Wnanau Ora - Transforming Futures - Te Puni Kokiri

Hon Tariana TuriaMinister responsible for Whānau OraMe te mea ko Kōpū, ka rere i tepae.Whānau Ora is like the beauty ofthe star, Kōpū, that heralds thecoming of the dawn. Like the stars,our whānau continue to provideus with reason to be hopeful. Theyprompt us to plot our destiny;to chart the steps necessary toachieve our aspirations.This, then, is the transformationthat we have been witnessingthroughout the motu – restoring theopportunity for our whānau to value the essencefrom which they come. It has been, if you like, acoming home.But the transformation is not just groundedfrom a basis of optimism – it is pragmatic; it ismeaningful to each whānau; and it is firmly drivenby outcomes.The outcomes we seek are that whānau will be:• self managing• living healthy lifestyles• participating fully in society• confidently participating in te ao Māori• economically secure and successfully involvedin wealth creation• cohesive, resilient and nurturing.How each whānau expects toachieve such outcomes will bedetermined by them, to fit theirown unique set of circumstances.Perhaps the biggest immediatedifference is that services,programmes and agencies arerequired to work differently; tocentre their focus on whānau.Officials from Te Puni Kōkiri,the Ministry of Health and theMinistry of Social Developmentare working intensively withWhānau Ora provider collectives to completetheir Programmes of Action. These Programmesof Action will ensure there is a planned approachto the actions providers need to take to moveto a new way of working under the Whānau Oraapproach.The process to date reflects a sea change inthinking around service provision. The levelof interaction between whānau, hapū, iwi andservice providers has improved markedly.Best of all, whānau are empowered to developa plan for their future; to trust in their ownsolutions.Whānau Ora is ultimately about survival. We canall be proud of the difference we are making –and I thank you all for your mahi.Whānau Ora Transforming our futures 3

items. They were also encouraged to visit thePacific Trust Canterbury health clinic where thefamily had flu vaccinations and it was discoveredthat Oliula needed help to reduce her high bloodpressure. In the meantime, their landlord wasworking quickly to have their home repaired.‘Putting our whānau needs first, then finding ways to help them is what Whānau Ora is about. It is about supporting our communities who supportour whānau who support our mothers, fathers, children, grandparents, aunties, cousins, etc.’Pacific Trust Canterbury’s Quit Smokingcoordinator Christine Leleifenika said adoptinga Whānau Ora approach meant the organisationhad been able to wrap itself around families likethe Iosefas, helping them to identify what theyneeded during the crisis and what they neededto sustain themselves in the future, as well asoffering support from people with a wide range ofexpertise.Pacific Trust Canterbury service manager forMental Health and Social Services Mark Esekielusaid the approach was highly beneficial inidentifying family needs after the February quake.‘At an organisational level, all services have hadto work in a more collaborative way, both with oneanother and with other Pacific providers. Focusingon all the needs of the Pacific community postquake has been important in helping us tostep back from delivering individual services tofocused areas of the population and to work in amore collaborative and cohesive way to supportour whole community,’ he said.‘Putting our whānau needs first, then finding waysto help them is what Whānau Ora is about. It isabout supporting our communities who supportour whānau who support our mothers, fathers,children, grandparents, aunties, cousins, etc.’Oliula says that of all the services offered, havinga translator to explain what was happening andwhat was available to help her family was themost important.Now that she has strong links with Pacific TrustCanterbury, she has asked to make use of otherservices, such as budgeting advice.Whānau Ora Transforming our futures 7

Listening to whānau and going the extra mileKia tū tika ai te whare tapu o NgāpuhiRheumatic fever is a key health issue inNorthland. So when a Māori health and socialservices provider in Kaikohe was approached bywhānau concerned about the disease, it didn’thesitate to help.Te Hau Ora o Kaikohe, a member of Te Pu o teWheke Ngāpuhi Whānau Ora collective, runs arheumatic fever school screening programme ineight local schools.Special projects manager Erena Kara said thatthis year alone, a number of local tamariki hadbeen diagnosed with acute rheumatic fever. Thegroup A streptococcus (strep A) throat infectionis a precursor to contracting rheumatic fever, andone of the ways to identify whether this infectionis present is through a throat swab.Te Hau Ora o Kaikohe kaimahi go into schoolsand swab tamariki who are complaining of asore throat. Every week, about 95 children aged5 to 14 years are swabbed. Each month, anaverage of 35 of these swabs test positive forstrep A, indicating that these children need acourse of antibiotics.School – about 10 minutes from the town – to askfor help.‘Swabs were taken immediately and, by the closeof business, the lab had received the swabs,’Erena said.‘We consider this to be a success, as the whānauwere comfortable enough and felt safe to cometo our kaimahi and ask to be swabbed. For us,this meant the kaimahi have been visual inthe schools, proactive in making contact withwhānau, and breaking down barriers for whānauin the community.’Te Hau Ora o Kaikohe’s school screeningprogramme contract is limited to swabbingschool-aged children. That is what they arefunded to do. However, by listening to what thewhānau wanted, the provider was able to beflexible and contribute directly to its populationoutcomes and Whānau Ora aims.The Kaikohe provider is one of seven members ofTe Pu o te Wheke Ngāpuhi.Recently, Te Hau Ora o Kaikohe was notifiedthat two children in one whānau had returned apositive result for strep A. The tamariki had beentravelling to a tangi in a van with eight or nineother whānau members.‘On learning that the tamariki had testedpositive for strep A, the whānau took a proactiveapproach and, using the information they hadbeen provided with, attempted to make anappointment at the local GP (general practitioner)clinic for the whānau to be swabbed,’ Erena said.With no immediate appointments available,the whānau decided to try the accident andemergency clinic. But they discovered therewould be a cost involved in swabbing the wholewhānau. The waiting time was also longer thanthey had anticipated.So they decided to visit the school screeningprogramme and drove from Kaikohe to TautoroKaimahi Charlotte Poa swabs Kapuatere Barber’s throat as part ofthe Kaikohe rheumatic fever school screening programme.8 Whānau Ora Transforming our futures

Strengthening whā nau connectionsJohni Rutene has big plans for his whānau.He wants to reconnect his 180-strong family witheach other and their Wairarapa turangawaewae,strengthen their bonds and improve their overallwhānau ora.‘For the last five years, I’ve been wanting to dosomething to unite our whānau with a continuousnurturing connection,’ he said.‘But it was really only since I became aware ofWhānau Ora that I started getting glimpses of hopearound how that rejuvenation process might go.’Johni, his wife Micaela and some of his cousinshave been working on their whānau-centred plan.It’s almost finished. The next step is to set up afamily trust and apply for Whānau Integration,Innovation and Engagement funding. This isavailable to support whānau, who, among otherthings, want to strengthen whānau ties.‘With our whānau plan, maybe we could get ourturangawaewae back, so we have a place to callour own,’ he said.‘I have young kids and it’s really important thatthey are involved and they get given that tahaMāori.‘I’m turning 40 this year, and I am dedicating mynext 10 years to te reo, tikanga and te ao Māorifor myself and my whānau.‘I am very excited about getting these plans offthe ground. We have to look forward . . . I knowthis is going to help our whānau.’For more information on the Whānau Integration,Innovation and Engagement Fund, go to:www.tpk.govt.nz/en/in-focus/whanau-ora/fund/Johni described the whānau plan as having astrong focus on reconnecting whānau members totheir whakapapa, tikanga and taha Māori.‘But we’re also including everything we mightcome across in the future,’ he said.‘We’re looking at growing our whānaueconomically, (and in) employment, health,education, rongoā and te maara kai. Things arereally hard for whānau, and they’re going to getharder. We need to learn – as a family – aboutthings we can grow that we can eat.’The Rutene plan is based around holding six huinext year, with the first commemorating the 25thanniversary of the death of his grandparents,Ihaka and Eraina Rutene. The focus of the otherfive hui will reflect the Rutene whānau approachto their own whānau ora.Johni wants his whānau to learn aboutthemselves, their turangawaewae at Te Whiti,Gladstone, and the marae they belong to.Johni Rutene with his children, 21-month-old Māhinarangi (front left),six-year-old Lucia, seven-year-old Vinnie, four-year-old Maui andwife Micaela.Whānau Ora Transforming our futures 9

Comprehensive care from Te Whā nau o WaipareiraComprehensive, holistic care will be the hallmarkof services offered from Te Whānau o Waipareira’snew four-storey Whānau Ora complex in westAuckland.Integrating a host of health, social, justice andeducation services, the Henderson WhānauHouse is also home to the Whānau Centre HealthClinic and Waipareira’s new-look Whānau Oraworkforce: kaimahi (service workers), kaiārahi(navigators) and kaiwhakahaere (leaders).Te Whānau o Waipareira is part of the NationalUrban Māori Authority Whānau Ora collective.It has been operating a ‘Whānau Ora, WhānauTahi’ approach to service delivery sinceJanuary 2011.So far, more than 200 staff have taken partin training and developmental workshops onunderstanding outcomes, whānau-centredpractice and privacy requirements when workingwith whānau.Dr Glenn Doherty, Clinical Director of the WhānauCentre Health Clinic, said it was an exciting timefor Te Whānau o Waipareira.‘Waipareira is the only service entity of its kindin New Zealand run and operated by Māori for allpeople wanting new approaches to their personalcare and the care of their whānau,’ he said.‘The whānau have been impressed with thenew centre, given it has been expanded toinclude more comprehensive services than theclinic had before.’There is now an expanded dental service andan on-site pharmacist. Waipareira is also in theprocess of co-locating various Waitemata DistrictHealth Board and government services. It isnegotiating with a radiology service, and there areplans to accommodate visiting specialists and abirthing unit.In addition to core general practice and nursingservices offered by the Whānau Centre HealthClinic, there are podiatry, midwifery and dieticianservices.‘We are about to employ a GP to run a chroniccare clinic and we are looking at working with anendocrinologist to run virtual and on-site clinicsfor our difficult diabetic clients,’ Glenn said.‘We also have family violence, Māori mobilenursing and cardiac rehabilitation servicesintegrated with the clinic.’Whānau Ora kaiārahi will work with familiesto identify their needs and aspirations andhelp them develop a plan to achieve them. Thekaiārahi will then help whānau learn how to findthe best resources and services they need, eitherwithin Te Whānau o Waipareira or externally.Exciting times – Dr Glenn Doherty.Glenn said the wide range of services offeredby Waipareira means whānau accessing theirservices will get comprehensive care – ‘not justsnapshots of care or contact’.10 Whānau Ora Transforming our futures

Realising a dreamWhā nau tahi, whānau ora!Janine Kaipo is overwhelmingly enthusiastic–about Te Hau A whiowhio o Otangarei’s WhānauOra vision.‘It’s absolutely awesome,’ the Whangareicollective’s spokeswoman said.‘Whānau Ora has given us a big opportunity todrive change and contribute towards our whānaureaching their own aspirations.‘Our collective is committed to transforming ourmahi, working to our strengths and abilities andfocusing on care under kaupapa Māori. This careis available to all peoples.‘As non-government organisations, we have beentalking about this for years, but the system hasn’tallowed us to do it. Whānau Ora has given us theopportunity to “de-frag” it and make it work muchbetter. We are very excited.’The six-member Otangarei collective services oneof the lowest-income suburbs in Whangarei. Itsmembers have a history of flax-roots engagementwith whānau and communities.a Whānau Ora centre; strengthening educationand training links to jobs; and creating a positiveimage of whānau capability by using its socialmarketing tools. In particular, the collective iskeen to explore the role of its member NorthlandTV Charitable Trust (Channel North) and its localiwi radio station partner Ngāti Hine FM.The collective has just begun holding communityhui to develop the Whānau Ora centre plans.Already, thought has gone into how the centremight provide programmes for whānau, activitiesfor rangatahi, taha Māori training, professionaldevelopment and initiatives for preventing familyviolence.‘It has been a huge job and we were exhausted atfirst,’ Janine said. ‘But you can’t mess around. Ourvision is that whānau reclaim their rangatiratangawithin a nurturing community. When that’sachieved, everyone’s dream will be realised.’Since November last year, collective members havespent one day every week, learning each other’sstrengths and mapping their Whānau Ora vision.Knowing that whānau consultation was crucial,the collective designed a simple Whānau Oraquestionnaire and took it to their families.About 200 surveys were completed earlier thisyear. Survey responses shaped and informed thecollective’s direction.‘A lot of the feedback was really simple stuff . . .Whānau wanted things like warm homes, to havefood, a job, no violence . . . that was wellbeing forthem,’ Janine said.Other strong themes were that families wished tocontrol their own destiny, wanted more culturaldevelopment and a greater input from kaumātua,and placed a high value on education.Armed with this feedback, the collective is nowworking towards three more goals: establishing–Te Hau A whiowhio o Otangarei collective member Janine Kaipo,treats Whaea Pat Fenton to a foot massage, while Whaea Hazel Kingirelaxes after enjoying her massage. The mirimiri – a first for bothkuia – was one of the activities offered at the Otangarei WhānauCelebration Day held in late July.Whānau Ora Transforming our futures 11

Whaioranga Trust benefits from integrated contractAfter 30 years working in the Bay of Plenty,Whaioranga Trust knows that addressingindividual needs effectively requires thecollaboration of whānau, service providers andfunders. Integrated contracts are helping them toachieve just that.Tauranga’s Whaioranga Trust is one of nineproviders in Ngā Mātaapuna Oranga PrimaryHealth Organisation’s Whānau Ora collective.The trust aims to support, empower and enhancewhānau from newborn up. Services offeredinclude Tamariki Ora, mental health, socialservices, traditional healing and disabilityservices.Trust manager Alice Nuku admits that previously,despite its range of services and wrap-aroundapproach, Whaioranga had become ‘siloed’. Shesaid staff were obliged to work within the specificcriteria attached to particular contracts, and theysometimes found it difficult to look beyond thosedemands.For both clients and staff there could be annoyingduplication of assessments and referrals to meetcontract entry criteria. Plans could be inflexibleand overly prescriptive and, more importantly,clients sometimes seemed even less connectedto whānau, family and community as a result.‘Depending on the situation, an assessmentcould take one and a half hours, and writing upthe assessment would take another 30 minutes,’said Alice.‘Then there’s travel and preparation work to besent off, taking another hour. Multiply all that byfive people for the five services someone mightneed . . .’She said Whaioranga Trust had alreadyexperimented with multidisciplinary teams asa way to cut workloads. So when the Ministryof Social Development suggested rolling allcontracts into one integrated contract, theyjumped at the chance.Whaioranga Trust workers sitting from left are: Vivienne Parker,Alison Palmer, Ian Davis, Michelle Haua, Betty Dickson, Dot Gwerderand Aneta Ohia. Standing, from left, are: Miriama Westworth, AliceNuku and Rawi Nuku.Alice did have initial concerns that contact withpersonnel at the Ministry of Social Developmentand the district health board might be reducedthrough this arrangement. ‘But the new contractspecifies that we meet every six months. It’sawesome.’Finally, and perhaps most impressively, the wholeprocess of setting up an integrated contract tookjust six months. That tight timeframe would nothave been possible without the efforts of theNational Integration Advisor and the districthealth board’s Māori Funding and Planning team.Because of their work, the integrated contract wasup and running from 1 July 2011.The new contract has slashed administrativerequirements, freeing staff to be more innovativein how outcomes are met and what and howservices are delivered.‘Now staff know they are not looking after anindividual client but the whole family. This ismuch closer to how staff work naturally and ismore aligned to Whānau Ora,’ Alice said.12 Whānau Ora Transforming our futures

Enhancing the Ōrākei experienceEveryone has a different idea of whānau ora, andhow their whānau will achieve that.Ngāti Whātua kuia Puawai Rameka recognisesWhānau Ora working in her hapū every timeshe sees the increasing number of kaumātua atŌrākei Marae.‘A couple of years ago, there was a tangi at themarae, and during the course of the last day,everyone went to the urupā and then later cameback to the wharenui to talk and mihi mihi,’ shesaid.‘I was walking into the wharenui and suddenlyrealised I was seeing something quite special.There was a big row of kaumātua sitting in chairs,and it was that sight that stopped me in my tracks.‘I counted those kaumātua and there were justover 30 of them – all over 70 years of age.‘In my lifetime, I have never known a time whenwe had so many kaumātua of that age still alive.We are witnessing a major change and a majorsuccess that I put down to the impact our clinicsare having. It was such a simple sight but sopowerful an expression that progress is beingmade in the health of our people.’Puawai said most of the kaumātua were living atŌrākei or in the eastern areas, near the clinicsand other health services provided by her hapū.‘Not long ago, our people couldn’t afford togo to the doctor and then couldn’t afford themedication if they got it. It took quite a while forolder people to get used to the idea of going tothe clinic.‘But things have changed, and an awful lot ofpeople have now become more educated towardstheir health.‘We have the clinics and so many other serviceswhere treatment can come to them, they get themedication they need when they need it, and theydon’t have to worry about the cost. I just can’tbelieve the difference in the way things are now.I am over the moon.’Ngāti Whātua o Ōrākei Māori Trust Boardspokesman Eru Lyndon said that Whānau Oragave the trust board the opportunity to applythe experience of Ōrākei and enhance it, for thebenefit of everyone.‘Stories like Whaea Puawai’s are motivatingbecause they are real stories and show that theefforts of leaders like her created change. Theopportunity now is to work smarter on the partof both providers and government agents andfunders. I’m heartened to see that progress isbeing made on this front, but there is much morework to be done.‘People say whānau ora has been around forever,and essentially it has, but we’re not all the waythere yet. There is a need to get this stuff right.By doing so, there are going to be downstreamsavings and benefits for everyone.’Six Ōrākei providers are working together inthe trust board’s Whānau Ora collective. Theyprovide services to communities in central andeast Auckland, particularly Ōrākei, the suburbs ofTāmaki and Otāhuhu.Kaumātua Alec Hawke (left) and Herbie Hetaraka (right) with Puawaiat Ōrākei Marae.Whānau Ora Transforming our futures 13

Turuki support makes a positive differencefor quake whā nauChristchurch earthquake refugees GeorginaKiwara and her whānau had just moved intoemergency housing in South Auckland whenTuruki Health Care workers swept into their lives.Turuki’s impact was immediate. For the formerChristchurch East residents forced from homesdamaged by the February earthquake, it was alsolife changing.Georgina, her two daughters, five mokopuna anda nephew and his wife had spent five days livingin their Aranui garage – a basic shelter with noamenities.With the help of their whānau, they relocated toAuckland on 26 February and started trying to puttheir lives back together.Almost two weeks later, Georgina, two daughtersand three grandchildren were given emergencyaccommodation in Manurewa. That’s when TurukiHealth Care found them.‘We moved into an emergency home on Friday,and two Turuki workers turned up that night whilewe were having tea,’ Georgina said.‘We had next to nothing – no beds, no blankets,no nothing. They asked us what we needed,took one of my daughters with them and told usthey would be back. I thought they were going toget second-hand stuff, but they came back withbrand new blankets, pillows, towels, sheets, pots,spoons . . . I couldn’t believe it. I’ve never hadanything like that before.’Georgina Kiwara, left, with Turuki Health Care primary health care manager Renee Muru and nurse Vicky Maiava.14 Whānau Ora Transforming our futures

The workers also came back with about $300worth of groceries for the quake-traumatisedwhānau.In the weeks that followed, Turuki continuedhelping the whānau with their immediate needs.This included providing them with new beds andhousehold furniture, arranging to get their familyvan, Georgina’s mobility scooter and freezertransported up from their Christchurch home andgetting a school uniform for Georgina’s eight-yearoldgrandson. Turuki Health Care also sent a vanto the Kiwara home to take the whole whānau tothe health clinic for check-ups.‘Having workers that have a combination of skills in both primary health care and social work is also keyfor this approach becauseit allows us to get the full picture of what is happening for the whānau. Once we have thatpicture, our long-term mahi with the whānau begins.’ Georgina and her whānau are now living in rentalaccommodation in Manurewa. They are, Georginasaid, ‘all right now’.She tells all her visitors about Turuki Health Care’sassistance.‘They helped me with a lot of stuff,’ Georgina said.‘It’s the first time I have had help from people likethat. I’ve always tried to manage on my own andhave never had help like that before.‘I was really surprised, and then I was glad. I can’tget over what they have done for us and reallycan’t thank them enough.’Turuki Health Care is one of four South AucklandMāori health and social service providers in theKōtahitanga Roopū Whānau Ora collective.Turuki’s primary health care manager Renee Murubelieves collaboration is key to the success of theWhānau Ora approach.‘We have to deal with the acute needs first andforemost – it’s imperative to get the whānau intoa situation where they can then focus on theshort-term, medium-term and long-term goals.Then you can look at supporting the whānau inmore aspirational planning,’ she said.‘Having workers that have a combination of skillsin both primary health care and social work isalso key for this approach because it allows us toget the full picture of what is happening for thewhānau. Once we have that picture, our long-termmahi with the whānau begins.’Renee said that by viewing the whānau as awhole, Turuki’s team, supported by the whānau’skey worker, are more efficient and effective.It’s a process that helps with continuity of care,relationship building and establishing a platformwhānau are comfortable with.Turuki Health Care worked with Housing NewZealand, Work and Income, and Harvey Norman inMt Wellington to help Georgina and her whānauwith their needs.More than 20 families who arrived inAuckland after the Christchurch earthquake inFebruary 2011 have benefited from Turuki’sassistance. Some of this work is ongoing, asTuruki continues to support whānau with theirgoals and aspirations.Whānau Ora Transforming our futures 15

Health scare prompts whā nau changesA Porirua whānau has made big lifestyle changesafter one of their family members had a massiveheart attack when he was only in his early 40s.The health scare spurred the Ngāti Toa/NgātiKoata Hippolite whānau to take action.For the five sisters and two brothers still livingin Porirua that action included getting medicalchecks, embarking on a family ‘Biggest Loser’weight competition and doing regular exercisesuch as walking, playing whānau hockey andgoing to the gym.The medical checks revealed that some ofthe whānau had diabetes. Testing positive tohigh cholesterol and high blood pressure alsoput other whānau members into the high-riskcategory for heart disease.One family member said that their brother’s heartattack, coupled with a history of heart diseasethat went back at least two generations, shockedthem into action.‘We all got a fright. It was a real wake-up call. Wehad horrible eating habits – we had to change,and compared with what we were like before theheart attack, we’re much better. It’s made a bigdifference. But it’s something we are going tohave to watch all the time. This will be a life-longthing.’Their moves towards healthier lifestyles havebeen supported by their children, a couple ofwhom organised ‘The Biggest Loser’ weightcompetition among the siblings’ families. With awhānau-contributed putea and bragging rightsat stake, competition was fierce. It is rumoured16 Whānau Ora Transforming our futures

Peter Hughes, Chief Executive ofMinistry of Social DevelopmentWhānau Ora is an inclusive, culturally-anchoredway of working with whānau and families acrossNew Zealand. It identifies their needs and theirstrengths so that they can meet their own socialrequirements and move towards self-reliance. Itpromotes collaboration in determining the bestmix of services for each community, family andindividual.The Ministry of Social Development is one ofthree agencies making this a reality, with ChiefExecutive representation on the GovernanceGroup, Deputy Chief Executive representation onthe Implementation Group and regional managerrepresentation on the 10 Whānau Ora RegionalLeadership Groups. In addition, the Ministry ofSocial Development is developing integratedcontracts for Whānau Ora providers.These streamlined andsimplified agreementsencourage communityproviders and Governmentto share the risks andresponsibility of improvingoutcomes for families bygetting them around a table with key agencies,such as justice, education and health.The result is a holistic package of services tailoredto the specific needs of whānau and familiesusing common language, a common approachand common sense.Integrated contracts allow Whānau Ora providersand collectives to innovate, to concentrate onresults and to focus on what they do best –deliver the best results for whānau.Whānau Ora Transforming our futures 19