KaiawhinaFlourishing Families Perinatal Kaiawhina - adding different skills to the mix of service options

Over the last year Flourishing Families, a community based Perinatal Mental Health Service in Rotorua, has been contracted to deliver Perinatal Support via a full time Kaiawhina. This role supports tangata whaiora within both Flourishing Families, which has a primary care early intervention focus, and the Perinatal Mental Health Team within the secondary Mental Health Service for Northern Lakes region.

The Perinatal Kaiawhina role is broader and more diverse than the support offered via the existing support services in the Lakes region. It is not mental health support, but fills the gaps that other services often don’t address that are essential for perinatal clients – child care, assistance with housework, and general support focussed on enhancing self-care. There is no specific qualification; key requirements are the person skills – being approachable, respectful, understanding, reliable, flexible, optimistic, creative and enthusiastic. Where input from a mental health support worker is required, referral to existing agencies is still used, but is only accessible via the secondary Mental Health Service with a focus on more severe or complex mental health issues.

Over the last 10 months the Perinatal Kaiawhina has worked with 27 tangata whaiora and their whānau. Support is usually for 2-4 hours per week, based at home or within the community, over a period of 2-3months. The support is closely tied in to the tangata whaiora management plan and is an integral part of this. Goals and tasks are determined by the tangata whaiora in collaboration with the clinician. Clear and regular communication between all parties has been an essential part of the process. The Kaiawhina attends a weekly meeting with the Perinatal Mental Health Team Leader and the Flourishing Families Clinical Leader to review all clients receiving support, and to adapt care plans in response to client need.

I asked the Kaiawhina – Melissa Valenzuela - to reflect on her work to date:

1. What drew you to the role? 

“A passion for children, having my own struggles and challenges as a young mother. I felt the need to reach out to other mothers who were maybe struggling alone, I didn’t want them to feel isolated and alone in their feelings. Helping other mums and their babies within my own personal life gave me so much, I found it so rewarding which gave me the drive to reach out more. I wanted to see mums working together to boost their self-worth, confidence, and to take time out for themselves without the guilt.”

2. What have you learned from the role?

“I have learned so much on so many levels, everything I have done I can use not only with work but also personally too through my interactions with my own family and children. I have learnt that working on and keeping a balance with our mental health applies to everybody, not only someone who has been diagnosed or struggling with depression or a mental illness should take care of themselves. A mental illness in the family can impact everyone, not just the individual, especially on the children, they are very vulnerable in this situation and their wellbeing needs to be kept an eye on too. The circle of Security is amazing and is such a fantastic tool in raising our children and also can be applied in our other relationships too. The first 1000 days in a baby’s life is vital. I have learnt to ‘be with’ emotions a lot more, with my personal relationships and also those whom I work with, validating and reassuring is key.”
3. What things have you done in your role? 

“With tangata whaiora: walking, exercise, cooking and meal prep, massage with mums and babies, cleaning and household chores, putting babies to sleep or allowing mum to sleep while caring for baby, bathing and changing baby, looking after siblings, playing, singing, reading books, having a cuppa, meditation and breathing, helping mum see their child as an individual. In addition, I assist with child care for the weekly Mother Matters group, attend the Flourishing Families open mornings and whānau days – to assist with children so parents can have a break, attend meetings with the wider community, do networking, have weekly supervision, and have ongoing professional development – attending courses, reading, doing on-line activities.  I have also been involved in the ‘Wheke for Pepe’ project where we deliver crochet octopus to our Special Care Baby Unit.”

4. What has been rewarding in the work so far?

“Absolutely everything I have done this far has felt extremely fulfilling and rewarding, knowing I am making a difference in the mothers and families lives, seeing how they flourish throughout their journey through depression and other issues and come out the other side more resilient, stronger, more aware and confident.”

5. What are the challenges?

“Challenges are finishing up with a family when a connection is developed, I enjoy my time with the children and I find it hard at times to say goodbye. Sometimes when there are other issues within the family that can be problematic, I feel a little helpless in what further I can do, sometimes knowing there are boundaries to adhere to and only so much can be done.”

6. What do you see your role brings beyond the usual Mental Health Service intervention?

“I believe this role allows more of the time to connect, form a stronger trusting relationship with mother and baby and see more of what could be helpful, especially working with a clinician and being able to check in with concerns or ideas relating to the individual I am working with. Sometimes I see or observe things in the home that would not really be known if they were to go into a session somewhere else. We look at the individual as a whole, they have physical, spiritual and emotional needs, not just treat them with meds and send them on their merry way. We also have time to look at things holistically if the client wishes to do so.”

7. What difference you think it makes to the whānau you work with?

“I think it makes a huge difference, when mum feels fit, healthy, strong and in tune with her needs and why she is feeling the way she does, knowing she is not alone in her feelings lays the foundations for a clearer mindset and the family unit functions a little better. It develops an awareness for life that they matter, they are important and how they are feeling during such a difficult time will pass with time. I feel Flourishing Families give whānau a safe, comforting confidential place to share and feel at home when they are feeling distressed. It gives them some relief I believe in so many ways, even for the partners or husbands knowing there is someone for their partner to talk to or get extra hands on help if needed.”

Contribution

From a clinical perspective, having the Perinatal Kaiawhina has been a wonderful resource.  It has enabled a practical, holistic, option for whānau, who often lack the practical and emotional support that is essential in the postnatal period. The Kaiawhina is able to offer more time and to build a responsive relationship with tangata whaiora in the time and space that feels more comfortable. Her non-clinical but skilled approach has been welcomed by all, consolidating the messages and gains made from the clinical work. Having the Kaiawhina embedded within the service has been an important aspect of it working well, as has been extensive varied training and ongoing supervision from the Clinical Leader. Tim Gutteridge from the Perinatal Mental Health team has also appreciated having access to the Perinatal Kaiawhina when working with whānau with more complex needs, bringing a practical resource in to enhance parent and child wellbeing and interaction.

Client feedback

Tangata Whaiora complete a session rating for each Kaiawhina visit. Ratings from these are consistently high – average 39.2/40 (SD .8). Further, written feedback provides more insight to the valuable contribution the Kaiawhina makes, as the following sample demonstrates:

“Was nice to have someone look after my baby so I could have some 'me time'”

“They are really helpful to give motivation”

“It's very helpful to have becoz after their support I start to go out and start to do my own work again”

“Very useful! Melissa helped me to view my baby as 'my daughter'”

“It made me realize I had support and I wasn't weird for my feelings”

“There was no judgement.  Only kindness and personal interest”

Summary

Over the last 15 years Lakes DHB has invested in innovative, community based responses to Perinatal Mental Health. The establishment of the Perinatal Kaiawhina embedded within and being an integral part of Perinatal Services has been a logical extension of this. It has highlighted the value of combining clinical services with non-clinical responses, offering a much broader, holistic range of options to tangata whaiora and whānau in locations that are comfortable to them. It is not about replacing clinical staff or services with non-clinical, but working in true partnership to better meet the needs of the whānau we work with, across the continuum. It is refreshing to have input from staff with different perspectives and skill sets, bringing personal and professional qualities to the workplace that enhance and develop the whole team. Hopefully we will see such initiatives being extended into other areas over time as we explore more creative ways to address the increasing demand on mental health services.