Toward a transformed system to address child abuse and family violence in New Zealand

Executive Summary Introduction The Glenn Inquiry (TGI) has contracted Institute of Environmental Science and Research Limited (ESR) to bring together the relevant experience and expertise to collaboratively model a transformed system to address child abuse and neglect (CAN) and family violence (FV) in New Zealand. Our approach We have treated the task of reducing FV and CAN as a ‘wicked problem’1; that is, reducing FV and CAN is a problem that cannot be solved once and for all, and is not a matter of simply applying expert knowledge. The methods used in this project have been chosen because they are appropriate for working with wicked problems: stakeholder engagement, systems thinking and inter-disciplinary analysis. In this report, we refer to both CAN and FV. We recognise that, for some purposes, dealing with CAN requires particular strategies and treatment; however, the purpose of this report is to develop a transformed system that will reduce both CAN and other forms of FV. While the underlying causes of CAN and other FV may be considered independently, and some responses to each form of abuse will need to be particular, this report proposes a wider system of responses that will enable targeted interventions for each form of abuse. We use the term ‘family violence’ in this report in the sense it has come to be understood in Aotearoa, and is used in Te Rito: New Zealand Family Violence Prevention Strategy. In this use, FV includes intimate partner violence, child abuse and neglect, elder abuse, inter-sibling abuse and parental abuse. The project consisted of four work-streams: A review of the international and national literature on what would constitute a high performing system to address CAN and FV, including a review of New Zealand’s current approach with a focus on government legalisation, policies and initiatives; Qualitative modelling of the system dynamics associated with the existing way in which New Zealand has responded to CAN and FV; A secondary (sociological) analysis of suggestions for system improvement from the People’s Report; and, Developing a systemic model of a transformed system through collaborative workshops with sector experts

Determinants of Physical Health Self-Management Behaviours in Adults With Serious Mental Illness:A Systematic Review

Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-management behaviours in adults with SMI. Data about American Association of Diabetes Educator’s Self-Care Behaviours (AADE-7) were mapped against the novel Mechanisms of Action (MoA) framework. Twenty-eight studies were included in the review, reporting evidence on 104 determinant-behaviour links. Beliefs about capabilities and beliefs about consequences were the most important determinants of behaviour, especially for being physically active and healthy eating. There was some evidence that emotion and environmental context and resources played a role in determining reducing risks, being active, and taking medications. We found very limited evidence associated with problem solving, and no study assessed links between MoAs and healthy coping. Although the review predominantly identified evidence about associations from cross-sectional studies that lacked validated and objective measures of self-management behaviours, these findings can facilitate the identification of behaviour change techniques with hypothesised links to determinants to support self-management in people with SMI

Determinants of Physical Health Self-Management Behaviours in Adults With Serious Mental Illness: A Systematic Review

Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-management behaviours in adults with SMI. Data about American Association of Diabetes Educator's Self-Care Behaviours (AADE-7) were mapped against the novel Mechanisms of Action (MoA) framework. Twenty-eight studies were included in the review, reporting evidence on 104 determinant-behaviour links. Beliefs about capabilities and beliefs about consequences were the most important determinants of behaviour, especially for being physically active and healthy eating. There was some evidence that emotion and environmental context and resources played a role in determining reducing risks, being active, and taking medications. We found very limited evidence associated with problem solving, and no study assessed links between MoAs and healthy coping. Although the review predominantly identified evidence about associations from cross-sectional studies that lacked validated and objective measures of self-management behaviours, these findings can facilitate the identification of behaviour change techniques with hypothesised links to determinants to support self-management in people with SMI. Systematic Review Registration: PROSPERO, registration CRD42018099553

Cane and commitment: gender and familial relations on smallholder sugar cane farms in Fiji

xii, 366 leaves :ill., maps (some folded) ; 30 cm. Includes bibliographical references. University of Otago department: Anthropology. "March 2000."This thesis examines the socio-economy of smallholder sugar cane farms in Fiji with particular attention to the participation and experiences of women. There is also consideration of the involvement of other household members, especially children in the farm economy. Questions concerning the study are; how are smallholder cane farms operated in terms of allocation of labour and resources? What is the relationship between paid and unpaid work on the farm? What are the notions of family and work that orientate the farm economy and how is this articulated to the production of sugar cane in Fiji? The study also sought to examine how issues concerning the sugar industry at national and global levels played out in a localised context, including the trends towards trade liberalisation resulting in the demise of preferential trading agreements. The thesis explores these questions from inside the farm through ethnographic research undertaken with twenty farming households during 1996 and 1997. The study examines intra and inter-household relations within smallholdings and is primarily a qualitative account that contextualises the experiences of respondents with historical, socio-economic and comparative literature on Fiji and linkages with the sugar industry at local, national and global levels. The field site was situated on the island of Vanua Levu in the northern region of Fiji. The households in the study comprised both Fijian and Fiji Indian respondents who lived on smallholdings and relied primarily on selling sugar cane for their cash income. The study focuses on the way gender relations intersect with generational relations, denoting age and kinship, in orientating socio-economic processes within the farm. I conclude that smallholder households are internally differentiated by gender and generation in allocation and control over production and resources. Constructions of seniority which have become embedded in cultural 'traditions' and institutions generally favours older male members of the household which is exemplified by their predominance as household heads and legal title holders to land leases and cane contracts. Familial and household relations are maintained through the process of marriage which was found to be the linchpin between paid and unpaid work on these smallholder farms. I argue that the unpaid work of women and children is integral to the production of cane, by contributing to the cane cultivation process and by performing work that allows other members of the household to participate in cane production. The thesis therefore aims to deconstruct perceptions of separation in production processes of remunerated and unremunerated labour that are evident in sugar industry discourses and aspects of economic analysis from the Fiji government

Making Services Reachable: He Waka Tapu case study

In 2013 the Institute of Environmental Science and Research Limited (ESR) was successful along with their partners in obtaining 3 years of research funding from the Ministry of Business, Innovation and Employment (MBIE). The aim of the research was to develop a practical model or models to enable constructive engagement between services and hard-to-reach populations. Our research recognised that ‘hard-to-reach’ is a problematic way of thinking about potential clients of a social service. The ‘hard to reach’ may not see themselves as ‘hard-to-reach’, and it may be services that are ‘hard to reach’. Our research focused on ‘making services reachable’ and took an approach which highlights how the uptake of service emerges from the interaction between a social service, a client and the client’s family, plus the wider service ecosystem. This report details the findings of one of the three case studies within the research, with He Waka Tapu (HWT), a Christchurch based kaupapa Māori social service provider (indigenous social service provider). They had been identified as being successful in engaging with ‘hard-to-reach’ populations with a focus on Māori (indigenous population of New Zealand).</p

Improving engagement with social services a service ecosystems approach

A key challenge for social policy makers and service providers is to enable constructive engagement between the social services and the‘hard to reach’ individuals and collectives in order to reduce disparities and enhance individual and population wellbeing. The concept of ‘hard to reach’ (Boag-Munroe & Evangelou, 2012) refers to those who are deemed to be in need of social service or health intervention but, for whatever reasons, do not access services or do not engage constructively with services. The New Zealand Ministry of Business, Innovationand Employment (MBIE) is helping address this issue through its “Health and Society” Research Investment Funding. It has awarded a three-year contract for the research reported in this paper, to strengthen ways for social services to engage with families/ whānau and individuals (Foote etal., 2014). The project comprises three case studies, cross-case analysis, development of a provisional model of critical success factors for improving uptake of services in relation to ‘hard to reach’ populations, testing and refining the model, and dissemination of findings in the social service sector. The aim is to develop a model that will guide the design and evaluation of services in ways that support ‘hard to reach’ populations to connect with and take up services in ways that improve outcomes for families/whānau

A scoping review of equity-focused implementation theories, models and frameworks in healthcare and their application in addressing ethnicity-related health inequities

Abstract Background Inequities in implementation contribute to the unequal benefit of health interventions between groups of people with differing levels of advantage in society. Implementation science theories, models and frameworks (TMFs) provide a theoretical basis for understanding the multi-level factors that influence implementation outcomes and are used to guide implementation processes. This study aimed to identify and analyse TMFs that have an equity focus or have been used to implement interventions in populations who experience ethnicity or ‘race’-related health inequities. Methods A scoping review was conducted to identify the relevant literature published from January 2011 to April 2022 by searching electronic databases (MEDLINE and CINAHL), the Dissemination and Implementation model database, hand-searching key journals and searching the reference lists and citations of studies that met the inclusion criteria. Titles, abstracts and full-text articles were screened independently by at least two researchers. Data were extracted from studies meeting the inclusion criteria, including the study characteristics, TMF description and operationalisation. TMFs were categorised as determinant frameworks, classic theories, implementation theories, process models and evaluation frameworks according to their overarching aim and described with respect to how equity and system-level factors influencing implementation were incorporated. Results Database searches yielded 610 results, 70 of which were eligible for full-text review, and 18 met the inclusion criteria. A further eight publications were identified from additional sources. In total, 26 papers describing 15 TMFs and their operationalisation were included. Categorisation resulted in four determinant frameworks, one implementation theory, six process models and three evaluation frameworks. One framework included elements of determinant, process and evaluation TMFs and was therefore classified as a ‘hybrid’ framework. TMFs varied in their equity and systems focus. Twelve TMFs had an equity focus and three were established TMFs applied in an equity context. All TMFs at least partially considered systems-level factors, with five fully considering macro-, meso- and micro-level influences on equity and implementation. Conclusions This scoping review identifies and summarises the implementation science TMFs available to support equity-focused implementation. This review may be used as a resource to guide TMF selection and illustrate how TMFs have been utilised in equity-focused implementation activities

Adapting an equity-focused implementation process framework with a focus on ethnic health inequities in the Aotearoa New Zealand context

Abstract Background Health intervention implementation in Aotearoa New Zealand (NZ), as in many countries globally, usually varies by ethnicity. Māori (the Indigenous peoples of Aotearoa) and Pacific peoples are less likely to receive interventions than other ethnic groups, despite experiencing persistent health inequities. This study aimed to develop an equity-focused implementation framework, appropriate for the Aotearoa NZ context, to support the planning and delivery of equitable implementation pathways for health interventions, with the intention of achieving equitable outcomes for Māori, as well as people originating from the Pacific Islands. Methods A scoping review of the literature to identify existing equity-focused implementation theories, models and frameworks was undertaken. One of these, the Equity-based framework for Implementation Research (EquIR), was selected for adaptation. The adaptation process was undertaken in collaboration with the project’s Māori and consumer advisory groups and informed by the expertise of local health equity researchers and stakeholders, as well as the international implementation science literature. Results The adapted framework’s foundation is the principles of Te Tiriti o Waitangi (the written agreement between Māori rangatira (chiefs) and the British Crown), and its focus is whānau (extended family)-centred implementation that meets the health and wellbeing aspirations, priorities and needs of whānau. The implementation pathway comprises four main steps: implementation planning, pathway design, monitoring, and outcomes and evaluation, all with an equity focus. The pathway is underpinned by the core constructs of equitable implementation in Aotearoa NZ: collaborative design, anti-racism, Māori and priority population expertise, cultural safety and values-based. Additionally, the contextual factors impacting implementation, i.e. the social, economic, commercial and political determinants of health, are included. Conclusions The framework presented in this study is the first equity-focused process-type implementation framework to be adapted for the Aotearoa NZ context. This framework is intended to support and facilitate equity-focused implementation research and health intervention implementation by mainstream health services

Research to improve the up-take of service by people considered hard to reach: synthesis of findings and a practical guide for service innovation

This paper is a synthesis of findings from a three year research programme on “engaging with the ‘hard to reach’ to improve uptake of social and health service”. The researchers recognised that ‘hard to reach’ is a problematic way of thinking about potential clients of a service. The ‘hard to reach’ may not necessarily see themselves as ‘hard to reach’, and it may be services that are ‘hard to reach’. The project chose to focus on ‘making services reachable’. Following a typology published by Heatley (2016), the kind of programmes and agencies that have informed our findings, and for whom our findings are intended to be useful, are those that work with clients with complex needs (requiring multiple forms of support or intervention) and low capacity to “understand and manage their access to available services” (Heatley, 2016). Our data confirms that clients with complex needs tend to experience the services, rather than themselves, as being ‘hard to reach’. The research took an ecosystems approach, highlighting how uptake of service emerges from interaction between a social service, a client and the client’s family, plus the wider service ecosystem. Six principles for designing social service engagement with those deemed hard to reach Service is not a service product delivered. Service is an experience in which a service seeker benefits by accessing resources offered by another. Service (co-)design is about reciprocal values of the parties involved, not merging or agreeing on values. Structures and processes need to be (co-)designed to enable and support negotiated meaning and empowerment. Capability and social, cultural and financial capital is needed from all parties – service needs to recognise, enhance and build capability and capital with clients. Engagement with clients with complex needs is about negotiating core assumptions with them on the purpose, course and context of service offered. Negotiation of core assumptions is needed in every key relationship in service provision, and is ongoing and dynamic