Evaluation of the Bringing them home and Indigenous mental health programs

1.11 Findings of the previous evaluations of the Link-Up, BTH and SEWB RC Programs

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There have been a number of major previous evaluations/reviews of and reports on the Link-Up, BTH and SEWB RC Programs. These include:

• overall evaluations or surveys of the government's responses to the BTH Report, including those by, or for:
  • government organisations eg a major inquiry by the Senate Legal and Constitutional Committee (SLCC 2000), and an evaluation by the Ministerial Council of Aboriginal and Torres Strait Islander Affairs (MCATSIA) (Success Work 2003)
  • Stolen Generations organisations eg a survey of progress as at November 2002 by the NSDC (O'Brien & Bond 2002), and a discussion paper by the Central Australian Stolen Generations and Families Aboriginal Corporation (CASG&FAC, 2002)
• in relation to Link-Up, evaluations at both a national level (KPMG 1999b; ATSIS 2003a) and a State/Territory level in:
  • NT (Bentleys MRI nd)
  • WA as part of a review of the BSF Program (OTS Management 2005)
  • NSW, in addition to the BTH services, as part of a review of SEWB services in that State (IPS 2006)
• in relation to the Link-Up, BTH and SEWB RC Programs, a report on the national BTH Workshops held in 2004 (Kuracca Consultancy nd)
• in relation to the SEWB RCs, an evaluation of the Emotional and Social Well Being (Mental Health) Action Plan, which includes the SEWB RCs (Urbis Keys Young 2001) and a report on a national SEWB RC Workshop held in 2004 (Kuracca Consultancy 2005).

This sub-section briefly identifies the key lessons from the above reports of greatest relevance to this evaluation.

1.11.1 Valuable services with high levels of satisfaction

The national and State-level evaluations of the Link-Up and BTH programs have concluded that overall they are providing a valuable and useful service (Bentleys MRI nd, p21).

Where feedback from clients has been available, there have generally been high levels of client satisfaction with the services provided (ATSIS 2003a).

1.11.2 Good practice

Several reports have examined good practice in relation to the Link-Up and/or BTH services (Success Works 2003, pp59-60, 611-62; KPMG 1999b; IPS 2006). The key themes in relation to this have included:

• Clear directions, planning, leadership and vision – a clearly defined organisational vision, encompassing planning and direction (Success Works 2003).
• An integrated holistic approach to service delivery, which meets client needs through a variety of available services (IPS 2006; Success Works 2003).
• Flexibility and responsiveness to clients – encouraging ways of working which suit the client group, incorporate a culturally appropriate manner of working, and build trust by providing a physically and emotionally safe environment (Success Works 2003).
• Appropriate identification of client base without exceeding the boundaries of service provision (IPS 2006).
• Integrated teamwork by a highly skilled workforce with clinical (in the case of BTH workers) and cultural competence. This includes the provision of training opportunities, support, supervision and opportunities for debriefing among colleagues and as part of professional supervision (Success Works 2003).
• Established networks and a commitment to collaboration and partnerships with other key organisations (Success Works 2003). This includes effective referral networks with both Aboriginal and mainstream organisations (KPMG 1999b).
• Auspice agencies which are viable and sound – this includes having longer term viability, an ability to combine resources rather than funding dollar allocations, flexibility to meet the changing needs of the community (IPS 2006), and sound policies and procedures (Success Works 2003).
• Developing quality assurance and evaluation processes to ensure the services engage in an action research process of continually improving the services they provide (KPMG 1999b; see also Success Works 2003). Top of page

1.11.3 Limitations of the programs

The main limitations of the Link-Up and BTH Programs identified in previous reports are that:

• The programs are not adequately meeting the needs of the Stolen Generations – this has been the conclusion of both government reports (SLCC 2000; Success Works 2003) and Stolen Generations organisations (O'Brien & Bond 2002; CASG&FAC 2002) which have assessed the government response to the BTH Report.
• The funded services have targeted the whole Aboriginal community rather than Stolen Generations members (SLCC 2000, p281; O'Brien & Bond 2002, p15).
• There has been inadequate consultation by OATSIH or the services with Stolen Generations members to enable them to have sufficient input into the nature of the services provided (CASG&FAC 2002, p20), especially during the establishment and operation of the programs.
• Stolen Generations members are dissatisfied with the services provided for various reasons, including: not finding the counselling services culturally appropriate (IPS 2006, p21); not wanting to access Link-Up services which are co-located with mental services since 'they have no wish to be stigmatised as people with mental problems' (O'Brien & Bond 2002, p33); and being reluctant to access support from agencies associated with government (Success Works 2003, p16). One of the factors prompting the recent NSW review was an awareness that 'many Stolen Generations people were choosing to access support from each other rather than through the funded BTH programs' (IPS 2006, p16).
• Services have predominantly been provided to second and subsequent generations of the Stolen Generations, rather than the first generation (Bentleys MRI nd, p16). The NSDC reports that provision of any services to second and subsequent generations is a 'contentious issue in several States' (ie amongst first generation members) (O'Brien & Bond 2002, p15).
• BTH resources have sometimes been redirected into other activities conducted by the auspice organisations (OTS 2005, p6; Bentleys MRI nd, p84-85).
• The services have generally adopted a reactive rather than proactive and strategic approach to service delivery (OTS 2005, p4) – for example, mostly responding to clients who approach the service (Bentleys MRI nd, p16).
• Insufficient promotion of the programs in the Aboriginal community and more broadly, which is connected to the factor above (Success Works 2003, p65; IPS 2006, p22).
• The need for stronger links with other agencies and service providers, including at a Commonwealth and State government level (Success Works 2003, pvi). For example a survey of major organisations for the evaluation of the WA BSF Program found that 70% of respondents were not aware of the BSF services in their region. There was also some confusion about the role and potential benefits of the program for clients (OTS 2005, p5, 8).
• The lack of national service standards for the programs, particularly in relation to Link-Up services (OTS 2005; ATSIS 2003a; KPMG 1999b, p9).
• Inadequate coordination between the programs, especially the BTH and Link-Up Programs (Bentleys MRI nd, p15; ATSIS 2003a) and the Link-Up/BTH and SEWB RC Programs (Kuracca Consultancy nd, p5).
• Workforce issues, including: variable skill and qualification levels of staff, with Indigenous staff being much less likely to have, for instance, formal mental health qualifications (IPS 2006, p18); problems with staff retention and turnover related to such issues as staff burnout, the stressful nature of the work, uncompetitive pay (Bentleys MRI nd, p87; see also IPS 2006, p19); variations in job descriptions (Kuracca Consultancy 2005, p5); and insufficient access to training and professional support (ATSIS 2003a, p101; Kuracca Consultancy nd, p5, 7; IPS 2006, p19).
• More outreach work is required by the services (ATSIS 2003a), including to areas where Stolen Generations members live (IPS 2006, p22; O'Brien & Bond 2002, p33).
• Difficulty engaging male clients (IPS 2006, p21).
• Lack of attention to evaluation and monitoring (eg OTS 2005, p8; Success Works 2003, pvi). The MCATSIA report recommended an overall evaluation framework be developed for BTH activities (Success Works 2003, p67).
• Difficulties experienced by Link-Up in accessing records. For example the MCATSIA evaluation recommended a national policy be developed to provide unhindered access to records (Success Works 2003, p19). Top of page

Previous reports examining the SEWB RCs have generally concluded that there are major limitations in how they are performing their roles (Urbis Keys Young 2001, ppiii-iv). This has included lack of clarity around their functions (Kuracca Consultancy nd, p8), and a failure to adequately meet the professional development needs of Link-Up and BTH workers (O'Brien & Bond 2002, p33; IPS 2006, p22).

1.11.4 Future demand

The ATSIS evaluation of Link-Up concluded that in Tasmania, most people who were going to access the Link-Up service had already done so, and it was time to move the service scope on to support the further needs of these people (ATSIS 2003a, p9). However no other reports examined by this review argued that the Link-Up or BTH services may have reached their logical conclusion.

Some reports have noted that it is difficult to estimate the potential demand for the Link-Up and BTH programs (in addition to the actual demand currently), but suggest that it may possibly be quite large:

• The 1999 national evaluation of Link-Up services recommended that outreach activities be funded for three years with a focus on identifying demand, and that a decision then be made as to whether to meet demand in regional areas by establishing a regional service in each State/Territory or providing outreach services (KPMG 1999a, pp85-86).
• The evaluation of the BSF program in WA concludes that there is likely to be a considerable level of potential demand (termed 'latent demand') from second and subsequent generations of the Stolen Generations, due to the larger number of generations affected and an increasing realisation by subsequent generations that they have passed on their own sense of pain at what happened to future generations (OTS 2005, p2).
• Surveys by the NSDC found that several thousand people, particularly in country and rural areas, would make use of Link-Up services if they could access them (O'Brien & Bond 2002, p33).

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