Author: Julianne Johns
“Given the effect of communication disorders on family and social life and the connection between language and culture, it is likely that stroke-related communication disorders are culturally determined."
Speech language therapist and researcher, Dr Karen Brewer (Whakatōhea, Ngaiterangi), launched Ngā Whāriki Kōrero in July 2020 at the University of Auckland.
This is a fantastic kaupapa Māori speech language therapy package for whānau with communication difficulties caused by stroke. The outcome of Karen’s HRC-funded post-doctoral research, these resources began with the many hours Karen spent hearing the stories of Māori and their whānau after stroke. She went on to listen to the experiences of speech language therapists, Māori health specialists and Stroke Foundation community advisors.
Though developed with the work of speech language therapists in mind, both Ngā Whāriki Kōrero and the learning behind, it has great potential to amplify mātauranga Māori and support the work of rehabilitation providers and researchers—anyone involved as communication partners of Māori with a range of communication disorders.
"The therapy must not sit solely with the discipline of speech-language therapy but facilitate working across disciplines to benefit whānau. “
We will profile Ngā Whāriki Kōrero in an upcoming blog, but first some background.
As she began her work, Karen quickly recognised that a Māori therapy resource without reference to the social political, historical and economic context in which it is delivered, would not meet the needs of whānau or improve therapy outcomes.
In her 2016 article, The complexities of designing therapy for Māori living with stroke-related communication disorders, Karen draws on He Korowai Oranga: Māori Health Strategy and Whānau Ora guidelines, as well as kaupapa Māori theory to shine a light on challenges and pathways for therapists in Aotearoa New Zealand when designing and providing kaupapa Māori therapy—therapy designed by Māori for Māori and undertaken in a Māori way—for stroke related communication disorders.
She reminds us, “The creation of a kaupapa Māori speech language therapy approach should bring together people with stroke, whānau members and service providers to create therapy that crosses sectors and disciplines and acknowledges the wider social and political context.”
Health related quality of life, family, relationships, return to work, depression and social participation and leisure are all vulnerable to stroke-related communication disorders. The impact of these disorders on life participation is influenced by cultural, social, economic and political factors. Māori have particular, often negative, experiences of these factors in relation to tino rangatiratanga and are likely, therefore, to have unique experiences of stroke-related communication disorders and associated therapy needs.
Considering that most therapy services are delivered in the context of the New Zealand public health system, Karen proposes an approach in which non-Māori speech language therapists develop cultural safety and clinical skills, before providing kaupapa Māori resources.
This hierarchy of skill and resource acquisition is framed as a poutama, a stepped pattern. Moving from rung-to-rung therapists learn how to master each, before moving to the next.
Poutama (ladder) How to master each rung.
1 Learn why be culturally safe
2. Learn how to be culturally safe
3. Learn how to interact
4. Develop resources to build relationships
5. Resources for Education
6. Resources for treatment
Karen went on to develop Ngā Whāriki Kōrero, a beautiful Māori speech language therapy package for whānau with communication difficulties caused by stroke. This resource package supports clinicians to step along the first three rungs via online professional development modules then employ a website collection of video and written resources, an information and support booklet and an interactive therapy resource.
Ref: Reference Brewer, K et al (2016) The complexities of designing therapy for Māori living with stroke related communication disorders; NZMJ, 129 (1435)75-82