Primary ry mental health support for people wit ith dia iabetes
Today’s presentation • Background to the project • Profile Northland and Tairāwhiti’s approaches • Hear from participants in Northland’s Rangatahi project • Early feedback on what is working and what challenges have been encountered
Background • Improving mental health and wellbeing has the potential to improve both quality of life and glycaemic control • The MOH funded projects aim to improve access to primary mental health services for people with poorly controlled diabetes • The project includes Northland and Tairāwhiti DHBs – rapid implementation within existing resources (over 200 contracts across community providers) • Opportunity to be innovative, supported by Ministry flexibility • The Ministry funded an evaluation to learn from the project
The evaluation • The projects are pilots – the evaluation is focussed on learning from the pilots Data collection (2017) Formative evaluation contributes to local planning Workshop to Set up admin Develop discuss first data Interviews/ evaluation quarter Site visits templates/ workshop (key approaches for Co-design evaluation with sites evaluation client stakeholders) specific findings recruitment initiatives Plan timelines and finalise approach Process evaluation provides feedback on progress Quarterly evaluation Progressive Logic model Practical Agree reports Quarterly data collection Quarterly and evaluation approaches to Timelines evaluation February to interviews key from clients admin data questions data collection approach October 2017 (Hua Oranga, stakeholders reporting survey) Final evaluation workshop and Outcomes evaluation synthesis Complete ethics review process – agree site requirements report Final extract of Final interviews Final provider Site visits admin data, with key interviews and September- financial data - stakeholders survey October 2017 30 September Interviews
Hua Oranga • Tool developed based on Te Whare Tapa Whā • Developed by Mason Durie and Te Kani Kingi and adapted by Dr Simon Bennett • Four domains with four (5-point scale) questions in each domain • Taha whānau • Taha wairua - Spiritual • Taha tinana - Physical health • Taha hinengaro - Mental health
Tairāwhiti approach
Tairāwhiti approach – about Tairāwhiti • Population around 48,000 people . • Over half of population Māori • Average deprivation score of 7 with 67% of Māori and 30% of non - Māori considered to live in the most deprived areas • Rurality – with around 30% of residents living in rural districts and facing additional challenges in accessing services • Around 2,000 people identified with diabetes and approximately 700 with an HbA1c over 64 • Three PHOs (12 practices): Ngati Porou Hauora, National Hauora Coalition, Midlands/Pinnacle Health and further iwi- led NGOs.
Tairāwhiti approach - consultation • Child & youth diabetes service doing well – focus on adults • Appropriate messaging and communication “Is diabetes a disease? My doc doesn’t tell me nothing about it. It only seems to affect me when I’m hurt – takes ages to recover” • Whanau approach “I come home to a greasy meal and cakes” • Flexible approach “no use coming to see just me when you turn up during the day, wait until everyone is home” • Finding the right triggers “it’s only me and my sister left. My mum and dad and siblings died because of diabetes and I still lived the way I did until recently” • Mana-enhancing, aspirational and empowering service
Tairāwhiti approach – targeted Māori or Pacific person with poorly controlled Diabetes (HbA1c level of 64mmol/mol or more) and an indication of potential mild to moderate mental health issues: • poorly controlled diabetes • low/non-attendance • low/non-adherence with medication regimes • living in socially isolated situations • pressing issues (wider than health)
Tairāwhiti approach – Adult Service • Multi- model trialling four “pathways” • Kaiāwhina -led supports (external referral model) • Kaiāwhina - led supports (“in - house” model) • Social worker- led supports (“in - house” model) • Primary MH service only – more flexible approach • Approaches to reflect whānau needs and aspirations firstly • Supported by: • Clinical champion • Hua Oranga assessment tool • Workforce development
Tairāwhiti approach Mihi and time to connect is crucial Small wins “Translator approach”
Tairāwhiti’s achie ievements – early days yet A case study – Mark in kaiāwhina programme: Before Now – six weeks later No interest in preparing meals Engaged in sandwich club Difficulty shopping Kaiāwhina supermarket tours, gaining confidence in buying right food within his budget Little contact with whānau Joined lunchtime walking group Overweight (127kg), no exercise Losing weight (125kg) Uncontrolled diabetes (HbA1c 86) Reducing HbA1c (now 82) Wanted to lose weight and sort Feeling happier and has a plan towards new out his lounge. Felt hopeless. lounge suite.
Northland’s approach – about Northland • 2013 census population of about 151,692, predicted to increase to 171,100 by 2018. • A high proportion of Māori - Nga Iwi o Te Tai Tokerau comprises 30% of Northland’s population. • An ageing population – driven by decreasing numbers of children. • A higher proportion of economically deprived communities than New Zealand as a whole • A dispersed rural population – poverty and lack of public transport can make it difficult for people living in rural localities to access some services. • Two PHOs – Manaia Health and Te Tai Tokerau • Three programmes – the tamariki, the rangatahi, the adult programme
Northland’s tamariki programme Whānau with child newly Whānau with Child with diagnosed with T1 DM in poorly controlled T1 DM previous year high HbA1c • n = 7 • n = 11 • HbA1c = 47-94mmols • HbA1c = 67 to >130 mmols • Average HbA1c = 65mmols • Average HbA1c = 91 mmols • European/ Samoan/Other = 5 • European / Other = 2 • Maori = 2 • Maori = 9
Hine’s story Whānau with child newly diagnosed with T1 DM in previous year • Hine: 10 yrs old • Solo mother on benefit • Lives with Grandmother (2 years) • T1 DM. Dx 2013. HbA1c = 93mmols • Agency involvement: Police, CYF, Community Mental Health, NDHB Diabetes Team, NDHB Psychologist, Grandparents Raising Children, GP, School
What parents said 1. How well do you understand your child’s diabetes ? 1. Do you feel that looking after your child’s diabetes is taking over your life? Not at all Yes – I fully No - never Yes – almost all 1 2 3 4 5 1 2 3 4 5 understand the time 2. Do you feel angry, scared and/or sad when you think about your child (tamaiti) 2. How well do you know what to do to care for your child’s diabetes ? /family/ whānau living with diabetes ? Not at all Yes – I fully 1 2 3 4 5 No - never Yes – almost all understand 1 2 3 4 5 the time 3. Do you feel your whānau /family know how difficult it is to care for a child with diabetes? What would help? Not having it at all Not at all Yes - they fully Being closer to support – Normal things 1 2 3 4 5 understand Technology to assist with lows at night 4. How well do you think your child is coping with diabetes? Support with other diabetes families More education 1 2 3 4 5 Pump Not at all well Very well Tax free healthy food
What children said Do you feel that diabetes is taking over your life? No Yes Sometimes Do you feel angry, scared or sad when you think about living with diabetes? Do you know what to do for your diabetes? Not often Very often Sometimes Yes No Some of it Does your whānau/family know how difficult it is for you to live with diabetes? How often do you do what you are supposed Yes No Maybe to when caring for your diabetes? Most of Not often Sometimes Do your parents worry about your diabetes? the time How often do you feel sick because of the About the They worry A little too highs and lows from your diabetes? right way too much much Not often amount Very often Sometimes How often does having diabetes stop you from doing something you want to do? What would help? Not often Very often Sometimes Having new and different strategies to help me take How well do you think you are coping with every injection and blood sugar levels diabetes? Very well Not very well Okay Not taking injections To get a routine quickly because I think that routine will help me get used to my diabetes Having a monitor to see my levels Having friends who have diabetes
Northland’s rangatahi programme • Aims: Innovative ways to engage with youth with diabetes • Activities: • A series of workshops delivered by the Company of Giants theatre group • Bring together clinicians and patients in a new model of care that removed barriers of access, and where the clinicians were naïve participants – engaging in full and level playing field • Progress to date: • First cohort – Five youth • Second cohort – Nine youth; five continuing from cohort one
A little something fr from our participants
Meet Heath and Mataara
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