Interim Evaluation of the Northern Territory Aboriginal and Torres Strait Islander Community Aged Care Workforce Development Projects - Final Report
10: Evaluation Element 7: Northern Territory Workforce Development Projects as a Whole
10.1 Overview
This section reviews the three Workforce development Projects as a whole and addresses the key evaluation questions; namely, have the Workforce Development Projects been successful in:- Building the capacity and sustainability of the Aboriginal and Torres Strait Islander community aged care workforce in the NT
- Improving the quality of community aged care services to Aboriginal and Torres Strait Islander people in the NT, and
- Assessing whether the Projects as a whole, have had a positive impact on the aged care workforce and what the impact is.
This section also draws together an overview of the evaluation and highlights some of the other issues impacting on the Projects as a whole.
10.2 The Workforce Development Projects as a Whole
In assessing the Workforce Development Projects as a whole it is imperative to be mindful that this is an interim evaluation conducted in the first year of the implementation of the Projects. The evaluation has shown that the multifaceted approach taken by the NT and Australian Governments is appropriate to address the complex challenges faced by aged care services in delivering services for Aboriginal and Torres Strait Islander people in the NT.The Workforce Development Projects have successfully captured and framed the key elements essential to influence the delivery of aged care services in the NT. These are:
- Employment for Aboriginal and Torres Strait Islander people in the communities in which they live
- Resources to deliver culturally appropriate training to foster appropriate aged care service delivery, and
- Contemporary training to meet the learners’ needs and equip them to meet the needs, and improve the quality of, the aged care clients they care for.
Above all, the evaluation documents a wide range of feedback from stakeholders detailing how they have experienced the implementation of the Projects, what worked for them, what did not work, and areas where improvements can be made both in the NT and in other jurisdictions. Recommendations are detailed in previous sections of this report and summarised in Section 2: Recommendations for Improvement.
As a whole, the Workforce Development Projects have been successfully implemented in a challenging environment where numerous factors impact on the outcomes of the Projects. The groundwork has been established and with flexibility, creativity, partnership and a long term commitment the objectives of the Projects can be achieved.
10.3 Building the Capacity and Sustainability of the NT Aboriginal and Torres Strait Islander Aged Care Workforce
The conversion of CDEP placements in communities into paid jobs has been successful in building the capacity of the community aged care workforce and has had a positive impact on the workers and on the aged care services and is fundamental to improving and increasing aged care service provision. Without a consistent workforce, care outcomes cannot be achieved.Information collected through this interim evaluation has not yet demonstrated an impact on the sustainability of the NT community aged care workforce, which is to be expected as the Workforce Development Projects are in their infancy. In particular, the workforce has a turnover rate of 26%, which is similar to the Australian community care sector but is still a significant management issue, and is impacted on by a range of issues noted in previous sections and including, literacy, education levels, cultural issues and social issues.
The evaluation data does suggest that sustainability of the workforce can be developed as the NT Employment Project is sustained and the NT Training Project and associated support projects are continued.
The impact of the Projects on sustainability will be able to be further measured over time and in the context of meeting the government’s Closing the Gap target of halving the gap in employment outcomes for Aboriginal and Torres Strait Islander people in a decade through the continued evaluation and employment measures101.
Two areas which have a significant impact on the capacity and sustainability of the workforce are the complexity of aged care service delivery in the NT and training and resources. These are discussed below.
10.3.1 Complexity of aged care service delivery
Although it was never the intention of the Projects or the evaluation to identify and address all the issues that impact on and affect the delivery of quality outcomes for clients, the evaluation has resulted in a greater understanding of this complexity in the context of employment and workforce development strategies, training and resources. Information obtained through the evaluation and discussed in previous sections highlights this complexity and related challenges, and the impact of these on the capacity and sustainability of the aged care workforce.Issues impacting on the sustainability of the workforce and quality of care were identified in discussions with coordinators and workers in the case studies and telephone interviews, with RTOs and with other stakeholders. Additionally, issues impacting on coordinators were highlighted by the DoHA administered questionnaire and through subsequent consultations with coordinators that focussed on workforce and development issues (which informed the NT Aboriginal and Torres Strait Islander Staff Mentoring Training Workshops Project). Identified issues include:
- Remoteness including difficulties in travel and accommodation
- Lack of or difficulty maintaining physical resources
- Attracting, training and maintaining appropriately skilled coordinators
- Attracting, training and maintaining Aboriginal and Torres Strait Islander staff
- Managing staff and other issues that result in inconsistent attendance
- Challenges in reinforcing work practices and motivating staff
- Understanding of community care, assessment, care planning and contractual requirements
- Local community issues including remote locations, family and cultural issues and responsibilities, housing and infrastructure constraints, population movement and environmental challenges such as road closures
- Shire issues including the recently implemented changes in shire boundaries and management, changes to shire representative responsibilities in shire offices and communities, and relationships with local community representatives
- NT government issues including changes to responsibility for programs and funding, policy changes, and other local Territory influences, and
- Commonwealth government influences including program funding requirements, quality reporting requirements, policy changes and other government influences.
10.3.2 Training and resources
Providing education and training to Aboriginal and Torres Strait Islander aged care workforce is integral to the delivery of high quality care. The NT Training Project is delivering training that is suitable to the needs of the communities and workers who are responsible for care delivery. The training framework is competency-based, nationally recognised and results in workers demonstrating their competency to deliver care and services relevant to their work circumstances.Similar training is delivered Australia-wide in the mainstream aged and community care and primary health sectors. The training is suitable to the workforce and the services being provided to the community aged care clients. The training has mainly met the needs of the community aged care workforce (some improvements have been identified through consultation with stakeholders) and, it is envisaged that the development and use of the Aboriginal and Torres Strait Islander training resources will further align the training with participants’ needs and expectations.
Whilst many workers did not see aged care work as a career path, keeping the learning and development options open for Aboriginal and Torres Strait Islander community aged care workers is key to improving the quality of care for clients. Some coordinators have accessed Certificate IV training through the Project. Providing the option for all workers to pursue further education and training is also important to the ongoing development of the workforce as has been demonstrated in other sectors, such as the primary health care sector and residential aged care sector.
The promotion and ongoing provision of the NT Training Project is integral to the improvement of care outcomes as currently only five per cent of NT Aboriginal and Torres Strait Islander aged care workers have these work-relevant qualifications (compared to 54% of Australian community care workers)102. In addition, the staff turnover rate for workers is around 26%, necessitating ongoing training provision.
10.4 Assisting with Improving the Quality of Community Aged Care Services to Aboriginal and Torres Strait Islander People in the NT
The interim evaluation has not yet definitively shown that the workforce development approach has assisted with improving the quality of community aged care services to Aboriginal and Torres Strait Islander people in the NT; nor would the evaluators expect it to in these early stages. The evaluation has highlighted that to achieve improved quality of services a range of interconnected elements need to be considered and that development of the workforce is only one element in quality improvement.Overall the evaluation has highlighted that to assist with the continuous improvement of the quality of care for Aboriginal and Torres Strait Islander people in the NT the continuation of the Workforce Development Projects and the related support activities for the coordinators and shire representatives is critical.
Overall, the training delivered reflected the identified current client needs.
It is anticipated that the approach being undertaken by DoHA that includes: training and support for workers; support and training for coordinators and shire representatives; and ongoing support of aged care providers to meet their service delivery contract requirements will contribute to the ongoing improvement of quality service delivery.
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10.5 Increasing the Capacity of Training in the NT
One of the outcomes sought from the implementation of the NT Training Project was to increase the capacity of aged care training in the NT, that is, has the NT Training Project increased the number and availability of suitably qualified aged care trainers in the NT? It was identified by DoHA that the success and sustainability of the Workforce Development Projects as a whole relied on having a number of training providers in the NT to deliver training on an ongoing basis.Four RTOs have been engaged to provide training within specific regions of the NT. Section 7: Evaluation Element 3: Northern Territory Training Project outlines the issues experienced and identified by RTOs in the first year of training delivery and highlights that there have been significant challenges. Prior to the implementation of this project two of the RTOs were already well established trainers in the NT, one was a newly developed NT training company and one was an established training organisation in Queensland with an office in Alice Springs.
The conduct of the NT Training Project has increased the present capacity of training in the NT through the recruitment of trainers from throughout Australia and the NT by the NT based training organisations and through the Queensland training provider locating trainers in the NT.
Discussions with RTOs revealed that they have significant difficulty in recruiting NT based trainers and have, throughout the course of the Project, advertised both in the NT and Australia-wide to recruit suitable trainers. Unfortunately few NT people have taken up the training roles developed through the NT Training Project therefore not adding to the permanent pool of skilled trainers in the NT. The reason for this may be the specific skills required for the trainers. These are described below in: What makes a successful trainer?
The benefits of engaging NT-based RTOs include:
- The cost of utilising locally-based training is generally less than engaging fly-in/fly-out trainers
- They have local community knowledge which assists with working with shire representatives and builds local relationships
- They are more likely to have experience in working with local Aboriginal and Torres Strait Islander people and in working and travelling in remote areas, and
- They now have experience in the NT Training Project and are familiar with the Project requirements; knowledge that assists them to contribute to the improvement of the Project over time.
Given the challenges experienced by the very experienced, local RTOs in the first year of the NT Training Project, it is deemed more appropriate to maintain the local RTOs due to:
- Their understanding of Project requirements, reporting, and communities
- The extensive time it took RTOs to develop relationships with their allocated shire and community contacts
- Their knowledge of local community issues, challenges, workers and service situations
- Their experience and growth in meeting the challenges faced to date, and
- Their relationships with DoHA.
What makes a successful trainer?
The evaluators sought to identify what constitutes a successful trainer; information from the RTOs revealed that the most successful trainers have:- Relevant aged care experience (preferably in community or residential aged care)
- Training qualifications that meet the requirements of RTO status
- Cultural competence and awareness
- Experience with Aboriginal and Torres Strait Islander adult learners and/or English as a second language adult learners
- Clear spoken English (some RTOs had overseas trainer applicants whose spoken English was difficult to understand, thus excluding them from employment with the sector)
- Ability and resilience to travel widely in remote areas (and spend some time away from home), and
- A sense of humour!
10.6 Learnings from the Evaluation
DoHA implemented an evaluation of the Workforce Development Projects at the commencement of the Projects, to ensure that the evaluation framework could be developed as the Projects were implemented to identify improvements on an ongoing basis and to understand the impacts of the Projects in the future. The concurrent evaluation enabled the evaluators to be involved through the formative phase of the Projects and to develop a comprehensive range of baseline measures/results that have informed the interim evaluation and can inform future evaluations.This is particularly important as the achievement of some of the outcomes of the Projects is expected to be longer term. The timeframe of this initial evaluation only considered the delivery of approximately nine months of training, which, whilst informing the identification of some improvements to processes, has not been long enough to clearly identify significant improvements in sustainability of the workforce or client outcomes.
The evaluation has identified a clear and comprehensive suite of baseline measures. To ensure the ongoing effectiveness of the Projects it is recommended that an independent evaluation continues and uses these baseline measures to assess the impact of the Projects. It is; however, envisaged that the ongoing evaluation will need to revisit and improve some data collection tools104, further explore the impacts of the Projects, explore areas identified by this evaluation but not explored and consider the expansion of the evaluation to consider the effectiveness and efficiency of RTOs.
In relation to the last point, the RTOs were very open to receiving feedback, discussing strategies for improving training delivery and dealing with the challenges of remote training provision. Including some measures of RTO effectiveness and efficiency in the ongoing evaluation may assist in measuring the impact of the NT Training Project in the future and in achieving improvements in efficiency.
To understand the ongoing effectiveness of the Workforce Development Projects it is recommended that:
- An independent evaluation continues and is framed against the learnings from the interim evaluation
- Data collection mechanisms are revisited and improved, and
- Consideration is given to evaluating the effectiveness and efficiency of the RTOs.
10.6.1 Clarity of Projects information
To increase the clarity of project requirements for the future, it is recommended that project guidelines are developed for the NT Training Project to clearly articulate the program requirements and accountabilities of all stakeholders. This should ensure consistent approaches in providing information about training provision, the outcomes expected (including achievement of certificates), and timeframes and training methodologies. These guidelines would also ensure that other stakeholders, such as government representatives, shire and community groups, and service providers have a clear understanding of the Project.It is proposed that the ongoing evaluation use the learnings from this interim evaluation to frame the evaluation elements and approaches to best demonstrate the achievement of Project outcomes in the future.
10.7 The Future
The evaluation has identified some key factors influencing workforce development in the NT Aboriginal and Torres Strait Islander Aged Care Sector and highlighted the complexity of delivering services in the NT. The evaluators have summarised and pictorially depicted the key influences, inputs and outputs affecting the provision of aged care services that have been identified through the conduct of this evaluation and their knowledge and experience of the sector. As described earlier in 10.3.1, responsibility for these key factors is not solely in the domain or influence of the Workforce Development Projects, but it is important to give these factors consideration when seeking to understand the impacts of these Projects. These key factors are depicted in Figure 10.1. This diagram identifies that:- The Aboriginal and Torres Strait Islander community aged care workforce, clients and their family and communities are key inputs into the ongoing development of the workforce and improved quality of care outcomes
- Funding providers provide key inputs in the form of accountability and reporting structures, funds, Standards, equipment and facilities, information and training and development for community aged care service providers. It is anticipated that funding providers, through the accountability and reporting frameworks, the implementation of the Community Care Common Standards and through the learnings from the Workforce Development Projects will be able to further monitor and support services to meet their contracted outputs
- The Workforce Development Projects build onto the existing inputs to create real jobs and to enhance workforce skills through the provision of training, support, information and resources to facilitate the training
- It is hoped that the community aged care service providers will fully utilise these inputs, with the aim of improving their service delivery outputs by identifying eligible clients, identifying care needs, providing resources to provide care and services, build the capacity of their services to increase the scope of services, implement human resource management systems and further develop links with primary health care services in their communities
- It is envisaged that these inputs and the systems in place to support the community aged care service providers will, in due course, result in improved workforce outputs (capacity to provide community aged care services, a sustainable workforce and suitably qualified workers) and improved quality of care outputs (community aged care clients receiving care to meet their assessed needs, compliance with funding and program requirements and the Community Care Common Standards)
- An ongoing evaluation framework that includes ongoing measures of workforce sustainability, the impact of training, impacts of developed resources, improvement in the quality of care for Aboriginal and Torres Strait Islander people in the NT and an assessment of RTO training delivery underpins the inputs and outputs. The evaluation has gathered baseline information on the initial implementation of the Projects and could be built upon to understand the ongoing impacts of the Projects. In the context of the post NTER, and National Partnership targets to close the gap in unemployment between Indigenous and non-Indigenous Australians, the following key questions could be addressed through an ongoing evaluation:
- What is the history of this workforce and what are the legacies that the implementation of these Projects needs to consider?
- What is the social and cultural environment in communities of the NT, and how has this impacted on the implementation of the Projects?
- What does building capacity and sustainability mean for this workforce, and how can this be achieved?
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Figure 10.1: Key Factors Influencing Workforce Development in the NT Aboriginal and Torres Strait Islander Aged Care Sector
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101. See 3.1.1 Context
102. See 4.3.11 Qualifications in Health/Aged Care
103. Department of Health and Ageing 2010 op cit
104. These are further discussed in Section 5: Evaluation Element 2: Northern Territory Resources Project