Interim Evaluation of the Northern Territory Aboriginal and Torres Strait Islander Community Aged Care Workforce Development Projects - Attachments

1. Rationale for the NT Aboriginal And Torres Strait Islander Community Aged Care Workforce Development Initiative under the NTER¹

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Purpose

This paper outlines the policy context and the rationale for the Aboriginal and Torres Strait Islander community aged care workforce development initiative currently being implemented in the Northern Territory (NT) by the Department of Health and Ageing (DoHA).

Background and Policy Context

Community Development Employment Project (CDEP) Program

The CDEP program commenced in 1977 as a community-based employment initiative available to Aboriginal and Torres Strait Islander communities, or distinct groups of Aboriginal and Torres Strait Islander people within a community. The program was initially implemented in 12 remote Aboriginal communities in the NT. By 2003, the CDEP program had expanded so that as of June 2003 it was estimated to have over 31,000 participants across Australia.

Prior to 2007, the CDEP program was a key avenue of employment for Indigenous people across Australia, particularly those living in remote areas². In 2002, one in four Indigenous workers were employed through the CDEP scheme nationally. In non-remote areas, only 1 in 10 Indigenous workers were employed through CDEP, compared to the majority of workers (60%) being employed through CDEP in remote areas³. It is likely that the proportion also varied across employment sectors. For example, up to two thirds of the workforce in community aged care services in the NT worked on a casual, sometimes ad hoc basis, through CDEP placements⁴.

In 2007, the former Australian Government announced a number of reforms to the CDEP program, including abolition of the program in urban and regional centres from 1 July 2007 and implementation of the NTER Employment and Welfare Reform measure.

Impacts of CDEP Changes in the NT

Due to the NT community aged care sector’s reliance on CDEP placements (estimated at approximately two thirds of the workforce), removal of the CDEP program has the potential to impact negatively on service providers’ capacity to access local staff, the flexibility of working conditions and on individuals’ ability to work and meet their cultural and community obligations.

Northern Territory Emergency Response Employment and Welfare Reform Measure

In 2007, the Northern Territory Emergency Response (NTER) gave rise to the NTER Employment and Welfare Reform Measure. This measure included specific funding for the Northern Territory Jobs Package, which aims to create real employment opportunities for Aboriginal and Torres Strait Islander peoples that support delivery of Australian Government funded services in a range of areas, including in aged care, across the whole of the Northern Territory (NT).

In support of these initiatives, the Northern Territory Flexible Funding Pool (FFP) Special Account was established to develop, promote, assist or implement initiatives related to the NTER. Funding is appropriated to, and administered by, the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) and includes funding to convert the existing CDEP positions as well as an allocation for related training initiatives.

Under this measure, the Department is responsible for converting CDEP positions in community aged care service delivery to paid employment in the NT. Initially, funding was provided for conversion of up to 254 CDEP placements in HACC services however, since the implementation of this package, additional CDEP placements in community aged care government service roles were identified by the NTDHF in HACC services and by the Department in Aboriginal and Torres Strait Islander Flexible Aged Care (Flexi) services. To date, the Department is now administering funding for approximately 349 part time, paid employment positions in community aged care services in the NT as follows:

• 304 in HACC services, administered through funding agreements between the Department and the NTDHF; and
• 45 in Aboriginal and Torres Strait Islander Flexible Aged Care (Flexi) services administered through funding agreements between the Department and eligible Flexi services.

Prior to the introduction of this measure, a substantial proportion of the Aboriginal and Torres Strait Islander community aged care workforce in the NT was made up of CDEP placements (estimated to be up to two thirds of this workforce in the NT1). The high number of CDEP placements in the NT meant that a relatively substantial amount of funding for training was made available under the FFP Special Account specifically for the NT.

This level of funding facilitated an opportunity for the Department to take a more strategic approach to workforce development in the NT compared to the approaches being considered in other States and Territories under the BAIWICC measure.

To this end, the Department sought agreement from FaHCSIA in 2007-08 to develop a broader Aboriginal and Torres Strait Islander community care workforce strategy for the NT prior to the roll out of any specific training programs to services. In addition, the Department entered into a partnership arrangement with the NT Government to ensure that training opportunities could be provided to all Aboriginal and Torres Strait Islander community aged care workers in the NT, not just former CDEP participants.

Impacts of Shire Reform (2008) in the NT

Another compounding factor to be considered in the context of community aged care workforce development in the NT is the additional disruption to service delivery brought about by the recent NT government shire reforms. On 1 July 2008, the NT Government replaced the more than 50 existing community government councils in regional areas of the NT with 9 shire councils. Prior to the introduction of these reforms, Aged and Community Care services in the remote parts of the NT were mostly provided by community government councils. Approximately 32 community government councils were funded by the Department to provide either Community Aged Care Packages (CACPs) or Flexi services. A similar number were funded by the NT Department of Health and Community Services for Home and Community Care and Disability Services.

Consultation and Research

Prior to developing the current NT Aboriginal and Torres Strait Islander community aged care workforce development initiative, the Department embarked on a program of research and consultation throughout 2007-08. This process was undertaken to ensure that an appropriate strategy was developed for the NT and that adequate consideration was given to the current issues and challenges identified for this workforce.

NT specific consultation was undertaken with the following stakeholders:

• government funding bodies (NTDHF, DoHA NT State Office, FaHCSIA, DEEWR)
• community aged care service providers, and
• advocacy and development agencies.

In addition, consultations began in 2007-08 with the National Aboriginal and Torres Strait Islander HACC Reference Group (NATSIHACCRG) regarding the development of a high-level, national workforce development strategy, which could inform policy to address the needs of Aboriginal and Torres Strait Islander HACC workers.

Consultation mechanisms included attending NATSIHACCRG meetings and organisation of, or attendance at, a series of workshops relevant to the Aboriginal and Torres Strait Islander community aged care sector including:

• Top End Remote HACC Forum – Darwin, November 2007
• Aboriginal and Torres Strait Islander HACC and Community Care Urban Workshop – Adelaide, May 2008, and
• Aboriginal and Torres Strait Islander Aged Care Program Tri-State Workshop – Darwin, Aug 2008.

A large number of issues and challenges facing Aboriginal and Torres Strait Islander community care were highlighted through undertaking these processes. These are outlined at Attachments A – B.

Other Considerations

A shortage of NT-based training providers with capacity to deliver training in remote areas, particularly in the aged care sector, has contributed to the limitations outlined above. Anecdotal evidence suggests that training delivery continues to be poorly coordinated across different regions of the NT. Approaches have ranged from local training programs involving NT-based trainers in limited locations, to national programs involving organisations contracted from outside the NT. Both approaches have ultimately achieved limited coverage and inequitable training outcomes across the NT for a range of reasons. In addition, while evidence demonstrates that Indigenous training is most effective and best attended when delivered on site in the community⁵, training initiatives seldom have adequate funds to offer on-community training.

Of note, DEEWR recently advised agencies that retention of Indigenous people in CDEP-converted jobs depends on employees and employers being supported, and is not only based on remuneration. Other factors that maximise successful outcomes are:

• being listened to by management and peers
• providing a structured mentoring program for employees
• supporting and providing formal training for mentors
• opportunity for development
• interest in, and enjoyment of, the job
• employers’ understanding of Indigenous culture, and
• defining what are the employees and employers role, responsibility and expectation of the job.

Aged care service managers play a key role in recruitment and retention within the Indigenous community aged care workforce, and in improving the quality of service delivery. Due to a widespread lack of support and training, there is a high turnover of non-Indigenous coordinators in remote services, which greatly limits opportunities to develop a stable and suitably skilled Indigenous workforce.
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Workforce Development

Workforce development is a widely used term in the vocational education and training (VET) sector. It aims to build capacity at the individual and organisational level, through improving employee performance and job satisfaction and thus developing a skilled workforce. Effective workforce development incorporates multiple activities that extend beyond training⁶, including:

• identifying the necessary skills for a particular job role
• producing resources tailored to teach these skills effectively
• training workers to achieve skills matched to their job
• mentoring and supporting learners to attain qualifications and build a career pathway
• actively recruiting unemployed people into training as a pathway into employment
• evaluating the appropriateness and effectiveness of workforce development programs to enable continuous improvement
• building strategic linkages across sectors and organisations, and
• a long-term investment in workforce development programs.

Essential Elements Identified for the Aboriginal and Torres Strait Islander Community Aged Care Workforce in the NT

As a result of the consultation and research processes noted above, the Department determined that the following considerations would need to be taken into account to ensure delivery of an effective strategy for development of the Aboriginal and Torres Strait Islander community aged care workforce in the NT:

• The need for culturally appropriate training resources taking into consideration potential language barriers as well as different levels of literacy and numeracy.
• Training should be provided on-site, within communities to ensure minimal disruption to service delivery, affordability and cultural safety.
• Training should preferentially by local training providers with a proven track record in local Indigenous communities, an understanding of factors specific to the NT and to build capacity in local organisations to ensure sustainability and availability of on-going training.
• A parallel process of evaluation of process to ensure capture of base-line data, opportunity for feedback and continuous improvement throughout the project and ongoing collection of information to inform future or national workforce development options.

The NT Aboriginal and Torres Strait Islander Workforce Development Initiative

In 2008, based on the above outlined information, the Department identified three related projects to support the conversion of existing CDEP placements to paid employment in the NT community aged care workforce. Collectively, these four elements (outlined in more detail below) constitute the Aboriginal and Torres Strait Islander workforce development initiative (the initiative) currently being implemented by the Department in the NT.

The overarching aim of the initiative is to build capacity and sustainability in the Aboriginal and Torres Strait Islander aged care workforce in the NT, with a view to improving the quality of community aged care for Indigenous people.

1. Funding jobs from changes to CDEP processes
Under the NTER Employment and Welfare Reform Measure, the Department is administering funding for approximately 349 permanent, part-time jobs HACC and Flexi services across the whole of the NT (described in detail above).

2. Resource development
In 2008, the Department engaged Human Capital Alliance (HCA) to identify the core skill sets for Aboriginal and Torres Strait Islander community aged care workers, develop a skills audit tool to assist with targeted training delivery and to identify or develop culturally appropriate training resources for this group.

To date, a skill audit has been undertaken to identify the core skills required to work in NT Indigenous community aged care services. These skills have been mapped to nationally accredited training packages, to assess whether a Certificate III in HACC or Aged Care would equip this workforce with the most appropriate skill base.

The skills audit has identified a vast skill base which reflects the broad range of services delivered NT community aged care services. Many skills extend beyond the Certificate III in HACC into the health training package. As a result, a skills audit tool has been tailored to Indigenous community aged care workers, which recognises the broad skill base of NT community aged care services that will need to be addressed through training.

An audit of training resources appropriate to learners in Indigenous community aged care services has also been completed. The audit identified over 170 resources, but found that resources were pooled around particular skill areas (providing meals, personal care), while resource gaps existed in some key areas of service delivery (working effectively in a community care environment, medication).

In response to these findings, expanding and updating existing resources to fill these gaps will now be prioritised.

3. Workforce training
In 2008, the Department engaged 4 locally based Registered Training Organisations (RTOs) to deliver training to the Aboriginal and Torres Strait Islander community aged care workforce in the NT (in partnership with NTDHF).

Contract negotiations between the Department and the RTOs were undertaken to ensure that the project addresses the following constraints and challenges in staff training and development:

• low levels of literacy and numeracy – training will provide literacy and numeracy support, and use flexible teaching approaches (eg visual tools, demonstrated learning)
• high levels of staff turn-over and job sharing among family members – training aims to support workers to remain in employment through building skills and self-confidence, and will be offered to community members to increase skills among non-employed family carers and school leavers
• prior delivery of non-accredited training, leading to increased need for appropriate recognition of current competency (RCC) tools – all training will be nationally accredited, include a formal RCC process, and provide statements of attainment for each training participant
• lack of culturally appropriate training workforce and infrastructure – the selection of training organisations was based on their location in the NT, and their demonstrated experience working with Aboriginal and Torres Strait Islander people
• unsuccessful attempts to bring workers into regional areas to attend training – all training will be provided on-community, and
• difficulties providing effective on-site training in remote locations with limited funding – training is being delivered by four organisations to achieve full coverage of the NT and improve the efficiency of travel to remote areas. The training project has allocated adequate funds to cover extensive travel costs to all communities that require training.

In addition, this training project will encourages coordinators to participate in training alongside their staff, to improve their own skills and stay informed about what their staff have been trained in. Coordinator involvement is necessary to achieve consolidation of competence in the workplace.

4. Evaluation
In 2008, the Department engaged Gevers Goddard Jones to undertake an evaluation of the initiative as a whole. As an important component of the workforce development approach, a concurrent evaluation has been included as a key element of this initiative. This will enable continuous improvement throughout the initiative, and will also fill gaps in knowledge to inform policy development in the Aboriginal and Torres Strait Islander aged care sector. The purpose of the evaluation is to show whether this initiative has been effective in:
building the capacity and sustainability of the Indigenous workforce, and
improving the quality of service delivery in Indigenous community aged care services.

In order to assess this, the evaluation is required to examine the impacts of CDEP changes on communities, service providers and individuals as well as the approach to workforce development undertaken by the Department in the context of all of the issues outlined in this document.

Given that CDEP reforms are relatively recent, an evaluation of new arrangements is necessary to identify whether the potential impacts outlined above have eventuated within community aged care services, and inform program managers and policy makers on how these impacts could be addressed. The NTER and NT- wide reforms to the council structures are also causing additional challenges for communities and service providers, which need to be evaluated more broadly.
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Attachment A

Issues with Aboriginal and Torres Strait Islander HACC and Community Care Service Delivery

On 8 May 2008, a workshop was held in Adelaide to identify needs of HACC services for Aboriginal and Torres Strait Islander people in urban locations. The workshop included participants from service providers, advocacy and development agencies, HACC officials and the Department. A number of issues were identified as follows:

Access
Of major importance to note is that access is not a geographical issue. A number of factors contribute to access issues for Aboriginal and Torres Strait Islander elders. Elders in urban areas are often isolated and many are also full time carers. Family members are not taking on carer roles and elder abuse is an issue. Available services are often inappropriate and people who relocate from rural and remote areas may face additional challenges such as language barriers, transition issues and transportation costs. Cultural safety was identified as a key barrier to access with elders preferring to access Aboriginal and Torres Strait Islander specific medical or housing services instead of available mainstream HACC services.

Service Model
The current model of service delivery was identified as a major issue. Specialist services for Aboriginal and Torres Strait Islander people are lacking and current funding models and multiple accountability requirements for HACC and other community and aged care programs is a major barrier for Aboriginal and Torres Strait Islander organisations.

Workforce
Workforce issues were identified as a major barrier to the provision of appropriate Aboriginal and Torres Strait Islander HACC services. It was noted that the cultural competency or understanding of Indigenous specific issues of non-Indigenous workers was often a problem, as was low recruitment and retention rates for Aboriginal and Torres Strait Islander workers. Availability of appropriate training and support services and the ability of small services to provide training for workers due to the cost of sending people on training courses and back filling positions was identified as a problem. In addition, lack of appropriate training, poor remuneration and limited career opportunities for Aboriginal and Torres Strait Islander aged care workers was identified as a major cause of the low recruitment and retention rates.

Attachment B

Issues identified for the Aboriginal and Torres Strait Islander community aged care workforce

The Mapping of the National Aboriginal and Torres Strait Islander Home and Community Care (HACC) Workforce report⁷ completed in February 2007 report identified the following characteristics specific to the national Aboriginal and Torres Strait Islander HACC workforce:

• estimated to be almost 1,400 (although this is likely to be an underestimate, 2006 ABS Statistics are 1750 for Indigenous Aged and Disabled Care Workers)
• the majority are employed in Aboriginal and Torres Strait Islander specific HACC services - around 295 services nationally, with only 18% located in metropolitan areas
• 81% of workers are women, and the majority are aged over 35
• 72% work part-time
• 52% have worked in their service for less than two years
• 18% have completed a Certificate III in Aged Care, and only 9% have completed Year 12
• wages are generally less than $20 per hour, and
• Aboriginal and Torres Strait Islander workers are under-represented in management and clinical positions.

The subsequent development of the recommended workforce strategy and associated consultations, coupled with an examination of existing research, also identified a number of key issues relevant to the Aboriginal and Torres Strait Islander community aged care workforce in Australia. For example:

Recruitment and Retention
Indigenous workers value the flexibility of community care employment which allows employees to meet cultural, community and family commitments. However, poor pay and conditions and a lack of advancement are commonly cited as challenges to staff recruitment and retention. In addition, many people who work in Indigenous community aged care services have aspirations for career progression and an interest in undertaking training to open potential career pathways.

Training and Accreditation
Recent VET sector research demonstrates that many Indigenous learners, especially those in remote locations, take longer periods of time to complete training than non-Indigenous learners. Lower levels of numeracy and literacy, geographical, seasonal and cultural realities often cause well intended and planned training timeframes to be extended. While high rates of Indigenous people participate in VET, completion rates are relatively low⁸.

There has historically been limited success in training outcomes for all Indigenous people in remote locations, not just those on CDEP. For example, in 2007 it was estimated that less than 9% of the Indigenous community aged care workforce in the NT held relevant industry qualifications⁶. Attempts over recent years to provide training to workers in Indigenous HACC services has resulted in a mix of accredited and non-accredited training, thus creating the need for processes such as recognition of current competence (RCC), which identify workers’ existing skills.

Career Pathways
Existing data demonstrates that the aged care workforce is an inherent part of Aboriginal and Torres Strait Islander communities, and therefore needs to be utilised to complement, strengthen and provide pathways into the broader health and community care workforce. Aged care work represents a key pathway into other areas of the workforce for Aboriginal people and/or Torres Strait Islanders. The skills needed to work in aged care are often core skills required for other areas of health and community services. As noted in Aboriginal and Torres Strait Islander Participation in VET “many people choose to undertake training in the community services and health industries in order to improve the health and wellbeing of their family and community.”⁹ This needs to be considered when developing training strategies.

Specialised Service Delivery
Indigenous aged care services often deliver a broad range of services to meet community need and support older Indigenous people. Some services are known to deliver a level of care that extends beyond program funding parameters, for example medication and health management. Indigenous community aged care services therefore depend on a workforce with a wide range of skills to meet the complex care needs of their clients, and to fill gaps in services that are not available in remote settings.

In addition, the high need to address social and emotional wellbeing and chronic diseases among Indigenous aged care clients demands a broad range of workforce responses. An emphasis on rehabilitation and allied health capacity is required and is underprovided, especially in rural and remote areas. These factors reinforce the need for a flexible and multi-disciplinary approach to training, incorporating the broader aged care, disability, family support, child care, social and emotional wellbeing and primary health care workforce training units.

Skill Sets
Training or RCC in these skills, either in clusters or as individual statements of attainment, may over time permit individual workers to attain a Certificate II, III or IV in Aged or Community Aged Care or workers may be offered the opportunity to undertake a Certificate courses in Aged or Community Care in the first instance. Consistent with available resources, individual jurisdictions and providers need to determine an appropriate approach to maintaining, and wherever possible increasing, the capabilities of the workforce through training.

Management
The HACC Mapping report highlighted that only 18% of Aboriginal and Torres Strait Islander HACC workers were employed as service managers/coordinators. HACC services have indicated that this is due to a lack of suitably experienced and qualified people to fill the role.

High turnover of non-Indigenous coordinators has a flow-on affect on staff morale and development, and affects the quality and appropriateness of the service as a whole. For example, non-Indigenous coordinators may have limited cultural awareness, and may try to impose an inappropriate model of service delivery. The initiation and effectiveness of on-site training may also be limited where co-ordinators lack commitment to a service. Alternately, there are many non-Indigenous coordinators who have a commitment to skilling the local community for work in aged care this reflects in the effectiveness of the service.

The Mapping report recommended that staff be given the opportunity to obtain at least a Certificate III, as workers with this qualification felt it opened the door to a co-ordinator role or a position in residential aged care. Additional professional development supports should be developed to assist non-Indigenous managers to up-skill Aboriginal and Torres Strait staff to fill management and co-ordinator positions.
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1. Written by DoHA
2. Gelade & Stehlik (2004) Exploring locality: the impact of context on Indigenous vocational education and training aspirations and outcomes
3. ABS (2002) National Aboriginal and Torres Strait Islander Social Survey 2002
4. Gevers Goddard Jones 2007 Mapping of the National Aboriginal and Torres Strait Islander Home and Community Care (HACC) Workforce Department of Health and Ageing Canberra
5. Community Services and Health Industry Skills Council (2006) Research Report – Aboriginal and Torres Strait Islander Participation in VET March 2006 Commonwealth of Australia
6. NCOSS (2007) Models of workforce development (Available at: http://www.ncoss.org.au/projects/workforce/workforce-development-models.pdf) TAFE NSW Workforce Development - a whole-of-system model for workforce development
7. Gevers Goddard Jones 2007 Mapping of the National Aboriginal and Torres Strait Islander Home and Community Care (HACC) Workforce Department of Health and Ageing Canberra
8. N Rea J Messner & C Gipey (2008) Desert Knowledge CRC: The Character of Aboriginal Training Pathways: A Local Perspective S Gelade & T Stehlik (2004) Exploring Locality: The Impact of Context on Indigenous Vocational Education and Training Aspirations and Outcomes.
9. Community Services and Health Industry Skills Council (2006) Research Report – Aboriginal and Torres Strait Islander Participation in VET March 2006 Commonwealth of Australia

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