3 - (OP25) Adapting CBT and ACT Using Te Whare Tapa Whā: Integrating Evidence-based Approaches with a Culturally Important Model of Health in Aotearoa New Zealand

Around the world, including in Aotearoa New Zealand, young people aged 16–25 experience high rates of depression and anxiety, yet have some of the poorest access to mental health care. Common barriers to treatment, including high cost of care and inaccessibility of services, perpetuate inequity in mental health treatment, with treatment often inaccessible to those youth who need it most. Effective and culturally responsive psychological care remains particularly inequitable. In countries like Aotearoa New Zealand, there is need for evidence-based, culturally appropriate models of care for young people.

This project outlines early outcomes of a project integrating Te Whare Tapa Whā, an indigenous model of health, with Cognitive Behavioral Therapy (CBT), and Acceptance and Commitment Therapy (ACT), delivered within an 8-session model to address mild to severe depression and anxiety among young people. The Te Whare Tapa Whā model integrates mental (hinengaro), physical (tinana), social (whānau), and spiritual (wairua) domains. We describe the 8 session model and how these approaches were integrated, including through clinician and youth advisory group feedback.

The 8 session model was assessed using a hybrid implementation effectiveness model integrating administrative data, online client surveys conducted at intake, and implementation surveys against the RE-AIM framework. Clients could consent to an additional evaluation which included completing additional online client surveys midway through and at the conclusion of sessions, feedback forms, and qualitative interviews. During the evaluation period, 549 young people participated in the program. Of those, 73 consented to additional evaluation.

In our findings, we outline staff and client feedback on the treatment model. Feedback was positive from youth, with the majority reporting they liked the model and felt it met their needs. While the majority of staff reported the model was a good fit for their service, qualitative feedback indicated a desire for a more flexible model of care. Early evidence of clinical efficacy was examined using linear, mixed-effects models with maximum likelihood estimation to examined change over time on the PHQ-9 and GAD-7. Preliminary analyses indicate reductions in depressive and anxiety symptoms from baseline to post-treatment, as measured by the Patient Health Questionnaire–9 (PHQ-9; mean change = [5.18], p < 0.001) and the Generalized Anxiety Disorder–7 (GAD-7; mean change = 5.09, p < 0.001). While effect sizes were large, sample size was small and we lacked a comparison group. While adoption was strong, enabled by good perception of the model and resourcing, key barriers to implementation were noted.

This project highlights the potential of adapting evidence-based psychotherapies to a particular context, in our case Aotearoa New Zealand, with an emphasis on working with stakeholders to develop culturally appropriate models. We highlight how culturally grounded adaptations can be effective approach to equitable, and acceptable, mental health care for young people - when careful attention is paid to the implementation barriers that can limit sustainable delivery.