Fakaalofa lahi atu
On Wednesday 20 September 2017, we were thrilled to host the Pacific Advisory Group’s (PAG) second bi-ennial Fono on Infant, Child and Adolescent Mental Health for all Pacific and Non-Pacific clinicians who work with Pacific children and families. Themed ‘Blame the Brain’, this Fono brought together parents, practitioners, dedicated district health board and NGO representatives, educators, social workers, and more to discuss the impacts of neurological conditions.
On the Day
John Kumitau of Emerge Aotearoa hosted the event, reminding us all of the fun and challenges of family life. Never without a smile, John broke the ice and kept the day rolling with zeal and finesse. All accomplished while maintaining impeccable timing and celebrating the passionate speakers who so kindly shared their stories, work and experiences with us.
Introduction to Werry Workforce Whāraurau
Our very own Sue Dashfield was first to present our Werry Workforce Whāraurau work, and the latest resources and web hubs we have to assist you and the infants, children and adolescents you support throughout your work. Sue also took the opportunity to note the real and present need to have a culturally competent workforce to respond to the diversity of a modern New Zealand. As such, we are proud to host the National ICAMS/AoD Pacific Fono to aid in this endeavour.
A Perspective from Pacific Families
We heard from proud Mum, Migi Sio, who shared a crucial perspective from the family. Migi and her husband, Lealofi, have two young boys with Autism, but their individual experiences of the condition have been entirely distinctive. She spoke on the challenging process of diagnosis, and how culturally aware support made huge and important differences to the family’s life. We were honoured that Migi shared her story, as it was representative of many of New Zealand’s Pacific families who have similar circumstances.
ADHD? ABC? What does this mean?
Clinical Manager / Psychologist for Takanga A Fohe, Waitemata District Health Board and member of the Pacific Advisory Group, Epenesa Olo-Whanga, provided an in depth overview on Attention Deficit Hyperactive Disorder (ADHD).
Having authored a report on school recommendations for ADHD children as well as having scoped and implemented infant mental health services, Epenesa shared her wealth of knowledge on how to support children and youth who experience the condition.
She highlighted how ADHD can affect children and young people’s quality of life and the potential for comorbidity. Often the first line of defence is helping parents, in a culturally mindful manner, to help support the child or young person.
Trauma, Culture and the Brain
Dr Alistair Bush, Consultant Psychiatrist at Capital and Coast District Health Board as well as Family Therapist at Health Pasifika Children and Adolescent Mental Health Services, presented on Trauma, Culture and the Brain. Opening with a timely quotation on belonging from two term O le Ao o le Malo (Samoan Head of State) and notable scholar, Tui Atua Tupa Tamasese Efi (below), he highlighted the importance of recognising the brain as a relational organ. He related this to our foundations in culture, and to the Samoan concept of Va; the relational space that is negotiated between the self and others. Dr Bush deftly demonstrated how this interacts with our relational brain, and how cultural elements inform how we experience the ‘self’ in relation to our family and ancestors. Therefore, these need to all be considered as key factors in understanding the individual.
Dr Bush then related the literature surrounding trauma intervention Eye Movement Desensitization and Reprocessing (EMDR), and its support across 16 affirmative randomised controlled trials and a number of Cochrane protocol meta-analysis reviews. He then moved to the Fonofale model of health, created by Fuimaono Karl Pulotu-Endemann, a Pacific Island model encompassing the values and beliefs from many Pacific cultures. The model holds eight elements as important factors in healthy development: culture, spiritual, physical, mental or emotional, other, environment, time and context.
Turning his talk to a moving case study of how a culturally resonate approach, when paired with evidence-based interventions, can interact more readily with the relational brain, Dr Bush made an engaging and motivating case of how we can better support Pacific children and youth experiencing trauma.
"I am not an individual; I am an integral part of the cosmos. I share divinity with my ancestors, the land, the seas and the skies. I am not an individual, because I share a tofi (inheritance) with my family, my village and my nation. I belong to my family and my family belongs to me. I belong to my village and my village belongs to me. I belong to my nation and my nation belongs to me. This is the essence of my sense of belonging." - Tui Atua Tupa Tamasese Efi
'Blame my brain' - Fetal Alcohol Spectrum Disorder
Dr Rose Hawkins, Regional Disability Advisor and Pacific Principle Advisor for Oranga Tamariki (Ministry for Vulnerable Children) shared an informative talk on Fetal Alcohol Spectrum Disorder (FASD).
Althought it was discovered in 1973, this little discussed condition was opened by Dr Hawkins pointing out the incredible suspected levels of those affected. 50% of children in care of Youth Justice Residence are suspected to be affected by FASD, yet as it is ‘invisible’ (no physical signs) in 90% of cases, it is not often considered. The effects of FASD can include physical, mental, behavioural and/or learning disabilities. It’s neurological characteristics can have profound impacts and Dr Hawkins highlighted they can include impacted ability to abstract, poor memory and problem solving abilities, trouble with sequencing, and issues with narrative construction and comprehension. Childen and youth who are affected also have specific problems in learning from consequences, egocentric notions of fairness, and often need to be engaged as if they are approximately half their age chronologically. However, in the right environment and with early intervention, many of the struggles and stress they experience can be relieved.
Finishing with a key message, Dr Hawkins promoted the need to consider FASD more often, particularly in the youth justice context. Achieving diagnosis can often lead to the right support for them and their families, providing not only relief but the answers they need to move forward.
Making a Difference to Pacific People with Disabilities
All the way from Niue Island, Karolini Tutavaha came to provide a moving speech on ‘Making a Difference to Pacific People with Disabilities’. She opened, igatia e tau mena tote, (distribute small things and one thing will lead to another), and reminded us how little things can build much.
Her emotive story began with the diagnosis of her son, Chad, with a developmental delay and ASD. She was told that Chad would never walk, talk or use the bathroom independently, and he was unlikely to live beyond 28 years of age. However, she recalled; one thing, will lead to another.
Karolini therefore set her own goals for her son, determined to see if small things could indeed, lead to others. She therefore taught Chad signs so that he could communicate his needs, and learn to walk by standing him against the wall and helping him learn every movement of his legs throughout each step. She also spoke openly of the challenges of helping him through cultural differences and of finding unique compromises through unwavering commitment. Chad is now 31 and lives in a residential facility where he has independence and comfort. Karolini and Chad’s journey touched us all and reminded us, Igatia e tau mena tote.
The ASD Toolkit
Our final presentation came from John Vogenthaler (Te Pou), who has recently helped create of a new toolkit for children and youth on the Autistic Spectrum (ASD).
John put forward the importance of presenting ASD in a way that’s reflective of lived experience as this can vary widely across the spectrum. Over 44,000 people in New Zealand are on the spectrum and most are younger. Yet John noted only 25% are receiving support.
In many cases, this may be appropriate, but it is important to note that while only 6% of the New Zealand population experiences depression, 26% of those with Autism wiill experience depression. Furthermore, women with Autism in particular are 10 times more likely to commit suicide. As such, it is important that we understand the individuals personal experience from their point on the spectrum. For example, John related how those with Autism experience sensory information differently, and be aware of sensations many others might not notice. The toolkit has a health passport, cue cards and routine which children and youth with Autism can struggle with; and a village map to track progress. Contact John.Vogenthaler@tepou.co.nz if you would like a copy.
We’d like to thank all of those who came along to this biennial PAG Fono. We are glad our event made you feel welcome, inspired you and wider helped considersiderations the cultural needs of our mental health workforce and the infants, children, youth and families we support New Zealand.
We look forward to welcoming you all again at our next event!