Strategies

This topic reminds you of some of the strategies you might use when at work to support the needs and goals of your tangata.

• Needs are the basic things that people require in order to survive, for example: shelter, food, and healthcare.
• Goals are something that you want to do, be, or have. It’s something you must work to get in the future, and you can apply that to any challenge in life.

SMART goals

Goals can be challenging, but by setting SMART goals they are more likely to be attained. The following slides explain the SMART goals. Use the Turn button to display each slide's information and use the arrow keys to move between slides.

A holistic approach to health means providing support that looks at the whole person. This approach considers a person's physical, emotional, social and spiritual wellbeing.

Physical Wellbeing

• encourage independence with daily tasks
• work alongside health professionals to help with exercises
• empower clients to make lifestyle changes
• encourage healthy personal hygiene habits and independence

Spiritual Wellbeing

• support connections to nature and their environment
• respect beliefs, values, traditions, and practices that support self-awareness and identity
• follow certain procedures or protocols if asked when providing support care
• ask the person about appropriate personal contact for them, such as touching their head or exposure of body parts

Social Wellbeing

• support activities that have positive social relationships, for example, classes, interests, hobbies, coffee with friends
• encourage communication with friends, whānau, etc.

Cognitive or Mental and Emotional Wellbeing

• maintaining physical health
• managing stress
• helping them keep their mind healthy by doing mind activities such as puzzles, games
• being aware that they are eating a proper diet
• limiting alcohol intake
• getting them social and joining in with activities
• listening to your client without judgement
• responding accordingly and emphatically
• showing compassion
• encouraging healthy sleeping habits

Community engagement

Staying engaged with friends, whānau, and the wider community can be an important step in recovery from mental health and addiction issues. You can help your client by identifying opportunities for community participation and social inclusion. A person-centred approach will help you work collaboratively with the person to identify and choose activities and opportunities for inclusion that match their interests.

There may be barriers to community engagement that you may be able to help address. These could include:

• Physical health issues: if the tangata feels tired or physically unwell, they may not want to engage. Let your supervisor know so that the tangata’s GP or health provider can be informed.
• Financial constraints: the tangaga may feel they cannot afford to engage in activities outside the house. Look out for ways to engage that do not cost money and are easily accessible. Ensure that your tangata is getting all the financial support that is due to them.
• Lack of confidence: the tangata may feel anxious about meeting new people. This can be addressed by accompanying the tangata or encouraging whānuau to attend.
• Feeling unskilled: the tangata may fear that they do not have the skills required to undertake the activity. This can be addressed through careful selection of suitable activities and encouragement to try new things.

Ref: Baxter, L., Burton, A. and Fancourt, D. Community and cultural engagement for people with lived experience of mental health conditions

Pae Ora strategies

The Pae Ora (Health Futures) Act was passed in 2022. From the Act, six strategies were developed to set the direction for how health services would meet the needs of New Zealanders. The strategies are as follows:

• The New Zealand Health Strategy

• Pae Tū: Hauora Māori Strategy
• Te Mana Ola: The Pacific Health Strategy
• The Women's Health Strategy
• The Health of Disabled People Strategy
• The Rural Health Strategy

The strategy that you use will depend on the needs of the service user that you are supporting.

Click on the link to access the Ministry of Health page listing the six strategies. Click on the link for each strategy and review the content.

Te Wheke | The Octopus

 

Image referenced from Therapeutic Landscapes paper by Jacqueline McIntosh et al.

Te Wheke also known as the octopus, is a health concept by Rose Pere, a renowned Māori spiritual and academic leader.

This concept recognises that all aspects of a person's life are interconnected and must be addressed for overall health and flourishing. The following is a breakdown of the elements:

Te Whānau | The family. The body and head represent the individual whānau unit.

Waiora | Wellbeing. The "eye" of the symbolic family unit will reflect total well-being.

Wairuatanga | Spirituality. The creator is a powerful influence, and the uniqueness of being Maori is sustained through this belief.

Mana Ake | Awareness of hereditary from forebearers. Unique identity of individuals and family.

Mauri | Life force. An appreciation of the mauri (life force) of objects, individuals, whānau (family), and every whānau within a community.

Hinengaro | The mind. Learning that arouses, stimulates and uplifts is important.

Whatumanawa | Open and healthy expression of emotion. An understanding of emotional development in all areas.

Whanaungatanga | Extended family. The principle of all working to support each other across generations.

Taha Tinana | Physical Wellbeing. Specific physical, material, emotional and social needs related to physical survival.

Ha a koro ma a kui ma | Breath of life from forbearers. Links with heritage passed down by our forebearers.

Fonofale | A Resilient Home

Image referenced from Pacific Advance Secondary School.

A model developed by Fuimaono Karl Pulotu-Endemann, incorporates the values and beliefs of Samoans, Cook Islanders, Tongans, Niueans, Tokelauans and Fijians.

It encompasses different foundations of life, including family, cultural values and beliefs, spiritual, physical, mental and other. These foundations are interrelated, and health is about maintaining and sustaining balance between these foundations (Pulotu-Endeman, 2001).

In a health and well-being context, it is important to be able to notice any changes in a person's health or abilities, whether they are improvements or deteriorations.

When professionals talk about changes, this means changes in emotional, psychosocial, cognitive, physical, sensory, psychological, or environmental.

Te Whare Tapa Whā | The Four Cornerstones

Image referenced from Therapeutic Landscapes paper by Jacqueline McIntosh et al.

Te Whare Tapa Whā, a model developed by Sir Mason Durie, shows the importance of balance and encompasses four main elements using the analogy of a house with four walls:

Taha tinana | Physical health

Its first element, taha tinana (physical body), refers to the body and is the physical expression of health and wellbeing.

Taha wairua | Spiritual health

The second element, taha wairua (spiritual realm), reflects the spiritual aspects of wellbeing.

Taha whānau | Family health

The third element, taha whānau (family and community), highlights the need and significance of the family and community to one’s health and wellbeing

Taha hinengaro | Mental health

The last element, taha hinengaro (mental health), describes the importance of the mind.

All four elements are interwoven and interact to support a strong and healthy person. Rochford (2004) suggests if one of these key elements is missing or damaged, then the resulting imbalance may lead to negative health outcomes. To achieve balance and good health, individuals must live in harmony with others, their communities and the spiritual realm. (Jacqueline McIntosh et al, 2021)

Te Pae Māhutonga

Te Pae Māhutonga (Southern Cross Star Constellation) was developed by Mason Durie to represent the elements of modern health promotion.

The following content is adapted from Te Pae Māhutonga: A Model for Māori Health Promotion.

The four central stars are used to represent the four key tasks of health promotion and are named accordingly to reflect particular goals of health promotion:

• Mauriora - cultural identity
• Waiora – physical environment
• Toiora – healthy lifestyles
• Te Oranga – participation in society

The two pointers are:

• Ngā Manukura - leadership
• Te Mana Whakahaere - autonomy

'Let's get real'

The seven real skills of Let’s get real were developed for mental health, addiction and disability services. 

Click on this link to display the Te Pou website and rewatch the video called An introduction to Let’s get real.

Nōku te Ao Like Minds 

The Nōku te Ao Like Minds public awareness programme was discussed earlier in the course. This programme aims to increase social inclusion and end discrimination towards people experiencing mental illness. 

You read sections of the report titled Nōku Te Ao: Sovereignty of the Māori Mind. This report presents a Māori worldview of discrimination faced by people experiencing mental distress. It also propose strategies to address mental distress and discrimination. 

Activity

• Click on this link to access Te Whatu Ora’s page, Nōku te Ao. Review pages 55-60 of the report.
• Reflect on the Seven Levers for Change. How could these levers be used to address the goals of reducing mental distress and reducing discrimination against Māori experiencing mental distress? 
   

An essential part of a support worker role is to be able to collaborate effectively with other people and organisations to support tangata and their whānau.

Let's look closely at the descriptions of some of these attributes:

1. Communicate constructively. When you collaborate with others your communication needs to be clear, direct, honest, positive and respectful.
2. Listen actively. Listening by absorbing, understanding and thoughtfully considering the ideas and beliefs of others. Part of listening is the practice of receiving the information and taking an appropriate time to respond without getting defensive or reacting negatively.
3. Be reliable. Keeping your commitments and doing your job to the best of your ability at all times.
4. Be willing to share information, knowledge and experience. Being a good, objective source of information, and keeping the healthcare team updated with the latest information.
5. Be discrete. A service user's medical information is confidential, and there is no exception. Discuss with tangata, who you can relay and discuss information with to ensure the successful delivery of care and prevent unwanted surprises.
6. Be an active participant. Engaging in discussions and meetings and take initiatives to support the service user, their whānau and the healthcare team.
7. Be cooperative. Look beyond individual differences to focus on what is best for the person being supported and solve problems or issues in positive ways.
8. Be respectful. Consistently act according to your values, be courteous and considerate towards the service user, their whānau and the healthcare team.

Multi-disciplinary team in healthcare

A multi-disciplinary team is a range of health professionals working together to support the outcomes of a service user.

The MDT can include:

Working collaboratively in a multi-disciplinary team that is made up of people with different roles, professions or areas of expertise will help the tangata you support to meet their goals. When working collaboratively, members of a multi-disciplinary team contribute and share their views and perspectives about a person or situation to achieve a common goal and deliver high-quality support.

Following is a list of the important benefits to the tangata you support when working collaboratively to achieve a common goal.

• The care provided addresses the needs of the whole person, not just particular aspects.
• Whānau are kept up-to-date with changes in the person’s condition and can talk openly with care providers.
• Care can be customised to meet the person’s individual needs.
• Whānau can support goals in the care and rehabilitation of the person.
• There is a better understanding between all the people involved in the tangata’s care.

Natural strengths and support

Most tangata will have some sort of natural support provided by whānau, friends or support groups. Make sure you leverage this support where appropriate. In most cases, this support will be given gladly, but be mindful that sometimes whānau members may struggle to provide the support required. If you feel a whānau member is not coping well, report it to your supervisor.

Drawing on the natural strengths of the tangata is another important strategy.  Identify what they can do rather than focusing on what they can't. Encourage their determination to overcome mental health and addiction challenges. Emphasise their resilience and strength in the face of challenging circumstances.

Empathy is the ability to identify and share the emotions another person is feeling. Empathy is different to sympathy.

• With sympathy, you understand the challenges a person is going through and feel compassion for them.
• With empathy, you experience emotions that are similar to the tangata’s, which provides a deeper understanding of their situation.

Watch: Brené Brown on Empathy vs Sympathy (2.53)

Watch the following video and reflect on the question that follows.

Empathy in health care

Empathy is a powerful tool in health and social care work. Moudatsou et al. describe the ways in which empathy can improve health and social care.

• It allows the provider to identify the patient’s experiences and concerns.
• It strengthens the relationship between patient and provider.
• It leads to better health outcomes.
• It increases patient satisfaction.
• It reduces patient stress.
• It leads to increased productivity and improved job satisfaction for the health care provider.

(Ref: Moudatsou et al., 2020 ).

How to improve your empathy

• Put yourself in the tangata’s shoes: try and understand how they may be feeling about their current circumstances.
• Active listening: concentrate on what the person is saying to help identify what they are thinking and feeling.
• Ask questions: asking open-ended questions will allow you to better understand how the tangata is feeling.
• Encourage open communication: encourage the tangata to share their thoughts and concerns, and let them know it is safe to do so.
• Whakawhanaungatanga: form a personal relationship with the tangata, within the limits of your professional boundaries
• Practice person-centred care: when you focus on the whole person, you will be better able to understand their thoughts and feelings.
• Apply a non-judgemental attitude: the tangata is more likely to share with you if they are not being judged.
• Practice cultural competence: respecting the tangata’s cultural preferences will make your interactions more constructive and informative. 

Peer support and lived experience workforce

It is acknowledged that people with the lived experience of mental health or addiction issues may be ideally placed to support tangata going through these challenges. Te Pou defines the following peer workforce values:

• Mutuality: The authentic two-way relationships between people through ‘the kinship of common experience’.
• Experiential knowledge: The learning, knowledge and wisdom that comes from personal lived experience of mental distress or addiction and recovery.
• Self-determination: The right for people to make free choices about their lives and to be free from coercion based on their mental distress or addiction.
• Participation: The right for people to participate in mental health and addiction services.
• Equity: The right of people who experience mental distress and/or addiction to have fair and equal opportunities to other citizens and to be free of discrimination.
• Recovery and hope: The belief that there is always hope and that resiliency and meaningful recovery are possible for everyone.

Ref: Te Pou, Consumer, peer support and lived experience.