The design and relevance of a computerized gamified depression therapy program for indigenous māori adolescents

BACKGROUND

Depression is a major health issue among Māori indigenous adolescents, yet there has been little investigation into the relevance or effectiveness of psychological treatments for them. Further, consumer views are critical for engagement and adherence to therapy. However, there is little research regarding indigenous communities' opinions about psychological interventions for depression.

OBJECTIVE

The objective of this study was to conduct semistructured interviews with Māori (indigenous New Zealand) young people (taitamariki) and their families to find out their opinions of a prototype computerized cognitive behavioral therapy (cCBT) program called Smart, Positive, Active, Realistic, X-factor thoughts (SPARX), a free online computer game intended to help young persons with mild to moderate depression, feeling down, stress or anxiety. The program will teach them how to resolve their issues on their own using Cognitive Behavioural Therapy as psychotherapeutic approach.

METHODS

There were seven focus groups on the subject of the design and cultural relevance of SPARX that were held, with a total of 26 participants (19 taitamarki, 7 parents/caregivers, all Māori). There were five of the groups that were with whānau (family groups) (n=14), one group was with Māori teenage mothers (n=4), and one group was with taitamariki (n=8). The general inductive approach was used to analyze focus group data.

RESULTS

SPARX computerized therapy has good face validity and is seen as potentially effective and appealing for Māori people. Cultural relevance was viewed as being important for the engagement of Māori young people with SPARX. Whānau are important for young peoples' well-being. Participants generated ideas for improving SPARX for Māori and for the inclusion of whānau in its delivery.

CONCLUSIONS

SPARX computerized therapy had good face validity for indigenous young people and families. In general, Māori participants were positive about the SPARX prototype and considered it both appealing and applicable to them. The results of this study were used to refine SPARX prior to it being delivered to taitamariki and non-Māori young people.

TRIAL REGISTRATION

The New Zealand Northern Y Regional Ethics Committee; http://ethics.health.govt.nz/home; NTY/09/003; (Archived by WebCite at http://www.webcitation/6VYgHXKaR).

Measuring outcome in child and adolescent mental health services: consumers' views of measures

BACKGROUND

Outcome measurement in child and adolescent mental health services in New Zealand became mandatory in 2005 and little is known about how this is perceived by service users.

AIMS

This study aimed to ascertain what service users think about routine outcome measurement in child and adolescent mental health services.

METHOD

Nine semi-structured focus groups of child and adolescent service users (n=34) and family members (n=21) were held in different sites in New Zealand to determine their views on outcome measures.

RESULTS

Consumers supported outcome assessment with some provisos that have important implications for clinical services: the method of collecting information is critical to acceptance; assessment should be done in the context of an established relationship with the clinician; care is needed over the timing and context of assessment, access to information and feedback of results; and measures should be brief and holistic and their limitations recognised.

CONCLUSION

Service users support outcome measures but their implementation requires care and consultation.

Offending behaviours of child and adolescent firesetters over a 10-year follow-up

BACKGROUND

To assess the postintervention arson recidivism and other offending rates of a group of 182 firesetting children and adolescents referred to the New Zealand Fire Awareness and Intervention Program (FAIP) over a follow-up period of 10 years. To investigate predictors of offending behaviour as well as variables associated with previous involvement in firesetting behaviour and offending severity.

METHOD

Data collected at the time of the FAIP intervention was provided by the New Zealand Fire Service and the offence histories of the sample were accessed from the New Zealand Police database (NIA). Data were analyzed using both descriptive and inferential statistics.

RESULTS

Although the arson recidivism rate was low (2%), rates of general offending were high, with 59% of the sample having committed an offence during the follow-up period. Fifteen percent of the sample was classified as severe offenders, 40% as moderate and 4% as minor. Of offenders, 12.6% had been imprisoned during the follow-up period. Offending was predicted by experience of abuse and a previous firesetting behaviour at the time of the FAIP intervention. Living with both parents at the time of intervention decreased the probability of an individual engaging in future offending behaviour. The presence of family stress and a diagnosis of Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) were associated with previous firesetting behaviour. In addition, involvement with family violence (as a perpetrator, complainant or victim) was associated with more severe offending behaviour.

CONCLUSIONS

In light of existing research, the findings of this study indicate that many firesetters are at risk for future offending and that identification of high-risk individuals is therefore an important consideration for any organization involved with firesetters. To minimize this risk, there is a need for a collaborative, multiagency approach to firesetting behaviour involving comprehensive risk assessment and appropriate referral for at-risk individuals.

Sexually abusive youth: a review of recidivism studies and methodological issues for future research

This paper is a critical review of the recidivism studies on sexually abusive youth. Recidivism studies looking at sexually abusive youth have only appeared in the literature in the last 10 to 15 years and the small number of published studies, along with difficulties in defining recidivism, have affected the quality of outcome data. The most consistent criteria for recidivism applied in the literature uses official records to determine subsequent arrests and/or convictions for sexual and/or non-sexual offences. However, official records are conservative and so will underestimate recidivism rates. Recidivism rates for sexually abusive youth who have received treatment for sexual re-offending are approximately 10%, though rates vary greatly (0% to 42%), while recidivism rates for non-sexual offending are higher (ranging between 8% and 52%). Research indicates that comparison groups of untreated sexually abusive youth have higher rates of sexual and non-sexual re-offending than those who have received treatment. Specific recommendations are made for strengthening research design in future studies. These include using multiple sources to determine recidivism (e.g. official records, self-report, family report and standardised psychological tools), having comparison groups of treatment dropouts and untreated sexually abusive youth and including long-term, longitudinal follow-up of youth.

The New Zealand drug harms ranking study: A multi-criteria decision analysis

AIMS

The harms arising from psychoactive drug use are complex, and harm reduction strategies should be informed by a detailed understanding of the extent and nature of that harm. Drug harm is also context specific, and so any comprehensive assessment of drug harm should be relevant to the characteristics of the population in question. This study aimed to evaluate and rank drug harms within Aotearoa New Zealand using a multi-criteria decision analysis (MCDA) framework, and to separately consider harm within the total population, and among youth.

METHODS

Two facilitated workshops involved the separate ranking of harm for the total population, and then for youth aged 12-17, by two expert panels. In the total population workshop, 23 drugs were scored against 17 harm criteria, and those criteria were then evaluated using a swing weighting process. Scoring and weighting were subsequently updated during the youth-specific workshop. All results were recorded and analysed using specialised MCDA software.

RESULTS

When considering overall harm, the MCDA modelling results indicated that alcohol, methamphetamine and synthetic cannabinoids were the most harmful to both the overall population and the youth, followed by tobacco in the total population. Alcohol remained the most harmful drug for the total population when separately considering harm to those who use it, and harm to others.

CONCLUSIONS

The results provide detailed and context-specific insight into the harm associated with psychoactive drugs use within Aotearoa New Zealand. The findings also demonstrate the value of separately considering harm for different countries, and for different population subgroups.

Indigenous Adolescents' Perception of an eMental Health Program (SPARX): Exploratory Qualitative Assessment

Background

Depression is a major health issue for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (Māori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioral therapy. SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a computerized intervention developed in New Zealand to treat mild-to-moderate depression in young people. Users are engaged in a virtual 3D environment where they must complete missions to progress to the next level. In each level there are challenges and puzzles to completeIt was designed to appeal to all young people in New Zealand and incorporates several images and concepts that are specifically Māori.

Objective

The aim was to conduct an exploratory qualitative study of Māori adolescents’ opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions were gathered to inform the design of a computerized cognitive behavior therapy program.

Methods

Taitamariki were interviewed using a semistructured interview once they had completed work with the SPARX resource. Six participants agreed to complete the interview; the interviews ranged from 10 to 30 minutes.

Results

Taitamariki participating in the interviews found SPARX to be helpful. The Māori designs from the SPARX game were appropriate and useful, and the ability to customize the SPARX characters with Māori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall, using SPARX led to improved mood and increased levels of hope for the participants. In some instances, SPARX was used by wider whānau (Māori word for family) members with reported beneficial effect.

Conclusions

Overall, this small group of Māori adolescents reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of these young people.

Effects of GABAA and GABAB receptor agonists on reticular-elicited hippocampal rhythmical slow activity

Hippocampal rhythmical slow activity (RSA) can be elicited by stimulation of the midbrain reticular formation. All classes of anxiolytic drug so far tested reduce the frequency of this RSA. Anxiolytic barbiturates and benzodiazepines, as opposed to compounds such as buspirone, are thought to act as receptor agonists of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). In the present study muscimol (a GABAA receptor agonist) and baclofen (a GABAB receptor agonist) were injected into freely moving rats. Baclofen produced a dose-related decrease in frequency of RSA in the range 1 to 9 mg/kg i.p. and abolished RSA at 27 mg/kg. Muscimol produced an increase in RSA frequency with an inverted U-shaped dose response curve in the range 0.0001 to 1.0 mg/kg with maximal effect at 0.001 mg/kg. The effects of classical anxiolytic drugs in the present test resemble those of the GABAB receptor agonist baclofen more than they resemble those of the GABAA receptor agonist muscimol but it is possible that they are acting via GABA systems which employ low rather than high affinity GABAA receptors or through some transmitter system other than GABA.

Resiliency in the victim-offender cycle in male sexual abuse

The prevalence of childhood sexual abuse in child molesters is considerably higher than that in the general population. This finding had led to the "victim-offender cycle" being popularized as an explanation for sexual offending. However, not all child molesters were victimized as children, so it is of interest to examine the factors that contribute to the victim-offender cycle or, conversely, resiliency. This study examined the "moderating factors" that may prevent a male victim of sexual abuse from entering the victim-offender cycle. Two groups were interviewed as part of the study: a "resilient group" (n = 47) and a victim-offender group (n = 41). After correction for age and education level, the resilient group were less likely to have fantasized and masturbated about the abuse, less likely to report deriving pleasure from the abuse, more likely to have had frequent social contact with adolescent peers and to have had more family and nonfamily support during childhood. The findings support the need for multifactorial models of resiliency, the victim-offender cycle, and sexual offending. Recommendations about the prevention of the victim-offender cycle are made, including the need for a thorough systemic assessment of all male victims of sexual abuse and the involvement of their family system in counseling.

"If he had 40 cents he'd buy matches instead of lollies": motivational factors in a sample of New Zealand adolescent firesetters

Motivation has been proposed as an important factor in both the causality and subsequent treatment of juveniles who deliberately light fires. Thus, a wide range of research has previously been completed, investigating such motives. This research has resulted in the creation of classifications of firesetting motives and behaviours, all of which fit upon a continuum of motivational categories-ranging from curiosity or match play, through to deliberate delinquent acts. This current study aimed to gain insight into how both firesetters and their caregivers perceived firesetting motivation. A total of 18 male youths, who had engaged in deliberate firesetting, and 13 parents were interviewed. Qualitative analysis gathered from interviews with adolescent participants reported personality and individual characteristic themes, the most frequent of these being anger, experimenting, peer pressure, and boredom. Parents on the other hand initially cited family historical factors as being a cause for their son's firesetting. This study showed the difficulties in attempting to classify firesetters. It became clear that there were often multiple motivations involved in adolescent firesetting, meanwhile a variation of motivations were reported by parents and firesetters. The differences between and ambiguities inherent in existing motivational typologies also became evident. The study produced strong evidence for the effectiveness of utilising multiple sources to gain a comprehensive understanding as to why children deliberately light fires.

Resiliency in the victim-offender cycle in male sexual abuse

The prevalence of childhood sexual abuse in child molesters is considerably higher than that in the general population. This finding had led to the "victim-offender cycle" being popularized as an explanation for sexual offending. However, not all child molesters were victimized as children, so it is of interest to examine the factors that contribute to the victim-offender cycle or, conversely, resiliency. This study examined the "moderating factors" that may prevent a male victim of sexual abuse from entering the victim-offender cycle. Two groups were interviewed as part of the study: a "resilient group" (n = 47) and a victim-offender group (n = 41). After correction for age and education level, the resilient group were less likely to have fantasized and masturbated about the abuse, less likely to report deriving pleasure from the abuse, more likely to have had frequent social contact with adolescent peers and to have had more family and nonfamily support during childhood. The findings support the need for multifactorial models of resiliency, the victim-offender cycle, and sexual offending. Recommendations about the prevention of the victim-offender cycle are made, including the need for a thorough systemic assessment of all male victims of sexual abuse and the involvement of their family system in counseling.

Community reintegration of sex offenders of children in new zealand

Reintegration of offenders following incarceration is most successful if matched to the needs of offenders, victims, and the community. This study explored child sex offenders' expectations for and experiences of reintegration into the community. A longitudinal design was used in which semistructured interviews covered issues identified in the literature as being related to reintegration. Nine offenders were interviewed within 1 week prior to release, 3 months post release, and 6 months post release. Interviews were analysed using thematic analyses producing six key themes. The interviews revealed that most of the participants feared their release from prison into the community and once released struggled to live in society. Overall, reintegration planning was simplistic and aimed primarily to manage risk factors rather than promote reintegration. Those participants who reported most satisfaction with their adjustment following release had more comprehensive reintegration plans, which enabled them to visualise what life would be like after release.

A Comparison of Pacific, Māori, and European Violent Youth Offenders in New Zealand

Pacific Island and Māori youth are disproportionately overrepresented in Aotearoa/New Zealand in violent offending. To date, research has not examined Pacific Island violent youth offenders in comparison with other ethnic populations. This study compared Pacific Island violent youth offenders with Māori and European violent youth offenders to determine whether similarities or differences existed in their offending, social, and demographic characteristics. Findings showed that Pacific Island violent youth offenders, in comparison with Māori and European violent youth offenders, were more likely to have grown up in the lowest socioeconomic deprivation areas in New Zealand, were more likely to be older when they first started offending, and their first offence was more likely to be of a serious, violent nature. Family violence was present among all three ethnic groups highlighting the ongoing importance of intervention in this area. The findings of the current study are likely to have implications for government department policy makers, along with program providers and practitioners. Recommendations are made regarding clinical implications and future research on this population.

New Zealand youth that sexually offend: improving outcomes for Māori rangatahi and their whānau

Māori youth are overrepresented in criminal justice statistics and youth forensic services. Māori youth that engage in sexual offending behaviors have a higher risk of dropping out of treatment than Pākehā(1) youth. Research into Māori mental health is important to inform ongoing service development and is essential to strive for equity in mental health outcomes and offending rates among Māori. In this study, the researchers investigated the coexisting emotional and behavioral problems and victimization histories of an age-matched sample of Māori (n = 75) and Pākehā (n = 75) youth who were referred to a community treatment program for sexual offending in Auckland between 1996 and 2008. The Child Behavior Checklist was used to investigate ethnic differences. After controlling for socioeconomic deprivation, Māori youth scored significantly higher than Pākehā youth on the Delinquent Behaviors syndrome scale. Māori youth were also more likely than Pākehā youth to have a background of physical abuse. Implications of these findings are discussed, with regard to the unique needs of Māori youth and appropriate interventions.

Workforce Factors for Psychologists in CAMHS in New Zealand

BACKGROUND

  Recruitment and retention of psychologists for Child and Adolescent Mental Health Services (CAMHS) is difficult worldwide. This study: 1) identified factors that promote or hinder recruitment and retention of CAMHS psychologists; 2) explored training and its impact on CAMHS as a career choice; and 3) identified strategies to improve recruitment and retention of CAMHS psychologists in New Zealand.

METHOD

  Surveys were undertaken with four New Zealand groups: 1) all registered psychologists; 2) final-year professional psychology interns; 3) directors for professional psychology training programmes; and 4) psychology professional leaders in the public health system.

RESULT

  Psychologists with more pre-qualification training in CAMHS were more likely to work in CAMHS. Other psychologists reported they would have more likely worked in CAMHS if they had received more pre-qualification training. Factors that promote or hinder training, recruitment and retention are discussed.

CONCLUSIONS

  A range of practical strategies for improving recruitment and retention of psychologists to CAMHS were identified, including particular strategies for psychologists from minority cultures (particularly, Maori and Pacific Island psychologists). While undertaken in New Zealand, many of these findings are relevant internationally.

"Inflaming your neighbors": copycat firesetting in adolescents

The objective of this article is to consider and discuss existing research and theory concerning copycat problem behaviors and copycat offending and how this may be applicable to populations of firesetting children and adolescents. The primary databases used to search for literature were PsychInfo, Medline, and Eric. Google Scholar was used as an additional Internet search engine. While the primary focus was on literature published since 1990, earlier literature considered to be important was also included. Qualitative and quantitative studies suggest that consumption of violent media affects aggressive behaviors and supports the existence of a copycat effect within some offending populations. Existing literature suggests that processes such as desensitization, observational learning, priming, and alteration of scripts are involved in copycat behaviors and are mediated by individual, environmental, and media factors. While literature concerning firesetters has largely overlooked the possibility of a copycat effect, given their young age, and the often antisocial nature and individual and environmental problems associated with firesetters, they may be a population particularly vulnerable to such an effect. There is a need for consideration of the potential role of the media in copycat behaviors and for care to be taken in the way that the media reports events.

Characteristics of Female Youth Offenders in New Zealand

Female youth offending is poorly understood, despite increased rates of such offending. Research indicates there are a range of factors that have a causal impact on the development of offending in young people. This study investigated risk factors using a retrospective file audit of 184 female youth offenders in New Zealand. The findings were classified using Bronfenbrenner's ecological model, which highlights the different contextual levels that influence behavior, including individual, family, peer, school, community, and cultural factors. The results indicate that there are significant risk factors for female youth offenders. There were high rates of mental health difficulties, drug use, histories of maltreatment, family stressors, peer issues, and school behavior problems in the cohort. There was very little difference between violent and nonviolent offenders. All the young women had risk factors affecting them at many levels. Targeted, multisystemic intervention and prevention programs are therefore needed to address female youth offending.

The Views of the Public on Youth Offenders and the New Zealand Criminal Justice System

Public perceptions of crime and punishment have taken on increasing importance as countries grapple with how to address youth violence. The current study aimed to compare the views of those who have had personal experience of victimisation from youth offenders and those who have not, on what could be improved in managing youth offending in New Zealand. A qualitative methodology was used with data from open-ended survey responses from a nationally representative sample. Public sentiments favoured addressing systemic issues and providing rehabilitation as main emphases followed by more punitive measures, prevention, and restorative justice. Victims were over-represented on sentiments of prevention whereas non-victims were over-represented in support for more punitive measures and restorative justice. There was also considerable support for a multi-facetted approach that utilised a number of the approaches above, suggesting that the solution is as complex as the offender's circumstances. These findings are very much in line with the current goals of the youth justice system with its emphasis on diversion and rehabilitation.

Screening for mental health needs of New Zealand youth in secure care facilities using the MAYSI-2

BACKGROUND

Young people admitted to secure facilities generally have particularly high rates of mental, emotional and behavioural problems, but little is known about the mental health needs of this group in New Zealand.

AIMS

To describe prevalence of probable mental health disorder and related needs among young people in secure facilities in New Zealand.

METHODS

Massachusetts youth screening instrument - second version (MAYSI-2) data were obtained from the records of young people admitted to one secure care facility (n = 204) within a 12 month period. We used descriptive statistics to determine prevalence of problems overall and multivariate analysis of variance to compare MAYSI-2 scores between gender and ethnic groups.

RESULTS

Nearly 80% of these young people scored above the 'caution' or 'warning' cut-off on the MAYSI-2, a substantially higher proportion than reported in studies in other countries. There was a tendency for girls and for Maori and Pacific Islander subgroups to have a higher rate of probable psychopathology.

CONCLUSIONS

Young people in secure facilities in New Zealand have substantial service needs. Early intervention that engages them in services upon first contact with the youth justice system might help reduce this burden. Further validation of the MAYSI-2 in New Zealand may be warranted because of the unique ethnic make-up of these young offenders. Copyright © 2017 John Wiley & Sons, Ltd.

Young people and caregivers' perceptions of an intervention program for children who deliberately light fires

A significant number of children and adolescents engage in deliberate fire setting, beyond the scope of curiosity and experimentation. Interventions developed to respond to the needs of such fire setters generally involve educational and/or psychosocial approaches. Research evaluating the effectiveness of these interventions is dominated by outcome studies which rely on recidivism rates determined by either official records or parent reports. There has however, been no process evaluation studies published. This study presents a process analysis which aimed to identify the strengths and weaknesses of a Fire Awareness and Intervention Program in New Zealand, from the perspectives of program consumers. Qualitative research methods were employed, with data being derived from in-depth interviews with young people and their parents/caregivers. The analysis indicated that (a) the FAIP was generally regarded as a positive experience, (b) practitioners' qualities of empathy and understanding are important for developing rapport with the young people and their parents, (c) education-based intervention tailored to the young person's age and developmental level is important, (d) educational resources need to be updated and used flexibly to respond appropriately to the age and developmental level of the young person, and (e) inter-agency and intra-agency relationships need to be developed and maintained, with formal arrangements for reciprocal referral systems developed in order to respond to the needs of the clients. The resulting implications for service providers, along with future research are discussed.

Young female offenders and the New Zealand Youth Justice System: the need for a gender-specific response

Young female offenders comprise approximately one fifth of the New Zealand youth offender population; however, they remain an understudied population of offenders. This paper aims to provide a current overview of the key characteristics of this population and recommendations for how the youth justice system could better cater to this population. These recommendations include more training of professionals (specifically judges, youth advocates and justice coordinators) and practitioners (specifically social workers, psychologists and youth workers) in the youth-justice system in matters specific to young female offenders. A gender-responsive and trauma-informed approach to addressing offending behaviour is also necessary. There is a need for new empirical research in the New Zealand context on young female offenders and the best way to address offending by this group. Finally, a focus on the diversity of young female offenders is a priority, given the over-representation of indigenous and ethnic-minority communities in justice jurisdictions worldwide.

"I Couldn't Do It to a Kid Knowing What It Did to Me": The Narratives of Male Sexual Abuse Victims' Resiliency to Sexually Offending

Research has shown that child sexual abuse victims are overrepresented among sexual abuse offenders, leading to the sexually abused-sexual abuser hypothesis. However, a large proportion of child sexual abuse victims do not go on to sexually offend, and such individuals are labeled as resilient victims. Surprisingly few studies have looked at why some male victims of sexual abuse do not go on to offend. In-depth qualitative interviews were conducted with 47 resilient men focusing on their beliefs as to why they had not gone on to sexually abuse others. Results revealed four themes for why the victims did not offend: empathy, morals, lack of sexual desire, or a combination of the previous three. In regard to the process of developing their resiliency, some participants claimed they made a conscious decision, whereas others reported the decision was an unconscious one. The various factors that were reported as contributing to the conscious or unconscious decision (becoming aware of sexual abuse, admitting the experience had happened to them, empathy, social support, and lack of sexual desire to abuse) are discussed, along with the four themes, and the implication of these results for prevention. Finally, conclusions are drawn that the victim-offender pathway is far from inevitable as most participants stated their reason for not offending was directly related to their own experience of sexual abuse victimisation.

All-of-community by all-of-government: reaching Pacific people in Aotearoa New Zealand during the COVID-19 pandemic

A large portion of Pacific communities throughout Aotearoa New Zealand continue to face socioeconomic hardship and have ongoing health needs that are affected by social and economic influences. The impact of COVID-19 has only exacerbated these needs and will continue to have an adverse effect on the current wellbeing, future health and sustainable development of these communities-if targeted efforts are not undertaken to meet their unique needs. The collective worldview of Pacific communities is fundamental to their existence; therefore, a response needs to be within a collective community. This viewpoint looks at the worldview of Pacific communities and the impact of COVID-19 and then discusses six key priorities for working with these diverse communities. The successful management and elimination of a pandemic should be assessed by how well Pacific and other vulnerable communities survive such a crisis.