedia presentations and Matariki-inspired narratives demonstrated the many creative hidden talents of our PHO whānau at a team building event in June. Pictured here, Phil Back, member of Team Fu-Fu and the Fun Guys, proudly holds the team ball “Fu-Fu the Fun Guy”.
Fun goes viral!
The practice’s equity team is led by nurse manager Barbara Dunn, with cultural officer and diabetes nurse Cushla Money helping to champion efforts for service improvement, along with nurse colleagues Navkiran Kaur and Faith Blair, and administrator Hayley Robertson. Since March, the team has organised training on topics relating to unconscious bias and Te Tiriti o Waitangi, as well as adopting more Te Reo Māori when greeting patients. Planning for bilingual signage and training on the correct pronunciation of Indian names is also underway. The work supports their efforts to complete the Royal NZ College of General Practitioners’ equity module for accreditation as a teaching practice. But Barbara stresses that the work is far more than a ‘tick the box’ exercise. “There’s a heightened awareness about the importance of equity and for us, we want to make our team aware of how we can all make simple changes that, over time, will become embedded in our everyday practice. It’s important work and we’re grateful to our practice directors for backing us to do it.”
The practice team of 44 staff have embarked on an equity journey and are strengthening their understanding of Te Ao Māori and other cultures as part of a commitment to improving access to healthcare for their 9,500 enrolled patients. Practice data is also being used to inform decision-making as they work towards delivering more culturally responsive services.
The PHO’s equity team, including Director of Māori Health and Wellbeing, Kiri Peita, Equity Programme Lead, Michaela Kamo and Iwi Network Lead Waimaria Awa, is supporting the Katikati team as they roll out their changes. A focus for Cushla is building connections with other community and iwifocussed health providers.
“As well as Māori, we need to forge links with our Pacific Island and Indian communities for whom diabetes can sometimes be challenging for them to manage due to various barriers, including language,” says Cushla. “Navkiran is a real asset to our team by translating a lot of health information for our Indian patients. We have pamphlets in Punjab and Hindi, but I’d like to get a lot more for other culturesPracticetoo.”manager Keren Hoogwerf is supporting the team by examining their enrolled patient data, and identifying how
“As Māori, we stand on the shoulders of those who have gone before us,” says Roy. “For whānau who present to our service in a state of negative noa, the navigator can help to restore mana and motivate them to transform by connecting people back through generations.”
This year ministry funding has helped Ngāti Ranginui employ both an adult and child and adolescent trauma therapist, a genealogist and a non-clinical educator who visits businesses, organisations and schools to provide wellbeing education. The genealogist helps to restore lost connection for whānau.
Whānau who access the Mataora service through a range of providers connect with clinical and cultural practitioners as part of a holistic approach that works to address the harm and associated behaviours caused by trauma. At Poutiri Trust, whānau have access to healing via tā moko, while Ngāti Ranginui whānau have an opportunity to reconnect with their whakapapa using a ‘whakapapa navigator’ or esteemed genealogist. The therapies work alongside trauma counselling provided by clinical psychotherapists.Followingasuccessful bid for funding from the Ministry of Health, six Bay of Plenty providers are now offering the service: Poutiri Trust, Ngāti Ranginui Iwi, Te Ika Whenua (Murupara), Ngāti Kahu Hauora (Bethlehem), Te Awanui Hauora (Matakana Island) and Kimi Hauora (Tamapahore).
“Ninety percent of whānau with substance abuse have a history of trauma. That’s led to unhealthy relationships and behaviours. But rather than focus on what they’re doing wrong, our service looks at what they’ve been exposed to in their hikoi through life.”
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Mataora Tamoko practitioner Karam Hood, Poutiri Trust CEO Kirsty Maxwell-Crawford, Awanui Mataora practitioner, Hon. Peeni Henare, Awanui Hauora GM Uta Roretana, Ngāti Ranginui CEO Mel Tata, Pou Tikanga Hori Ahomiro, Maara Kai Facilitator Paul Tuanau, and Poutiri Programme Manager Ray Wihapi.
Poutiri Trust general manager Kirsty Maxwell-Crawford says the collaborative contract ensures that people in high Cultural and clinical therapy combine to restore health A new collaborative kaupapa Māori mental health and addictions service operating in the Bay of Plenty is helping to restore whānau wellbeing by combining traditional cultural practices of healing with clinical therapy and education. needs areas, particularly Māori whānau, have better access to mental health and addiction services. “Historically, access to services at a primary healthcare level have been poor, especially for Māori,” she says. “This contract addresses those unmet health needs, particularly for those most impacted by health inequities. “This is a new approach but it also reflects the healing modalities of Te Ao Māori that have been very present in whānau, hapu and iwi for 23 generations. We’ve designed the service so that whānau are free to choose a range of clinical and cultural options in their wellness journey.” Roy Nathan manages the Taiparirua team that delivers the Mataora service for Ngāti Ranginui Iwi on 9th Ave in Tauranga. He says the referral process recognises how “there’s more than one way to get into a whare.”“Weare a whānau-inclusive iwi with a range of services, so in working with
whānau in one area, such as social services, we may identify someone who may also benefit from Mataora. “Whānau can also self-refer, and choose the hauora provider that is closest to them, or one they have the strongest relationship with.”While Ngāti Ranginui Iwi and other providers have operated other community mental health and addiction services before, this service stands out for its cultural component and its focus on trauma as a major driver of addiction and substance abuse, he says.
Associate Health Minister Hon. Peeni Henare attended a function in Te Puke to learn more about the Mataora service in July. Pictured (left to right)
Chief executive Lindsey Webber says the PHO is committed to supporting staff to embrace te reo Māori as a central part of the PHO’s kaupapa and identity. “Even a little knowledge of te reo can help us understand and appreciate important aspects of Māori culture and the values that underpin these, and subsequently apply them in our mahi.
Support for learning Our PHO’s te reo Māori journey continues in earnest, with a dedicated Kaiako (tutor) working with staff one on one to provide more tailored support and encouragement.
Laura Penny from the PHO’s Network Services Team champions He Pounamu by summarising each session for staff, providing online links to learning
This year Te Haana Jacob started working with staff who take part in fortnightly He Pounamu sessions to upskill in te reo Māori as part of ongoing professional development. Participation is voluntary and sessions are recorded so staff can refer to them later. Topics covered include pronunciation, mihi (greetings), waiata and karakia.
Kiri says Laura is one of many incredible PHO whānau doing their part to keep te reo Māori“Normalisingalive. our language comes in many shapes and forms, from starting our hui with karakia, singing happy birthday in te reo Māori, having karakia to bless our morning tea to singing waiata, and even just saying, ‘Kia ora’ when we answer the phone.”Laura is of Scottish ancestry and, before arriving in New Zealand then working at the PHO, had no opportunities to learn te reo. She feels grateful for the chance to experience the PHO’s cultural haerenga, regular morning karakia and He Pounamu. “I’ve been able to not only learn about the pronunciation of te reo, but have had the chance to gain a much deeper understanding and connection to te ao Māori and to Aotearoa.” She encourages everyone to start learning te reo Māori – it’s never too late. “Nobody will care if you make mistakes or need to start from a complete beginner level – it’s not just about learning correct pronunciation, but about showing up, honouring the language and the history that goes with it. As long as you come with an open mind and good intentions, you’re already on the right track!”
“All our strengths matter, and no matter how different we are, we can all collaborate and contribute to develop a strong team.”
“Everyone will be supported to develop their te reo skills without prejudice or judgement, and the passionate team that run our He Pounamu programme are right behind you.”
He Pounamu started in 2020 following a staff survey, and is part of the PHO’s wider cultural journey, recognising the inseparable links between Māori language andPHOculture.director of Māori Health and Wellbeing, Kiri Peita, says it has been rewarding to see participants actively complete their ‘homework’ and engage with sessions. “It shows a commitment to the journey, which recognises that whatever we learn, no matter how small, it is valuable and adds to our kete of knowledge.”
Our PHO warmly congratulates the appointees to the Iwi-Māori Partnership Board (IMPB) for Te Moana a Toi. The PHO’s iwi partners Ngāti Ranginui and Ngāi Te Rangi are represented by Melanie Tata and Roimata Ah Sam respectively. Each of the 15 iwi appointees play a fundamental role in transforming people’s experiences with health services around the rohe. As part of game-changing health reforms for Aotearoa, which came into effect on 1 July, the IMPB will work to address wellbeing priorities and barriers to access for whānau, in partnership with Health New Zealand, the new Māori Health Authority, and other entities. wboppho.org.nz
Te Haana learned te reo Māori as a first language and enjoys sharing her knowledge with Māori and non-Māori, encouraging everyone to give the language a go. “All you can do is start and try,” she says. “Hesitancy culls opportunity for growth... there is nothing wrong with trying andInre-evaluating.”hersessions, Te Haana offers a variety of ways to learn and says everyone on a te reo Māori journey is “always a student, never a master.”
IN BRIEF Successful appointeesIMPB 8 | Te Rerenga | August 2022
He Pounamu sessions are interactive and available to PHO whānau either in the office or working from home. resources and reminding everyone of their homework.
