Evaluation of the Bringing them home and Indigenous mental health programs

6.3 A lack of national consistency in service delivery

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There is clearly a need for some flexibility in program implementation between locations to allow services to tailor their responses to suit their location and local communities. However, the third key limitation of the program is the lack of national consistency in service delivery in all of the programs, resulting in an undesirable level of variation for a national program of this nature. This variation is evident at the State, Territory, regional and local levels. Many of those consulted expressed concern about this, particularly in relation to the BTH and SEWB RC Programs. This inconsistency flows from two factors. One is major variability in the understanding of and implementation of the programs. The other is the lack of adequate national guidelines. Of the four programs, only the Link-Up Program has any national guidelines at all, and some feel these are poorly written because they are ambiguous and open to multiple interpretations.

The lack of national program guidelines for the four programs has hampered the ability of services to meet their core responsibilities under each program and to effectively meet the needs of Stolen Generations members.

The consultations indicated that many managers and workers are not fully aware of what is required of them under the BTH and SEWB RC Programs, and have done the best they could with little direction at the national or State level. A number of examples of this variation are discussed elsewhere in this report and include:

• marked variations in position descriptions and salary levels, particularly for BTH Counsellors, which are set by the employing ACCHSs (see chapter 8)
• lack of clarity by some auspice organisations and workers about the intended nature of the Programs, particularly the BTH Program (see chapter 7)
• marked differences in the nature, range and impact of the activities undertaken by SEWB RCs, including that many have predominantly focused on one of their core objectives (developing curricula and delivering training) rather than their other three roles (developing information systems, providing workforce support and promoting linkages) (see chapter 9).

The consultations indicate that both the funded services and OATSIH have contributed to the undesirable level of variation across the programs. For instance on the services’ side, there are a number of ways in which the BTH services are not meeting what would appear to be clear contractual requirements, or only meeting them to a variable extent. Examples include the requirements that:

• Clients referred by Link-Up are to be an important target group for the program, and that services develop and maintain close working relationships with other relevant services including mainstream mental health services and Link-Up. As discussed in chapter 9, the development of linkages with Link-Up and mainstream health agencies is highly variable.
• Staff receive professional supervision and debriefing from a qualified mental health professional. As discussed in chapter 8 this is not happening for many BTH Counsellors.

From OATSIH’s side, it would appear that there has been insufficient guidance and direction from OATSIH about program implementation in terms of:

• The contractual conditions set down for the services – some could be more detailed, and others added.
• National guidelines – as set out in chapter 3, only Link-Up has any national guidelines, and these are not very detailed and are poorly worded, and the BTH Program and SEWB RCs have no specific guidelines.
• Ongoing monitoring by OATSIH – as discussed in chapter 7, there are different approaches to program management by the State/Territory offices, and more active engagement by the State OATSIH offices overall would be beneficial.
• Mechanisms to share/discuss/document/promote good practice and other aspects of service delivery at a State and national level – this is particularly important given that many service providers are in a relatively early stage of program implementation, and the Aboriginal SEWB field is a comparatively new, under-developed and under-resourced one.

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