Evaluation of the Bringing them home and Indigenous mental health programs

Executive Summary

Up to Bringing Them Home

prev page| TOC |next page

The Office for Aboriginal and Torres Strait Islander Health (OATSIH) within the Department of Health and Ageing (DoHA) commissioned Urbis Keys Young to conduct a comprehensive evaluation of the Bringing Them Home (BTH) and Indigenous Mental Health Programs. The evaluation covers four programs:

• The Link-Up Program, formally known as the Access to Effective Family Tracing and Reunion Services Program. This program provides a national network of services supporting and assisting Aboriginal people affected by past removal policies in tracing their genealogy and family history and potentially reuniting them with their families.
• The Bringing Them Home (BTH) Program, which provides funding for BTH Counsellor positions in Aboriginal Community Controlled Health Services (ACCHSs) around Australia to provide counselling to individuals, families and communities affected by past practices regarding the forced removal of children from Aboriginal families.
• The Social and Emotional Wellbeing (SEWB) Regional Centre (RC) Program, which funds SEWB RCs around Australia to provide professional support to Link-Up and BTH staff as well as other workers, especially mental health workers, to develop, deliver and purchase training, and to conduct activities to support this including developing cross-sector linkages and maintaining information systems.
• The Mental Health Program, which funds Mental Health Service Delivery Projects in ACCHSs nationally to develop and evaluate culturally appropriate approaches to mental health service delivery.

Definitions
Methodology
Key findings
Issues related to the four programs
Likely future demand
Good practice principles

Definitions

In this report:

• The term 'Stolen Generations' is used to refer to Aboriginal and Torres Strait Islander peoples affected by past government removal policies and practices. The plural 'Generations' is used to draw attention to the trans-generational impacts of past removal practices.
• A distinction is made between first generation members of the Stolen Generations (those directly removed) and second, third, fourth etc generation members (descendants of the first generation members).
• The term ‘Aboriginal’ is used to refer to both Aboriginal and Torres Strait Islander peoples. Although the programs cover both these peoples, forcible removal practices in Australia were primarily targeted to Aboriginal peoples.

Top of page

Methodology

The methodology for the evaluation included seven key components:

• Fieldwork to 15 locations around Australia, covering six States and Territories: Sydney and Taree in NSW; Brisbane and Rockhampton in Queensland; Perth, Broome, Albany and Kununurra in WA; Darwin, Alice Springs and Katherine in NT; Adelaide and Port Augusta in SA; and Melbourne and Shepparton in Victoria. The visits included consultations with staff of the services and other stakeholders (both Aboriginal and non-Aboriginal) in all locations. In addition consultations were conducted with a total of 49 clients in six locations, and 40 Stolen Generations members (including both clients and non-clients of the services) in five locations.
• Telephone interviews with 33 key informants. These informants included: people in fieldwork locations who were unable to attend the consultations on the field visit; and those suggested by OATSIH, the Reference Group established to guide the evaluation, the National Sorry Day Committee and other key informants. A key priority was stakeholders located in places which were not visited for the fieldwork.
• Written submissions – a total of 16 submissions were received, mostly from record-keeping/searching agencies.
• A survey in relation to the Mental Health Service Delivery Projects – this was a short pro-forma of questions distributed by OATSIH to its State offices. A response was received in relation to 11 of the 19 projects.
• Literature review – to identify current and emerging issues, policies and approaches to meeting the mental health and SEWB needs of Indigenous peoples who have been affected by dispossession, forced removal from families and associated grief, trauma and loss. This was to include identifying best practice models and possible alternative service delivery models for consideration.
• Program data on the Link-Up and BTH Programs – this was provided by OATSIH to the consultants, drawing on data provided to OATSIH as part of the services’ annual reporting requirements.
• A Communications Strategy, which was developed and implemented by specialist Aboriginal communications firm Gavin Jones Communications (GJC) in consultation with the evaluation team and OATSIH. This included various media activities and establishment of a website. Part A of the Strategy informed key stakeholders and community members about the evaluation and how they could contribute to it, and Part B of the Strategy will be conducted after the public release of this report to DoHA to publicise the findings of the evaluation. This will include a short community summary report of the key findings of the evaluation, which will be available on the internet.
  The evaluation was conducted under the guidance of a Reference Group established by OATSIH for this purpose. The Reference Group comprised representatives of key stakeholders and experts on Aboriginal SEWB, most of whom were Aboriginal.

Top of page

Key findings

The key findings of the evaluation are as follows.

Key achievements

There have been four main achievements of the programs:

• Link-Up and BTH services have provided services to a large number of Aboriginal clients nationally.
• The Link-Up and BTH and Programs and Mental Health Service Delivery Projects have provided services to many Aboriginal people who are unlikely to have received services otherwise.
• The programs have generally provided services in a culturally appropriate manner. This includes being delivered in ways that are generally consistent with the National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013 and the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Social and Emotional Well Being 2004-2009.
• There are generally high levels of client satisfaction and positive outcomes for clients of Link-Up and BTH services and the Mental Health Service Delivery Projects. This is not the case for a number of the SEWB RCs.

Key limitations of the programs

There have been four key limitations of the programs:

• Lack of focus on the first generation Stolen Generations members – the majority of clients of both the Link-Up and BTH programs are second and subsequent generation members, and conversely, only a minority of clients are first generation. While some services do proactively target first generation members, most do not. There needs to be much greater focus on the needs of first generation members.
• A significant and undesirable level of variation in the skills and qualifications of staff in the Link-Up and (particularly) the BTH Programs. In addition program staff have had variable, and often insufficient, access to training and professional support opportunities (eg professional supervision for BTH Counsellors) – even though workforce support is a key role of SEWB RCs. As a result of these and other factors, staff burnout and turnover have been significant problems for the programs.
• A lack of national consistency in service delivery for all four programs, due to major variability in the understanding of and implementation of the programs and the lack of adequate national guidelines.
• Limited geographical coverage of the programs. This is because services covering large geographical areas tend to focus primarily on clients in their immediate vicinity, since such clients provide more demand than the services can meet. Most BTH and Link-Up services (with some exceptions) do very little outreach work – this disproportionately impacts on first generation Stolen Generations members since they tend to live in rural and remote areas. It therefore appears likely that the geographical coverage of the programs is far less in practice than in theory considering the official boundaries covered by the services.

Management and administrative issues

• The management of the programs by the State/Territory OATSIH offices (who have responsibility for day-to-day management) has worked moderately well. The relationships that State OATSIH office staff develop with the services appear to be critical to the effectiveness of service delivery. However, the quality of these relationships (and the frequency of contact) varies from one location to another, from good through to poor. Tighter contractual and reporting mechanisms are required.
• Management of the programs by the funded services has been conducted well or reasonably well in most instances.
• There are both advantages and disadvantages to locating BTH services in ACCHSs. The advantages include that ACCHSs are well-established and known organisations in the Aboriginal community, and location within them promotes a holistic approach to health incorporating both physical and mental health. Disadvantages include, for example: variable (and in some instances inadequate) understanding of the roles and responsibilities of BTH Counsellors; pressure on the services to provide general Aboriginal SEWB services to the whole Aboriginal community rather than a targeted program for Stolen Generations members due to the high level of unmet need for these services; and some ACCHSs are using BTH resources for other activities (eg retaining quite large percentages of BTH funds to cover administrative overheads).
• Little attention has been give to proactive promotion of the programs by most of the funded services. Most services largely respond reactively to clients who approach them.
• Coordination with other programs and services – has been poor in relation to coordination between the Link-Up and BTH Programs for many of the services. Close coordination is critical for clients of both programs. Coordination of the funded services with other external agencies, programs and services is also critical, and most services have conducted this liaison either very well or moderately well. Of the State-level programs, liaison with mainstream mental health programs run by State health departments was regarded as the most critical (particularly the BTH Program). In practice although many BTH services have close liaison with agencies of this nature, others do not.
• Data management – there have been significant problems with the Foxtrot data system for the Link-Up services, which is regarded as cumbersome and not very user-friendly. More regular training is also required.
• Evaluation and monitoring – most (but not all) of the services have done relatively little in the way of evaluation and monitoring beyond meeting the formal reporting requirements to OATSIH and participating in the present evaluation and some State-level evaluations.

Top of page

Issues related to the four programs

Link-Up Service

A key challenge for Link-Ups relates to accessing records. Some Link-Ups have experienced considerable barriers in accessing records from government and non-government organisations. Where formal protocols have been established between Link-Ups and record-keeping agencies, this has made accessing of records much easier, more efficient and cheaper.

BTH Program

In order to implement the BTH Program effectively, it is critical that services be offered in a broad range of ways which extend beyond the mainstream clinical counselling model. Examples include:

• offering group activities (including in community settings eg barbecues and fishing trips)
• adopting a very flexible approach to service delivery eg BTH Counsellors being available at short notice, and clients being able to ‘drop in’ to the service on an informal basis
• promoting contact with and development of good relationships with Stolen Generations organisations, including attending or complementing their activities as appropriate.

SEWB RCs

To date the performance by SEWB RCs of their roles has varied considerably. Most have focused on only one of their four core roles (curriculum development and training), and have not given enough attention to their other three roles (training needs assessments, provision of support to the health workforce in terms of professional supervision etc and development of cross-sector linkages). Further guidance is required in relation to SEWB RCs’ roles, given the very variable understanding of this between Centres.

Mental Health Service Delivery Projects

Very limited feedback was available on the Mental Health Service Delivery Projects beyond some of the projects themselves and a small number of clients. The main achievements of the projects have included:

• high levels of client satisfaction and positive outcomes
• culturally appropriate service delivery
• conducting activities which contribute to community capacity building.

The main limitations identified in relation to these projects is that they have:

• long waiting lists, and are not always able to respond to Stolen Generations members who approach the service
• limited physical access due to transport and other difficulties, and limited provision of outreach services
• limited capacity to respond to clients’ full range of needs.

Top of page

Likely future demand

Future demand for each of the programs is likely to at least stay the same, or possibly to increase. Some key factors which could potentially increase the demand include more proactive marketing of the programs and targeting first generation members in particular, and BTH organisations providing services to meet the needs of a wider range of Stolen Generations members. Increasing public attention to Stolen Generations issues could also have an impact in some jurisdictions. However, demand for BTH services could potentially decrease if there were other general Aboriginal SEWB services available, and the services were better directed towards the intended target group of Stolen Generations members.

Literature review

The literature review found, amongst other things, that there is very little literature concerning best practice approaches to meeting the SEWB needs of Stolen Generations groups (and therefore little material of direct relevance to the aims of the literature review), and that the findings of the evaluation here are highly consistent with those of previous evaluations of the programs.
Top of page

Good Practice Principles

The report identifies ten Good Practice Principles (GPPs) throughout the report. Here they are grouped together in relation to particular topic areas. A number of these GPPs have funding implications which would need to be considered.

Location of services

GPP2

Link-Up, BTH and SEWB RC services should be located in Aboriginal community controlled organisations. Link-Up and BTH services should be located in premises which: provide confidentiality (both in terms of access to the service and within the service); are convenient to access, including by public transport; have a ‘community’ rather than ‘clinical’ feel; and are not near places with negative associations for Aboriginal people.

Service delivery issues

GPP1

Link-Up, BTH and SEWB RC services should provide regular outreach services to clients to ensure that they provide an adequate service to their whole catchment area. First generation members should be given priority access to outreach services by Link-Up and BTH services.

GPP7

In most instances, Aboriginal clients prefer to see an Aboriginal BTH Counsellor. In some instances this may not be possible, or clients may prefer to see a non-Aboriginal BTH Counsellor. Where possible, client preferences should be accommodated. Likewise, clients should also have a choice of a male or female BTH Counsellor, as appropriate.

GPP10

BTH services should adopt a flexible approach to service delivery that extends beyond the mainstream clinical counselling model. This includes conducting group activities in community settings, encouraging clients to drop into the service on an informal basis, being available at short notice, and offering services on an outreach basis. BTH services should liaise closely with Stolen Generations organisations to ensure that services meet the needs of these groups’ members.

Inter-agency relationships

GPP4

All Link-Up and BTH services should establish protocols for referral between the two programs. All new Link-Up clients should be immediately offered the option of referral to a BTH Counsellor by their Link-Up service. Where new clients decline this, Link-Up services should remind them of this option throughout the process leading up to and including their reunion. All clients participating in a reunion should be offered the opportunity to have a BTH Counsellor attend the reunion, and to have post-reunion counselling.

GPP5

Link-Up and BTH services should develop and maintain close working relationships with all relevant Commonwealth and State Government, and non-government, programs and services. A particular priority for BTH services is mainstream mental health services.

Staff support

GPP8

All BTH and Link-Up staff should be given access to and participate in appropriate training on a regular basis.

GPP9

All BTH Counsellors should have access to regular supervision by a qualified mental health professional, either within their team or through an external organisation (on either a one-to-one or team basis).

Activities to complement service delivery

GPP3

Link-Up and BTH services should conduct regular awareness-raising activities in their communities to ensure the existence and nature of the program is well-known in their entire catchment area.

GPP6

All services funded under the BTH, Link-Up, SEWB RC and Mental Health Programs should conduct regular evaluation and monitoring activities using an ‘action research’ model whereby evaluation findings are used to inform service delivery on an ongoing basis.

Recommendations for suggested future directions

The report makes a number of recommendations for suggested future directions of the programs. Many of these have funding implications that would need to be considered.
The key areas in which recommendations are made include:

• Ensuring Link-Up and BTH services have a stronger focus on first generation Stolen Generations members, through:
  • services being required to record and report on the Stolen Generations status of clients
  • proactively seeking out and tailoring services to meet the needs of first generation members; this work, in particular, is likely to require additional resources.
• Actions to address workforce issues, including:
  • requiring minimum skill levels for Link-Up and BTH workers
  • actions to improve the pool of potential workers (eg through establishing scholarships)
  • actions to ensure BTH and Link-Up workers have access to regular training and professional support – especially through strengthening the role of SEWB RCs.
• Developing national guidelines for all four programs.
• Extending the geographical reach of the programs – for instance, through requiring services to conduct a certain amount of outreach work, or exploring innovative models to provide services in locations which are further away from service outlets (eg brokerage).
• Improving the operation of Regional Centres – eg through requiring all SEWB RCs to:
  • be accredited as Registered Training Organisations (RTOs)
  • better meet the needs of Aboriginal SEWB workers located further away from the Centres (for instance, through providing more training on an outreach basis, and exploring alternative training delivery methods such as teleconferencing and web-based methods)
  • retaining one Centre each for Victoria, NSW, SA and the ACT, and two each for WA, NT and Queensland.
• Encouraging evaluation and good practice activities, through:
  • developing an Evaluation Framework and supporting manual
  • holding regular good practice forums
  • establishing a website for the programs.
• Providing additional funding for complementary programs ie
  • Additional SEWB workers in ACCHSs or a national Aboriginal SEWB program
  • re-establishing the Innovative Grants Program
  • providing funding for Stolen Generations groups.
• Enhancing coordination between Link-Up and BTH services.
• Improving processes for accessing records (eg through developing more protocols with record-keeping/searching agencies).
• Conducting further research on:
  • the trans-generational impacts of Stolen Generations experiences, and how these are similar to or different from the impacts on first generation members
  • the various groups of clients of the Link-Up and BTH Programs, and their needs in relation to the programs.

Top of page

prev page| TOC |next page