Evaluation of the NT MOS projects
Outreach service
Up to Closing the Gap: Northern Territory
MOS Plus provides a suite of therapeutic services addressing trauma from abuse and neglect to children under 18 years of age, and their families in remote Indigenous communities of the NT.
It is an outreach service model (fly or drive in/out) with staff based in Darwin and Alice Springs. Currently services are provided by two staff teams: Top End/Katherine based in Darwin; and Central Australia/Barkly based in Alice Springs. Outreach staff comprise a mix of Counsellors together with Aboriginal Therapeutic Resource officers (ATROs).
There were differing views in relation to an outreach service model, particularly for a counselling and support service in the sensitive area of trauma related to child abuse and neglect.
Literature reviewed, too, revealed mixed views about the 'fly in/fly out' model, because the service it provides is often unreliable (due to difficulties in attracting and retaining workers, the large areas serviced and transport issues, particularly in the wet season - as discussed).
The literature further suggests that the effectiveness of an outreach model can be increased where service providers work collaboratively, and as a means to improve service provision. One example, such as outreach services sharing transport in and out, causes less disruption to communities as it allowed a number of services to be accessed at the same time and also enhanced privacy around which services were being accessed. This approach can also help establish multi entry point approaches both for the service providers into the community, and for the community in being able to access services. Again, the literature notes whilst co-operation and networking with other service providers was productive, establishing productive working relationships also often took time. 32
A number of stakeholders were not supportive of a service outreach model, particularly one delivered centrally across such a high number of communities. The concerns mainly related to the capacity of the service to visit regularly enough to enable timely, safe therapeutic interventions. Other stakeholders stressed the importance of the service being delivered and provided within the context of the region and its communities (as discussed earlier in this Report) - not 'remotely'.
Others acknowledged the 'realities' of the infrastructure in the NT, and spoke of the characteristics of a successful fly in/fly out service model. These included developing a rapport with the community through consistent contact, not just in times of crisis or referral, and gaining an understanding of how the community works in terms of the 'multi layers' of with whom to speak, about what, in community.
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Others interviewed spoke of some of the benefits of an 'outside' visiting service in remote communities, which can be so isolated that it is entirely kinship groups. The potential for the service to create trusted relationships outside the family group was seen as a way to build resilience and capacity within the child and his/her networks.
Many interviewed spoke of the need for an outreach service to work collaboratively and to be locally supported. This was identified as a means of ensuring a MOS Plus 'service imprint', and building capacity within communities through linking more closely with local Aboriginal community workers, existing services and service developments such as regionally focused primary health care. This was also suggested as a strategy to ensure (regionally appropriate) cultural safety in service engagement and provision.
Such an approach is also supported by the literature reviewed. Santhanam (2005) notes that having an Aboriginal worker as part of the 'fly in/fly out' team [such as the MOS Plus ATRO] was seen as a critical factor for providing a user friendly practice, and helped to engage the community. Further, that the 'fly in/fly out' model works most effectively if it is supported by a locally based Aboriginal support worker (such as an Aboriginal Liaison Worker, as discussed) in the community who can provide appropriate ongoing support to clients, some community development work, as well as providing support to the [MOS Plus] specialist flying in and out. 33
Research literature also notes that effective programs need to build the capacity of local communities in order to become sustainable, and that capacity building needs to occur at the individual, organisation and community level. An example of a remote area child and youth mental health program was cited as a program which over four years had built most capacity within the service context through workforce development and improving support structures. This resulted in increased capacity to deliver services and engage with community, but had not made a measureable impact on community outcomes at that stage. This is a further example of the time required to establish knowledge, trust and traction in service development and provision.
It was further noted that mentoring local Aboriginal support workers (such as Aboriginal Liaison Workers in community, in terms of the MOS Plus service) was used in the Communities for Children program as a way of helping local people build skills and confidence. 34
Findings
- The challenge for a new outreach service is to leave a 'service imprint' between service visits, and in the context of changing staff personnel both within the MOS Plus service team and in local organisations and key contacts in community.
- Continuity and regularity of service provision is required to enhance knowledge and understanding of the MOS Plus suite of services by local organisations and community members.
Footnotes
32 Santhanam, 2005; Flaxman et al, 2009. Appendix D: Literature Review
33 Appendix D: Literature Review
34 Appendix D: Literature Review