Abstract
BackgroundThe Auckland Regional Forensic Psychiatry Services (ARFPS) in New Zealand has introduced structured clinical judgment instruments developed in Ireland (DUNDRUM-3 and DUNDRUM-4) to assist staff decision-making regarding service users’ clinical pathways. In New Zealand, Māori (the indigenous people) constitute 43% of the in-patient forensic mental health population. The aim of this study was to determine the face validity of the measures for Māori.MethodsParticipatory Action Research was aligned with a kaupapa Māori (Māori-orientated) research approach, to give full recognition to Māori cultural values. Two hui (gatherings) were held with Māori clinical and cultural experts at the service. The first hui (n = 12), explored the cultural appropriateness of the measures. The second (n = 10) involved a reflection on appropriate adaptions to the measures. Discussions were digitally recorded, transcribed and thematically analysed.ResultsAlthough the usefulness of the measures in enhancing the overall quality of clinical decision-making was confirmed, the DUNDRUM measures were considered to be limited in their ability to fully measure Māori service user progress and recovery. Suggestions were made to develop an additional ‘pillar’ focused on cultural identity and spirituality for DUNDRUM-3; to use both service user and family ratings for the adapted DUNDRUM-3 and DUNDRUM-4 measures; and to involve cultural expertise at the point of structured clinical judgement when using the measures.ConclusionsThis is the first study to consider the face validity of the DUNDRUM-3 and DUNDRUM-4 for indigenous peoples, who are internationally over-represented in forensic mental health services. Suggested changes would require a negotiated, collaborative process between Māori cultural expertise and the original authors of the measures.
Highlights
The Auckland Regional Forensic Psychiatry Services (ARFPS) in New Zealand has introduced structured clinical judgment instruments developed in Ireland (DUNDRUM-3 and DUNDRUM-4) to assist staff decision-making regarding service users’ clinical pathways
Kaupapa Māori Research (KMR) stems from a Māori worldview giving full recognition to Māori cultural values and systems, and is carried out according to Māori cultural ethics [15], whereby the issue of research interest are identified by Māori and the outcome of the research considered of benefit to Māori
The results from the first hui were drawn from the three areas of discussion posed: (1) the strengths and usefulness of the DUNDRUM-3 and DUNDRUM-4 for tāngata whai i te ora, (2) the limitations of the DUNDRUM measures for tāngata whai i te ora, and (3) recommendations for the adaption of the DUNDRUM measures to be more suitable for tāngata whai i te ora
Summary
The Auckland Regional Forensic Psychiatry Services (ARFPS) in New Zealand has introduced structured clinical judgment instruments developed in Ireland (DUNDRUM-3 and DUNDRUM-4) to assist staff decision-making regarding service users’ clinical pathways. Within the refined recovery pathways, progress is determined by attaining key recovery ‘milestones’, which signal success of therapeutic engagement at one level of security to the extent that the service user has demonstrated the ability to manage risks at a reduced level. Entry to the pathway at milestone one is determined by a comprehensive holistic needs assessment and decision-making by a multi-disciplinary panel, independent of the daily management of the service user [2]. The needs identified are used to develop the service user’s holistic care and treatment plan This plan is aimed at reducing risk and facilitating the recovery journey necessary for eventual discharge and transition to prosocial life in the community [4]. As each milestone is achieved the level of security is reduced [5]
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