Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.
One of the great challenges facing human systems today is how to prepare for, manage, and adapt successfully to the profound and rapid changes wreaked by disasters. Wellington, New Zealand, is a capital city at significant risk of devastating earthquake and tsunami, potentially requiring mass evacuations with little or short notice. Subsequent hardship and suffering due to widespread property damage and infrastructure failure could cause large areas of the Wellington Region to become uninhabitable for weeks to months. Previous research has shown that positive health and well-being are associated with disaster-resilient outcomes. Preventing adverse outcomes before disaster strikes, through developing strengths-based skill sets in health-protective attitudes and behaviours, is increasingly advocated in disaster research, practise, and management. This study hypothesised that well-being constructs involving an affective heuristic play vital roles in pathways to resilience as proximal determinants of health-protective behaviours. Specifically, this study examined the importance of health-related quality of life and subjective well-being in motivating evacuation preparedness, measured in a community sample (n=695) drawn from the general adult population of Wellington’s isolated eastern suburbs. Using a quantitative epidemiological approach, the study measured the prevalence of key quality of life indicators (physical and mental health, emotional well-being or “Sense of Coherence”, spiritual well-being, social well-being, and life satisfaction) using validated psychometric scales; analysed the strengths of association between these indicators and the level of evacuation preparedness at categorical and continuous levels of measurement; and tested the predictive power of the model to explain the variance in evacuation preparedness activity. This is the first study known to examine multi-dimensional positive health and global well-being as resilient processes for engaging in evacuation preparedness behaviour. A cross-sectional study design and quantitative survey were used to collect self-report data on the study variables; a postal questionnaire was fielded between November 2008 and March 2009 to a sampling frame developed through multi-stage cluster randomisation. The survey response rate was 28.5%, yielding a margin of error of +/- 3.8% with 95% confidence and 80% statistical power to detect a true correlation coefficient of 0.11 or greater. In addition to the primary study variables, data were collected on demographic and ancillary variables relating to contextual factors in the physical environment (risk perception of physical and personal vulnerability to disaster) and the social environment (through the construct of self-determination), and other measures of disaster preparedness. These data are reserved for future analyses. Results of correlational and regression analyses for the primary study variables show that Wellingtonians are highly individualistic in how their well-being influences their preparedness, and a majority are taking inadequate action to build their resilience to future disaster from earthquake- or tsunami-triggered evacuation. At a population level, the conceptual multi-dimensional model of health-related quality of life and global well-being tested in this study shows a positive association with evacuation preparedness at statistically significant levels. However, it must be emphasised that the strength of this relationship is weak, accounting for only 5-7% of the variability in evacuation preparedness. No single dimension of health-related quality of life or well-being stands out as a strong predictor of preparedness. The strongest associations for preparedness are in a positive direction for spiritual well-being, emotional well-being, and life satisfaction; all involve a sense of existential meaningfulness. Spiritual well-being is the only quality of life variable making a statistically significant unique contribution to explaining the variance observed in the regression models. Physical health status is weakly associated with preparedness in a negative direction at a continuous level of measurement. No association was found at statistically significant levels for mental health status and social well-being. These findings indicate that engaging in evacuation preparedness is a very complex, holistic, yet individualised decision-making process, and likely involves highly subjective considerations for what is personally relevant. Gender is not a factor. Those 18-24 years of age are least likely to prepare and evacuation preparedness increases with age. Multidimensional health and global well-being are important constructs to consider in disaster resilience for both pre-event and post-event timeframes. This work indicates a need for promoting self-management of risk and building resilience by incorporating a sense of personal meaning and importance into preparedness actions, and for future research into further understanding preparedness motivations.
From 2010, Canterbury, a province of Aotearoa New Zealand, experienced three major disaster events. This study considers the socio-ecological impacts on cross-sectoral suicide prevention agencies and their service users of the 2010 – 2016 Canterbury earthquake sequence, the 2019 Christchurch mosque attacks and the COVID-19 pandemic in Canterbury. This study found the prolonged stress caused by these events contributed to a rise in suicide risk factors including anxiety, fear, trauma, distress, alcohol misuse, relationship breakdown, childhood adversity, economic loss and deprivation. The prolonged negative comment by the media on wellbeing in Canterbury was also unhelpful and affected morale. The legacy of these impacts was a rise in referrals to mental health services that has not diminished. This adversity in the socio-ecological system also produced post-traumatic growth, allowing Cantabrians to acquire resilience and help-seeking abilities to support them psychologically through the COVID-19 pandemic. Supporting parental and teacher responses, intergenerational support and targeted public health campaigns, as well as Māori family-centred programmes, strengthened wellbeing. The rise in suicide risk led to the question of what services were required and being delivered in Canterbury and how to enable effective cross-sectoral suicide prevention in Canterbury, deemed essential in all international and national suicide prevention strategies. Components from both the World Health Organisation Suicide Prevention Framework (WHO, 2012; WHO 2021) and the Collective Impact model (Hanleybrown et al., 2012) were considered by participants. The effectiveness of dynamic leadership and the essential conditions of resourcing a supporting agency were found as were the importance of processes that supported equity, lived experience and the partnership of Māori and non-Māori stakeholders. Cross-sectoral suicide prevention was found to enhance the wellbeing of participants, hastening learning, supporting innovation and raising awareness across sectors which might lower stigma. Effective communication was essential in all areas of cross-sectoral suicide prevention and clear action plans enabled measurement of progress. Identified components were combined to create a Collective Impact Suicide Prevention framework that strengthens suicide prevention implementation and can be applied at a local, regional and national level. This study contributes to cross-sectoral suicide prevention planning by considering the socio- ecological, policy and practice mitigations required to lower suicide risk and to increase wellbeing and post-traumatic growth, post-disaster. This study also adds to the growing awareness of the contribution that social work can provide to suicide prevention and conceptualises an alternative governance framework and practice and policy suggestions to support effective cross-sectoral suicide prevention.
In September 2010 and February 2011 the Canterbury region of New Zealand was struck by two powerful earthquakes, registering magnitude 7.1 and 6.3 respectively on the Richter scale. The second earthquake was centred 10 kilometres south-east of the centre of Christchurch (the region’s capital and New Zealand’s third most populous urban area, with approximately 360,000 residents) at a depth of five kilometres. 185 people were killed, making it the second deadliest natural disaster in New Zealand’s history. (66 people were killed in the collapse of one building alone, the six-storey Canterbury Television building.) The earthquake occurred during the lunch hour, increasing the number of people killed on footpaths and in buses and cars by falling debris. In addition to the loss of life, the earthquake caused catastrophic damage to both land and buildings in Christchurch, particularly in the central business district. Many commercial and residential buildings collapsed in the tremors; others were damaged through soil liquefaction and surface flooding. Over 1,000 buildings in the central business district were eventually demolished because of safety concerns, and an estimated 70,000 people had to leave the city after the earthquakes because their homes were uninhabitable. The New Zealand Government declared a state of national emergency, which stayed in force for ten weeks. In 2014 the Government estimated that the rebuild process would cost NZ$40 billion (approximately US$27.3 billion, a cost equivalent to 17% of New Zealand’s annual GDP). Economists now estimate it could take the New Zealand economy between 50 and 100 years to recover. The earthquakes generated tens of thousands of insurance claims, both against private home insurance companies and against the New Zealand Earthquake Commission, a government-owned statutory body which provides primary natural disaster insurance to residential property owners in New Zealand. These ranged from claims for hundreds of millions of dollars concerning the local port and university to much smaller claims in respect of the thousands of residential homes damaged. Many of these insurance claims resulted in civil proceedings, caused by disputes about policy cover, the extent of the damage and the cost and/or methodology of repairs, as well as failures in communication and delays caused by the overwhelming number of claims. Disputes were complicated by the fact that the Earthquake Commission provides primary insurance cover up to a monetary cap, with any additional costs to be met by the property owner’s private insurer. Litigation funders and non-lawyer claims advocates who took a percentage of any insurance proceeds also soon became involved. These two factors increased the number of parties involved in any given claim and introduced further obstacles to resolution. Resolving these disputes both efficiently and fairly was (and remains) central to the rebuild process. This created an unprecedented challenge for the justice system in Christchurch (and New Zealand), exacerbated by the fact that the Christchurch High Court building was itself damaged in the earthquakes, with the Court having to relocate to temporary premises. (The High Court hears civil claims exceeding NZ$200,000 in value (approximately US$140,000) or those involving particularly complex issues. Most of the claims fell into this category.) This paper will examine the response of the Christchurch High Court to this extraordinary situation as a case study in innovative judging practices and from a jurisprudential perspective. In 2011, following the earthquakes, the High Court made a commitment that earthquake-related civil claims would be dealt with as swiftly as the Court's resources permitted. In May 2012, it commenced a special “Earthquake List” to manage these cases. The list (which is ongoing) seeks to streamline the trial process, resolve quickly claims with precedent value or involving acute personal hardship or large numbers of people, facilitate settlement and generally work proactively and innovatively with local lawyers, technical experts and other stakeholders. For example, the Court maintains a public list (in spreadsheet format, available online) with details of all active cases before the Court, listing the parties and their lawyers, summarising the facts and identifying the legal issues raised. It identifies cases in which issues of general importance have been or will be decided, with the expressed purpose being to assist earthquake litigants and those contemplating litigation and to facilitate communication among parties and lawyers. This paper will posit the Earthquake List as an attempt to implement innovative judging techniques to provide efficient yet just legal processes, and which can be examined from a variety of jurisprudential perspectives. One of these is as a case study in the well-established debate about the dialogic relationship between public decisions and private settlement in the rule of law. Drawing on the work of scholars such as Hazel Genn, Owen Fiss, David Luban, Carrie Menkel-Meadow and Judith Resnik, it will explore the tension between the need to develop the law through the doctrine of precedent and the need to resolve civil disputes fairly, affordably and expeditiously. It will also be informed by the presenter’s personal experience of the interplay between reported decisions and private settlement in post-earthquake Christchurch through her work mediating insurance disputes. From a methodological perspective, this research project itself gives rise to issues suitable for discussion at the Law and Society Annual Meeting. These include the challenges in empirical study of judges, working with data collected by the courts and statistical analysis of the legal process in reference to settlement. September 2015 marked the five-year anniversary of the first Christchurch earthquake. There remains widespread dissatisfaction amongst Christchurch residents with the ongoing delays in resolving claims, particularly insurers, and the rebuild process. There will continue to be challenges in Christchurch for years to come, both from as-yet unresolved claims but also because of the possibility of a new wave of claims arising from poor quality repairs. Thus, a final purpose of presenting this paper at the 2016 Meeting is to gain the benefit of other scholarly perspectives and experiences of innovative judging best practice, with a view to strengthening and improving the judicial processes in Christchurch. This Annual Meeting of the Law and Society Association in New Orleans is a particularly appropriate forum for this paper, given the recent ten year anniversary of Hurricane Katrina and the plenary session theme of “Natural and Unnatural Disasters – human crises and law’s response.” The presenter has a personal connection with this theme, as she was a Fulbright scholar from New Zealand at New York University in 2005/2006 and participated in the student volunteer cleanup effort in New Orleans following Katrina. http://www.lawandsociety.org/NewOrleans2016/docs/2016_Program.pdf
