Evaluation of the NT MOS projects
Analysis and recommendations
Up to Closing the Gap: Northern Territory
Table of contents
An evolving service model
NT service sector context
Community engagement
Service focus
Staffing
Data management
An evolving service model
Based on the research and evidence considered for this evaluation, there is support for the key principles and characteristics of the MOS plus services, albeit there are some elements and approaches requiring further development and improvement. These principles are also supported by research literature, which finds that most clinicians working with children believe that therapeutic counselling needs to be ecologically based (i.e. in the local context) and involve family or carers where possible. O'Brien (2010) and Purdie et al (2010)2 also suggest that children and young people can be traumatised if support services are withdrawn suddenly.The MOS plus service is a relatively new and evolving service model. It requires time to engage with the sector and with communities, and to adapt and respond to service and community need.
Recommendation 1
That the MOS plus service is a new and evolving service model that should continue, to enable further development and refinement responsive to community and service needs and the changing primary health and community care environment in the Northern Territory.NT service sector context
MOS plus is also operating in an environment of change, including: the NT implementation of the "Growing them strong, together: Promoting the Safety and Wellbeing of the Northern Territory's Children" Report3 recommendations; and primary health care reforms, including regionalisation.Recommendation 2
That further development of the MOS plus services align with service planning and development in response to both the recommendations of the Growing them stronger, together Report and the primary health care reforms, to ensure an integrated family and children's services response in remote communities.Top of pageCommunity engagement
Cultural competence and respectful engagement in remote communities was considered by all stakeholders interviewed to be of equal or even greater importance than the provision of specialist counselling and support services. The complexity of communities, and the need to understand the local and regional context of each community, was also highlighted.(See recommendation 3 and recommendation 4)
There are 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.
In community the focus was on service continuity, consistency and regularity. These were highlighted by those interviewed as the key to successful service engagement in community. This was raised both in terms of the NT service provision history of services 'starting and stopping', and that it requires service continuity for people in the sector and in community to gain a knowledge and understanding of the support available.
The benefit of an outreach service in remote communities, which can be so isolated as to comprise entirely of kinship groups, was described as enhancing the capacity for confidential referrals for engagement and support by an 'external', objective specialist. A successful outreach service was described as one which worked collaboratively and was locally supported. This was identified as a means of ensuring a MOS plus 'service imprint', as well as a strategy to ensure (regionally appropriate) cultural safety in service engagement and provision.
(See recommendation 5 and recommendation 6)
Recommendation 3
That the MOS plus service model strengthen culturally safe practices by expanding service links with existing regional and community networks and groups to enhance both knowledge of the MOS plus service and to build upon established services and strategies.Recommendation 4
That the MOS plus service model strengthens its focus on strategic planning and targeting service engagement and intervention responsive to regional community and service need through the collaborative efforts of the respective Regional Team Managers and the Clinical Practice and Cultural Competence Advisers.Recommendation 5
That the MOS plus service model further develops culturally safe engagement approaches and continues as an outreach counselling and support service within community.Recommendation 6
That a regular, consistent service schedule that is informed by strengthened strategic planning and targeting of the MOS plus service at the regional and community level, is further developed with each community to maximise opportunities to align with key community and Regional events such as Council and network meetings.Top of page
Service focus
There is support from outreach service providers, local organisations and community members interviewed, for counselling and support service engagement with children in communities. This was with the stipulation that the child is engaged and supported within the context of the family.There are mixed views about the expansion of service scope from MOS to MOS plus. Many stakeholders interviewed were concerned the specialist area of child sexual assault counselling and support would be 'lost' in the expanded service scope. However, the 'initial assessment' data of MOS Projects' casework cases shows sexual assault was by far the most commonly identified underlying cause of trauma for clients referred to the service, over the period of the evaluation. The number of cases citing sexual assault has continued to grow in the period following the service scope expansion to MOS plus.
As an evolving service, stakeholders stressed the importance of service continuity to ensure an understanding and acceptance of the MOS plus suite of services in community. As the service develops further, there is the capacity to review the service in more depth, particularly in terms of the effectiveness of counselling interventions with children, adolescents and their families in community, in relation to all forms of abuse and neglect, including sexual assault.
The capacity to undertake such a review in the future should be enhanced by the recommended further development of the MOD data management system - in terms of both recording all categories of abuse identified during the counselling intervention (not just the presenting issue) and more expansive descriptors as to the outcomes of casework.
Reservations were raised by many stakeholders about the use of terminology such as abuse, sexual assault and neglect, as there are differing understandings in community of what these terms may mean. Trauma as a concept was more clearly understood and recognised by those interviewed in community, particularly Aboriginal Liaison Workers in local agencies and community members.
In community, the feedback indicated a need for a broader counselling and support service approach, encompassing trauma from any form of abuse or 'community life' experience. The intervention could then be tailored to the child and family's needs, from the suite of MOS plus services.
Recommendation 7
That the MOS plus service focus (inclusive of child sexual assault) is retained, and consideration is given to community-friendly terminology to promote the suite of support services available.Recommendation 8
That as the MOS plus service develops further, a review is undertaken to assess the effectiveness of counselling and support interventions with children, adolescents and their families in community in relation to all forms of abuse and neglect, including sexual assault. The scope of the review should be enhanced by further development of the MOD system in terms of both recording all categories of abuse identified during the counselling intervention and more expansive descriptors as to the outcomes of casework.Top of page
Staffing
There is support by both service organisations and community members for key aspects and principles of the MOS plus staffing model. Aligning Aboriginal and non-Aboriginal workers in the outreach staff team was considered crucial. An appropriate gender mix in the staffing profile was also highlighted to ensure cultural safety in both service engagement and capacity strengthening in community, particularly given the sensitivities of the service focus on children with trauma related to abuse and neglect.(See recommendation 9)
The current staffing model profile comprises a central management team providing leadership and professional guidance to outreach teams.
Currently there are two Regional Team Managers (RTMs) - Top End & Katherine; and Central Australia & Barkly. For a range of factors including, but not limited to the: geographic spread of communities; diversity of communities; need for 'local' cultural competence; need for fieldwork supervision and mentoring, and tailored professional development, there is a clear requirement to increase the number of RTMs to enable this all to occur effectively.
(See recommendation 10)
A principal advisor role in the critical area of cultural competence could provide leadership, expertise and mentoring for the Aboriginal Therapeutic Resource Officers (ATRO) in particular, and for all outreach staff. This would also offer a career path for Aboriginal staff in the MOS plus service.
(See recommendation 11)
The difficulties of recruitment and retention of staff in the NT is well documented. This impacts upon the location of the regional teams and the complexity of needing to balance employing highly skilled staff in the specialist area of therapeutic responses to child abuse and neglect, and staff who have experience in working with Indigenous people in remote communities.
The appropriate number of outreach staff would be further informed by the suggested expansion in the leadership and management team. The new and additional roles offer opportunities in terms of: staff retention and professional development; linking in with initiatives underway in community; and tailoring the service response to each community to maximise effectiveness and strengthen capacity in community (see Diagram).
There is an imperative to engage more effectively with Aboriginal Liaison Workers in the respective local organisations, and with Aboriginal Community Controlled Health Services (where they exist) to ascertain more clearly the strategies and strengths of networks and interventions already in place, and to add specialist value to supporting and strengthening those strategies.
To strengthen this further, it is suggested the MOS plus service creates an identified service link with the Aboriginal Liaison Worker from the most appropriate local or regional organisation for each community. Part of this person's role would then become the MOS plus key point of community contact, between scheduled visits of the outreach team.
This would: promote continuity of service; enhance understanding of the service supports available; provide a community friendly point of referral; strengthen capacity within the existing service networks in community; and encourage community ownership of both the issues contributing to trauma in community - and of the services.
(See recommendation 12)
The role of the ATRO requires greater clarity to reflect the important elements of the role in terms of: the cultural competence of the outreach staff team; cultural safety in all aspects of engagement with community; knowledge and understanding of the local community and the context for community engagement and service intervention approaches.
The ATRO also has an important function in ensuring the MOS plus service is known and understood in community, and in working together with the counsellor to ensure appropriate service engagement with community.
(See recommendation 13)
An opportunity for the ATROs to gain (further) qualifications or accreditation was raised by a number of stakeholders.
(See recommendation 14)
Top of page
Diagram: Proposed staffing model
Text version of Proposed staffing model
This diagram illustrates the proposed staffing model, with all staff either reporting directly to the Project Manager, or in the case of operational outreach staff (counsellors and Aboriginal Therapeutic Resource Officers), through one of four Regional Team Managers. Each Regional Team Manager is responsible for one of the four MOS Plus regions of Top End, Katherine, Barkly and Central Australia. There are a minimum of ten staff positions reporting directly to the Project Manager: the Principal Clinical Practice Advisor; the Principal Cultural Competence Advisor; two Challenging Behaviour Advisors; the Information Manager; the four Regional Team Managers and the Administration Support staff.Recommendation 9
That efforts are maintained to ensure a mix of Aboriginal and non Aboriginal staff are retained in the outreach service team, along with an appropriate gender mix, to enhance the cultural safety of service establishment and provision in community.Top of page
Recommendation 10
That the Regional Team Manager role is reviewed to enhance the focus on: strategic regional service networking, planning and development; and professional development and fieldwork supervision of outreach staff; and that the number of positions is increased.Recommendation 11
That a Principal Cultural Competence Advisor role is established within the MOS plus service management and leadership team to enhance culturally safe approaches and provide leadership, expertise and mentoring for all MOS plus outreach staff in the critical area of cultural competence, strengthen strategic planning and targeting of the service in regions and communities, and to provide a career path for Aboriginal staff.Recommendation 12
That a MOS plus community link/contact role is established within the most appropriate existing Aboriginal Liaison Worker position in the respective communities, to both strengthen the MOS plus service imprint within community and to provide a community and family friendly point of referral.Recommendation 13
That the role of the ATRO is reviewed to enhance the focus on imparting knowledge, understanding and acceptance of the MOS plus suite of services in community along with strengthening general community engagement and culturally safe approaches, and that consideration is given to a more community friendly title for this position to more accurately describe the role.Recommendation 14
That opportunities are explored to enable ATROs within the MOS service to gain (further) qualifications or accreditation recognising their skill, experience and pivotal role in the service. This should align with the recommendations in the Growing them stronger, together Report in relation to the development of workforce strategy.Data management
The effectiveness of the MOD database system in capturing outputs and appropriate outcome measures in an evolving and responsive service model, will be critical. The suggested review of elements of the MOD database should enable improvements which better capture data relating to all activities and service outcomes, to better inform service development, resource allocation and efficiency measures.Suggested improvements to the database are discussed in Chapter 4, along with a number of recommendations as listed below:
Recommendation 15
That MOD (or any subsequent data collection tool) records the following with regard to community meetings:- purpose of the meeting (pre-coded response options)
- whether the meeting is formal (pre-arranged) or informal
- with groups or individuals
- number of attendees
- outcome of the meeting (pre-coded response options).
Recommendation 16
That MOD (or any subsequent data collection tool) be revised to capture:- all referrals to the service
- all referral sources
- the nature of the referral follow up (pre-coded response options. (eg telephone, meeting)
- groups of individuals with whom follow up is conducted
- whether the referral resulted in a case being open
- the reason for a case not being opened (pre-coded response options).
Recommendation 17
That all categories of 'abuse and neglect' addressed during the casework intervention are recorded, and that this information can be accessed in an efficient way.Recommendation 18
That the reasons for closing a case and the outcomes of casework are recorded by more expansive descriptors (pre-coded response options).Recommendation 19
That the 90 day data rule is reviewed to determine its suitability for remote settings.Recommendation 20
That the data collection forms are simplified to remove unnecessary duplication.Recommendation 21
That Jabiru, Adelaide River and Borroloola Town Camps are removed from the MOD Schedule.Footnotes
2 Appendix D: Literature Review
3 Report of the Board of Inquiry into the Child Protection System in the Northern Territory 2010