A STORY OF BABUSHKA

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IPAC 08
Patients Politics Performance

• A STORY OF BABUSHKA
• AND THE KORU

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• I see no hope for the future of our people if
  they are dependent on the frivolous youth of
  today, for certainly all youth are reckless
  beyond words. When I was a boy, we were taught to
  be discreet and respectful of elders, but the
  present youth are exceedingly unwise and
  impatient of restraint.

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Mo Harte
Dave Ayling
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• I see no hope for the future of our people if
  they are dependent on the frivolous youth of
  today, for certainly all youth are reckless
  beyond words When I was a boy, we were taught to
  be discreet and respectful of elders, but the
  present youth are exceedingly unwise and
  impatient of restraint.

Plus ça change, plus cest la même chose
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(No Transcript)
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• QUALITY RELATIONSHIPS

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Roadmap

• Why Youth Health?
• demographics and morbidity
• what young people say and need
• developmental perspectives
• About YOSS
• Client relationships
• what makes a difference
• YOSS relationships
• internal and external
• Challenges

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Large proportion of the population
19,929 young people aged 10-24 (P. Nth) 27 of
total population 26 aged 10-14 years 35 aged
15-19 years 39 aged 20-24 years 71.4 NZE,
15.4 Maori, 12.5 NZ, 3.7 Pacific Peoples, 7.4
Asian, 1.1 Other
www.stats.govt.nz

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Significant health issues

• Accidents and injuries
• Motor vehicle
• Violence
• Sporting
• Mental health
• Depression and anxiety
• Suicide and suicide attempt
• Lack of connection
• Health risk behaviours
• Alcohol and drug
• Pregnancy
• Sexually transmitted infections
• Long term illness and disability

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Distinct developmental period and needs

• Stages of adolescence
• Early - Coming to terms with body/biological
  changes
• Middle - Establishing self among peers as a
  worthwhile individual
• Late - Vocational/educational issues and
  one-to -one intimate relationships

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A developmental perspective is essential

• Major causes of morbidity and mortality are
  developmentally based
• Many strategies have been adult based and have
  not worked for young people
• Opportunity to make a difference
• There are skills specific to youth health,
  which can be learnt and which will enhance
  healthy outcomes with young people

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Why Youth Health?
Health statistics and demographics Developmental
perspectives
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What young people say

• On the way services are delivered
• On the services they receive

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Barriers
cost embarrassment confidentiality appropriate
and accessible services knowledge cultural
sensitivity accessible information communication w
aiting accessibility

• the cost of doctors visits and prescriptions
• embarrassment, and a concern to avoid making a
  fuss
• lack of, or perceived lack of confidentiality
• lack of appropriate and accessible services for
  mental health and drug and alcohol problems
• lack of knowledge about sexual and reproductive
  health care services
• an absence of Maori, Pacific or Asian staff
  and/or a lack of cultural sensitivity
• a lack of accessible information regarding
  services
• the perception that communication between
  adults and young people is sometimes
  authoritarian, judgmental and patronising
• lengthy waiting times or inability to get an
  appointment
• the physical location and accessibility of
  services, including transport problems
• 
  
  
  
  Youth Health, A
  guide to action, Ministry of Health,2002

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What young people want

• free or affordable
• locally delivered
• confidential
• non-judgmental
• culturally appropriate
• gender appropriate staffing
• comprehensive range of health care services
• staff who can relate to young people
• services available where and when young people
  require them
• Youth Health, A
  guide to action, Ministry of Health,2002

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Services young people want

• sexual and reproductive health services
• counselling
• alcohol and drug services
• general health services
• recreational services

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Why YOSS?
Why Youth Health?
Health statistics and demographics Developmental
perspectives
What young people say about the health
services they receive and what they need
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Roadmap

• Why Youth Health?
• demographics and morbidity
• what young people say and need
• developmental perspectives
• About YOSS
• Client relationships
• what makes a difference
• YOSS relationships
• internal and external
• Challenges

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History of YOSS

• 1994 Manager position funded
• volunteer youth worker (funded 1995)
• Information, support, recreation programmes
• 1997 Counselling service
• 2001 Alcohol or drug youth worker
• 2004 YOSS health service
• 2004 10 year celebration of service
• 2008 Clinical Psychologist
• 2008 2000 registered clients in health service

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Youth One Stop Shop

• Director Trissel
• Youth Worker Colin
• Counsellors Doug, Susan, Lynley
• AOD Youth Worker Suzanne
• Clinical Psychologist Robyn
• Support Worker Camille
• Youth Health Nurses Mo, Rachael
• Youth Health Doctor Dave
• Team leader Edna

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Roadmap

• Why Youth Health?
• demographics and morbidity
• what young people say and need
• developmental perspectives
• About YOSS
• Client relationships
• what makes a difference
• YOSS relationships
• internal and external
• Challenges

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Quality Relationship Perspectives
Professional
Client
Quality Relationships
Management
Site PHO DHB
Team
Governance
Community
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Client Relationships

• Social network
• whanau family friends peers school
• Youth Health Service
• nurse doctor support
• YOSS
• counsellors AOD youth worker youth
  development
• clinical psychologist
• Other health providers
• CAFS SHS General Practice MidCentral
  Health
• External agencies
• CYFS Police YMCA Barnados school work
  WINZ alternative education

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Client Relationships
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(No Transcript)
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Engagement

• To engage a young person, the young person needs
• Power
• Confidentiality
• Participation
• Consent
• Decision making
• Feeling vibe
• culture
• way of working

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How we foster relationships

• Safety
• physical, emotional, cultural, confidentiality
• Trust
• engagement
• motivation to look at change or doing
  things differently
• a long time to make, a short time to break
• reciprocal relationship
• confidentiality
• Working within developmental frameworks
• content and style appropriate
• Triaging health needs and messages
• comprehensive assessment generates comprehensive
  needs
• working plan to address these needs over time
• KISS
• Honesty
• they know they will hear the truth
• confidentiality

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Client Relationships
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What the clients said

• time spent
• honest caring attitudes
• did not feel like a number
• they felt like they belong
• trusted us that we would have relationships
  with other services and access what ever needed
  to be done in safe manner

YOSS focus group 2007
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Roadmap

• Why Youth Health?
• demographics and morbidity
• what young people say and need
• developmental perspectives
• About YOSS
• Client relationships
• what makes a difference
• YOSS relationships
• internal and external
• Challenges

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Quality Relationship Perspectives
Professional
Client
Quality Relationships
Management
Site PHO DHB
Team
Governance
Community
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What we do to foster relationships

• Within Youth Health Service
• team meeting Golden Hour
• process, policy and standards
• interpersonal and interprofessional respect
• constant dialogue and positive critique
• Within YOSS
• team meeting
• case review meeting
• Te Wana Quality programme
• Wider connections
• site visits
• intensive networking

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Roadmap

• Why Youth Health?
• demographics and morbidity
• what young people say and need
• developmental perspectives
• About YOSS
• YOSS relationships
• internal and external
• Client relationships
• what makes a difference
• Challenges

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Challenges

• Patients
• Politics
• Performance

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Challenges

• Patients
• How do we maintain effective relationships when
  we are busy?
• How do we stay fresh and approachable?
• Maintaining effective peer participation
• Honesty are we interested in the best outcomes
  for our clients? How do we manage other agendas?
• Trust a labour intensive activity

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Challenges

• Politics
• Managing conflicting agendas
• Art of caring v managed medicine
• Gaining traction on youth health
• Funding
• Relationship with General Practice
• Team dynamics
• Negative stereotypes
• Ethics

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Challenges

• Performance
• Few indicators with youth health validity
• Perhaps team culture/climate
• How to live with current contractual and
  financial performance measures
• Measuring integrative processes with reductionist
  indicators
• Client and community valid indicators

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The koru, which is often used in Maori art as a
symbol of creation, is based on the shape of an
unfurling fern frond. Its circular shape conveys
the idea of perpetual movement, and its inward
coil suggests a return to the point of origin.
The koru therefore symbolises the way in which
life both changes and stays the same.
Te Ara The Encyclopedia of New Zealand
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Copies of presentation available from yoss.org.nz