August 2017 News Matua Raki - Addiction …...August 2017 News Passion Commitment Excellence Wellbeing in the workforce Worker wellbeing is receiving increasing attention. Both internationally,

Inside: International Drug Policy Symposium, Stories from familyand whānau articles & more...

Matua Raki NewsA

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Passion Commitment

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Wellbeing in the workforceWorker wellbeing is receiving increasing attention. Both internationally, and more specifically in New Zealand, there are an increasing number of organisations and resources available to support wellness.

Read more 0n Page 7.

Contents

To download electronic copies of this newsletter or any of Matua Raki’s workforce resources, visit our website:matuaraki.org.nz

To inquire about our resources or request hard copies, contact us at matuaraki.org.nz/contact

August 2017 edition

Coming events ........................................................................................................3

“He mana tō te kupu – Words have great power”. .............................................. 4

Cognitive Impairment Workshops by Dr Jamie Berry ......................................... 6

Wellbeing in the workforce ....................................................................................7

Addiction Research Symposium May 2017 ........................................................... 8

Around the sector .................................................................................................10

Matua Raki Addiction Peer and Consumer Days .................................................11

We are Family: Stories from family and whānau ................................................ 12

Working with Māori, an e-learning tool .............................................................. 13

Te Reo Hāpai – The Language of Enrichment ..................................................... 14

The 5-Step Method for working with families and whānau ............................... 16

Managers talk about peer support specialist workers ........................................ 18

Reflection on Harm Reduction International ................................................... 20

Helping families to find a balance in an unbalanced world ............................... 21

International Drug Policy Symposium ................................................................22

Addiction Leadership Day ................................................................................... 24

Welcome to Tommy Benefield ............................................................................ 31

Matua Raki News

Matua Raki News 2 August 2017

www.matuaraki.org.nz

http://www.matuaraki.org.nz/about#contact

Coming events

Careers in the addiction sectorVisit our webpage if you are looking for a job or want to know what scholarships

are available. If you have a vacancy to advertise, there is a link to the Te

Pou website where you can log in to add and manage your own vacancies.

www.matuaraki.org.nz/careers

Keep up to date on addiction sector news, events and jobsMatua Raki sends regular email updates to people interested in keeping

up to date with relevant addiction sector news, upcoming events and

job vacancies. To sign up to the addiction sector noticeboard visit:

www.matuaraki.org.nz/subscribe

8 August Wellington SA(CAT) Workshop

10 August Palmerston North SA(CAT) Workshop

15 August Hamilton SA(CAT) Workshop

17 August Auckland SA(CAT) Workshop

29 Aug - 1 Sep Sydney The MHS Conference

6 September Wellington Pre-Cutting Edge Events

6-9 September Wellington Cutting Edge Conference

12-15 November Melbourne APSAD

21 November Auckland Peer & Consumer Day

23 November Christchurch Addiction Leadership Day

For more details please contact [email protected] Would you like your event listed here? Go to our website, www.matuaraki.org.nz, click on events and sign up or log in to add your event.

3Passion Commitment Excellence


“He mana tō te kupu – Words have great power”. Keri Opai

Welcome to the Matua Raki Newsletter. The opening words are from Keri Opai who spoke at the launch of Te Reo Hāpai – The language of enrichment. Keri led the development of this resource which is a new Māori glossary that not only provides translations for existing words, it has also created many new words in te reo Māori - for use in the mental health, addiction and disability sectors.

In this issue, we are focusing on peer support work from a service manager’s

viewpoint. Peer support workers are people with lived experience of, and

recovery from, dependence on alcohol or other drugs (AOD) and/or mental

health issues. Having peer support workers as part of a service makes

recovery visible to the people coming to the service seeking support,

and to their colleagues. It’s not about proposing the ‘best’ way to recover

nor endorsing a certain kind of recovery. It’s about being alongside, the

connector between the service and the community as people come to

terms with their substance use and practice making changes in their

lives. It gives a powerful message of change, diversity and hope.

There are many types of peer support roles and in this issue, we have

interviewed two managers who have AOD peer support workers as an

Suzy Morrison, project lead and guest editor

Matua Raki


integral part of their service delivery. The Phoenix Centre is a community

based assertive outreach AOD service in Counties Manukau. Everyone who

accesses Phoenix has a clinician and a peer support specialist working

with them. Supriya Maharaj shares her four years of experience being part

of this dynamic team, initially as a clinician and currently as manager.

Supriya speaks of the peer support role and the importance of connecting

people into their community as an essential part of ongoing recovery,

saying “a peer support specialist’s lived experience of using services

or overcoming similar challenges, is a priceless tool for engagement".

Mirror HQ in Dunedin works with vulnerable young people aged 12 – 22

years who are experiencing complex issues. Tanya Phillips is the Clinical

Team Leader and has overall management of a multidisciplinary team

which includes a peer support specialist. Tanya describes the peer support

role as adding value to Mirror HQ by being “active right across service

delivery, from participating in reviews to working directly with young

people and our community".

To the service managers and/or team leaders reading this, my challenge

to you is to connect with Supriya or Tanya or other services who employ

peer support workers. Ask questions about the added value of having

people with lived experience as part of the team and the blending of

professional and experiential knowledge they bring to the service and the

impact this has on people accessing and working within AOD services.

Also in this issue is an article about the 5 Step-Method training initiative.

Matua Raki are implementing a rigorous training, accreditation and

evaluation of the 5 Step-method here in Aotearoa New Zealand. Addiction

services are often working with family and whānau affected by someone

else’s use of alcohol or other drugs. The 5 Step-Method sees family members

as people needing support for themselves, in their own right, rather

than solely as supporters for family and whānau with AOD problems.

People affected by someone else’s problematic use of alcohol or other

drugs are a hidden group. There have been limited opportunities for

people to give voice to their experience. In response to this, the Matua Raki

Consumer Leadership Group have gathered stories for publication. “We

are Family: Stories from family and whānau concerned about someone

else’s use of alcohol or other drugs” offer just such an opportunity. These

are personal stories of courage and hope. Each story is deeply personal

and gives voice to the experience of coming to terms with how things are

and how it is possible to live well despite the challenges. Breaking the

silence through story. The family has their own recovery road to travel.

“Words have the power to explain, express and define how we understand

and experience the world.” Keri Opai.

Both resources Te Reo Hāpai and We are Family are free and available

to be ordered on our website www.matuaraki.org.nz


Recognising, Assessing and Responding to Cognitive Impairment in the Context of AOD Rehabilitation In November and early December 2016 Dr Jamie Berry, Senior Clinical Neuropsychologist and Director at Advanced Neuropsychological Treatment Services (ANTS) in Sydney, delivered three one-day workshops on using the Montreal Cognitive Assessment (MoCA) to assess and use to develop appropriate strategies to respond to cognitive impairment in people accessing addiction treatment.

The workshops followed Dr Berry’s engaging and informative presentation

to the Christchurch Addiction Leadership Day the day before. This

presentation is available on the Matua Raki website.

The MoCA is a validated tool to screen for the presence of cognitive

impairment that does not require the time, the training or specific

neuropsychological skills to use and interpret. While the MoCA results

are indicative of cognitive impairment and probable damage in a range of

brain locations, and thus functioning, results are not specific or detailed

enough to generate diagnostic information and as such it does not

replace a full neuropsychological assessment. However, with limited

access to neuropsychologists in most areas of New Zealand the use of

the MoCA fills an important function when completing a comprehensive

assessment and developing appropriate treatment and intervention

planning with people accessing addiction services.

As Dr Berry points out, up to 80% of people accessing treatment is

for addiction, will be experiencing a level of compromised cognitive

functioning. It is important that people working in the addiction sector,

have a good understanding of the impact of limited cognitive functioning,

are able to assess for this and adapt treatment plans accordingly.

The initial session provided by Dr Berry were very well received and Dr

Berry was invited to return to New Zealand for a series of 11 workshops

provided throughout the country. The aim was to give a larger number

of addiction practitioners the opportunity to familiarise themselves with

and learn to administer the MoCA and, equally importantly, to use the

specific information identified from people’s responses to the MoCA

to put into place ‘cognitive remediation’ strategies to help people with

specific frontal lobe deficits.

Overall the interest in these workshops has been outstanding and they

have been very well-supported, with most sessions over-subscribed.

Dr Berry is an engaging presenter who provides practitioners with

very relevant and practical knowledge and skills to understand and

work with cognitive impairment. Feedback from attendees has been

extremely positive.

Dr Berry rounded off this tour of New Zealand at the end of June with

four workshops in Dunedin, Christchurch, Hamilton and Wellington,

which were all fully booked. He returns in September to present at the

Cutting-Edge conference.

Cognitive Impairment Workshops by Dr Jamie Berry

Dr Jamie Berry


continued from the cover

Reports are emerging that address the needs of particular workforce

groups, however, little is known about the wellbeing status of the addiction

workforce. Inspired by the work of David Best (Best, Savic & Daley, 2006)

Matua Raki, in partnership with Network of Alcohol and other Drugs

Agencies (NADA), New South Wales (NSW); and National Centre for

Education and Training on Addiction (NCETA), Flinders University, South

Australia (SA) are examining addiction worker wellbeing, quality of life,

resilience and associated contributory factors.

Wellbeing in the AOD sector has traditionally been measured by stress

and burnout. These measures, as endpoints, can be associated with a

range of health issues for clinicians, and organisational implications of

absenteeism, performance and staff turnover. In recognising that workers

do not function in isolation of the rest of life, we would like to explore the

dynamic nature of work and its relationship to addiction worker wellbeing.

We will be asking the workforce, (administrators, support workers,

educators and practitioners alike) to participate in an online survey. The

survey will contain questions regarding demographic characteristics,

working conditions, work life balance, personal characteristics and

organisation supports.

Findings from the study will be collated to improve our understanding

of the factors that contribute to worker wellbeing and quality of life. This

valuable information can be used to inform organisations, managers

and workers about ways in which worker wellbeing can be enhanced

and improvements made that will benefit services, addiction workers

and clients.

Keep an eye out in your inbox for the survey link later this year.

Wellbeing in the workforce


The Addiction Research Symposia are an annual event run in collaboration between the Universities of Auckland, Otago, Massey, Victoria and Auckland University of Technology, with support from Matua Raki. They provide a forum for:

› New Zealand addiction researchers to meet and share their work

› research students to present to their peers with support from colleagues

› addiction researchers to network and discuss issues of common interest.

This year the event was hosted by AUT at the central city campus. The

day was beautifully opened by Herewini Easton who welcomed those

from around the motu to Tāmaki Makaurau/Kaipara to the Manukau

Harbour. He thanked not only those sharing their knowledge and

information in the formal presentations, but also those attending the

day for their openness to sharing and learning. Professor Max Abbott

and Dr Maria Bellringer went on to welcome us to the campus and

acknowledge the partnership between the Universities and Matua

Raki. A full day of presentations, posters and networking sessions

was on offer with the following pānui highlighting some of what was

available. Further information can be found on the Matua Raki website

www.matuaraki.org.nz/workforce-groups/addiction-research/150

Associate Professor Joe Boden (University of Otago, Christchurch), drew

on information from the 1265 individuals born in Christchurch in 1977,

representing 97% of the births of that year. Extracting data of experiences

of alcohol use from early adolescence, the study has reported on age of

onset and patterns of use. The majority of cohort members had their first

drink by age of 6-10 years, typically provided by family members. There

was little relationship between age of onset and subsequent drinking

frequency, however, those who did drink larger quantities when younger,

were more likely to generate adult alcohol use disorder (AUD). Other

risk factors to AUD included permissive parental attitudes to alcohol

use and novelty seeking behaviour.

Associate Professor Chris Wilkins (Massey University, Auckland), reflected

on the current policy shift towards the legalisation of cannabis. Noting

the lessons available from gambling regulations and the Psychoactive

Substances Act he advocates for a shift in cannabis policy that is not

based on the removal of a black market per se, but rather as cannabis

being a commodity similar to that of alcohol, available for commercial

market and with income generated for regulation and enforcement.

Marta Rychert (Massey University, Auckland) followed on from Chris

referring to the Psychoactive Substances Act of 2013. She discussed the

perceived social acceptability and safety of synthetic cannabis use in

comparison to other drugs, including alcohol and methamphetamine.

Dr Simon Adamson (University of Otago, Christchurch), chaired the

session dedicated to postgraduate researchers. Boshra Talebi Haghighi

(AUT), discussed the ready accessibility of the internet and the diverse

populations of those classed as ‘internet addicts’. She raised the question

that on the basis that negative repercussions and ‘lying’ are symptoms of

problematic internet use, how could self-report assessment be trusted?

Her PhD study uses a computer application to assess problematic use.

Diana Atigari (Victoria University, Wellington) explained the investigation

into a novel kappa and delta opioid receptor agonist-MP1104. Kappa

opioid receptor agonists reduce the rewarding effects of drugs of abuse by

decreasing dopamine levels in the reward circuitry, however side effects

like aversion, dysphoria and depression limit their clinical development.

MP1104 has been shown to have potent analgesic effects, a longer action

of duration (than morphine) and high anti addiction properties, making it

an exciting potential for development as a non-addictive pain medication.

Jamie Walker’s (University of Otago/ARA institute, Christchurch)

presentation focused on ibogaine, available for prescription for opioid

dependence yet typically used among a ‘hidden population’. His exploration

of ibogaine users revealed that they all reported struggling with their

existing opioid use/doses; were cognisant of the risks; took actions to

minimise use; sought general practice medical assistance although

experienced widespread ‘ignorance’ from the health sector; and noted

a marked improvement in anxiety and depressive symptoms.

In rounding off this session, Derek Quigley (University of Auckland),

embarking on his PhD and inspired by his own journey of recovery

discussed the merits of case study as a means of research. Similarly,

Addiction Research Symposium May 2017


Trish Jamieson bought her passion of work in the addiction sector, with

a focus on fetal alcohol spectrum disorder (FASD). She noted that based

on current alcohol use by pregnant women, there are an estimated 600

new cases of FASD each year, yet few services available for those living

with FASD.

The afternoon session had a specific focus on interventions. Hannah

Linkhorn (Manukau DHB), introduced SpillIt-IT (www.spillIT.co.nz),

offered to presentations admitted to the Plastics Department following

an injury involving alcohol. The text messaging system provided either

a standard, generated, neutral message or a self-written, personal

message to individuals aimed to deter subsequent harmful alcohol

use. Many patients declined to participate in the messaging system and

indicated significant denial about the impact of their substance use,

for those who did. In considering the ‘wheel of change’ she noted how

patients admitted for surgery (associated with alcohol use) were not at a

stage that supported an intervention of this level and as such may need

to adjust their intervention to be more focused at a pre-contemplative

stage. Nicola Guy (University of Otago, Wellington) challenged by the

inconsistent and often limited short term reporting of outcomes for

substance use interventions reported on a systematic review noting the

correlations between personality disorder and alcohol use disorder, and

how we need to tailor treatments to best suit. Don Hamlyn (Northland

DHB) reported on the impact of Wernicke’s encephalopathy among long

term alcohol users and the frequent late diagnosis of the disorder. He

encouraged his service to develop a research proposal to implement a

community treatment protocol offering high thiamine dosing. Joanna

Chu (University of Auckland), reflected on the government’s goal of

being smoke free by 2025 and described some of the challenges to two

current smoking cessation trials and offered information about a new

trial to address these challenges.

The final session provided us with some fantastic presenters, established

in the addiction research field. Professor Susan Schenk introduced us

to her laboratory studies exploring, behavioural flexibility- the ability

to make adaptive changes in behaviour as circumstances, notably drug

availability change. Whilst this flexibility is deemed an essential survival

skill, the inflexibility among drug seeking rats was evident. Grace Wang

(AUT) described the wide spread and normative use of the internet,

concurrent with the negative consequences of low self-esteem and

expectations with regard to the future associated with excessive use.

Our concluding presenter for the day, Professor Peter Adams (University

of Auckland) eloquently described from a public health perspective, not

only the creative design, but also the spatial positioning, of electronic

gambling machines that work to discourage social interaction, minimize

scrutiny and ultimately promote a style of play orientated towards heavy

or problematic use.

The day was well attended, the questions following each session were

thought provoking, the networking session interactive and the posters

enlightening. This event is run annually, with the University of Otago,

Christchurch playing host in 2018. More information can be found at


Professor Peter Adams, Associate Professor Simon Adamson, Professor Janie Sheridan and Dr David Newcombe

Professor Max Abbot

Participants enjoying the addiction research symposium


Around the sector

Robyn Shearer, chief executive, Te Pou

A Word from Te Pou

Throughout my career working

in the health sector I have

known about the challenges

of managing expectations.

The public purse is never big

enough to meet expectations

and rationing is part of running

a tax payer funded health and

disability system.

Te Pou o te Whakaaro Nui aspires

to help support people to deliver

world class mental health,

addiction and disability services.

For the most part, we do well. As part of an international benchmarking

forum we can compare our results to other OECD (The Organisation for

Economic Co-operation and Development) countries. Whilst we are not

at the top of the league table, we are not at the bottom. The question I

think that is important to ask is - are we okay with being in the middle of

the pack? Should we aspire to do better? Be number one in the world? I

believe we should and can. New Zealand punches well above its weight

in other areas. We are great when it comes to rugby and yacht racing. So

why don’t we aspire to be part of a highly valued health system?

New Zealanders have always valued the public service as being free

and accessible. But we believe it’s now time to acknowledge that due to

population growth and changes in our social and economic structure,

we cannot deliver first class health services in the same way we have

done in the past.

Is it time to have more transparency on what we can do well with the

public funding that is available. Maybe we can be clear about what

services can be offered and let the public know this – and then also talk

about the gaps in services. Reframing the conversation about what

we could be doing if we had the opportunity to organise and fund our

services differently.

Te Rau Hinengaro, the New Zealand mental health survey (2002) enabled

us to understand what our community needed. This research population

health study provided evidence on the need . The survey provided insight

about how we could meet the needs of different parts of our community,

who required support with mental health and addictions issues. This study

was based on similar studies in the UK and Australia. These countries

have since done further research and gathered an evidence base for the

needs of their communities. How has this helped them? Having this sort

of evidence assists with prioritisation, understanding service models and

investment. It helps provide an objective view on targeting resources.

New Zealand is now lagging behind countries who have a similar health

system. Our challenge is being able to identify our mental health and

addiction priorities based on research and evidence. It’s great that we

have a health survey and are getting better at collecting information on

current service performance - but what we don’t have is an understanding

of the gaps of our services based on evidence.

Now more than ever, it is a challenge to manage expectations within

the mental health, addiction and disability sector. We are hearing that

services are struggling to meet demand. We know the workforce numbers

need to grow in line with population growth. However, what we don’t

know and understand is the gaps in services to meet the needs of our

population. We need solid evidence to clearly understand what can be

managed in the current system with the current funding – and know

where the gaps in services exist. I am advocating strongly for better

evidence on describing the gaps.

We are working hard to support our workforce with knowledge and

skills to support consumers and whānau. We also need to be realistic

about what cannot be done with the current funding. This will enable

us to find and provide new community solutions.

I’m interested to hear your feedback on this issue.

Ngā mihi nui

Robyn


Matua Raki Addiction Peer and Consumer Days

Supporting the people to support the people Matua Raki hosts a series of Addiction peer and consumer days designed to strengthen the peer and consumer workforce. The most recent was at the Saint Columba Centre in Ponsonby, Auckland on 8 June. It was a comfortable venue and we enjoyed some interesting presentations and shared delicious food.

AOD services from across wider Auckland were well represented and

35 people from eighteen different services attended. Some hadn’t met

before so the day was a great opportunity to make connections and

discover what other services provide. Being aware of other services in

the community, what they do and who to talk with serves to support

the people coming in the doors of our AOD agencies. Recovery lives

in the community and that’s where peer support workers are located.

Our aim for the days is to provide a place where we can gather together and

focus on supporting each other and where we can facilitate networking.

There is an emphasis on self-care and a sharing of the strengths and

connections we each bring. We also do our best to support each other

and identify the particular challenges and experiences we face as people

with lived experience working in the AOD sector.

We always begin the day with a story. Jo Grammer has been working as a

peer support specialist for three years as part of the team at the Phoenix

Centre in South Auckland (part of Emerge Aotearoa). Jo shared her story

for the first time in public and it was astounding. It was a powerful and

courageous story of active addiction, her recovery journey and where

she is today, doing work that she loves. Jo didn’t know, during the dark

and lonely times, that her experience would serve to support others in

the future.

Jo provides peer support, getting alongside people as they work to come

to terms with their own addictions. Her story shone a light on the hope

which is an essential ingredient for any change to take place. Stories

are wonderful connectors and Jo’s telling set the scene for the day and

reminded us of why we are here doing the work.

Marc Beecroft, the Regional Consumer Advisor/Peer Support Team

Leader from Odyssey in Christchurch took us through the growth of the

workforce in the South Island and plans for the future.

The CADS Auckland Consumer Team delivered a workshop on stigma

and discrimination with a focus on stigma in the workplace.

This time round we had a ‘surprise’ for the people. Drama skills coach Paul

Stephenson facilitated us for two hours of, in his words, “silly games”. In

order to be well in the work we do, we need to take our recovery seriously,

we also need to learn, through a variety of self-care methods, not to take

ourselves too seriously. The method on this day was facilitated play and

consequent laughter. And oh, how we laughed!

Evaluations from the day emphasised the therapeutic value of laughing

together and gratitude for the opportunity to connect with each other.

A special thank you to Haydee Richards from Phoenix and to Brody Runga

from Odyssey for developing and supporting the day.

The group at the 8 June Addiction peer and consumer day


We are Family: Stories from family and whānau

Supporting the people to support the people Problematic use of alcohol and other drugs (AOD) affects people across all walks of life and at all stages of life. Being affected by someone else’s problematic use of AOD can be challenging, shameful and lonely. Silence divides us and diminishes our strength.

People affected by someone else’s harmful use of alcohol or other drugs

are a hidden group. There have been limited opportunities for people to

give voice to their experience. The booklet, “We are Family: Stories from

family and whānau concerned about someone else’s use of alcohol or

other drugs” offers just such an opportunity.

The Matua Raki Consumer Leadership Group have gathered these stories

for publication. You will see they are stories of courage and hope. Each

story is deeply personal and gives voice to the experience of coming to

terms with how things are and how it is possible to live well despite the

challenges. Breaking the silence through story is an antidote to the shame

and stigma that keeps people isolated. We are connected through story.

We see ourselves on the page and know we are not alone. There is hope.

Gratitude and respect for the people who so generously shared their stories with us so that others may benefit from their experience, strength and hope. Thank you.

“We are Family” was launched at Leadership Day on 20 July in Auckland.

This is a free resource and can be ordered through the Matua Raki website

https://www.matuaraki.org.nz/resources


Working with Māori, an e-learning tool

Increasing the cultural competency of our health workforce is an important part of ensuring that health workers are competent practitioners when working with tāngata whai ora and whānau, in their various roles.

Having a basic understanding of Māori values, protocols and practices

will allow practitioners to think how they might communicate and

engage effectively, approach situations in a manner that is meaningful

and relevant to tāngata whai ora and whānau. Given the disparity for

Māori in mental health and addictions areas, support to develop tools

to assist practitioners in this sector is very much needed.

Working with Māori, is an interactive, e-learning cultural competency

tool developed primarily for the mental health and addictions sector. This

e-learning is a future development of the ‘Working with Māori’ online

modules developed by Te Pou o te Whakaaro Nui. The initial project

scope was originally developed by Maynard Gilgen from Matua Raki

who laid a solid foundation for which this e-learning tool has been built

upon. The modules are underpinned by the poutama tukutuku pattern,

indicating a stepped progression of learning as depicted in the pattern

itself. There are three modules in total with module one completed and

the following two modules currently underway.

Module One has been designed as an introduction module, to give

context and relevance to the modules currently being developed.

Developed alongside Ashley Koning, our e-learning technical expert,

an innovative approach used is the delivery of the e-learning module,

using various interactive mediums including visual, audio and pictorial

learning platforms.

The key learning outcomes of module one includes;

› awareness of key points in Māori and settler history

› awareness of the reasons for The Treaty of Waitangi and outcomes

› an overview of social determinants of health and Māori health statistics

› an overview of mental health and addiction statistics for Māori.

Module one was launched at Leadership Day in Auckland 20 July. To

enrol in the eLearning please go to https://www.matuaraki.org.nz/initiatives/cultural-competency/144

A Wise Group staf f member checking out this new and exciting cultural competency tool.


Te Reo Hāpai– The Language of Enrichment

Tēnā koutou, otirā, tēnā tātou e ngana nei ki te hiki i te hauora o ō tātou whānau, hapū, iwi, tāngata whai ora tonu. E mihi ana rā!

Keri Opai, Paeārahi (Strategic Lead) for Te Pou o te Whakaaro Nui, is an

experienced educator and interpreter of Te Reo and has a Master’s Degree

in Mātauranga Māori (Māori Knowledge). He has led the development

of an exciting new resource which provides terminology in te reo for

common use words in the addictions, mental health and disability fields.

Keri says “When I began this project, creating Te Reo Hāpai – The language

of Enrichment, the question I was asked mostly was – why? Why create a

glossary of te reo Māori terms for use in the mental health, addiction and

disability sectors? He aha te painga? – What is the benefit? My answer was

“He mana tō te kupu” – “Words have great power” - a whakataukītanga

kōrero (proverbial saying) that our tauheke (elder) of Taranaki, Huirangi

Waikerepuru, would often quote”.

Words have the power to explain, express and define how we understand

and experience the world. If our knowledge and use of words is limited,

inappropriate, outdated or unclear, this can be inherently conveyed in

communicating our understandings and experiences. An example is the

word for ‘addiction’. There had been a couple of terms previously used

by people to try and explain addiction which when translated literally

really didn’t capture the experience for tāngata whai ora and, in fact,

could be considered quite stigmatising.

Keri has sought to include ‘words of great power’ in te reo from a strengths

base and a mana enhancing Māori worldview for the benefit of tāngata

whai ora. In order to achieve this, wherever possible, Te Reo Hāpai

combines the lived experience of tāngata whai ora and tāngata whaikaha

(people with disabilities) with clinician and practitioner input. Feedback,

information and guidance has also been provided by an expert advisory

panel in creating the more than 200 interpretations for the unique

terminology used by the mental health, addiction and disability sectors.

Te Reo Hāpai has been supported by the Māori Language Commission and

these terms are available for wide spread use. “It’s a fantastic achievement

and makes it possible for us as resource developers to improve our ability

to be responsive to Māori” says Vanessa Caldwell, National Manager,

Matua Raki, “these terms capture the human experience much more

so than many clinical terms. We would encourage people to use these

words often, get familiar and comfortable with them so they become

common terms we can interchange with more clinical terminology

much like we do now with “client” and “tangata whai ora”.

Te Reo Hāpai is by no means a comprehensive word list. More te

reo research and creation in these sectors is urgently needed

to continue to enhance language used. Space is available in

the resource for readers to note iwi, rohe and kaumātua

variations and contribute to future growth of Te Reo

Hāpai – The Language of Enrichment.


Front left to right – Te Ngaruru Wineera (Ngāti Ruanui, Ngāti Toa), Dr Huirangi Waikerepuru (Ngāti Ruanui, Ngā Puhi), Ria Waikerepuru (Ngāti Ruanui), Keri Opai (Ngāti Ruanui, Te Atiawa) and Tepene Karaka (Tainui)


The 5-Step Method for working with families and whānau

Addiction services are often working daily with the families and whānau of people affected by addiction. In the last few years however mental health and addiction services have been asked to make a paradigm shift in the way they offer mental health and addiction support to ensure more effective engagement and support for family, whānau and the children of the people they work with.

Supporting Parents Healthy Children (SPHC) was launched by the Ministry

of Health in 2015. The guidelines outline expectations (primarily for

adult mental health and addiction services) and recommendations to

increase family and whānau participation in services, with a particular

focus on parenting and earlier intervention for children of parents with

mental health and or addiction issues.

In addition, the Substance Addiction (Compulsory Assessment and

Treatment) (SACAT) Act has now made its way through the parliamentary

process and has Royal Assent. The new Act has clear requirements for

addiction staff and services to involve and inform family and whānau

throughout the legislative process. Services will also have obligations

to family members when people do not meet the high threshold for

compulsory assessment and treatment.

The 5-Step Method is grounded in rigorous research and has a clear

theoretical model which underpins the intervention. It gives a structured

way to work with family members and is both simple and effective. The

model sees family members as people needing support for themselves

in their own right, rather than solely supporters for family and whānau

with substance or gambling problems.

ImplementationMatua Raki are implementing a rigorous training, accreditation and

evaluation process of the 5 Step-Method here in Aotearoa New Zealand.

This implementation process will be quite different from other trainings

we have offered in the past and includes;

› Training and accrediting addiction practitioners in the 5-Step Method.

› Training these accredited 5-Step practitioners to deliver training to other practitioners in the 5-Step Method, and accrediting them as trainers.

› Training practitioners to become accredited assessors.

› An ongoing process for cultural adaptation

› Evaluation of the effectiveness of the model in the Aotearoa New Zealand context.

This process means that New Zealand can develop a sustainable foundation

for the use of the Method, maintain fidelity to the Method and know

whether or not this Method works for us here in New Zealand.

In May Matua Raki hosted Professor Richard and Gill Velleman from

AFINet (Addiction and the Family International Network) for the initial

5-Step Method practitioner training. We had 17 trainees from around

the country who participated across the 3-day training. These trainees

are now undergoing the accreditation process.

Early in 2018 the Vellemans will return to train these accredited practitioners

to become trainers in the 5-Step Method. After this time, the training will

become more widely available around the country, as the New Zealand

based trainers begin to train their peers and colleagues in the sector.

For more information about the 5 Step-method implementations please

contact [email protected]

Foot note: The 5-Step Method implementation is one of the initiatives

that Matua Raki is involved with in relation to this work. For further

information about Supporting Parents Healthy Children please go to

http://supportingparentsnz.org/


http://supportingparentsnz.org/

The 5 Step-Method practitioner trainees with Professor Richard and Gill Velleman


Managers talk about peer support specialist workers

The value peer support specialists bring to organisations offering treatment for addiction and co-existing problems is becoming increasingly apparent. Here we feature two short profiles where managers talk about the importance of peer specialist workers and how their lived experience contributes to effective treatment at their services.

Peer support specialists bring a real face of recovery

Supriya Maharaj is the service manager at the Phoenix Centre in Counties

Manukau. ‘Phoenix’ is the addiction service offered by Emerge Aotearoa,

New Zealand’s largest mental health NGO. The centre is community-

based and takes an assertive outreach approach. It’s a mobile service

tailoring a programme specifically for each client based on their needs.

Everyone who comes to the centre is assigned both a clinician and a peer

support specialist to help support them in the community. Everything

done with the client happens in this joint or shared way with clinicians

specialising in treatment and peer support specialists supporting

engagement and connection.

It’s Supriya’s role to coach and lead the team while monitoring service

delivery. She started at the centre four years ago as a clinician and still

sees a small number of service users. She also does initial assessments

which, “helps her keep a feel for things".

The value of peer support specialists, she says, is that they bring a real face

of recovery. Just like sponsors in the 12-step environment, peer support

specialists act as role models who have been through recovery themselves.

They also bring longevity.

“As we often don’t see how a service user progresses once they finish

treatment, our peer support specialists demonstrate what recovery can

look like years down the track,” Supriya says.

“Connecting service users with their community is essential to ongoing

recovery, and the peer support specialists are great because they know

what’s available out there and which service is best for this or for that.

They break down the barriers and this is invaluable because it can be really

scary. A lot of our service users have never accessed anything before. A

peer support specialist’s lived experience using services or overcoming

similar challenges is a priceless tool for engagement.”

Assigning both a peer support specialist and a clinician to every service

user is a fairly unique approach, but it is one that was built into the

centre’s methodology from its inception in 2011. Phoenix was created as

an alternative to residential services. It allows people to keep living their

normal lives as parents or workers in full time jobs while they receive

intensive treatment.

“This was the direction from the beginning because of the huge amount

of local and international research around the value of peer support and

how it helps with connection and engagement,” Supriya says.

Supriya Maharaj


“Emerge Aotearoa is so committed to the development of peer services that

it has been noted as a strategic objective in our business development plan.”

The centre has an open policy in terms of communication and service user

feedback, which, she says tends to articulate the value of peer support

specialists. Frequent reviews using treatment outcome tools like ADOM

are undertaken and treatment plans are reviewed every six months.

“All this confirms for us that the value of the clinician/peer specialist

partnership is undeniable. It definitely improves outcomes.”

Peer support specialists at the centre must have lived experience with

addiction and all have had peer employment training. Almost all have

completed advanced training and some have completed Mind and Body

Level 4 qualifications.

As a manager, Supriya says the peer support specialists really help keep

things real.

“Peer support specialists give context of recovery and remind us that

everything is a part of the service user’s journey. That means when we

discuss how best to work with people, it is very much strengths-based

and all about hope and possibility.”

Peer support specialist helps young people re-connect

Tanya Phillips is the clinical team

leader at Mirror HQ in Dunedin.

She has overall management

of a multidisciplinary team

that includes one peer support

specialist. The team has been in

place for three-and-a-half years.

Mirror HQ works with young

people aged 12-22 who are

experiencing CEP are often

vulnerable and at an age where

dangers from risk taking and experimentation are very real. The role of

the peer support specialist is to use her lived experience with addiction

to get beside the young people and support them wherever they identify

they have needs.

This can include a variety of activities. She can support the young people

into accessing work or accommodation. She may take them to WINZ

or to see the doctor. She might take them for walks or other forms of

exercise. Basically, Tanya says, the peer support specialist will work

with whatever the young person identifies as helpful, which can also

be formulated with their clinician.

The peer specialist might also strengthen the young person’s connection

or reconnection to other’s in their own communities more directly than

possibly a clinician can or has time for.

Tanya also says the peer specialist worker brings a broader perspective

to interactions with the young people, offering alternative and often

valuable viewpoints, simply because her lens is not clinical.

“Her lived experience with addiction and her non-clinical approach can be

incredibly useful therapeutically because she can develop relationships

that are less formal which can offer more invitations into ‘ordinary

conversations’ than might take place with a clinician.

“The role adds immense value to Mirror HQ. She is active right across our

service delivery, from participating in reviews and meetings to working

directly with young people and our community, to presenting in-service

educations sessions. The unique relationships she can have with the

young people bring a diversity of experience to the holistic wellbeing

approach we’re trying to create.”

But a challenge for the peer support specialist is a general lack of a specific

youth and specific CEP peer support network in the community. This

means supervision is often difficult to get locally. This, and the general

lack of direct and regular contact with her own peer support community,

can be somewhat isolating.

So, Tanya says team members work really hard to ensure there are

pathways for her to get clinical support through the team when she needs

it. The peer support specialist has also recently completed training with

Intentional Peer Support, which helps identify ways of building mutual

support, and says she has found this really helpful.

“What she’s learned there really lines up with her values, the values of

our service and the way we want to relate to young people and their

whānau,” Tanya says.

Tanya Phillips


Samuel Andrews and Gilbert Taurua from the NZ Drug Foundation had the opportunity to travel to Montreal to attend the 2017 Harm Reduction conference in the last month.

The conference puts the voice of people who use drugs at the centre of all

presentations and proceedings and really re-defines what ‘nothing about

us, without us’ looks like in practice. The strong peer community of people

who use drugs is a bit different to what we refer to back home. Over here

‘peers’ generally refers to people who have used drugs in the past and now

are in recovery. With the International Network of People Who Use Drugs

(INPUD) the members are actively using and bring a more urgent perspective

on the need for overdose prevention and comprehensive harm reduction.

The conference was opened in part by Jane Philpott the Canadian Minister

of Health. Any country would be privileged to have such a strong advocate

and ally for harm reduction. It is estimated that 2,300 people died of

overdose in Canada last year. She spoke from her heart and was able

to list the action she had taken to support harm reduction including

getting naloxone rescheduled, the roll-out of overdose prevention kits,

championing law change to allow supervised consumption rooms and

contributing to the decision to legalise the sale of cannabis.

The overdose crisis in North America from fentanyl was clear. Many

spoke about the wide scale contamination of not just heroin and opioids

but the whole illicit drug supply. Fentanyl and its analogues are highly

potent, few specs are a strong dose, and is causing hundreds of accidental

overdoses. It was a clear warning bell of something we might see in

New Zealand and how crucial it is to be get better access to naloxone.

The best aspect of this conference was everyone coming together

to reshape and extend harm reduction. The 1000 delegates from 70

countries represent an international evidence base of a full range of harm

reduction interventions, implemented in various regions and countries.

A consistent theme of presentations was the ability of harm reduction

tools and services to provide a really meaningful relationship between

people using services and those providing them. Treating people with

respect and giving them live saving equipment and information was

repeatedly shown to result in meaningful engagements. In New Zealand,

this could look like GP’s passing on harm reduction advice and patients

then feeling more comfortable to talk about more difficult topics or

potentially emerging struggles around their substance use.

The essential harm reduction services that are currently lacking in New

Zealand was also apparent, having been a forerunner in the 80’s we have

sadly lagged behind. Some services that would be amazing to have are:

supervised consumption rooms, legally endorsed drug checking services,

outreach by needle and syringe exchange to people injecting steroids

and amphetamines, greater responses to chem-sex and other practices

in the LGBTQI community, and harm reduction services in prison.

The conference reinforced the inequalities that communities of colour and

indigenous peoples worldwide experience in regard to the war on drugs.

The NZ Drug Foundation is looking to champion the establishment of an

international indigenous drug policy network as result of this conference

and strategic partners have been built as a result of our attendance.

While harm reduction can face (misinformed) political barriers we need

to continually push for greater access to the full range of services and

tools available. Harm reduction needs to be at the centre of responding

to drug harm and is the paradigm that will best see us into a future world

of full drug decriminalisation and legalisation.

Reflection on Harm Reduction International

Canada Conference:

Samuel Andrews in Montreal for the 2017 Harm Reduction Conference


Helping families to find a balance in an unbalanced world

Most Asians living in New Zealand are impacted by immigration either as first-generation migrants or when their forefathers moved from their homelands to New Zealand.

Many Asian migrants dream of having a better and enriched life in New

Zealand and sometimes neglect or deny the impact that immigration

brings to individuals and families. There are some that choose gambling,

alcohol and drugs and other unhealthy ways to cope with the stress of

their circumstances. To assist with the impact of immigration on Asian

communities, Asian Family Services has developed the ‘Tree Model’ to

depict the challenges, struggles, grief and loss and growth of individuals

and families.

The ‘Tree Model’, illustrates how a firmly grounded tree can lose its roots

during transplantation and how much it takes to adjust to the different

climate of a new ground. It is likened to the experience that an Asian

migrant goes through during the immigration process. The roots represent

culture, values, beliefs, identity and family including extended family.

The trunk represents status and self-esteem. The branches represent

language ability and education. The leaves represent achievements,

social network and friends. The fruit represent health.

Working with the clients’ dream of being fruitful and the importance

of health, the Asian Family Services’ team uses the ‘Tree Model’ to help

Asian communities understand their experiences, develop empathy for

themselves and those who are going through a similar process and to

encourage them to grow stronger roots in the new ground to produce

healthy fruit.

Introducing Asian Family Services

Asian Family Services provide professional, comprehensive, nationwide

services including information, education, social work and counselling

support for a range of issues affecting Asian families. These services are

offered in English, Mandarin, Cantonese, Korean, Vietnamese, Thai, Hindi

and Japanese. The team has provided professional treatment and support

for clients with gambling problems since 1998. In response to increasing

demand, the services were extended in 2010 to include a broader range

of issues affecting families in Asian communities.

Asian Family Services, New Zealand, Asian Helpline 0800-To-Be-Happy (0800 862 342)


International Drug Policy Symposium

The Through the maze: Health drug law symposium held at the Beehive 5-6 July has kick started an urgent discussion about the need to shift to drugs law underpinned with health principles. Stephen Blyth provided this report.

When symposium chairperson Alison Mau asked the assembled political

panel whether they thought drug prohibition is working, the crowd

held their breath.

One after another the six MPs all raised their hands to show they didn’t

think so. That’s where the agreement ended. Without further ado, the

debate was on between Hon Peter Dunne, Metiria Turei (Greens), Chris

Bishop (National), David Seymour (ACT), Marama Fox (Māori Party), and

David Clark (Labour). Much heat and a little light was shed.

Holding the 2017 Through the Maze drug policy symposium at the

Beehive was an attempt to bring both the issues and solutions to the

politicians own whare. Our aim was to share the best available evidence

and experience to shift thinking on what makes good drug law. We

were delighted to have over 200 people join us on the two-day journey.

To show what is possible the two opening keynote addresses highlighted

what is happening in Canada and Washington State, USA.

Former Canadian Deputy Prime Minister and Canadian Minister of Health

Anne McLellan was once adamantly opposed to shifting away from the

punitive approach to cannabis. As chair of the Task Force on Cannabis

Regulation and Legalisation in early 2016 she changed her mind after

listening to input from medical experts, addiction specialists, lawyers

and community members.

She shared the goals of the Canadian government in legalising cannabis,

which is due to happen in 2018; reducing access to cannabis by young

people, and eliminating the role of criminal gangs in drug supply. She

outlined the many safeguards that they will implement to minimise any

escalation in health harms caused by cannabis being legally available,

but she was also very candid.

“There will be surprises. We will make mistakes. You can learn from us,

just as we have learned from others,” McLellan said. Fortunately, in a legal

market tweaking regulations is imminently possible.

Just over the border in Washington State, Alison Holcomb talked about

her leadership introducing a legal cannabis regime while working for the

American Civil Liberties Union Washington chapter. She was lead author

of the ballot initiative passed by voters in 2012. This was not only intended

to radically cut convictions for minor drug use offences, but it was based

on expanding the resourcing for treatment, education and prevention.

Talk of social determinants of health was never far from the surface over

the two-day symposium. Khylee Quince, Senior Lecture at AUT and Drug

Foundation board member, spoke about how deeply discrimination

affects Māori in every step of the criminal justice approach to drugs.

Professor Tracey McIntosh, Professor of Indigenous Studies and Co-Head

of Te Wānanga o Waipapa spoke about the long-term impact of prison

A model drug law to 2020 and beyond


on Māori people’s lives: “Māori are often asked to create cultural solutions

to structural problems. It’s time for structural solutions".

The panellists that followed, including Julia Whaipooti, chair of Justspeak

and Kiri Allan, Labour Party candidate from Tairāwhiti, shared powerful

analysis and personal insights into the consequences of New Zealand’s

failing drug law.

On the final afternoon of the symposium, talk turned to practical, public

health innovations from leading practitioner/ researchers from Australia

and the UK. Dr Marianne Jauncey shared the history and impact of the

Uniting Medically Supervised Injecting Facility in Kings Cross. Then

Professor Fiona Measham told us about pill safety testing at UK music

festivals and Associate Professor Nicole Lee, from the National Drug

Research Institute, Curtin University, took us on some walk-through

evidence-based responses to methamphetamine in Australia.

In between these three well-travelled speakers we gained insights from

those leading work on the ground in Aotearoa. Included among these

three local women was Dr Vanessa Caldwell. She reminded everyone that

for too long a fragmented system has created barriers to achieving the

outcomes we need. Her closing remarks serve as a signal that vigilance is

required, even if change is achieved: shifting to a health based approach

isn’t enough, as stigma exists in all systems.

Faced with the impossible task of summing things up, Australian drug

policy researcher Alison Ritter offered a framework to move forward

with. She also suggested the NZ Drug Foundation’s brand-new model

drug law (see sidebar) would be the perfect place for our lawmakers to

start. It was a gratifying way to end two days.

The event exceeded the Drug Foundation’s expectations about firing

up a national conversation. Now is the time to keep the dialogue alive.

Leaving it to those inside Parliament alone won’t lead us where we need

to go. Therefore, we invite anyone with an interest in healthy approaches

to drugs to join in. You could start by reading, commenting on and

sharing our model drug law.

Watch / read more: nzdrug.org/drug-law-symposium

Launch of Whakawātea te Huarahi: a model drug law to 2020 and beyondAt Through the Maze the Drug Foundation released “Whakawātea te

Huarahi: a model drug law to 2020 and beyond”. In the roadmap for

reform we recommend that referrals to health services should replace

criminal convictions for drug possession, cannabis should be strictly

regulated, and government spending on drug education and treatment

should be increased.

We now want to hear what people think about the proposed approach.

Look out for meetings we will be hosting in the coming months. Get

an electronic copy or order a hardcopy from the Drug Foundation:

nzdrug.org/drug-law-2020


Addiction Leadership Day

AUCKLAND 20 JULY 2017

To support existing and emerging leaders and managers, Matua Raki and the National Committee for Addiction Treatment (NCAT) hold three addiction leadership days a year. The most recent took place at the Ellerslie Novotel in Auckland on 20 July 2017.

It was a very full and exciting day with presentations covering future

initiatives, and innovative and creative service delivery and interventions.

It was also a great opportunity for participants to network within the

mental health and addiction sector.

Childhood trauma and its effect upon physical and mental health/

addiction in later in life was a recurring theme. What follows is a brief

summary of some of the speakers’ presentations.

Alcohol and other Drug Treatment Court pilot evaluation

Litmus Ltd co-founder and researcher Liz Smith presented an overview

of an evaluation of the Alcohol and other Drug Treatment Court pilot

(the AODT Court).

Litmus completed one formative and two process evaluations between

in 2013 and 2016 to assess the operation of the AODT Court. Sapere

Research Group completed a cost-effectiveness analysis, and the Ministry

of Justice completed an outcomes evaluation in 2016.

Liz said the Ministry of Justice’s preliminary outcome results are promising

in terms of reduced offending. It shows short-term reoffending has

reduced by 15 percent compared to offenders going through the standard

court process.

She said there is also evidence of reduced alcohol and other drug

consumption in that of the 14,000 plus participant drug tests conducted

by April 2016 only 4 percent had been positive. To graduate from the

AODT Court a participant has to be alcohol and drug free. By April 2016,

there were 79 graduates, increasing to 117 by July 2017.

Stakeholders and participants also commented on positive changes to

participants’ health and sense of wellbeing. These include significant

changes of attitude, improved self-esteem, being more social and able

to regulate emotions.

“ Changes in participants were also recognised by whānau, some of whom said they wanted to start their recovery journey.”

Instances of imprisonment have also reduced. The Ministry of Justice

analysis indicated as many as 60 prison places may have been saved.

While the AODT Court has incurred higher than expected operating

costs, the Ministry believes the 60 saved places represent a cost-saving.

The Ministry will undertake further outcomes and cost-effectiveness

analysis in 2019 after more participants have been through the Court.

“It’s early days,” Liz said, “but the indications so far are fairly positive.”

Lessons and insights

The AODT court was modelled on international best practice and modified

to the uniqueness of Aotearoa. One instance of this has been establishing

the Pou Oranga role and embedding tikanga Māori practices within

the Court. Stakeholders believe tikanga Māori practices are important

Litmus co-founder and researcher Liz Smith


to support the cultural needs of Māori and non-Māori participants in

their recovery.

Liz noted that an inherent tension in a therapeutic court is balancing

treatment, justice and judicial priorities and processes. During the

pilot, the AODT Court team learned how to work effectively together

by negotiating from their differing organisational perspectives. Over

time the AODT Court team have become more confident in managing

the subtleties of the Court such as appreciating that relapses do happen

and knowing how to manage them.

Liz said participants’ experience of the AODT Court have been positive.

Some went in thinking the Court was an easy option to get them out of

jail. For these participants adjusting to the significant demands of the

AODT Court was challenging and some actively resisted the process.

The session closed with an inspiring video of graduates reflecting on

how their lives had been transformed by their experience in the AODT

Court. Liz said even those who didn’t make it to graduation said that they

had learned more about addiction and recovery by being in the Court.

The wonderful unsung heroes in our community

Grandparents Raising Grandchildren Trust (GRG) CEO Kate Bundle gave

an overview of the organisation’s work and spoke specifically about the

impacts of addiction on children and the wider whānau.

GRG supports families where grandparents have had to take over caring

for children because the parents can no longer do it. It seeks to help

these families achieve better lifelong outcomes for the children in their

care and to raise awareness through research and other initiatives. It

represents more than 3700 families across New Zealand who are raising

approximately 12,000 children.

In 2016 GRG initiated research into the social and economic issues

affecting grandparent families, and the role of addiction as a specific

factor has been the subject of further analysis. It has been the largest

study of its type in the world involving around 1100 participants who

were raising 1750 children.

“ If we support the families that are vulnerable now, we believe… we can reduce the likelihood of them re-entering that cycle of abuse.”

In 44 percent of cases drug addiction was cited as the most prevalent reason

for children going into grandparent or whānau care. Methamphetamine

was overwhelmingly cited as the drug most causing issues with synthetic

cannabis and cannabis also cited. Alcohol was the main cause in 25

percent of cases but in 80 percent of those cases other drug use was a

co-morbid factor. Forty-one percent of children were diagnosed with

mental health problems, with an average of 1.63 diagnoses per child.

However, Kate quoted an Australian study (Baldock, 2007) that looked at

20 grandparent families and concluded that a parent who uses alcohol

or other drugs is not necessarily unfit to look after children. However,

the research said alcohol and drug misuse frequently conflicts with a

child’s need for care.

“This really is something we see with drug and alcohol use because of the

confluence of other factors accompanying that choice of lifestyle that

eventually lead to a situation where a child’s life is endangered,” Kate said.

The research also showed those experiencing addiction had an average

of 4.5 co-morbidities compared to 3.2 in the whole group. Parents and

their children where addiction was involved were also found to have

more complex issues and parents had less or more random access to

their children.

“We feel very strongly that the caregivers picking up the pieces for these

children need better support,” Kate said.

“If we support the families that are vulnerable now, we believe from

what we have seen over the years that we can reduce the likelihood of

them re-entering that cycle of abuse.”

Grandparents Raising Grandchildren Trust CEO Kate Bundle


Oranga Tamariki – it’s about all of usTrish Gledhill and Chris Pickering from Oranga Tamariki gave a brief

progress overview for the new Ministry for Vulnerable Children which

came into being in April 2017.

The pair stressed that the work of Oranga Tamariki was about all of us.

“We share the same stories and are worried about the same families

and whānau. It’s about intergenerational trauma, addictions, grief and

loss,” Trish said.

She said the new Ministry rose from the conviction that something had

to change, that things were not working well in care and protection for

children; that children’s voices needed to be heard; and that services

need to be more trauma-informed.

“So, it signals a very different way of doing things. This is a transformation,

not a makeover. It requires a whole of sector approach and includes

prevention as a core focus.”

“ The objective is to get vulnerable children onto a different trajectory before they become part of the system.”

The wellbeing of New Zealand tamariki is valued above all else at

Oranga Tamariki.

“We’re bringing an investment approach to the work. This means intervening

early to address the factors contributing to child vulnerability and the

costs associated with poor outcomes. The objective is to get vulnerable

children onto a different trajectory before they become part of the

system,” Chris said.

Unsurprisingly the Ministry has high aspirations for Māori children

and their whānau who are over-represented in the care, protection and

youth justice system. Work is therefore focusing on developing services

and responses that are culturally appropriate and on building cultural

competence within the organisation.

A trauma-informed professional practice framework that is fitting for

Aotearoa is being put together for social workers. It’s led by a Te Ao Māori

worldview and recognises that trauma is multi-dimensional, historical

over generations and is happening in the system on a day-to-day basis.

Chris said it’s expected that four to five years will be needed for all the

new services, systems and processes to be developed.

“We are moving towards a system that is more focused on prevention,

early identification and intervention to support healing and recovery. In

the past, we’ve been focused on immediate safety and incident-driven

practice that didn’t necessarily take that holistic view in terms of the

broader needs and wellbeing of tamariki and their whānau.”

Trish and Chris gave a quick overview of the Ministry’s structure, including

a new Tamariki Advocate role which will embed the voices of children

and young people into everything it does.

With initial setup of the new Ministry complete, the service design area

of the organisation is now entering stage two, which is looking at the

detailed design of Care Support and Transition support services. Further

stages include implementing Youth Justice and Intensive Intervention

services (2018-2019) and then a Prevention service (2019-2020).

Chris Pickering and Trish Gledhill, Oranga Tamariki


“We have also developed a Blueprint for the Future Vulnerable Children’s

System which illustrates the service design specifications, based on the

aspirations described in the Expert Panel’s 2015 Final Report. We are

currently seeking input from partner agencies at a national level to look

at the implications of the future system for them. The process has been

really energising and people are seeing lots of opportunities,” Chris said.

Adverse childhood experiences: the body keeps the score

Psychologist and mental health

consultant Janet Peters shared

her personal experience of

trauma and addiction, and gave

her observations about what

needs to happen in New Zealand

to foster resilience.

She began by playing excerpts

from the documentary Resilience,

the biology of stress and the

science of hope, which screened recently in Auckland and Wellington.

It follows US research (the ACE study) that looks at the effects of adverse

childhood experiences (ACEs) on mental and physical health later in life.

According to Resilience, significant physical health mental health and

addiction problems are likely in adulthood when a person has an ACE

score of 4 or more. A score of 6 or more means life could be shortened by

20 years. It’s a growing understanding worldwide and many countries

are now looking at ACEs as a major public health issue with implications

for education, criminal justice, social justice and human rights.

“ Addiction is neither a choice nor a disease, but originates in a human being’s desperate attempt to solve the problem of emotional pain and of lost connection.” – Dr Gabor Mate

Janet shared some of her personal story. She quoted addiction specialist

Dr Gabor Mate who said, “Addiction is neither a choice nor a disease, but

originates in a human being’s desperate attempt to solve the problem

of emotional pain and of lost connection".

“And I really do believe that from my own experience,” she said.

She encouraged the audience to read the book The body keeps the score

by Bessel van der Kolk.

“My body has kept the score and I have suffered a number of adverse

health experiences as an adult as a result of childhood trauma.”

So, what does she believe works to build resilience and recovery?

“I think it’s really important that in any service we have empathetic,

compassionate and competent staff who can communicate effectively

with families. And staff have to know they’re valued, because there has

been so much bad press about mental health services in recent years,”

she said.

In particular what helped her was receiving support from family when

she wanted to change; good medication; residential care and therapy;

and good support from social agencies such as ACC, WINZ and the Police.

But she says she can’t stress enough the importance of connectedness

and community.

Janet really hopes we can start a national conversation or social movement

around ACEs in New Zealand. She’d like to see universal screening for

ACEs and that they become part of the Well Child Tamariki Ora approach.

She says there’s no reason why GPs can’t treat ACE scores like any other

vital sign such as height, weight and blood pressure.

But she said we need more avenues for referral if children have high

ACEs such as Whānau Ora, child counselling and services run by schools,

which is starting to happen in the US.

“All services, whether for children or adults, need to be trauma-informed

and addiction services need to be funded on a par with mental health.

In an ideal world, there would be services where you could walk in 24/7

and get help ‘just like that’,” she said.

Janet Peters

Marc Beecroft (NCAT), Fiona Anderson and Suzy Morrison (Matua Raki)


Coming ‘home’ with opiate addictionAddiction psychiatrist and National Association of Opioid Treatment

Providers (NAOTP) Chair Dr Emma Schwarcz spoke about New Zealanders

with opiate addiction being deported back to New Zealand from Australia.

She said the “silent situation” had recently turned from a trickle into a

small flood causing issues for the Auckland Opiate Treatment Service.

New Zealanders in Australia are termed ‘non-citizens’ and subject to the

Migration Act 1958. Under a 2014 amendment to this Act they can now

be deported if they are deemed a behavioural or health concern; or if

they have received a judicial sentence of 12 months or more.

Since the amendment more than 660 people have been sent back to New

Zealand (as of January 2017) and 1500 or so are predicted to be returned

in this manner. Fourteen of those already returned are undergoing

opiate substitution therapy with the Community Alcohol and Drugs

Service in Auckland.

“ The big issue is how to look at recovery in this population when we know recovery is all about being connected.”

One of the biggest issues facing the Auckland Opiate Treatment Service

(AOTS) is the multitude of agencies involved in the deportations. This

includes immigration, customs and border control agencies, detention

centres, Interpol, Ministries of Health and Justice and mental health and

addiction services in prisons and detention centres.

“We’re in the dark a lot of the time,” Emma said.

“There are multiple referral pathways and accompanying documentation

can vary from hundreds of pages to nothing at all. Sometimes there’s

no information as to whether they’ve been dosed while in detention in

Australia so there’s a lot of communication needed back and forth to

sort things out.”

AOTS sends each new person a letter of welcome which explains where

they need to go and what they need to do to have their treatment

organised. Sometimes they are met at the airport.

Emma said the backgrounds of the 14 in treatment are not surprising.

“There’s a lot of childhood trauma, family substance use, family violence,

death, sexual assault, etc. Most have multiple offences and incarcerations.

Almost all are hepatitis C positive and a lot use drugs intravenously and/

or use multiple drugs.

“A theme that has run through today has been disrupted families and

the importance of connections. Five of these people turned up here with

no family whatsoever, others with only distant relatives, so they’re lost

and totally at sea.”

Accommodation can also be a ’messy affair’. It’s organised by Immigration

Australia but it’s short-term and the placings can be miles from anywhere,

sometimes above pubs, with no transport or easy access to pharmacies.

However, she said a couple have seized the opportunity of a fresh start

away from their old contacts.

“The big issue is how to look at recovery in this population when we

know recovery is all about being connected. Hope, identity, meaning

and empowerment – all these things are compromised for a deportee

coming back, so it’s a long road.”

Engaging teenagers and young adults for behaviour changeBen Birks Ang (NZ Drug Foundation & Odyssey House) spoke about a

2016 project that involved a collective of organisations led by the Counties

Manukau AoD Provider Collaborative to investigate how to better engage

with young people around alcohol-related harm.

Ben Birks Ang

NAOTP Chair Emma Schwarcz


They engaged Rescue, a company specialising in social marketing for

behaviour change with international experience.

“We’re good at taking into account an individual’s values and attitudes,

but that’s much harder on a population level – so we usually segment our

population according to things like age and gender in an effort to reach

the greatest number, but that may not be the best approach,” Ben said.

“ A common theme from young people who were interviewed was that people their age can’t have a problem with alcohol because that ‘can’t be an issue for people under 30’.”

Ben shared five main observations arising from the study.

1. Young people are not a homogenous group

Rescue specialises in identifying “peer crowds” who share similar lifestyles

and interests. Many of these are outside the mainstream so Ben said we

need to ensure our messages also reflect what is important to them.

2. Risk factors tend to cluster, and not in the mainstream group

There are a lot of protective factors around being in the mainstream

peer crowd and most health risk factors are found in other groupings.

3. New Zealand has four identified teen peer crowds and five among young adults

Teen peer crowds › Mainstream – more conservative, lowest rates of alcohol harm;

includes a subgroup labelled Chill, the Māori/Pasifika version of mainstream.

› Popular – stylistic and fun-loving, image-conscious, second-highest rate of alcohol harm.

› Hip hop – relaxed while feeling the system is out to get them, highest rate of alcohol harm; includes a subgroup labelled Troublemakers, who are starting to posture into gang behaviour and trouble with the law.

› Alternative – don’t want to be seen as mainstream; commonly higher levels of experiencing mental health issues.

Young adult peer crowds › Mainstream – often have kids and are focused on their family,

lower risk of alcohol harm and also include the Chill subgroup.

Ben said what’s interesting here is that when we target alcohol related harm messages at Māori and Pasifika, essentially, we’re reaching this Chill subgroup who are relatively low risk.

“So, we’re giving them stigma, but failing to reach the Māori and Pasifika young people we want to reach who are sitting in other peer crowds.”

› Partier – lower importance placed on career or families so tend to stay longer in bars; includes University subgroup who share a slightly higher rate of drinking. Second highest rates of alcohol harm.

› Professional – don’t let their alcohol use get in the way of their career; tend to hang out in the same places as Popular/Partier so could be targeted alongside them.

› Hip hop – focused on having overcome challenges, highest rates of alcohol harm; Troublemaker subgroup often now involved with crime.

› Hipster – alternative, see themselves as unique and creative; drink frequently but in smaller amounts.

Note: the descriptors above were used to help the project team identify

the groups. They are not self-attributed labels.

4. Behaviours can be the same but reasons and experiences can be different

Reasons for potential harmful consequences from drinking experienced

can vary. For the Popular or Partier peer crowds, consequences that may

lead to help-seeking include missing class or work. However, among the

Hip hop young adults, the consequences were often more serious, such

as involvement with police or child protection services.

A common theme from young people who were interviewed was that

people their age can’t have a problem with alcohol because that ‘can’t

be an issue for people under 30’.

5. We need a clear, consistent, and relevant pathway for behaviour change

Ben said our current message is that addiction is the biggest problem

from alcohol, and the most widely known call to action is to get support.

But we need to be more consistent, with clear calls to action and a

nationally consistent menu of options for support for when people

recognise they need it.

To reach these groups we need to approach with messages that help them

be who they identify themselves as being. Just saying ‘Avoid this risk of

drinking’ across the board is not engaging with them at the moment.

The full presentation from last year’s project is available on the NZ Drug

Foundation website. A number of co-design projects are currently occurring

to identify how to better engage these peer crowds and improve their

wellbeing. More information about these will be shared on that same

webpage as it becomes available.


Addiction leadership day in action

Edward, (Odyssey), Johnny Dow (Higher Ground), Otto Mengedoht, Higher Ground

Emma Wood (Te Pou o te Whakaaro Nui)

Wolfgang Theuerkauf (Waitemata DHB), Raine Berry (Nelson-Marlborough DHB, NAOTP)Rawiri Pene (Higher Ground)

Lynette Hudson and Mike Douglas (the Salvation Army), Debby Sutton (Odyssey, AOD Provider Collaborative)


Welcome to Tommy BenefieldI have worked in the AOD sector within NGO’s and DHB’s for the last 16 years as a counsellor, a supervisor, an AOD specialist within mental health teams, a clinical director, a general manager, and for the last two weeks, the principal advisor for the Department of Corrections.

I have felt the effects of addiction personally within my family and seen

its devastation within my community growing up. I come to the AOD

sector neither from an altruistic nor an academic perspective, but rather

as a person who cares deeply about the individuals and communities

affected by addiction, and who is still optimistic and energetic enough

to believe he can be of some help.

I live with my wife Nicola, our two

young children Cassidy and Shiloh,

and our dog Charlie Ruffles. Before

devoting myself to parenthood I spent

all my spare time as a recording and

touring musician with several original

songs on radio and TV. My musical

hip-hop side-project released a song,

Parihaka, which was included in a tino

rangtiratanga museum exhibition,

had its lyrics featured in the NZAP

journal and saw me invited to guest lecture at Victoria University. All

four of my albums have charted in the NZ independent music charts.

Tommy Benefield

Workforce innovation award 2017

And the Award goes to…

Thanks to all those who submitted an application for this award which seeks to showcase

innovations that contribute to improving workplace wellbeing and staff engagement. This

initiative is designed to focus national attention on best workforce practices being carried out

in addiction treatment services.

The standard of the applications was very high and the deliberations will be intense. We will be announcing

the winners and showcasing their achievements at the awards dinner at Cutting Edge 2017.

Register at www.cuttingedge.org.nz for the Cutting Edge Conference in Wellington on 7-9

September 2017. The award will be presented at the Cutting Edge dinner on 7 September 2017. Join the celebrations!


Adapted from Language Matters from the National Council for Behavioral Health, Washington DC, USA

Say this … instead of …

Person with an addiction Addict, Junkie, Druggie, Alky, Alcoholic

Person in recovery Ex-addict, Abstinent, Used to be a …, Clean, Sober

Has an addiction/dependence Suffering from an addiction, Battling the booze

Not engaged Non-compliant

Medication is a treatment Medication is just another addiction

Lapsed/relapsed Using again, Fell over, Off the wagon

Positive urine drug screen Dirty urine

Treatment/intervention Rehab

Intoxicated Drunk, Pissed, Stoned, Out of it, Wasted

Distressed, agitated Crazy, Off his/her rocker, Lost it, Acting out

Person disagrees Denial

When discussing addiction …

Language is powerful – especially when talking about addiction

Stigmatising language perpetuates negative stereotypes

“Person-centred” language focuses on who the person is – rather than their disorder

Language matters

Documents

August 2017 News Matua Raki - Addiction …...August 2017 News Passion Commitment Excellence Wellbeing in the workforce Worker wellbeing is receiving increasing attention. Both internationally,