Evaluation of the Bringing them home and Indigenous mental health programs
7.2.4 Coordination with other programs and services
To operate effectively, the funded services need to liaise closely both with each other, and with external agencies, programs and services.
Coordination was regarded as particularly critical between the following funded programs: the SEWB RCs and Link-Up/BTH services (discussed in chapter 9) and the Link-Up and BTH services.
Coordination between the Link-Up and BTH ProgramsThe BTH standard contract recognises the importance of close liaison between these programs, in stating that clients referred by Link-Up are an important target group for the program, and requires the services to 'develop and maintain close working relationships' with a range of agencies including Link-Up services 'to facilitate smooth referral pathways and a coordinated approach to the provision of counselling and other mental health care'.
The consultations confirmed that close liaison between the Link-Up and BTH services is critical. All Link-Up clients should be offered the option of being referred to a BTH Counsellor as a matter of course immediately upon becoming a Link-Up client. Where new clients decline this, they should be reminded of this option throughout the process leading up to and including their reunion. This allows the Link-Up client to be provided with support as required from a BTH Counsellor with whom they have an ongoing relationship, and preferably including attendance by the counsellor at the reunion. At the very least BTH Counsellors should provide post-reunion counselling.
The consultations indicated that this support for Link-Up clients is of vital importance, particularly given the often protracted, complex, emotionally draining, uncertain and unpredictable nature of the process leading up to identification of family members and/or a reunion.
It took me 15 years to find my mother, who was in the US. They flew me over with a [Link-Up] caseworker, but both me and my caseworker were traumatised. You need a counsellor to debrief after coming back from a reunion.
However, the consultations indicated that in practice there often is not close liaison between Link-Up and BTH services, and only a minority of Link-Up services routinely give clients the option of referral to a BTH Counsellor at the beginning of the Link-Up process, who then works with clients up to and including any reunion. Most of the Link-Up clients consulted for the evaluation had not been referred to a BTH Counsellor (and vice versa), and most were unaware of their existence.
A key historical factor said to have contributed to the poor liaison between the two programs is that up until 2003 the two services were managed by different government agencies: ATSIC in the case of Link-Up, and OATSIH in the case of the BTH Program. Administration of the Link-Up Program transferred to DoHA on 1 July 2004.
There are several undesirable outcomes of the insufficient coordination between the Link-Up and BTH services:
- Link-Up clients can fail to receive access to BTH Counsellors. A number of the Link-Up clients consulted who were not connected to a BTH Counsellor would have liked this option. As noted in Chapter 5, this was one of the few key areas of client dissatisfaction with the Link-Up services.
- BTH clients can fail to access Link-Up services where this would be desirable.
- Both services can end up fulfilling some of each other’s role.
- Link-Up staff can find themselves providing de facto counselling services to their clients. This is beyond their official role, and staff may often not have adequate skills or qualifications to conduct this activity. This in turn can contribute to staff burn-out.
- Some of the BTH services with poor connections to Link-Up services conduct some activities which are part of Link-Up's function, particularly relating to record searches. This finding is reinforced by the fact that the Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) reports receiving requests from BTH services for family tracing training (which the Unit is unable to accommodate since its role is to assist Link-Up workers only). Therefore BTH services are using some of their staff resources to conduct Link-Up activities, at the expense of BTH Program activities. This illustrates that there is a lack of clarity and blurring of boundaries around the roles of the BTH Counsellors and Link-Up workers.Top of page
- The two services were co-located and run by the same auspice organisation eg in Adelaide and Albany.
- There were formal local protocols around this issue between the two services. (Note that the MoU between National Link-Up Services provides a standard protocol for referrals between Link-Ups, but not between Link-Up and BTH services.)
Those locations where liaison between the Link-Up and BTH Programs was particularly weak tended to include those where:
- There were poor relationships more generally between the two auspice organisations running the two programs due to broader Aboriginal community politics.
- There was not a Link-Up service in the same geographical location as the BTH service.
- 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.
Coordination with external agencies, programs and servicesCoordination by the funded programs with other external agencies, programs and services, including mainstream mental health services is also critical, as required by the two National Strategic Frameworks (Health and SEWB). The standard BTH contract recognises this, in requiring that the services 'develop and maintain close working relationships with relevant services including mainstream mental health services'.
From the consultations it appeared that overall most services liaise with other relevant agencies, services or programs either very well or moderately well. However, it was also apparent that there were some marked variations in the effectiveness of these processes between different services.
There were some types of agencies and services where the effectiveness of liaison was particularly variable. This included government and non-government record-keeping agencies (discussed in more detail in chapter 9). The other main area was programs and services run by Commonwealth and State Government agencies which address the needs of this target group.
Relatively few services mentioned having contact with Commonwealth Government agencies or programs (other than record-keeping agencies), but the agency most frequently mentioned was FaCSIA, which runs programs concerning parenting, families and Aboriginal communities.
There tended to be more contact with State Government agencies dealing with related target groups – most frequently the State health departments (including physical and mental health and substance abuse services), and child welfare departments. Other State departments included justice-related agencies and Privacy Commissioners.
Mainstream mental health services run by the State health departments were the State programs regarded as those most relevant to the target groups for these programs (particularly the BTH Program), and there was agreement by most staff and external stakeholders that BTH services should be liaising closely with these. (This is particularly critical for BTH services which do not have staff with mental health qualifications, since they can, or should be, more dependent on referrals to mainstream mental health services.)
However in practice, although many BTH services have close links with mainstream mental health agencies (in some instances facilitated by formal protocols), others do not, including some services which do not appear to regard this as critical to their role.
- GPP 5:
- 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.