Article

A Model for Consultation with Aboriginal Stakeholders About Young People's Mental Health and Wellbeing: the NSW School-Link Training Program

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Abstract

Objective: The aim of this paper is to describe a model for consultation with Aboriginal stakeholders used in the development of a training course, by the NSW Institute of Psychiatry, about young people's mental health and wellbeing. Historical, social and political factors contribute to the elevated rates of mental distress and disorder experienced by many Aboriginal young people. However, these young people often do not receive the help they need. Knowledge, skills and attitudes of clinicians are associated with the uptake of services. Therefore, a training course for clinicians was developed utilizing a detailed consultation process with Aboriginal stakeholders. Conclusions: The course was delivered as part of an ongoing comprehensive interagency training program for 2000 clinicians. The course was positively evaluated by participants and stakeholders, suggesting that the course development, including the consultation process with Aboriginal stakeholders, was effective in meeting participant and stakeholder needs. Agencies may be interested in the application of this model to consultation processes with Aboriginal communities and with other populations.

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... There were six program, health service, and intervention description and evaluation studies. Of the six program descriptions/evaluations, one was correlational, one was a pre-post evaluation, one was consultative, one was a six year field study, and two were first person accounts from intervention deliverers (Auclair & Sappa, 2012;Clark et al., 2014;Hillin et al., 2008;Lessard, Fournier, Gauthier, & Morin, 2015;Malone & Stanley, 2013;Tousignant, Vitenti, & Morin, 2013). The remaining five studies were participatory action interventions and analyses (Hinton, Kavanagh, Barclay, Chenhall, & Nagel, 2015;Kowanko et al., 2009;Liu et al., 2016;Lucero & Bussey, 2012;McCalman et al., 2009). ...
... Studies addressed general mental health issues (Auclair & Sappa, 2012;Clark et al., 2014), young people's health and well-being (Hillin et al., 2008), Indigenous people at risk of depressive illness (Hinton et al., 2015), and family wellness, including family violence, substance abuse, trauma, anger management, and addiction (Kowanko et al., 2009;Lucero & Bussey, 2012;Malone & Stanley, 2013). One study addressed cultural and spiritual identity (McCalman et al., 2009), and three addressed common mental disorders (Lessard et al., 2015), mental health, alcohol, and drug conditions (Liu et al., 2016), and suicide (Tousignant et al., 2013). ...
... All eleven studies explicitly described or evaluated the provision of health interventions by external health workers. In some interventions, having an external member to the community was beneficial when dealing with sensitive patient information (Auclair & Sappa, 2012;Hillin et al., 2008). Delivery by external workers also benefitted the image of some interventions by giving the impression that Aboriginal health issues were a priority and concern for non-Aboriginal people as well (Hillin et al., 2008). ...
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Objective: This review analyses the available literature that underpins intersectoral service integration processes and tools designed to improve mental healthcare for Indigenous children. Method: 10 databases and 12 grey literature sources were searched for publications in English and published between 1 January 2008 and 31 December, 2017 that evaluated or measured primary health care interventions that focussed on the intersectoral integration of services, service partnerships, or action across at least two sectors to improve children’s mental health, and that included Indigenous children 4-17 years old in one of the five CANNZUS countries (Canada, Australia, New Zealand, Norway and/or the United States). The five sectors considered were PHC, specialist mental health, education, child protection, and juvenile justice. Study characteristics were extracted and reported aims, strategies, enablers, and outcomes were identified and analysed. Results: Eleven studies were included: five were Australian; four Canadian; one from the USA; and one from New Zealand. Nine key strategies for service integration were: intervention delivery through community workers and external workers, interdisciplinary delivery, staff and organizational capacity building, engaging community, empowering families, individual counselling, adaption of care to Indigenous sociocultural specificities, and strengthening culture and identity. Six enablers of implementation were: involvement of community, access and cost, collaborative multidisciplinary health services, strong relationships, cultural sensitivity, and organizational and staff capacity. Six outcomes were: health and human services collaboration, psychosocial functioning and stress management, health service & organizational empowerment, development and promotion of appropriate health policy and protocols, linkage of health services, and community and family empowerment. Discussion and conclusion: The evidence for intersectoral interventions addressing Indigenous child mental health is in the early stages of development, but suggests potential for improving health outcomes for Indigenous children, their families and communities, as well as the satisfaction and utilisation of healthcare and community services. Further research surrounding cost evaluation, impact on the social determinants of health, extent of consumer engagement, and Indigenous voice is needed.
... There is also limited evidence for interventions to integrate such fragmented intersectoral services for Indigenous children's mental healthcare. Our scoping review of systems integration across at least two sectors to improve the mental health of Indigenous children (4-17 years) [39] found only five Australian studies [40][41][42][43][44]. These evaluated and/or described diverse inquiries: two explored Indigenous community and service provider perspectives of access to mental healthcare with the aim of driving service improvement [40,43], one described a model for consultation with Indigenous stakeholders to develop a training course [44], and two described and evaluated the process and impacts of empowerment programs for Indigenous adolescents [41,42]. ...
... Our scoping review of systems integration across at least two sectors to improve the mental health of Indigenous children (4-17 years) [39] found only five Australian studies [40][41][42][43][44]. These evaluated and/or described diverse inquiries: two explored Indigenous community and service provider perspectives of access to mental healthcare with the aim of driving service improvement [40,43], one described a model for consultation with Indigenous stakeholders to develop a training course [44], and two described and evaluated the process and impacts of empowerment programs for Indigenous adolescents [41,42]. Documented enablers of implementation were the involvement of community, access and cost, collaborative multidisciplinary health services, strong relationships, cultural sensitivity, and organisational and staff capacity. ...
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Background Systems integration to promote the mental health of Aboriginal and Torres Strait Islander children works towards developing a spectrum of effective, community-based services and supports. These services and supports are organised into a coordinated network, build meaningful partnerships with families and address their cultural and linguistic needs, to help children to function better at home, in school, in the community, and throughout life. This study is conducted in partnership with primary healthcare (PHC) and other services in three diverse Indigenous Australian communities. It entails conceptualising, co-designing, implementing, and evaluating the effectiveness of systems integration to promote the mental health and wellbeing of Indigenous school-aged children (4–17 years). This paper outlines a protocol for implementing such complex community-driven research. Methods/design Using continuous quality improvement processes, community co-designed strategies for improved systems integration will be informed by narratives from yarning circles with Indigenous children and service providers, and quantitative data from surveys of service providers and audits of PHC client records and intersectoral systems. Agreed strategies to improve the integration of community-based services and supports will be modelled using microsimulation software, with a preferred model implemented in each community. The evaluation will investigate changes in the: 1) availability of services that are community-driven, youth-informed and culturally competent; 2) extent of collaborative service networks; 3) identification by PHC services of children’s social and emotional wellbeing concerns; and 4) ratio of children receiving services to identified need. Costs and benefits of improvements to systems integration will also be calculated. Discussion The study will provide evidence-informed, community-driven, and tested models that can be used for implementing systems integration to promote the mental health and wellbeing of Indigenous children. It will identify the situational enablers and barriers that impact systems integration and determine the extent to which systems integration improves service availability, systems and child outcomes. Evidence for the cost effectiveness of systems-level integration will contribute to national mental health policy reform.
... We have sought to develop rapport and to build rich, dynamic working relationships. 1,4,9,11,12 Processes were established that would facilitate ongoing dialogue and generate feedback loops of accountability between the research team and the community. 9,11 See Table 1 for details. ...
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Objective: Recently, there has been a consistent call for Indigenous health research to be community-driven. However, for a variety of reasons, many projects, such as the one featured here, start as 'top-down'. Using ten accepted principles for Aboriginal health research, the present article illustrates how a 'top-down' project can be transformed into a 'bottom-up' community-driven project. Method: A table of examples is provided to show how the ten principles were translated into practice to create a bottom-up process. Results: We suggest that key elements for creating a bottom-up process are iterative conversations and 'community involvement' that goes beyond notional engagement. A feature of community involvement is generating and sustaining ongoing conversations with multiple levels of community (organisations, health professionals, Elders, community members, project-specific groups) in a variety of different forums across the entire duration of a project. Local research teams, a commitment to building capacity in the local Indigenous workforce, and adequate timelines and funding are other factors that we hypothesise may contribute to successful outcomes. Conclusion: The article contributes to a much-needed evidence base demonstrating how appropriate structures and strategies may create bottom-up processes leading to successful outcomes.
Chapter
Inequality in Australia is reviewed with special attention to Indigenous Australians. Recent reviews reveal inequality between rich and poor is increasing. High levels of poverty exist in Australia amongst both Indigenous and non-Indigenous people and there are serious impacts on young children. The situation of single parents, low paid workers and the unemployed is considered. The Intervention of the Commonwealth Government in the affairs of Indigenous peoples in the Northern Territory and its outcomes are reviewed. The importance of maintaining relations with cultural background is considered. Alternative views of the benefits of the Intervention are commented on and reference is made to the Harvard Project involving Native American peoples and sovereignty. Severe gaps exist in health and education and housing between Indigenous and non-Indigenous peoples which reflect the nature of the earliest encounters between them. Several programs providing opportunities for personal development of Indigenous peoples are considered.
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Some groups of young people experience elevated rates of mental disorders and low rates of uptake of mental health services. Because an association between staff competence and uptake of services has been demonstrated a key objective of this paper is to identify relevant staff learning needs. A learning needs analysis was undertaken of adolescent mental health workers employed in the health and education sectors in NSW, Australia, to explore their learning needs regarding Aboriginal, same-sex attracted and culturally and linguistically diverse young people. Significant differences were found between learning needs in relation to location but no significant differences were found in relation to agency or experience. Participants ranked their learning needs as high and their knowledge and skills in working with depression and related disorders in these young people as low. This article highlights issues that may be of interest to clinicians and their managers regarding training, policy and service delivery.
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