Evaluation of the Bringing them home and Indigenous mental health programs
5.3 The programs have generally provided services in a culturally appropriate manner
Table of contents
- Acknowledgements
- Study Team
- Glossary
- Executive Summary
1. Introduction- 2. Methodology
- 3 Overview of the four programs
- 4 Literature review
5 Key outcomes and achievements of the programs- 5.1 Link-Up and BTH services have provided services to a large number of Aboriginal clients
- 5.2 The Link-Up, BTH and SEWB RC Programs have provided services to many people who are unlikely to have received services otherwise
- 5.3 The programs have generally provided services in a culturally appropriate manner
- 5.4 A generally high level of client satisfaction and positive outcomes for clients of Link-Up and BTH services
- 6 Key limitations of the programs
- 7 Management and administrative issues
- 8. Workforce issues
- 9. Issues related to the four programs
- 10. Likely future demand
- 11. Conclusions and suggested future directions
- Appendix A: Stakeholders consulted
- Appendix B: Literature review
- References
A third major achievement is that overall the programs are providing services in a culturally appropriate manner.
Among other things the programs are generally delivering services in a way that is consistent with the two key National Strategic Frameworks (on Health and SEWB). This was the view of the fair number of service staff and OATSIH staff (and the very few external stakeholders) familiar enough with the Frameworks to be able to comment on this issue. (However, it should be noted that those consulted were only able to comment in general terms about this question, rather than in detail with reference to specific principles in the Frameworks.)
Nonetheless, this conclusion is also supported by the data gathered by the consultants as a whole for the evaluation. For example, the delivery of the services is consistent with the following key themes in the above Frameworks of greatest relevance to these programs:
- Cultural respect – ‘ensuring that the cultural diversity, rights, views, values and expectations of Aboriginal peoples are respected in the delivery of culturally appropriate health services’ (Australian Health Ministers’ Conference 2003, p3). Overall there is a strong emphasis in the services delivered on this cultural respect.
- Recognising and promoting Aboriginal concepts of holistic healing – a holistic healing approach is adopted to service delivery by the BTH services, recognising the inter-linked nature of problems for Stolen Generations members and other Aboriginal people, including that the impacts of Stolen Generations experiences can be complex, varied and direct or indirect.
- Promoting community control of primary health care services – almost all of the Link-Up and BTH services are located in Aboriginal community controlled organisations, including ACCHSs for the BTH services (exceptions include the Link-Up services in Lawson NSW and Brisbane, as these are stand-alone services, and the Link-Up and BTH service in Albany, WA, which is based in a Division of General Practice).
- Responding to grief, loss, anger, and Stolen Generations issues – this is the whole basis of the Link-Up and (particularly) BTH Programs, and a key component of the service delivery by Link-Up and BTH services. However, as discussed in chapter 6, there needs to be a stronger emphasis in the programs on Stolen Generations issues.
- Effective coordination of services with other agencies and planning processes, including facilitating improved access and responsiveness of mainstream mental health care for Aboriginal people. As discussed in chapter 7, the degree to which the BTH services have established links with other relevant agencies and structures (including mainstream mental health services) has varied considerably. Most of the services have links with various other agencies, but some could improve their coordination with other agencies, particularly State government programs and services, record-keeping agencies (for Link-Up) and mainstream mental health services.
- Ensuring staff with appropriate skills are recruited, retained and supported through ongoing training. As discussed in Chapter 8, there is an undesirably high level of variability in the skills and qualifications of staff in the programs (especially the BTH program), and access to ongoing training and support.
- Collecting, analysing and publishing data to evaluate programs in a way that enables comparison across jurisdictions and use of the data to improve service delivery. As discussed in chapter 7, there is generally little emphasis on evaluation within the programs beyond the formal reporting requirements to OATSIH.
In addition, whilst overall the Link-Up, BTH and SEWB RC Programs are providing services in a culturally appropriate manner, there is some variation in the effectiveness with which services have done this. For example, some BTH services have had greater success in establishing premises with a ‘community’ rather than ‘clinical’ feel (see chapter 7), developing strategies or programs to target Stolen Generations members, particularly first generation members (see chapter 6), and offering BTH services beyond the traditional clinical model of on-site one-to-one counselling (through activities such as group activities in community settings, narrative therapy approaches and outreach work) (see chapter 9).
It is also important to note that those consulted viewed the two national Frameworks referred to above as useful statements of agreed principle in relation to Aboriginal health and mental health/SEWB. However, they also regarded them as being of limited use in providing guidance on how to implement these precise programs in practice. The Frameworks therefore do not replace the need for more detailed national program guidelines for each of the programs (discussed further in chapter 6).