1. Cultural Assessment for SuicidePrevention with Mori Dr Nicole CoupeKi Tahu

2. Whakapapa Rangahau Past ResearchMaori Suicide ~80-100 /year Males 15-35 years Hanging 67%Maori Attempted Suicide ~700 / year Females Median age 30 years Overdose 3. RoopuTe Ira Tangata TeamInvestigation Team Simon Hatcher, Nicole Coupe, Mason Durie, ReesTapsell, Hinemoa ElderAdvisory Group (past and present) Maria Baker, Sharon Baillie, Tuwhakairiori Williams, PhyllisTangitu, Materoa Mar, Mel Robson, Ministry ofHealth, Counties Manukau, Northland and Waitemata(DHB reps)Project Team (past and present) Nicole Coupe, Ruth Herd, Karen Wikiriwhi, AliceWalker, Moana Pene-Prokopis, Te Ami Henare-Toka, Mihiteria King, Waiora Pene-HareEvaluation Tania Wolfgramm 4. Huarahi MethodologyRecruitment Counties Manukau, Northland and WaitemataDHBsEligibility >17, not at school and cognitively able toconsent, MaoriRandomisation Treatment as Usual (controls) and Powhiri: Modelof Engagement (intervention) 5. Person Identified Presenting To Emergency Department with an Episode of Deliberate Self Harm Project Staff determine eligibility and ethnicity from psychosocial assessment and discharge summaryEligible Non MaoriINELIGIBLE Eligible MaoriProject staff gathers information requiredUnable To Give Informed Consent or Still At School Collect (Age, Gender, Ethnicity, DSH details)Person randomisedinformation from DHB and NZHISPerson randomisedControl GroupExperimental Group Consent FormControl GroupIntervention GroupConsent Form Rating ScalesRating ScalesPatient SupportTreatment as Usual Problem Solving Therapy Vouchers GP visit Consent Form Consent Form Cultural Assessment Risk Assessment Rating Scales Rating Scales Treatment as Usual Patient support 3 and 12 months post indexpresentation Problem Solving Therapyrating scales telephone interview Vouchers GP visit DHB Records interrogated NZHIS information collected Cultural Assessment Risk Assessment 3 and 12 months post index Postcards 3 and 12 months post index presentation Postcardspresentation 1, 2, 3, 4, 6, 8, 10 & 12 months Rating scales 1, 2, 3, 4, 6, 8, 10 &rating scales post index telephone interview Telephone interview 12 months postpresentation DHB Records interrogated NZHIS information collected DHB Records interrogatedindex presentation NZHIS information collected 6. Tukunga IhoOutcome measuresThe primary outcome is:1. Beck Hopelessness Scale.Secondary outcomes are:1. Repetition self harm (3 months and one year).2. Anxiety and depression (HADS)3. Cultural Identity Profile & Sense of Belonging (SOBI)4. Quality of life measures (EQ-5D; SF36)5. Overall mortality at 3 months, one year, five years and ten years6. Health service use at three months, one year, five years and ten years 7. Powhiri Process of Engagement Taki/WeroConsent KarangaPatient support KarakiaPrayer (coming together) Whaikorero Problem solving therapy Waiata PST homework Koha Reciprocity HongiEnd of Patient support Hakari Food & drink closure PoroporoakiDissemination 8. Taki / Wero(challenge - consent) Consent 9. Karanga (Call Patient support) 10. Karakia (Prayer) 11. Whaikorero(Speech Problem SolvingTherapy) 12. Waiata (Song - Workbook) 13. Koha (Gift) 14. Hongi(coming together) 15. Hakari (Feast) 16. Poroporoaki(Farewell Dissemination) 17. N ReiraSo farTe Ira Tangata has: Recruitment 3 November 2009 N=167, 5 withdraws, 582 Mori presented to ED for self harm, 365 meet inclusion criteria & randomised intervention, 95 consented control group, 72 consented Three month follow ups: 97 of the 166 All Forms (58%) Twelve month follow ups: 116 of the 162 All forms (71%) 18. N ReiraFindings! Significantly decreased hopelessness Significantly increased time before re-presentation 19. Whoatu What you can do!Keep Improving Mori cultural identity through problemsolving therapy that addresses access to te reo Mori Whakapapa Whanau Whenua Marae Those things Mori