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University of Western AustraliaSuicide Prevention in Aboriginal and Torres Strait Islander Communities: Learnings from a meta-evaluation of community-led Aboriginal and Torres Strait Islander suicide prevention programs 04 April 2016

This meta-evaluation was prepared by Healthcare Management Advisors, in conjunction with the Telethon Kids Institute.

TABLE OF CONTENTS

EXECUTIVE SUMMARY II

1 CONTEXT 12 METHOD 33 META-EVALUATION ASSESSMENT 64 IMPLICATIONS 115 APPENDICES 14

APPENDIX A ATSISPEP STAKEHOLDER QUESTIONNAIRE 14

APPENDIX B THE NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC) EVIDENCE CLASSIFICATION SCALE 17

APPENDIX C META-EVALUATION ASSESSMENT TOOL 18

APPENDIX D PROMISING PROGRAMS: CASE STUDY ANALYSIS 24

APPENDIX E 37 EVALUATED PROGRAMS NOT INCLUDED IN THE META-ANALYSIS 147

References 156

University of Western Australia • Suicide Prevention in Aboriginal and Torres Strait Islander Communities: Learnings from a meta-evaluation of community-led Aboriginal and Torres Strait Islander suicide prevention programs

The Aboriginal and Torres Strait Islander Suicide Evaluation Project is funded by the Australian Government through the Department of the Prime Minister and Cabinet. The opinions, comments and analysis expressed in this document are those of the author/s and individual participants and do not necessarily represent the views of the Government and cannot be taken in any way as expressions of Government policy.


EXECUTIVE SUMMARYContextA key objective of the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) is the development of an evidence base for what works in community-led Aboriginal and Torres Strait Islander suicide prevention.

This report contributes to that objective through:

a meta-evaluation of 16 program evaluations with findings and success factors identified; cases studies of 19 promising practice programs with strong community leadership or engagement;

and providing an overview of 37 evaluated promising programs that were not within the ATSISPEP Terms

of Reference

Method


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The project to identify and analyse promising practice involved six steps:

(1) Identify in-scope suicide prevention activities – 88 were identified, of which 51 were selected for further analysis based on them being programmatic and/or previously evaluated. It should be noted that programs commenced or evaluated after December 2015 are not included in this meta-evaluation.

(2) Categorise the 51 programs as ‘promising’ or ‘other’ based on their level of community leadership/ engagement with reference to the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy. Through this, 14 were identified. (NB: The 37 programs that were assessed as ‘other’ are described in Appendix E to this report).

(3) Consult and seek expert opinion on the 14 identified promising evaluated programs by means of a stakeholder survey, and seek advice as to whether there were additional community-led or shaped promising programs that should be added to the list – 5 additional programs were identified (19 in all).

(4) Prepare case studies of the 19 selected programs.

(5) Develop and apply a meta-evaluation analysis framework to:

assess the evaluations which have been done on the evaluated case study programs (11 of the 14 programs were included in this part of the process); and

attempt to assess the 5 unevaluated case study programs using the meta-analysis framework and include these evaluations in the meta-evaluation itself – 16 programs in all.

(6) Distil findings and identify success factors based on the meta-evaluation.

Meta-evaluation assessment: evaluating the evaluations A meta-evaluation analysis is an ‘evaluation of evaluations’. The results of the meta-evaluation analysis are not a critique of individual programs. The analysis simply seeks to compare the strengths and weaknesses of the evaluations previously applied to the programs as a first step to distilling findings and identifying success factors.

The project team identified three categories of information for examination in its meta-evaluation analysis framework:

• Whether community leadership and engagement had been effectively evaluated;• Whether quality evaluation indicators were evident in the evaluation; and• Whether the evaluation included an impact assessment – in summary, did the evaluation seek to demonstrate

that the program worked?

The overall result was: • Eight of the promising programs were identified as having been the subject of an effective evaluation using

the meta-evaluation framework• Two of the promising programs were identified as having been subject to a partially effective evaluation –

that is, that some elements of the program were subject to effective evaluation but others were not. • Six were identified as having been subject to an ineffective evaluation.1

1 One case study was split into two, creating a nineteenth service that was analysed.


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Findings of the Meta-EvaluationThe meta-evaluation assessment enabled identification of broader issues that need exploration in future policy and program development of Aboriginal and Torres Strait Islander suicide prevention programs.

Finding 1: Evaluation should be built into suicide prevention program design. Communities, and service providers exploring new models of suicide prevention activity with communities, should routinely access evaluation expertise before commencing the implementation of a new initiative – otherwise they run the risk of being unable to demonstrate the ongoing value and scalability of their initiative.

Finding 2: Promising programs with strong community engagement and/or leadership are not evenly geographically distributed. The applicability of promising community led or shaped models for suicide prevention needs examination in a broader range of jurisdictions; there are large populations of Aboriginal and Torres Strait Islander people that seem less likely to be able to access promising programs in New South Wales, Victoria, South Australia and Tasmania.

Finding 3: Partnerships between Indigenous communities/providers and general population providers to develop new, or adapt existing suicide prevention programs for use in Indigenous communities should be encouraged. Governments should explore mechanisms for encouraging such partnerships.

Finding 4: Community leadership and engagement in Indigenous suicide prevention activity (universal and selective in the context of Indigenous communities) should be maintained, but strengthened in indicated and postvention services. Leadership groups in Aboriginal and Torres Strait Islander suicide prevention should assess whether there is a way to increase the breadth of new program development by program type beyond the current focus on prevention programs.

Finding 5: The systems approach to suicide prevention should be assessed for its suitability in diverse Indigenous community settings, and otherwise adapted under community leadership/ with community engagement to account for Indigenous cultural and experiential differences in those settings.

Success factors identified from the eight effectively evaluated programs

Success factors identified from the programs that have been effectively evaluated include:

• Peer to peer mentoring/education and leadership on suicide prevention;

• Counselling/safe space for people to discuss their concerns;

• Community site specific/using community organisations;

• Support materials, DVDs, no assumption of literacy in participants;

• Connects with young people through sport;

• Connects young people to country, culture and community life;

• Connects young people to Elders;

• Works through a cultural framework;

• Diverting young people from negative influences;


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• Addresses cannabis use;

• Awareness of critical risk periods;

• 24/7 program;

• Community engagement/empowerment model to address negative social determinants and support social and emotional wellbeing;

• Gatekeeper training; and

• Postvention.


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1 CONTEXT1.1 STUDY PURPOSE A key objective of the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) is the development of an evidence base for what works in Aboriginal and Torres Strait Islander suicide prevention.

This report provides this through:

a meta-evaluation of 16 program evaluations with findings and success factors identified from eight programs that were found to be effectively evaluated;

cases studies of 19 promising practice programs; and

providing an overview of 37 other programs that were not subject of the meta-evaluation (See 2.3 for background).

1.2 TERMS OF REFERENCE The terms of reference for this component of the ATSISPEP project were to:

Identify all programs that have been evaluated and assess the type of evaluation conducted:

• The level of rigour involved;• Whether the program was developed in response to the incidence of suicide, was community led,

[and] who developed and delivered it;• Where the program has been implemented and whether any impact analysis has been undertaken;

and• Gauge stakeholder and community perspectives, and follow up as necessary.

It is critical that the reader is aware that this is NOT an independent assessment of the effectiveness of programs. Rather, its major component is a meta-evaluation – an evaluation of the effectiveness of evaluations that have already taken place as the basis of broad findings and the identification of success factors.

Report structure

Our response to the terms of reference is reflected in the report structure. It comprises four sections:

• Section 1 – Context describes the background to the project and its scope (this section)

• Section 2 – Method specifies the project methodology including the meta-evaluation itself

• Section 3 – Results of the meta-evaluation


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• Section 4 – Implications including findings and the identification of success factors to guide communities and service providers working with those communities in future program development

Accompanying the main report are several appendices:

• Appendix A: ATSISPEP stakeholder questionnaire

• Appendix B: The National Health and Medical Research Council (NHMRC) Evidence Classification Scale– a framework used to characterise the methodologies for the case study evaluations

•Appendix C: Meta-evaluation Assessment Tool – the template developed by the project and applied in the case study analysis to assess the scope of the 16

case study projects selected for the meta-evaluation

• Appendix D: Promising Programs – Detailed Case Study Analysis– detailed commentary on the promising programs – the 19 case study projects

• Appendix E: 37 Evaluated Programs Not Included in the Meta-analysis – lists all targeted programs that were identified but not examined in detail in the case study analysis

References


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2 METHOD2.1 OVERVIEW The methodology used to identify relevant evaluated programs and to assess the type of evaluation conducted involved six steps. In summary these were:

(1) Identify: potentially in scope suicide prevention programs targeting Aboriginal and Torres Strait Islander people were identified;

(2) Categorise: the in scope programs were classified as ‘promising’ or ‘other’ using the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy to guide the process;

(3) Consult: the opinion of stakeholders and experts was sought on the promising programs identified above and whether there were additional programs that should be added to the list of promising programs;

(4) Case studies: a standard approach was applied to describing each program and the associated evaluation activity, where it had taken place;

(5) Develop and apply a meta-evaluation analysis framework: a framework was developed to assess the evaluations (where they had taken place) of the promising programs as effective, partially effective or ineffective and used the framework to help evaluate unevaluated programs; and

(6) Distil findings: findings and success factors in the programs that had been effectively evaluated were identified.

A detailed description of each step in the method is provided below.

2.2 IDENTIFY POTENTIAL PROGRAMS Potential programs were initially identified by means of a literature review involving systematic searches of databases, including:

MedLine (PubMed);

PsychINFO;

Cochrane library;

Google Scholar;

journals including Internet Interventions, the Journal of Medical Internet Research; and

Australian Health databases such as Indigenous HealthInfoNet and Lowitja Lit.search.


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The resulting list of programs was supplemented by personal knowledge of team members and advice from members of the Aboriginal and Torres Strait Islander Mental Health and Suicide Prevention Advisory Group (ATSIMHSPAG).

The above search identified 88 activities that supported suicide prevention targeted at Aboriginal and Torres Strait Islander people from the broadest universal level (‘upstream’ programs addressing social determinants and risk factors for suicide, including those that address child development) through to suicide prevention specific universal, selective and indicated activity, and finally postvention. This activity list included both programs and resource support materials.

2.3 CATEGORISE THE PROGRAMS The 88 activities were reviewed and a list of 51 priority programs identified based on their evaluation and/or programmatic nature (hence screening tools, training materials, brochures and course curricula were excluded). These potential in scope programs were categorised into two groups:

• Promising practice programs (14 programs): these were targeted programs subject to a formal evaluation and developed under community leadership or by community engagement as per the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy (the Strategy), and

• Other programs (37 programs): these were programs subject to limited evaluations, limited alignment with the Strategy and/or did not demonstrate community leadership or engagement as key elements. These other programs are listed in Appendix E: 37 Programs Not Included in the Meta-Analysis.

2.4 CONSULTATION The project team developed a survey seeking feedback on the potential 14 promising practice programs and their suitability for more detailed analysis. Respondents were asked to identify other community-led or -shaped programs that should be added to the list of potential promising practice programs.

134 respondents completed the survey, which can be found at Appendix A. Respondents identified a further five programs that the project team agreed should be added to the list of promising programs.

The method outlined in sections 2.3 and 2.4 above resulted in our sample of 19 programs that were the subject of case studies.

2.5 SELECTED PROGRAMS: CASE STUDIES For each of the 19 promising programs, the following has been delineated:

• The program or activity itself;

• The target group;

• Program objectives;


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• A summary of the evaluation findings;

• The degree of program alignment with the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy, including specific action areas and outcomes; and

• The NHMRC evidence classification applied to the evaluation (see Appendix B).

The description and analysis for each promising program is presented in Appendix D.

2.6 DEVELOP AND APPLY A META-EVALUATION FRAMEWORK The Project terms of reference required a meta-evaluation analysis. A meta-evaluation analysis is an evaluation of evaluations.2 It typically incorporates an assessment of an evaluation against evaluation standards. Based on the project terms of reference, the project team identified three broad criteria to underpin the meta-evaluation analysis:

(1) The evaluation of degree of community leadership and engagement in the development of the program and in the evaluation itself;

(1) Conformity with standards relating to the quality of the evaluation; and

(2) Conformity with the principles of impact assessment.

The results of applying the meta-evaluation analysis tool to each study are included in Appendix D and summarised in the next section (Section 3: Meta-Evaluation Assessment).

We reiterate the point made in Section 1 that the results of the meta-evaluation analysis are not an independent assessment of programs. The analysis simply seeks to compare the strengths and weaknesses of the evaluations that were undertaken on the programs and make findings on that basis.

2.7 ASSESS KEY THEMES AND IMPLICATIONS

The results of the meta-evaluation analysis of each case study were examined and key themes, commonalities and gaps were identified (see Section 4: Implications).

2 United Nations Development Program, Handbook on Planning, Monitoring and Evaluating for Development Results, 2009, p.131. Accessed on 17 March 2016 at http://web.undp.org/evaluation/evaluations/handbook/english/documents/pme-handbook.pdf.


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3 META-EVALUATION ASSESSMENT3.1 META-EVALUATION – SUMMARY OF THE ANALYTICAL FRAMEWORK

AND SCORING SYSTEM The meta-evaluation analysis examined the evaluation for each promising program against three components:

(1) Degree of community engagement: there were four criteria scored. Consistent with the project scope3 this included an assessment of:

The reason or need for program development – whether it was a response to higher than average levels of suicide in a community or other drivers (e.g., a new funding round);

The organisation responsible for implementing the program (e.g., a community controlled organisation, a non-profit organisation or some other type of legal entity) and the degree of community leadership or engagement in the program;

Where the program was implemented – a single locality, multiple localities or multiple jurisdictions; and

Whether the evaluation considered community perspectives.

(2) Conformity with standards relating to quality evaluations. We examined the extent to which the evaluations met accepted evaluation standards4 in relation to six criteria:

Clearly specified evaluation values; Clarity of the evaluation report; Disclosure of findings; Justified conclusions; Impartiality of reporting; and Evaluation impact.

(3) Conformity with the principles of impact assessment: standards relating to impact assessment examined the performance of the evaluations against a further six criteria5:

Evaluation questions are clearly specified; The program theory (cause and effect relationships) is described; The reasons for the project effects can be identified (causal attribution); Different data sets inform conclusions (triangulation); There is an explicit assessment of whether the program worked; and

3 Consistent with the project scope – see the project terms of reference at Section 1.2.4 See Owen, J. M. 2006. Program Evaluation: Forms and Approaches, Third Ed. Crows Nest, NSW: Allen and Unwin, pp. 150–155.5 Based on principles specified in OECD, Outline of Principles of Impact Evaluation, accessed on 17 March 2016 at http://www.oecd.org/dac/evaluation/dcdndep/37671602.pdf.


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There is a clear identification of learnings from the program to inform future program design.

In the assessment tool developed for the project, each criterion had a score range of 0 to 2, where:

2 = ‘fully complies’; 1 = ‘partially complies’; and 0 = ‘did not comply’ or the standard was not applicable.

The maximum score that a case study evaluation could obtain was 30, comprising:

degree of community engagement: maximum score of 6; quality evaluations: maximum score of 12; and impact assessment: maximum score of 12.

Based on this scoring framework we were able to assess the degree of conformity of the promising program evaluation with each meta-evaluation assessment component. There were three categories of performance applied:

ineffective evaluation; partially effective evaluation; or effective evaluation.

Table 3.1 describe the scores that lead to a particular component assessment

Table 3.1: Framework for summarising the meta-evaluation score for each promising program

Component Score Total score on individual criteria within a component

Ineffective evaluation

Community engagement: score 0–2; quality evaluations score 0–4; impact assessment rigour: score 0–4; overall assessment score: 0–10.

Partially effective evaluation

Community engagement: score 2–4; quality evaluations score 5–8; impact assessment rigour: score 5–8; overall assessment score: 11–20.

Effective evaluation Community engagement: score 4–6; quality evaluations score 9–12; impact assessment rigour: score 9–12; overall assessment score: 21–30.

The template for the analytical framework and its scoring system is shown in Appendix C.

3.2 META-EVALUATION ANALYSIS: SUMMARY RESULTS The results of applying the meta-evaluation assessment framework to each of the promising programs is summarised in Table 3.2 (see the next page).

It should be noted that the meta-evaluation assessment was not applied to three of the promising programs. The project team considered it inappropriate to apply the framework to:

• Case study 16 – The Healing Foundation, because the promising program is an organisation rather than a programmatic intervention, and

• Case study 17 –Djirruwang and


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• Case study 18 –Wontulp Bi-Buya – this is because both this and the above are workforce development and training programs rather than programmatic interventions that directly impact upon suicide prevention.


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HEALTHCARE MANAGEMENT Helping create better health services

3 META-EVALUATION ASSESSMENT

Table 3.2: Meta-evaluation assessment of the suicide prevention promising programs – summary of findings

Ref. No. Case study / promising program Evaluation status Meta-evaluation component assessmentOverall meta-evaluation scoreCommunity

engagementEvaluation assessment Impact assessment

rigourPrevention programs

1 Mowanjum Keeping Place and Media Project, Junba Project

Not previously evaluated Effective evaluationScore: 5/6

Ineffective evaluation Score: 0/12

Ineffective evaluation Score: 4/12 Ineffective evaluation Score: 9/30

2 GREATS Youth Service Previously evaluated Effective evaluationScore: 5/6

Partially effective evaluationScore: 7/12



3 Alive and Kicking Goals! Previously evaluated Effective evaluation Score: 5/6

Effective evaluation Score: 12/12



4 The Yiriman Project Previously evaluated Effective evaluation Score: 6/6




5 Warra-Warra Kanyi – Mt Theo Program

Previously evaluated Effective evaluation Score: 5/6




6 UHELP Previously evaluated Partially effective evaluationScore: 4/6




7 Family Wellbeing Project Previously evaluated Effective evaluation Score: 6/6




8 Wesley Lifeforce suicide prevention training

Not previously evaluated Partially effective evaluationScore: 4/6




9 EK Youth Services Network Not previously evaluated Partially effective evaluationScore: 3/6





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rigour10 Aboriginal Mental Health First Aid Previously evaluated Partially effective

evaluationScore: 3/6




11 QAIHC Lighting the Dark Previously evaluated Effective evaluation Score: 5/6




12 National Empowerment Project (NEP) Previously evaluated Effective evaluation Score: 6/6




Postvention program13 Suicide Story Previously evaluated Effective evaluation

Score: 6/6Effective evaluation

Score: 12/12Strong conformity

Score: 9/12Effective evaluation

Score: 27/30Crisis response

14 (a) StandBy CPR Not previously evaluated Partially effective evaluationScore: 4/6


Effective evaluation Score:11/12


15 (b) You me Which way Not previously evaluated Ineffective evaluation Score: 4/6




Healing16 The Healing Foundation Previously evaluated Not applied Not applied Not applied Not applied17 Red Dust Healing Previously evaluated Effective evaluation

Score: 5/6




Workforce Training Program18 The Djirruwang Aboriginal Mental

Health Worker Education and Training Program

Previously evaluatedNot applied Not applied Not applied Not applied


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rigour19 Wontulp Bi-Buya Suicide Prevention

Training CoursePreviously evaluated Not applied Not applied Not applied Not applied

Note: The analysis of case study 14 should be read in conjunction with case study 15. The latter case study is seeking to adapt the methods of 14(a) to the needs of local Aboriginal and Torres Strait Islander communities.


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5 APPENDICES

The following observations can be made about the scoring contained in for the 16 promising programs examined in the meta-evaluation assessment6:

(1) Promising programs were more likely to perform well on the community engagement assessment component:– 10 programs were effectively evaluated;– 5 programs were partially effectively evaluated; and– 1 program was ineffectively evaluated.

(2) Promising programs performed slightly less well on the quality evaluations assessment component:– 8 programs were effectively evaluated;– 2 programs were partially effectively evaluated; and– 6 programs were ineffectively evaluated’

(3) Promising programs performed least well on the impact assessment components of the evaluation:– 7 programs were effectively evaluated;– 2 programs were partially effectively evaluated; and– 7 programs were ineffectively evaluated.

(4) In the overall-meta-evaluation score:– 8 programs were effectively evaluated;– 2 programs were partially effectively evaluated; and– 6 programs were ineffectively evaluated.

The implications of these findings from the meta-evaluation analysis are examined in the next section.

6 This counts Case Studies 14(a) and 14(b) as two separate programs.

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4 IMPLICATIONS 4.1 FINDINGS FROM THE META-EVALUATION The meta-evaluation assessment has enabled identification of broader issues for consideration in Aboriginal and Torres Strait Islander suicide prevention program delivery:

Finding 1: Evaluation should be built into suicide prevention program design. Communities, and service providers exploring new models of suicide prevention activity with communities, should routinely access evaluation expertise before commencing the implementation of a new initiative – otherwise they run the risk of being unable to demonstrate the ongoing value and scalability of their initiative.

Related to the above:

Use the process of program evaluation to support the development of better programs. All the programs evaluated and included in this meta-evaluation have strengths that could be built upon. In this regard, evaluation itself, or evaluation frameworks such as the one developed by ATSISPEP based in part on this meta-evaluation, will be a useful tool not only in providing evidence of promising practice and success factors, but by providing a framework by which communities can build program capacity and effectiveness over time. In particular, communities should be supported to clearly articulate the underlying program logic (the cause and effect relationships) of the programs they initiate or shape.

Need for comprehensive evaluation of all programs. Continued evaluation and data monitoring is needed over several years to assess whether programs are having an ongoing impact on suicide levels at a community and regional level.

Finding 2: Promising programs with strong community engagement and/or leadership are not evenly geographically distributed. The applicability of promising community-led or -shaped models for suicide prevention needs examination in a broader range of jurisdictions; there are large populations of Aboriginal and Torres Strait Islander people that seem less likely to be able to access promising programs in New South Wales, Victoria, South Australia and Tasmania.

Finding 3: Partnerships between Indigenous communities/providers and general population providers to develop new, or adapt existing suicide prevention programs for use in Indigenous communities should be encouraged. Governments should explore mechanisms for encouraging such partnerships.

Finding 4: Community leadership and engagement in Indigenous suicide prevention activity (universal and selective in the context of Indigenous communities) should be maintained, but strengthened in indicated and postvention services. Leadership groups in Aboriginal and Torres Strait Islander suicide prevention should assess whether there is a way to increase the breadth of new program development by program type beyond the current focus on prevention programs.

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5 APPENDICES

Finding 5: The systems approach to suicide prevention should be assessed for its suitability in diverse Indigenous community settings, and otherwise adapted under community leadership/ with community engagement to account for Indigenous cultural and experiential differences in those settings.

4.2 SUCCESS FACTORS The meta-evaluation analysis of suicide prevention programs has provided useful insights into success factors in community-led or -shaped program design based on the eight effective evaluations identified in this project. These are:

Alive and Kicking Goals;

Yiriman Project;

Warra-Warra Kanyi – Mt Theo Project;

Family Wellbeing Project;

National Empowerment Project;

Suicide Story;

You me Which way; when considered in conjunction with learnings from

Standby CPR.

• A summary table is included overleaf.

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5 APPENDICESAPPENDIX A ATSISPEP STAKEHOLDER QUESTIONNAIRE

The survey was designed to obtain additional data for programs that had not been evaluated previously as well as those that had but which required additional independent information.

Table 5.3: Stakeholder questionnaireQuestion Answer options

Question 1: Can you please let us know if you have completed the earlier version of the survey? If you would like to repeat the restructured survey, please feel free to do so

• Yes• No

Question 2: Gender identity • Male• Female• Alternatively please advise us of your preferred gender

identity

Question 3: Please indicate which State or Territory you are from

• Western Australia• New South Wales• Queensland• Northern Territory• Victoria• South Australia• Australian Capital Territory• Tasmania

Question 4: Please tick the appropriate age category • 16–17 years• 18–29 years• 30–44 years• 45–59 years• 60+ years

Question 5: Are you of Aboriginal or Torres Strait Islander descent?

• Yes• No

Question 6: If you answered yes to the above question, can you please provide additional information

• Aboriginal and Torres Strait Islander • Aboriginal • Torres Strait Islander (on mainland) • Torres Strait Islander (on Islands)

Question 7: Please tick one category that best describes your status:

• Government employee • Social Worker

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Question Answer options

• Nurse • Mental Health Practitioner • Undergraduate University Student • Postgraduate University Student • Psychologist • Counsellor • Social Services Practitioner • Aboriginal Health Worker • Teacher • TAFE Student • General Practitioner • Occupational Therapist • Gatekeeper • High School Student • Psychiatrist • Defence Force member • Other

Question 8: The following programs and/or resources contribute to capacity building. Please tick each option you believe to be relevant (you may choose multiple responses per row) in regards to the programs and/or resources you have had involvement with

• Red Dust Healing • Indigenous Hip Hop Projects • Applied Suicide Intervention Skills Training (ASIST) • Suicide Story • Alive and Kicking Goals! • Aboriginal Suicide Prevention toolkit (Lifeline) • Deadly Thinking • Tracy Westermann Y Checklist • ibobbly • AIMhi Stay Strong IPad App (Menzies) • The Family Wellbeing Empowerment Program • Finding Our Way Back booklet (beyondblue) • safeTALK • StandBy CPR • StandBy Response Service • Creative Recovery • Solid Kids Solid Schools II • The Resourceful Adolescent Program • Marumali • Lighting the Dark, Preventing Aboriginal and Torres Strait

Islander Suicide DVD (QAIHC) • RACGP Course • Community Response to Eliminating Suicide (CORES) • Other

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Question Answer options

Question 9: For each of the following Training & Workforce initiatives you have had involvement with, please tick each option you believe to be relevant (you may choose multiple responses per row)

• Mental Health First Aid • Aboriginal Mental Health First Aid (AMHFA) • Working Together Book 2014 • Tracy Westermann Suicide Training • Gatekeeper Training • Yarning about mental health flipchart (Menzies) • Yarning about mental health manual (Menzies) • Keeping Strong flyer (beyondblue) • AIPA Cultural Competence Training • Other

Question 10: In what capacity was your experience? • Personal• Professional

Question 11: Are there any programs and/or resources that you WOULDN’T recommend? Please tell us the reason/s why & how improvements can be made:

Question 12: Are there any other programs and/or resources that are not included in this survey you would like to share with us?

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APPENDIX B THE NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC) EVIDENCE CLASSIFICATION SCALEClassification Definition

A Systematic review—systematic location, appraisal and synthesis of evidence from scientific studies

B1 Randomised controlled trial—subjects are randomly allocated to intervention and control groups, outcomes are compared

B2 Pseudo-randomised controlled trial— subjects are allocated to intervention and control groups using a non-random method, outcomes are compared

C1 Pre/post intervention case series—a single group of subjects are exposed to intervention, outcomes are measured before and after for comparison

C2 Post-intervention case series—a single group of subjects are exposed to an intervention, only outcomes after the intervention are recorded, no comparison can be made

D1 Representative survey study—a representative sample of a population is surveyed, generalisation of outcomes is possible

D2 Key informant survey—opinions and experiences of key subjects are recorded in a survey

Q1 Methodological qualitative study—qualitative data is methodologically collected, analysed and reported

Q2 Anecdotal qualitative study—qualitative data is collected and reported without methodological rigour; no formal data analysis was undertaken

M1 Mixed methods study—qualitative and quantitative data is methodologically collected, analysed and reported

Source: Adapted from both the NHMRC guidelines and the criteria adapted by McTurk et al. 2008.

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APPENDIX C META-EVALUATION ASSESSMENT TOOL Meta-evaluation assessment framework

Evaluation Meta-Evaluation Scoring Rationale Applied

Score Comment on criterion / pilot specific issue

Analysis component 1: degree of community engagement

1.1 Reason for program development Driven by need: response to incidence of suicide Other:

Not applicable

There is an underlying level of suicide in most communities. Higher levels of suicide are not a positive.

1.2 Who led the program implementation Community-controlled organisation led 2 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people.

Community-controlled organisation involved, but not leading (e.g., local mainstream health service led)

1

No community-controlled organisation involved 0

Not clear / not able to determine 0

1.3 Where implemented (locality / jurisdiction/s)

Multiple sub-regions across multiple jurisdictions 2 Application of the program across broader geographies has several benefits:Reduces the risk of selection biasIncreases the chance of demonstrating scalability

Multiple sub-regions within a jurisdiction 1

One locality / sub-region 0

1.4 Stakeholder / community perspectives Strongly supportive and actively engaged in the 2 People affected by an evaluation should be identified

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Meta-evaluation assessment framework



obtained evaluation (e.g., focus groups and community forums)

and given the opportunity to provide feedback. The degree of stakeholder involvement also affects the degree of support for scalability of a program beyond the geography where a program is implemented.

Reported to be supportive but no clear evidence of the nature of community involvement in the evaluation

1

Limited support for the program / no community involvement

0

Score for community engagement assessment component 6 (compared to maximum score for component of 6)

Summary assessment for community engagement Ineffective evaluation

Summary assessment for community engagement Partially effective evaluation

Summary assessment engagement Effective evaluation

Assessment component 2: findings – conformity with evaluation standards relating to Dissemination

2.1 Values interpretation Conforms, based on published information 2 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

Some evidence, but not strong 1

Does not conform / no published report 0

2.2 Report clarity Conforms, based on published information 2 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is

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provided.



2.3 Disclosure of findings Conforms, based on published information 2 A full set of evaluation findings, along with limitations, is accessible to persons affected by the evaluation.



2.4 Justified conclusions Conforms, based on published information 2 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.



2.5 Impartial reporting Conforms, based on published information 2 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.



2.6 Evaluation impact Conforms, based on published information 2 Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.


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Score for findings dissemination assessment component 12

Summary assessment for findings dissemination Ineffective evaluation

Summary assessment for findings dissemination Partially effective evaluation

Summary assessment for findings dissemination Effective evauation

Assessment component 3: impact assessment – conformity with principles of good evaluation design / level of rigour involved

3.1 Key evaluation questions specified Conforms, based on published information 2 Evaluation questions ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected.



3.2 Clear program theory / program logic specified

Conforms, based on published information 2 Program theory (also referred to as program logic) documents the causal (or results) chain from inputs to outcomes in a program intervention. Theory-based evaluation allows assumptions underpinning the program logic to be tested and avoids a ‘black box’ evaluation (identify an impact, but do not enable an explanation as to why).



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3.3 Counter-factual specified: method for comparing ‘with program intervention versus without’ identified to support causal attribution

Conforms, based on published information 2 Comparison groups are available to reduce or remove selection bias and avoid the risk of contagion.



3.4 Triangulation of findings Conforms, based on published information 2 Different data sets – and interpretation of that information – should support the same conclusion.



3.5 ‘Did it work?’ assessment provided Conforms, based on published information 2 There should be an explicit assessment of what worked and what did not as a result of the program.



3.6 Learning assessment provided Conforms, based on published information 2 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.



Score for impact assessment rigour component

12

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Summary assessment for impact assessment rigour





Effective evaluation

OVERALL SCORE FOR META-EVALUATION ASSESSMENT 30 Effective evaluation

Legend: framework for scoring

Component Score Total score on individual criteria within a component

Ineffective evaluation Community engagement: score 0–2; findings dissemination score 0–4; impact assessment rigour: sore 0–4; overall assessment score: 0–10.


Community engagement: score 2–4; findings dissemination: score 5–8; impact assessment rigour: score 5–8; overall assessment score: 11–20.

Effective evaluation Community engagement: score 4–6; findings dissemination: score 9–12; impact assessment rigour: score 9–12; overall assessment score: 21–30.

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APPENDIX D PROMISING PROGRAMS: CASE STUDY ANALYSIS

PREVENTION PROGRAMS

Case Study 1: Mowanjum: Connection to Culture (Mowanjum, WA)

Primary Source of Information for the Evaluation CommentsProject team interviews with stakeholders.

Program Description

Keeping Place and Media Project and the Junba Project commenced in 2012 in the community of Mowanjum, WA, in response to a cluster of youth suicides. The Elders of the Mowanjum community believed that the learnings and activities that connect young people to culture, country and a strong identity would give them strength and be the source of their happiness and health. Community Elders and artists expressed their fears for what they believe to be an inevitable loss of culture knowledge if committed efforts are not made to secure it for future generations. The programs respond to a belief that without culture, Mowanjum youth face losing their identity, and Elders fear the repercussions of that loss on their children’s health and wellbeing.

Objectives

Mowanjum Keeping Place and Media ProjectThe Mowanjum Keeping Place and Media Project records stories of people and places, language and perspectives for families and language groups living in the region. It delivers an interactive and participatory platform that supports the maintenance of culture and law through the promotion of intergenerational teaching and learning. Multimedia and digital archives are two of the engagement strategies in the program with digital film, photos and sound utilised to capture storylines, songs, and dance and for young people to interview each other. These tools attract young people to the program and are an effective way to engage with culture. The use of cameras also assists young people to overcome shyness. Cultural camps and the making of totems are another activity. Creative materials are produced by community members in collaboration with Mowanjum Aboriginal Art and Culture Centre and other partners for exhibitions, festivals, publications and community initiatives. Digital records of this material and its production are then stored for safekeeping, sharing and teaching.

Junba ProjectJunba is a form of storytelling through traditional song and dance. The Junba Project increases the number and scope of opportunities for young people to engage with Junba by arranging workshops that team youth with community elders and multimedia specialists.

Culturally, Junba is considered essential for good social and emotional wellbeing, and is a means for young people and families to strengthen intergenerational bonds and connection to country. Junba gatherings on country are arranged in the lead up to the annual Mowanjum Festival. During this time elders, parents and young people practise together. As learning is reinforced through practice and the retelling of stories, cameras are provided to young people so that photographs and moving image recordings can be made. Recordings are used in youth media workshops, as well as stored and shared via Storylines.

The program’s rationale is to keep culture strong through the engagement of Mowanjum’s young people working closely with Elders to achieve intergenerational knowledge translation and sharing. Training in managing the digital collection addresses community unemployment rates and creates culturally relevant jobs

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and long term employment for community members. Employment encourages community participation through meaningful work relating to cultural maintenance.

The projects give young people the opportunity to engage with the latest multimedia equipment within a meaningful, cultural context.

Outcomes

• Provides young people, Elders and children a pathway and a future built around a strong cultural identity and sense of belonging to their community. It develops a repository of cultural knowledge and multimedia skills among the community. The cultural and social fabric of the community has been directly strengthened by the program and the benefits to young people and Elders are recognised by many within the community;

• A team of Trainee Digital Collections Officers have been recruited from the community who are also excellent community liaisons and advocates for the project;

• Increased teaching and learning of Junba between Elders and young people;• Long term presence of the program in the community, sustainability of the program and the staff has resulted

in an increased response to the activities and involvement of young people; • The community have come to value the program and recognise the difference it is making to young people

and children;• Relationships of trust have been established between the program staff, Elders and young people, including

those who have been previously disengaged;• Ensures community ownership and community consultation, engagement and participation of the three

language groups in all aspects of the program; • A completely inclusive approach to anyone wanting to be involved in the program;• Fosters a sense of pride, identity and leadership among young people who are then acting as important role

models to young children in the community. An important outcome has been the eagerness with which young children are wanting to get involved and are aspiring to do the cultural activities and learnings;

• Elders and young people experiencing a number of positive effects from their cultural knowledge exchange;• Ongoing opportunities for community to be actively involved in the recording of material across different

media; • Promotes the planning, implementation and production of local initiatives that can then be stored and

preserved for intergenerational teaching and learning; and• Youth are encouraged to actively participate in exhibitions, festivals, bush trips and community initiatives, in

diverse creative roles including dancers, artists, photographers and production assistants. Training and production equipment is available for their use on bush trips and in-house at Mowanjum Art Centre.

ATSISPEP Assessment

Summary Comments

The Mowanjum Keeping Place and Media Project and the Junba Project are culturally embedded and responsive. They support Indigenous social and emotional wellbeing and self-determination, and pathways for young people.

Description of evaluation activities

There were no evaluation activities for this project.

Meta-evaluation Analysis

In the assessment against the meta-evaluation analysis framework, the Mowanjum Connection to Culture program received the following scores:

• Strong conformity against the community engagement assessment component (a score of 5 out of a possible 6)

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• Poor / doesn’t conform against the quality evaluations assessment component (a score of 0 out of a possible 12)

• Poor / doesn’t conform against the impact assessment rigour component (a score of 4 out of a possible 12)• A total score of 9 (out of a possible score of 30), which was categorised as poor conformity with the overall

meta-evaluation assessment criteria.

Table 5.4 provides details of the analysis underpinning the meta-evaluation assessment.

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Table 5.4: Mowanjum Connection to Culture – Meta-evaluation Assessment



Score Comment on criterion / project specific issue

Analysis component 1: degree of community engagement in the evaluation

1.1 Reason for program development Driven by need: response to incidence of suicide Not applicable

1.2 Who led the program implementation Community-controlled organisation led 2 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people. Elders worked with the Mowanjum Aboriginal Art and Culture Centre to produce materials (multimedia and digital archives) to support the project.


One locality / sub-region 0 Application of the program across broader geographies has several benefits:• Reduces the risk of selection bias• Increases the chance of demonstrating scalability.This project was focussed on the Mowanjum community.

1.4 Stakeholder / community perspectives obtained

Strongly supportive and actively engaged in the evaluation (e.g., focus groups and community forums)

2 People affected by an evaluation should be identified and given the opportunity to provide feedback. The degree of stakeholder involvement also affects the degree of support for scalability of a program beyond the geography where a program is implemented.The project was led by Elders and the local art and culture centre.


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Summary assessment for community engagement Effective evaluation

Assessment component 2: findings – conformity with evaluation standards relating to Quality evaluations

2.1 Values interpretation No published report 0 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

2.2 Report clarity No published report 0 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.

2.3 Disclosure of findings No published report 0 A full set of evaluation findings, along with limitations, is accessible to persons affected by the evaluation.

2.4 Justified conclusions No published report 0 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.

2.5 Impartial reporting No published report 0 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.

2.6 Evaluation impact No published report 0 Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.

Score for quality evaluations assessment component 0

Summary assessment for quality evaluations Ineffective evaluation


3.1 Key evaluation questions specified Some evidence, but not strong 1 Evaluation questions ensure there is an explicit link

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between the evaluation objectives, the evaluation design and the type of data collected.


Some evidence, but not strong 1 Program theory (also referred to as program logic) documents the causal (or results) chain from inputs to outcomes in a program intervention. Theory-based evaluation allows assumptions underpinning the program logic to be tested and avoids a ‘black box’ evaluation (identify an impact, but do not enable an explanation as to why).


Does not conform 0 No comparison groups were available to reduce or remove selection bias and avoid the risk of contagion.

3.4 Triangulation of findings Does not conform 0 Different data sets – and interpretation of that information – should support the same conclusion.

3.5 ‘Did it work?’ assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what worked and what did not as a result of the program. The link between development of cultural identity and the direct impact on suicide prevention could be more explicitly explored.

3.6 Learning assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.

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4



OVERALL SCORE FOR META-EVALUATION ASSESSMENT 9 Ineffective evaluation

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Case Study 2: ‘GREATS’ Youth Services (GYS): Locally based Upstream Approach (Maningrida, NT)

Primary Source of Information for the Evaluation CommentsProject team interviews with stakeholders.

Program Description

‘GREATS’ (Great Recreation, Entertainment, Arts, Training and Sport) Youth Services is a core program of the Malabam Health Board Aboriginal Corporation (MHBAC) and provides a range of programs and services for young people aged 10 to 20 years. The service commenced in 2009. Its range of programs and activities were in response to a series of suicides, self-harming and petrol sniffing incidents in the community. Anecdotal evidence suggests there has not been a youth suicide in Maningrida in the last three years.

Programs and services that are part of the GREATS program include:

• a range of activities encompassing sport, art, on country/cultural based and digital technology; • incorporates the community at all stages of the development of the programs and activities;• ongoing suicide prevention training of youth workers; • a drop-in service at the Youth Centre (up to 75 children and youth attend each day from 6–9 pm);• youth-in-crisis safe house; • youth patrol and outreach;• specialist programs and workshops such as sexual health and life skills program, the Strong Young Women’s

program ‘Gin Derta’, and Strong Young Men’s program ‘Ngarlapul’, which target disengaged and at-risk youth. During the dry season, these programs are often delivered on country with participation of Maningrida Elders;

• Youth Diversion Program in partnership with Northern Territory Juvenile Justice Department;• ‘Grog’ day safe drop-in;• Back to country cultural engagement trips with Elders;• The annual Lúrra Festival;• Specialty workshop with AOD unit, Legal Aid & Department of Children and Families;• School holiday programs (4 times per year);• Annual National Youth Week celebrations;• Bush camps to remove at-risk young people from the community and address their harmful behaviour;• Volatile Substance Abuse workshops on a needs basis;• Suicide intervention on a needs basis;• A biannual consultation with the whole of Maningrida to design programming; and• sexual health information and resources readily available after hours.

Objectives

As well as operating a drop-in service at the Youth Centre (Tuesday to Saturday), the youth services staff deliver specialist programs and workshops which target disengaged and at-risk Indigenous young people. During the dry season, these programs are often delivered on country with participation of Elders. GYS also operates a Youth Diversion Program in partnership with the NT Juvenile Justice Department, and a school holiday program.

The Centre trains and employs staff from across the clan groups and encourages young people from across the clan groups to work, train and participate. It fosters peer support and pathways for young people. Gender specific programs and cultural sensitivity is prominent and promoted when delivering programs. The Centre also includes Elders and Traditional Land owners in specialised workshops and programs. It conducts regular

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community assessments across the clan groups to ensure the centre and services are responsive to the needs and concerns of the community.

Outcomes

• Trains and employs only young local people from across the clan groups as youth workers, sexual health officers, youth diversion officers, and peer support workers;

• Provides a pathway to training and employment opportunities for young people in the community and mentoring roles for young people with children in the community;

• Delivers cross-sector case management of children and young people identified at risk; • High level of engagement in activities and services across the community; • Brings different agencies together to plan and coordinate approaches to young people; and • Ongoing review of suicide planning.

ATSISPEP Assessment

Summary Comments

GREATS youth service is an example of a program that is determined, led and governed by community to address the issues facing its young people. A distinguishing feature is the multi-pronged interventions aimed at addressing suicide prevention.




In the assessment against the meta-evaluation analysis framework, the GREATS program received the following scores:

• Strong conformity against the community engagement assessment component (a score of 5 out of a possible 6)

• Weak conformity against the quality evaluations assessment component (a score of 7 out of a possible 12)• Poor / doesn’t conform against the impact assessment rigour component (a score of 4 out of a possible 12)• A total score of 16 (out of a possible score of 30), which was categorised as weak conformity with the overall



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Table 5.5: ‘GREATS’ Youth Services, Maningrida – Meta-Evaluation Assessment


Evaluation Meta-Evaluation Scoring Rationale Applied Score Comment on criterion / project specific issue



1.2 Who led the program implementation Community-controlled organisation led 2 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people. GREATs was led by Malabam Health Board Aboriginal Corporation, in association with Elders.

1.3 Where implemented (locality/ jurisdiction/s) One locality / sub-region 1 Application of the program across broader geographies has several benefits:• Reduces the risk of selection bias• Increases the chance of demonstrating scalability



2 People affected by an evaluation should be identified and given the opportunity to provide feedback. The degree of stakeholder involvement also affects the degree of support for scalability of a program beyond the geography where a program is implemented. The initiative involves a number of target groups as well as a range of community groups.



Assessment component 2: findings – conformity with evaluation standards relating to Quality evaluations

2.1 Values interpretation Some evidence, but not strong 1 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

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2.2 Report clarity Some evidence, but not strong 1 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided. There is no published evidence on this project.

2.3 Disclosure of findings Some evidence, but not strong 1 A full set of evaluation findings, along with limitations, is accessible to persons affected by the evaluation.

2.4 Justified conclusions Some evidence, but not strong 1 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.

2.5 Impartial reporting Conforms, based on published information 2 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.The Menzies School of Health Research is involved in program development activities based on the GREATS program operations.

2.6 Evaluation impact Some evidence, but not strong 1 Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.

Score for quality evaluations component 7

Summary assessment for quality evaluations Partially effective evaluation


3.1 Key evaluation questions specified Some evidence, but not strong 1 Evaluation questions ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected.


Some evidence, but not strong 1 Program theory (also referred to as program logic) documents the causal (or results) chain from inputs to outcomes in a

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program intervention.


Does not conform / no published report 0 Comparison groups are not available to reduce or remove selection bias and avoid the risk of contagion.

3.4 Triangulation of findings Does not conform / no published report 0 Different data sets – and interpretation of that information – should support the same conclusion.

3.5 ‘Did it work?’ assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what worked and what did not as a result of the program.Stakeholder interviews advised that there had been no youth suicides in Maningrida in the three years to June 2015.

3.6 Learning assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.The stakeholder interviews provide some evidence in support of a multi-pronged range of interventions to address suicide prevention.

Score for impact assessment rigour component 4

Summary assessment for impact assessment rigour Ineffective evaluation

OVERALL SCORE FOR META-EVALUATION ASSESSMENT 16 Partially effective evaluation

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Case Study 3: Alive and Kicking Goals!: Peer-led Approach (Broome, WA)

Primary Source of Information for the Evaluation Comments

Tighe & McKay (2012) and additional material available at https://apps.aifs.gov.au/ipppregister/projects/alive-and-kicking-goals (accessed 17 March 2016)

Program description

Alive and Kicking Goals! (AKG) is a unique community-based, community-developed and community-driven as well as community- and peer-led suicide awareness and prevention program grounded in continual learning. AKG was developed in response to high rates of suicide experienced among young people in the Kimberley and as a way for the community to begin working towards more effective suicide prevention and better understanding of protective activities. AKG centred on enhancing the capacity, confidence, competence and esteem of community members through peer education within the frames of suicide awareness and prevention. AKG operates under the Men’s Outreach Services Inc., also based in Broome, and conducts workshops in ten Indigenous communities across the Kimberley region. These communities include Broome (the base), Derby, Fitzroy Crossing, Halls Creek, Looma, Bidyadanga, Beagle Bay, Djarindjin Community, One Arm Point and Lombadina. The initial mode of delivery was developed in conjunction with the Broome Saints Football Club (BSFC). BSFG has an extremely high standing in the community, and is predominantly an Aboriginal football club established in 1960.

Objectives

The program aims to prevent Indigenous youth suicide through the use of football and peer education. Volunteer youth leaders, who are well respected sportsmen, undertake training to become peer educators. They educate young people in communities about suicide prevention and lifestyle, and demonstrate that seeking help is not a sign of weakness. At the conclusion of the pilot, 16 young men had become peer educators (Tighe & McKay 2012). AKG was born from weekly meetings after training where the Project Mentor (PM) would train the youth subcommittee in leadership skills, and suicide awareness and prevention. These mini-workshops were holistic and looked at both protective and risk factors involved in Aboriginal suicidality. Those involved would learn healthful coping strategies, as well as help-seeking behaviours for themselves and others. A safe space was provided where the young people were able to discuss sensitive topics of importance to them.

Originally meeting every week after training, and conducted by the Project Mentor (PM), the youth subcommittee of young Aboriginal football players were trained in leadership skills and suicide awareness and prevention. These mini-workshops purposefully took a holistic approach to ensure coverage of both risk and protective factors connected to Aboriginal suicidality. The youth subcommittee were also taught about healthy coping strategies and help-seeking for both participants and others. These learnings and values were continued into the AKG workshops.

Outcomes

• The content and implementation of the AKG DVD and workshop were found to be relevant and appropriate within the Kimberley context. Many of the participants reported that the narrators of the DVD were telling stories that they could relate to and the teachings contained in the DVD were tangible and relevant;

• The DVD and workshop were well received by the participants with the use of local narrators and content specific to each of the communities involved;

• Almost 45% of the pre- and post-workshop survey participants acknowledged a positive change in attitude towards talking about suicide, their feelings, and help-seeking. In the focus group for participants aged 16+, participants who attended the workshop and watched the DVD provided confident and detailed answers

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https://apps.aifs.gov.au/ipppregister/projects/alive-and-kicking-goals

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about how to deal with a person with suicidal ideation when compared with those who had not attended a workshop;

• A key factor is that the program is community based, and is a suicide prevention initiative embedded within the contexts in which it is working;

• The space in which meetings took place was safe so members were able to discuss issues close to their own hearts; and

• The young men from the youth subcommittee have since become either PEs or remained on the Steering Committee. At the end of 2012 there were four full-time PEs; three young men and one young woman.

In total, 449 people completed at least part of the pre/post-workshop surveys with 255 (56.8%) completing both entirely. According to the pre/post-workshop surveys, the vast majority of the participants rated the DVD and workshop positively. While struggling with literacy, all participants noted positive changes occurred for the questions to varying degrees indicating the DVD’s impact on attitudes and knowledge. Many participants had some kind of experience with suicide.

Two significant findings emerged from the evaluation:

First, the way in which some participants constructed their responses around the recognition of someone who was feeling down or depressed was more a sense of physicality as to how a person looked (face and body) and their physical and emotional isolation away from family and community.

Second, some participants were shouldering the responsibility of saving people’s lives when, sometimes, a suicide may not be able to be prevented. People who take on supporting roles need to know that a suicide death is not their fault; they need to know that suicide prevention is a shared effort, not an individual one. When caregivers do not take care of themselves, they put themselves at risk of burnout, and worse. While well intentioned, these participants need to take care of their own wellbeing.

ATSISPEP Assessment

Summary Comments

AKG is a program designed to respond to local needs and interests and to effectively engage young people. It takes a strengths based approach focusing on enhancing protective factors by working to dismantle stigma, open a discourse around depression and suicidality, and encourage positive help-seeking among young people.

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A description of the evaluation activities prepared by the ATSIPEP project team is provided in the table below:

Project Name Approach Objective / Aims

Target Group Author Evaluationmethodology

Evaluation findings

Alive and Kicking Goals!

An Indigenous-led program to prevent youth suicide through the use of football and peer education, one-on-one mentoring, and counselling.

Young people Tighe & McKay (2012)

Conducted over 2010–2012. Utilised administrative data, observations and reflections, focus groups, workshops, surveys. Pre- and post-workshop qualitative (open-ended) surveys were utilised in the 16+ years’ group, as well as focus groups. These focus groups were also offered to people who had not attended an AKG workshop.Surveys conducted with teachers and parents.

• Evaluation tools showed that both the process and impacts of AKG are positive. The process evaluation covered an analysis of the appropriateness of AKG’s content and implementation within a Kimberley context, and the impact evaluation looked at participant-measured change in attitude and knowledge about suicide after the workshop.

• At the conclusion of the pilot, 16 young men had become peer educators, learning practical skills in suicide awareness and prevention.

• Preliminary findings were positive and will support the development of a sustainable intervention.

• The pilot project is ongoing, but its impact on suicide rates numbers has not been evaluated at this stage.

Alignment with Suicide Prevention Strategy The program aligns with Action Area 2 and outcomes 2.1–2.5.

NMHRC Evidence classification Methodological qualitative study (Q2)


In the assessment against the meta-evaluation analysis framework, the Alive and Kicking program received the following scores:

• Strong conformity against the community engagement assessment component (a score of 5 out of a possible 6)• Strong conformity against the quality evaluations assessment component (a score of 12 out of a possible 12)• Strong conformity against the impact assessment rigour component (a score of 9 out of a possible 12)

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• A total score of 26 (out of a possible score of 30), which was categorised as strong conformity with the overall meta-evaluation assessment criteria.


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Table 5.6: Alive and Kicking Goals! – Meta-evaluation Assessment







Multiple sub-regions within a jurisdiction 1 Application of the program across broader geographies multiple sub-regions, regions and jurisdictions) has several benefits:The program operated from Broome but also operated in several other sub-regions of the Kimberley.



2 People affected by an evaluation were identified and given the opportunity to provide feedback.



Assessment component 2: findings – conformity with evaluation standards relating to quality evaluations

2.1 Values interpretation Conforms, based on published information 2 Perspectives, procedures and rationale used to interpret the findings were described.

2.2 Report clarity Conforms, based on published information 2 The evaluation reports clearly described the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.


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2.4 Justified conclusions Conforms, based on published information 2 Conclusions reached in an evaluation were explicitly justified, so that audiences could assess their validity.

2.5 Impartial reporting Conforms, based on published information 2 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings. The evaluation results were reported in a peer-reviewed journal and the program independently evaluated by Griffith University.



Summary assessment for quality evaluations Effective evaluation


3.1 Clear link between evaluation questions and data collected

Conforms, based on published information 2 Evaluation questions should ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected. This link was not clear in the published report.


Conforms, based on published information 2 Program theory documents the causal (or results) chain from inputs to outcomes in a program intervention.


Some evidence, but not strong 1 Comparator groups were possible across the different sub-regional areas.

3.4 Triangulation of findings Conforms, based on published information 1 Three was some reference to triangulation in published material.

3.5 ‘Did it work?’ assessment provided on impact in reducing suicide

Some evidence, but not strong 1 There should be an explicit assessment of what worked and what did not as a result of the program. There is not an explicit

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reference to impacts on suicide rates in published material.

3.6 Learning assessment provided Conforms, based on published information 2 There was an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.


Summary assessment for impact assessment rigour Effective evaluation


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Case Study 4: The Yiriman Project: Connection to Country (Kimberley, WA)

Primary Source of Information for the Evaluation CommentsPalmer (2013)

Program Description

Aboriginal Elders in the West Kimberley initiated the Yiriman Project in 1997. It involves taking young people on country to help them develop a sense of their cultural heritage, which builds self-esteem and identity and prevents suicides. It started from a deep concern by Aboriginal Elders who wanted to address the number of young people engaging with social problems such as self-harm with drugs and alcohol, trouble with the law and a number of suicides among young people. The Elders followed long established traditions in setting up an organisation that would take young people, Elders and other community members on trips to country to hunt and collect food, meet their peers, interact with Elders, take care of country and walk as a way to learn stories, become healthy, build their skills and respect traditions.

The project began in Jarlmadangah Burru Aboriginal Community, approximately 100 kilometres south-east of Derby, WA, and has continued to operate under the clear direction of senior people. Yiriman is an intergenerational, on-country cultural program, conceived and developed directly by Elders from four Kimberley language groups: Nyikina, Mangala, Karajarri,and Walmajarri, who comprise the four cultural blocks in the West Kimberley region. Occasionally Yiriman is involved in supporting similar projects in the north and East Kimberley. Yiriman is auspiced by the Kimberley Aboriginal Law and Culture Centre (KALACC), which is the principal organisation for the maintenance of customary law and life in the region.

Objectives

The Yiriman Project’s key aim is to ‘build stories in young people’ and keep them alive and healthy by reacquainting them with country. The four language groups involved have similar cultural, geographical, language and kinship ties across a vast region of traditional lands stretching from the coastline south of Broome, inland to the desert areas south and just east of Fitzroy Crossing in the Kimberley in the far north of Western Australia.

The Yiriman Project consists of hosting ‘back to country trips’ where young people, Elders, other community members and stakeholder groups are brought together. Stakeholder groups include land care workers, educationalists, health practitioners, researchers and government officials. The Yiriman model is a means of providing young people with opportunities to participate more fully in community events and in life, but also provides inclusion in a range of other events, such as:

• land care;• cultural education;• fire management;• science and economic development;• health care and education;• tourism;• training for employment; and• language regeneration.

Yiriman trips vary in length – some last only a couple of days, others take a couple of weeks depending on the area travelled to, what work is undertaken, and the time of year. Picture book reports are produced regularly to show what has happened on trips using digital images, language, direct quotes and limited text. These picture books are also a way of sharing information about Yiriman projects to other groups.

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Outcomes

The evaluation identified the following critical factors to the success of the program:

• The significance of reconnecting young people to country, traditional lore and custom and relationships with the Elders;

• The considerable intergenerational contact between children, young people, parents and senior people. While on trips, young people in company with the adults, particularly Elders, participate in hunting expeditions, are taught language by the older people, sit around the camp hearing stories of the past, look after those who are less physically able by setting up camp and collecting firewood, take care of younger children, and work on other practical projects with members of their community while learning about and maintaining culture. The project’s engagement with these activities extends young peoples’ contact with other generations and groups;

• The experience of walking on country allows young people to get out of the towns and expose them to a different environment. Once there, they are provided with the opportunity to reconnect with their elders, Aboriginal culture and the land of their family. It is also a way in which young people’s attention can be diverted away from alcohol and drugs, antisocial activities and general unhealthy lifestyle choices and behaviour. For the duration of the trips, young people eat healthy food, are free of alcohol and other drugs, live without violence, enjoy themselves, spend time with knowledgeable and respected members of their community and take on new and exciting roles;

• Land care is another important element and function of the Yiriman Project’s back to country trips. Some of the initiatives run by the Yiriman Project have included the formation of a number of fire teams (in conjunction with the Kimberley Fire Project), a Ranger team and work with the Australian Quarantine Service. Also, initiatives from Yiriman have carried out fisheries research and supported various native title bodies; and

• Training and education opportunities are interwoven into many of the trips. An example is the work done with trainers and young people learning various traditional and modern methods of burning. Some have learned to take blood from animals and conduct post-mortems of animals for quarantine testing, use machinery for land care purposes, operate digital machinery to record research, build their literacy and numeracy levels, learn about health management and first aid, make films and other production work and create project reports using multimedia and public presentation software.

ATSISPEP Assessment

Summary Comments

The Yiriman Project is recognised as being a national best practice for providing a ‘back to country’ program for Aboriginal youth living in remote communities. It has been recognised by Reconciliation Australia, the Productivity Commission, and National Mental Health Commission. It has undergone an extensive evaluation identifying the rigour and effectiveness of the program for its context, with validated and culturally responsive and strength based methodologies underpinning its approach to suicide prevention. It takes an upstream, strengths based approach to addressing many of the risk factors for youth suicide and regards the role of connection to country, culture and law as critical for the youth of the regions in which it operates.

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Evaluation findings

The Yiriman Project

A community cultural connectedness program to assist young people to reduce risk-taking and self-harm behaviours and gain meaningful employment

Young people Palmer (2013) A mix of evidence and qualitative methodologies including participant and staff interviews, project documentation, direct participation and observation, written and verbal feedback from community members. The results were triangulated to ensure a robust evidence base and the accuracy of findings.

Qualitative evidence that: • young people gained a greater appreciation of

customary practices, • stayed drug and alcohol free during the program,

and, • improved confidence and self-esteem

Alignment with Suicide Prevention Strategy The program aligns with Action Areas 1 and 2 and outcomes 1.1–1.5, 2.1–2.3

NMHRC Evidence classification Mixed methods study M1


In the assessment against the meta-evaluation analysis framework, the Yiriman Project received the following scores:

• Strong conformity against the community engagement assessment component (a score of 6 out of a possible 6)• Strong conformity against the quality evaluations assessment component (a score of 12 out of a possible 12)• Strong conformity against the impact assessment rigour component (a score of 12 out of a possible 12)• A total score of 30 (out of a possible score of 30), which was categorised as strong conformity with the overall meta-evaluation assessment criteria.


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Table 5.7: The Yiriman Project, Kimberley WA, Connection to Country – Meta-evaluation Assessment





1.1 Reason for program development Driven by need: response to incidence of suicide Other:

Not applicable


1.2 Who led the program implementation Community-controlled organisation led 2 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people.This project was led by the Kimberley Aboriginal Law and Culture Centre (KALACC).


Multiple sub-regions across multiple jurisdictions 2 Application of the program across broader geographies has several benefits:• Reduces the risk of selection bias• Increases the chance of demonstrating scalability



2 People affected by an evaluation should be identified and given the opportunity to provide feedback. The degree of stakeholder involvement also affects the degree of support for scalability of a program beyond the geography where a program is implemented.




2.1 Values interpretation Conforms, based on published information 2 Perspectives, procedures and rationale used to interpret

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the findings are carefully described.

2.2 Report clarity Conforms, based on published information 2 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.


2.4 Justified conclusions Conforms, based on published information 2 Conclusions reached were explicitly justified, so that audiences can assess their validity.

2.5 Impartial reporting Conforms, based on published information 2 Reporting procedures guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.The Yiriman Project was independently evaluated by Murdoch University.


Score for findings quality evaluations component 12




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Conforms, based on published information 2 Program theory documents the causal chain from inputs to outcomes.



3.4 Triangulation of findings Conforms, based on published information 2 Different data sets – and interpretation of that information – should support the same conclusions.

3.5 ‘Did it work?’ assessment provided Conforms, based on published information 2 There is an explicit assessment of what worked and what did not as a result of the program.

3.6 Learning assessment provided Conforms, based on published information 2 There is an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.


12




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Case Study 5: Warra-Warra Kanyi – Mt Theo Program: A Cultural and Clinical Approach (Warlpiri, NT)


Saggers & Stearne (2010)

Program Description

Warlpiri Youth Development Aboriginal Corporation (WYDAC) Warra-Warra Kanyi (WWK) is a counselling and mentoring service that combines formal, tertiary counselling skills with a local Warlpiri approach and methodology to target high-risk behaviours in Warlpiri people aged approximately 12–25 in Yuendumu community. It works with numbers of young Warlpiri people on a variety of personal risk issues, most notably relationship issues, family violence, substance misuse (alcohol and cannabis) and suicidal and/or self-harming behaviour. The WWK team is uniquely comprised of four important parts: the WWK Coordinator/Counsellor, the WWK Youth Mentor, a team of Jaru Pirrjirdi Trainee Mentors, and the WWK Senior Cultural Advisor.

The Mt Theo Program (WYDAC) was started in 1993 by Elders from Yuendumu community in the Warlpiri region of Central Australia. The Program achieved unprecedented success in ending chronic petrol sniffing in Yuendumu, through a dual focus. The first step was the consistent removal of any petrol sniffers to the remote Mt Theo Outstation for 1–2 months of cultural respite and rehabilitation under the care of Warlpiri Elders. The second step was creating a 7-day/night youth diversionary service in Yuendumu filled with sports, art, bush trips and discos to keep Warlpiri youth entertained and engaged. In 2002 the program expanded, with the Outstation broadening beyond petrol sniffing to other substance abuse, including youth at-risk issues. Similarly, in 2003 there was a deepening of the basic youth program beyond an ‘entertainment’ and diversion focus. The Jaru Pirrjirdi (Strong Voices) project continued the youth diversion activities but also built a more comprehensive youth development program incorporating education, training, cultural activities, mentoring, leadership and career pathways. This project seeks to create meaningful and positive futures for Yuendumu young people aged 16 to 25 years.

The success of the Jaru Pirrjirdi Project in Yuendumu resonated loudly in other Warlpiri communities. At the express invitation of these communities, youth diversionary programs were begun in Willowra (2005), Nyirrpi (2008) and Lajamanu (2009). Similar to the growth of the Yuendumu youth program these services grew from an initial solid diversionary base to broader, more comprehensive youth development programs including training, education, employment and leadership outcomes as well as crisis response, education, group project work and bush trips. In 2008 Mt Theo Program client services were augmented by the creation of the Warra-Warra Kanyi (WWK) Counselling and Mentoring service in Yuendumu. Senior Jaru Pirrjirdi members were employed as WWK youth mentors to work with a WWK Counsellor to target critical youth issues. The WWK team engages with youth issues such as alcohol or other substance abuse, sexual health, relationship breakdown, domestic violence, depression and grief and suicidal behaviours.

Objectives

The WWK Project is comprised of five main elements:

• Prevention and Education;• Early Intervention;• Peer Mentoring and Counselling;• Community and Family Engagement; and• Re-engagement with the youth development project.

The key objectives of the Jaru Pirrjirdi Suicide Prevention Project – Mt Theo Program are to:

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• decrease the incidence of suicide attempts by building resilience to protect against suicidal ideation and other self-harming behaviours;

• strengthen the Jaru Pirrjirdi structure as part of a systemic and culturally appropriate solution to underlying issues;

• develop a pool of strong, trained, confident young mentors who are able to deal with underlying issues of suicidal ideation and other harmful behaviours; and

• graduate Jaru Pirrjirdi members into employment and positions of strategic power in the community.

Outcomes

The evaluation confirmed that the key outcomes of the WWK exceeded the aims.

A permanent, locally based, qualified counsellorThe provision of therapeutic services from a counsellor with tertiary qualifications is critical to the success of the project in fundamental client care processes, including the development of client care plans, identifying and implementing coping strategies, identifying and accessing sources of support, monitoring and managing risk, and exploring the deeper causes and triggers for the issues in a young person’s life. An important aspect has been the ability to appoint someone with significant time and relevant experience in the community as well as professional skill, and longevity of community relationships.

Employment of local youth WWK Youth MentorsYoung Warlpiri people have demonstrated strength, skill and capacity in caring for their at-risk peers. The WWK Youth Mentor position works very closely with, and reports to, the WWK Counsellor who in turn supports the development of, and provides professional supervision to, the Youth Mentor. The WWK Youth Mentor is an active collaborator in the care of appropriate clients (with primary care responsibilities remaining with the WWK Counsellor). Youth mentors will often have genuine, direct, honest and insightful advice on preventative behaviours, coping strategies and positive pathways.

Peer mentoring system Peer status is particularly powerful and important in Warlpiri youth culture. Through kinship and ceremonial systems, Warlpiri youths have formal obligations and responsibilities of care and protection towards certain other youths. Each person is in a particular relationship with each other and there is an appropriate peer to provide validated and skilful support. The exact same kind of support may not be accepted from a different peer (or indeed older person, or other mental health professional) simply because they are not the trusted or appropriate person to deliver this support. The WWK mentoring system is thus an attempt to further support and employ traditional and functional care systems.

Employment of Trainee MentorsTrainee Mentors are a group of young people who are currently active in the Jaru Pirrjirdi youth development project, and who have demonstrated a clear interest and capacity for helping at-risk peers. They are casually employed, operate under the close supervision of the WWK Counsellor (and, where appropriate, the WWK Youth Mentor) and are ‘matched’ with suitable clients according to important local and cultural factors such as gender, family group and skin name. This not only ensures that Trainee Mentors are in very frequent contact with their at-risk peers, but importantly that they are well placed and appropriate people to work with young people involved in WWK. There is a particular reliance on, and use of, the Trainee Mentors as a unique ‘early warning’ or risk identification system. At high-risk times, such as late at night or when substance misuse is a factor in a situation, the only other people present are peers. In these situations, the Trainee Mentors represent the crucial link between a developing crisis, and professional assistance. Usually, Jaru Pirrjirdi Trainee Mentors have struggled with, and successfully resolved issues in their own lives which are similar to those faced by youth in crisis; hence, their mentorship is particularly relevant, effective and appropriate.

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24-hour on-call service, seven days a weekThe Counsellor is expected to be available to community members at all times, day or night, weekends, and public holidays (with clear on-call protocols covered by other appropriate WYDAC staff members during periods of annual leave).

Addressing suicidal behaviour by working to address cannabis misuseCannabis misuse is a significant underlying factor in suicide risk for Warlpiri young people. This aspect of the program utilises the Mt Theo Outstation. The physical place Mt Theo (Puturlu) has significance as a cultural site among Warlpiri people, containing powerful Jukurrpa (Dreaming) sites and stories. Any young person who is misusing cannabis can have the opportunity to undergo cultural rehabilitation and a period of detoxification supported by experienced Warlpiri carers at Mt Theo. This works to assist young Warlpiri people to deal with their cannabis misuse, through respite from the pressures, demands and temptations of community life. Mt Theo fosters a strong link with Warlpiri culture and with all the inherent benefits embedded in that culture for at-risk Warlpiri youth. It is a place where strong, positive, healthy Warlpiri identity is forged, promoted, practiced and imparted.

Appropriate counselling and mentoringThese services take place in an appropriate setting (in the bush and out of community) and during an appropriate activity (for example, whilst hunting or whilst sitting together for 1–2 hours and waiting for the kangaroo to cook). Weekly young men’s mentoring trips, for example, are a regular event that involves the WWK Youth Mentor, Jaru Pirrjirdi Trainee Mentors and a group of at-risk young men with whom the team are currently working and who go out bush and hunt.

Inclusion of Elders of the Warlpiri communityElders are involved as support persons and through the role of Senior Cultural Advisors who act as a cultural supervisor and advisor, particularly for the non-Warlpiri staff of Warra-Warra Kanyi (and more broadly, other WYDAC and external agency staff). The WWK Senior Cultural Advisor also plays an important outreach and support role to the Mt Theo Outstation and to other Warlpiri communities requesting support. Finally, the WWK Senior Cultural Advisor plays an important supervisory role in the development of culturally relevant Warlpiri mentoring and counselling resources.

Deep understanding of the critical and heightened risk periods for the communityOver many long years of experience and communication with the community at Yuendumu, the WWK team is able to identify critical periods or situations when a risk situation is likely to develop. This predictive knowledge is crucial in developing an understanding of a ‘local calendar’. This allows useful preparation of staff, of resources, and early preventive work with families and peers and external agencies such as the police.

ATSISPEP Assessment

Summary Comments

The project demonstrates the importance of a clinical and cultural model as an effective means of supporting and empowering young people. The WWK is both a clinical and cultural program that provides extensive and appropriate wraparound services and rapid, consistent, accessible, local and informed crisis response to address suicide attempts, and preventing attempts from becoming completed suicides. The WWK is a culturally safe and accepted source of support for young people who have experienced suicidal thoughts, impulses, threats or attempts over a sustained period. It also deals with the issues underlying these problems and moves young people forward towards a positive and meaningful future pathway.

The centrality accorded a strong cultural identity to ensure young people’s sense of connection and confidence, and has proved highly effective in enabling them to move away from cycles of violence, self-harm and suicide, substance misuse, and criminal behaviour towards more positive and meaningful life pathways. The program has grown significantly since its grassroots inception into a comprehensive program of youth diversion, development, leadership and rehabilitation throughout the Warlpiri region. Most critically, Warlpiri people

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themselves created the program, and its ownership, design and growth remain under the control of the governing committee of Warlpiri people. It is an example of the importance of a team comprised of people with local knowledge and people with qualified experience who are responsive, local and informed, and available in the community on a permanent basis. The program also places emphasis on the ability of families and the community to recognise suicide risk and respond to it, and communicate their concerns as early as possible. The impacts of the program have been sustained over a long period of time; it supports inclusion and engagement across the community and is underpinned by local governance and community control.

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Evaluation findings

Warra-Warra Kanyi – The Mt Theo Program

A comprehensive program of youth development and leadership, diversion, respite, rehabilitation, and aftercare throughout the Warlpiri region

Young Indigenous people in the Warlpiri region, NT

Saggers & Stearne The evaluation process involved three phases: a ‘negotiation of evaluation framework’ in 2008; a ‘formative evaluation’ in 2009, consisting of in-depth interviews and focus groups, and observations; a ‘summative evaluation’ consisting of interviews and informal observations. Four main objectives were identified as measures, relating to: decreases in suicide attempts, self-harm and suicide ideation by increasing resilience and building protective factors; strengthen the program structure systemically and as a culturally appropriate solution to underlying issues; develop a resource of trained, strong and confident mentors, and; graduate program members as powerful

• The Evaluation showed that the Warra-Warra Kanyi service model succeeded in engaging young people, utilising 6 key areas: prevention and education; early intervention; individual counselling and mentoring; community and family engagement; case management; and re-engagement with other programs. Strengths of the program include:

• Preventative activity such as night school and bush trips provided workers and young people to engage informally about issues and concerns.

• Drawing on local understandings of Warlpiri behaviour and knowledge of the local context and calendar.

• Staff know all young persons in the community and are able to identify those at risk.

• Utilising community strengths and relationships, Elders and other community members complement the peer mentoring service.

• Case management was shown to be a tool to provide practical life skills, along with the re-engagement of young people in other program activities.

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Evaluation findings

members of the community and into employment.

Alignment with Suicide Prevention Strategy The program aligns with Action Areas 1–6 and outcomes 1.1–1.4, 1.6, 2.1–2.3, 2.5, 3.1–3.4, 3.6, 6.1–6.3

NMHRC Evidence classification Anecdotal qualitative study (Q2).


In the assessment against the meta-evaluation analysis framework, the WWK project received the following scores:



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Table 5.8: Warra-Warra Kanyi, Mt Theo Program – Meta-evaluation Assessment


Evaluation Meta-Evaluation Scoring Rationale Applied Score Comment on criterion / pilot specific issue




1.2 Who led the program implementation

Community-controlled organisation led 2 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people.Program is led by Warlpiri Youth Development Aboriginal Corporation (WYDAC).


Multiple sub-regions within a jurisdiction 1 Application of the program across broader geographies has several benefits:• Reduces the risk of selection bias• Increases the chance of demonstrating scalability



2 People affected by an evaluation were given the opportunity to provide feedback.




2.1 Values interpretation Conforms, based on published information 2 Perspectives, procedures and rationale used to interpret the findings were carefully described.

2.2 Report clarity Conforms, based on published information 2 Evaluation reports clearly describe the program

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evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.



2.5 Impartial reporting Conforms, based on published information 2 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.The program was independently evaluated by Curtin University.


Score for findings quality evaluations component 12





Conforms, based on published information 2 Program theory documents the causal chain from inputs to outcomes in a program intervention.

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Some evidence, but not strong 1 Comparison groups are available to reduce or remove selection bias and avoid the risk of contagion.





11



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Case Study 6: UHELP: Action Learning Model (Inala, QLD)


Project team interviews with stakeholders, including feedback from the internal project team evaluation

Program Description

headspace Inala (Queensland) partnered with the Suicide Prevention and Mental Health Program, Queensland Health and other local community organisations to design and develop a program that tapped into cultural learning styles and strengths. The headspace Inala Service Innovation Project was designed to actively engage Aboriginal and Torres Strait Islander young people in need of mental health intervention into a health care service using established relationships and a culturally safe and appropriate system of care. It sought to engage them into a set of physical, social and emotional wellbeing promotion activities. These aims were actioned through the delivery of an innovative group program that was designed to improve the mental health literacy of the general Aboriginal and Torres Strait Islander youth community, and identify and refer the young people most in need of support. The United Health Education and Learning Program (UHELP) model was developed, named by community and founded on four key components: 1) Awareness; 2) Engagement; 3) Learning/Modelling and 4) Ongoing Support.

headspace Inala is located in a region with a significantly large and culturally strong Aboriginal and Torres Strait Islander community. There is strong local leadership within the community from the Inala Elders Aboriginal and Torres Strait Islander Corporation (‘Inala Elders’). Historically, there has been a proportionally high rate of youth suicide among the Aboriginal and Torres Strait Islander people in the region. Aboriginal and Torres Strait Islander young people have struggled to have their mental health needs appropriately managed by mainstream mental health services, and are underrepresented in primary mental health care systems. It is significant that almost 70% of UHELP participants reported knowing someone that had died by suicide – a known risk factor for suicidality.

Objectives

The key objectives of the UHELP program are to:

• Improve the social and emotional wellbeing (SEWB) of Aboriginal and Torres Strait Islander young people in the Inala area and surrounding suburbs;

• Develop and refine a new and innovative intervention model that specifically addresses the social and cultural realities of young Aboriginal and Torres Strait Islander people. This includes incorporating cultural governance safeguards;

• Capitalise on the progress made by the Suicide Prevention and Mental Health Program, a community owned program run by the Inala Aboriginal and Torres Strait Islander Elders;

• Validate the use of Aboriginal and Torres Strait Islander–specific mental health outcome measures within a headspace context;

• Increase the capacity of the Aboriginal and Torres Strait Islander community’s young people to identify and appropriately respond to suicidal behaviour;

• Increase the accessibility and acceptability of individual, culturally appropriate counselling (hereafter referred to as ‘yarning’) for young Aboriginal and Torres Strait Islander people; and

• Foster collaboration between headspace Inala, the local community, and relevant organisations to improve the health and wellbeing of the community.

The aim of key component 1 (Awareness) was to improve the health literacy and knowledge of young Indigenous people about social and emotional wellbeing indicators, strategies and protective mechanisms. The program aspired to deliver positive messages and provide early intervention strategies in relation to mental health and wellbeing.

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The aim of key component 2 (Engagement) was to create culturally safe spaces and learning environments and to further develop relationships built on trust and mutual respect. The aim of this component was also to develop strong partnerships and linkages with community and government service providers to strengthen community capacity to improve health and wellbeing of the community.

The aim of key component 3 (Learning/modelling) was to deliver and consistently reinforce messages through diverse mediums and to strengthen the retention and application of learning by participants outside of the group.

The aim of key component 4 (Ongoing Support) was to identify and refer the young people most in need of support and to ensure that services were culturally appropriate to meet those needs.

Outcomes

The independent internal evaluation found that the UHELP program successfully:

• improved the knowledge and understanding of SEWB and help-seeking in youth in the community;• increased the capacity of youth to respond appropriately to suicidal behaviours;• increased the acceptability and accessibility of culturally appropriate counselling (yarning) throughout the

community; and• fostered fruitful collaboration between headspace Inala, the local community, and other related organisations.

The UHELP program invested in creating a culturally safe and appropriate learning space and offered an intensive six-week integrated program of physical, social and emotional wellbeing activities and support to participants. Independent analysis confirmed that the project goals were achieved and participants and other stakeholders provided anecdotal evidence of significant improvements in wellbeing, attitudes, behaviours and personal resilience.

The evaluation found that the UHELP program resulted in:

• a statistically significant decrease in self-reported suicidal thinking among participants immediately following the group program (as measured by the GHQ-suicide);

• improved social and emotional wellbeing of program participants;• enhanced participants’ understanding of physical, psychological, emotional, preventative and social health; • improved self-confidence, self-management, self-awareness, sense of belonging and a sense of

empowerment;• supported a marked increase in the number and effectiveness of coping strategies;• reduced levels of anxiety, psychological distress, depression and impulsivity and improved levels of self-

confidence and self-esteem (confirmed through psychometric testing);• participants demonstrated skills to manage stress, to take responsibility for their attitudes and behaviours and

to respond more constructively to life’s challenges;• significant reduction in stigma associated with acknowledging self-harm behaviours and seeking help; and• improved citizenship and engagement of participants in community life, increased social engagement, civic

responsibility and reciprocity and supported the emergence of leadership skills. Graduates of the Program emerged as new leaders in the community, both in their participation in a Youth Advisory Group (YAG), becoming Suicide Prevention and Mental Health Program (SPAMHP) future leaders, and through the modelling of socially responsible behaviours.

The UHELP Project met its key aims including actively engaging Aboriginal and Torres Strait Islander young people in physical, social and emotional wellbeing activities through a three-tiered holistic group program. It also aimed to engage young Aboriginal and Torres Strait Islander people in need of mental health intervention into a health care service using established relationships and a culturally valid and appropriate system of care. In total, 75 young people aged between 12 and 25 years participated in nine programs delivered over a 12-month period from October 2013 to September 2014. Eighty one percent (81%) of participants completed the full six-week program.

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Program delivery The program integrated a suite of learning, personal development, team building and mentoring strategies to enhance the social and emotional wellbeing of participants. The model was founded on the belief that learning is most likely to occur in an environment where there is engagement between knowledgeable, respectful and respected educators and students in a safe, responsive, culturally appropriate and welcoming space. The recruitment of highly skilled and experienced project staff, who were able to quickly develop relationships built on mutual respect, was critical to the overall success of the project. All project staff identified as Aboriginal, Torres Strait Islander people or both and were well connected, well respected and well established within the region.

The program was designed for delivery over a six-week period, with each weekly program running for two to three hours. By the end of the group program, participants would have had between 12 and 18 contact hours over the six-week period. The first week focussed on orientation: getting to know you and completing assessment measures, and the final week involved completing assessment measures, review, and a celebration of finishing the program.

As is culturally appropriate, male and female participants participated in the program separately. The groups were jointly facilitated by a male and a female project officer, with culturally sensitive material delivered by a same-sex facilitator.

Group topic areas included the following key features:

• Designed as a 30-minute block, with two sessions of content delivered each week over a four-week period. Topic areas presented during the same week had thematic ties;

• Incorporated a number of interactive activities to assist participant engagement and retention of information; • Interactive activities were crafted to tap into cultural learning styles and strengths;• All activities involved a mixture of yarning, cultural DVDs, individual and group activities;• Group processes were designed to be flexible enough that sessions could be delivered in 30-minute blocks

(one session per group) or 60-minute blocks (2 sessions per group). This would allow different delivery strategies for different attention spans;

• Activities developed for the groups were interchangeable;• Each activity was determined by the lead facilitator, based on participant commitment and interest levels.

Where there was high participant enthusiasm, group SEWB content could go for longer than 60 minutes, and additional activities could be introduced;

• Transport was provided to participants to increase accessibility and safety, given the combined factors of afterhours programming, the geographic spread of residency, and independent access regardless of what other family members had planned; and

• A multi-layered reward system for participation and achieving milestones. Participants were provided with a $150 reward for successfully completing the program. This included, for example, gym membership, netball/football fees, sports uniforms/equipment, movie tickets, and pamper packs that promoted self-care.

GovernanceHigh quality cultural governance ensured that the approach the project team took was consistent with Indigenous understanding of social and emotional wellbeing, help-seeking, education and appropriate offers of support. Taking a cultural governance approach increased the commitment from the community for the project, and demonstrated the value that headspace Inala placed on the partnership, and knowledge and wisdom of the community, particularly of the Elders.

A Youth Advisory Group (YAG) was established that consisted of local Indigenous young people who were already associated with either headspace Inala, or were Future Leaders with the Inala Elders Suicide Prevention and Mental Health Program. This group participated in and provided feedback into the SEWB group program content, processes and approach to engaging with and supporting project participants.

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Clinical governance of the project was provided by the headspace Inala Clinical Governance Advisory Group. Membership of this group includes local team leaders from tertiary mental health and alcohol and other drug services, clinical liaison officers and a local general practitioner. This group oversaw the development of safeguards for participants, including risk assessment strategies and follow-up mechanisms for group participants identified as requiring extra support.

Service delivery model was based on a partnership approach

The culture of the UHELP Program is respectful, nonjudgemental and supportive. The mutually respectful relationship and positive regard reported between participants and facilitators was identified by both internal and external stakeholders as a critical success factor.

Skilled FacilitatorsFacilitators demonstrate a special skill set which combines respectful management of the participants and the ability to develop relationships with them, many of whom had traditionally experienced great difficulties engaging with authority and trusting outsiders.

Use of appropriate and effective instruments and toolsThe use of the Westermann Aboriginal Symptom Checklist (WASC) as a psychosocial tool of engagement is regarded by project facilitators as an effective instrument for engaging with Indigenous youth and for developing relationships between participants and facilitators. Participants also appreciated having this questionnaire (particularly because of its face validity) and headspace staff reported that high subscale scores were meaningful indicators of participants in need of follow-up assistance.

Provision of culturally appropriate counselling and culturally safe placesThe program provides and promotes the accessibility and acceptability of individual, culturally appropriate counselling for Aboriginal and Torres Strait Islander people at headspace Inala, which is considered a culturally safe, appropriate, informed service. The significant increase in referral rates to headspace Inala since the UHELP commenced suggests the program has helped to generate the recognition that yarning at headspace Inala is a safe and culturally appropriate service, particularly as these increases have occurred in the context of client numbers at headspace Inala increasing overall.

Clinical and cultural governance

Taking a cultural governance approach increased the commitment from the community for the project, and demonstrated the value that headspace Inala placed on the knowledge and wisdom of the community and in particular the Elders. It also demonstrated that headspace Inala recognises that solutions to the challenges in headspace engaging with Aboriginal and Torres Strait Islander young people are best solved in partnership with the Aboriginal and Torres Strait Islander community. Governance processes were designed to fit with existing community oversight structures, specifically, the Suicide Prevention and Mental Health Program community meetings and Inala Elders’ Steering Committee meetings, as well as involvement of appropriate partners such as the Inala Clinical Governance Advisory Group.

Involvement of multiple stakeholdersUHELP project stakeholders had a shared vision and a similar mandate and worked together to the mutual benefit of Indigenous young people and the community. By sharing knowledge, resources and expertise, the capacity of all partners was strengthened and a new soft entry experience was established for vulnerable young people in the Inala region.

The SPAMHP and Youth Advisory Group informed, guided and provided feedback on all aspects of the program in the establishment, implementation and evaluation phases. These partnerships were built on a two-way flow of information and reported back and enabled UHELP to be quickly established as a credible, culturally effective program for young Aboriginal and Torres Strait Islander people in the Inala region.

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ATSISPEP Assessment

Summary Comments

The program is an important example of a culturally based approach within a mainstream mental health service setting that was able to link vulnerable Aboriginal and Torres Strait Islander young people with each other, support services and their communities. By delivering a range of activities and investing in the development of relationships, the program addressed cycles of isolation, juvenile offending and dysfunction, and enhanced the social and emotional wellbeing of participants.

UHELP is an example of how to promote more resilient and engaged young people. One of the critical elements of the program is getting young people to be proud of their Aboriginal identity and identifying how they belong to their community. By investing in the development of personal relationships and strengthening connections between young people, their families and their communities, UHELP enhanced the development of feelings of trust, safety, belonging and the sense of connection to community for participants and the Elders involved with the program.

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Evaluation findings

headspace – Inala United Health Education and Learning Program (UHELP)

A six-week program which aims to engage Aboriginal and Torres Strait Islander youth in physical, social and emotional wellbeing activities through a holistic group program

Indigenous youth aged 12–25

headspace Inala UHELP project team (2014) [not published]

Mixed methods evaluation approach, embedded in a Participatory Action Research (PAR) framework. The program was delivered 9 times, including twice in the pilot phase from Oct 2013 to Sept 2014. Pre-program data was collected plus post-program data, to track long-term change within a two-month follow up with participants using the (WASC), Kessler (K10); the suicide items from the General Health Questionnaire 28 (GHQ); and the Rosenberg Self-Esteem Scale (RSES)

The evaluation showed that the UHELP program:• improved the social and emotional wellbeing

of participants• increased understanding of physical,

psychological, emotional, preventative and social health and showed a marked increase in the number and effectiveness of known coping strategies

• a reduction in anxiety levels, psychological distress, depression and impulsivity and an improvement in self-confidence and self-esteem levels

• There was also a statistically significant decrease in self-reported suicidal thinking immediately following the program

Alignment with Suicide Prevention Strategy The program aligns with Action Areas 1–5 and outcomes 1.1–1.4, 2.1–2.5, 3.1, 3.5, 5.4

NMHRC Evidence classification Mixed methods study (M1) and pre/post case series (C1)


In the assessment against the meta-evaluation analysis framework, the UHELP project received the following scores:

• Weak conformity against the community engagement assessment component (a score of 4 out of a possible 6)• Non-conformity against the quality evaluations assessment component (a score of 0 out of a possible 12)• Weak conformity against the impact assessment rigour component (a score of 6 out of a possible 12)• A total score of 10 (out of a possible score of 30), which was categorised as poor conformity with the overall meta-evaluation assessment criteria.


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Table 5.9: UHELP Action Learning Model (Inala , Queensland) – Meta-evaluation Assessment





1.1 Reason for program development

Driven by need: response to incidence of suicide

Not applicable There is an underlying level of suicide in most communities. Higher levels of suicide are not a positive.

1.2 Who led the program implementation

Community-controlled organisation led

2 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people.


One locality / sub-region 0 Application of the program across broader geographies has several benefits:Reduces the risk of selection biasIncreases the chance of demonstrating scalability




Score for community engagement assessment component

4 (compared to maximum score for component of 6)

Summary assessment for community engagement



2.1 Values interpretation No published report 0 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

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2.2 Report clarity No published report 0 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.

2.3 Disclosure of findings No published report 0 A full set of evaluation findings, along with limitations, is accessible to persons affected by the evaluation.

2.4 Justified conclusions No published report 0 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.

2.5 Impartial reporting No published report 0 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.

2.6 Evaluation impact No published report Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.

Score for quality evaluations assessment component

0

Summary assessment for quality evaluations



3.1 Key evaluation questions specified

Some evidence, but not strong

1 Evaluation questions ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected.



1 Program theory (also referred to as program logic) documents the causal (or results) chain from inputs to outcomes in a program intervention. Theory-based evaluation allows assumptions underpinning the program logic to be tested and avoids a ‘black box’

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evaluation (identify an impact, but do not enable an explanation as to why).



1 Comparison groups are available to reduce or remove selection bias and avoid the risk of contagion.

3.4 Triangulation of findings Some evidence, but not strong

1 Different data sets – and interpretation of that information – should support the same conclusion.

3.5 ‘Did it work?’ assessment provided


1 There should be an explicit assessment of what worked and what did not as a result of the program.

3.6 Learning assessment provided Some evidence, but not strong

1 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.


6



OVERALL SCORE FOR META-EVALUATION ASSESSMENT

10 Ineffective evaluation

Legend: framework for scoring

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Case Study 7: Family Wellbeing Program


Con Goo (2003)

Program description

The Family Wellbeing Program (FWB) focuses on the empowerment and personal development of Indigenous people through people sharing their stories, discussing relationships, and identifying goals for the future. Workshops are held with both adults and children to highlight the various health and social issues experienced by Indigenous communities and the steps that can be implemented to deal with these issues.

Initially started in 1998 in South Australia by a group from the Stolen Generations, the Apunipima Cape York Health Council in Far North Queensland has modified the program to meet the specific needs of the local communities of Hopevale and Wujal Wujal. Survival experiences of course facilitators and participants are the main learning resource of the program. Group processes play an important role in facilitating a safe and supportive learning environment in which participants feel comfortable to reflect and express feelings.

An extensive evaluation by the University of Queensland and James Cook University demonstrated the effectiveness of the FWB empowerment approach as a tool for engaging participants on a wide range of issues affecting their health and wellbeing and those of their families. The program is being increasingly incorporated into a range of health interventions, workforce training and school curricula.

Objectives

FWB takes a community development approach to health and the social determinants impacting on health across the continuum of care, and is a framework for social and emotional wellbeing. FWB articulates the human qualities necessary for leadership and healthy relationships such as vision, respect, empathy, and compassion. It advocates relationships based on wisdom, acceptance, freedom and honesty and provides a safe forum for reflection and learning skills to achieve these personal qualities and relationships.

It seeks to:

• engage and support individuals and groups in Indigenous settings to take greater control and responsibility for their health and wellbeing;

• foster the empowerment and personal development of Indigenous people through people sharing their stories, discussing relationships, and identifying goals for the future;

• address the various health and social issues being experienced by Indigenous communities and the steps that can be implemented to deal with these issues;

• provide an ‘inside-out solution’ that builds on Indigenous strengths; and• provide a safe and supportive learning environment that provides an opportunity for people to reflect on and

share stories about important questions for life: Where am I going with my life? Who is benefiting and who is losing out? What can I do to change the situation? With what consequences?

Outcomes

Focussing directly on empowerment, this comprehensive program facilitates Indigenous people’s capacity to regain social and emotional wellbeing and begin to rebuild the social norms of their families and community. It successfully operationalises the links between empowerment at personal/family, group/organisational and community/structural levels and mechanisms to address Indigenous social and emotional wellbeing issues such as family violence and abuse, suicide prevention and incarceration.

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Drawing on a 10-year community research strategy using the Participatory Action Research (PAR) method, the evaluation of the Family Wellbeing Program found that the program:

• enhanced the capacity of program participants and their communities to take greater charge of issues affecting their health and wellbeing;

• developed capacity to analyse situations more carefully, take better care of themselves, give and demand more in their relationships, and participate more actively;

• participants’ sense of self-worth, resilience, problem-solving ability, and ability to address immediate family difficulties and change their social environment were all enhanced;

• evidence of increasing capacity to address wider structural issues such as poor school attendance rates, a critical housing shortage, endemic family violence, alcohol and drug misuse, chronic disease, and overrepresentation of Indigenous men in the criminal justice system;

• participants breaking new ground in areas such as values-based Indigenous workforce development and organisational change, as well as issues about contemporary Indigenous spirituality; and

• the focus on sharing stories/narratives is also the strength of the program.

ATSISPEP Assessment

Summary Comments

The Family Wellbeing Program is one of Australia’s preeminent empowerment, healing and social and emotional wellbeing programs whose effectiveness and responsiveness has been clearly demonstrated over many years and through a rigorous and comprehensive evaluation process. The review team rated it very highly as strong evidence of effectiveness and good practice. It is an example of the impact of a sustainable and longer term program and of the critical importance of empowerment to achieving social and emotional wellbeing.

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Target Group Author Evaluation methodology Evaluation findings

The Family Wellbeing Program

A family wellbeing course that aims to facilitate empowerment by developing analytical and problem-solving skills to address life challenges. The course is delivered in 5 stages, including a 1-week intensive course in the final stage

Adults Con Goo (2003) Evaluation used PAR and was based on participant feedback and interviews post-course and at 6 months later

• Feedback suggests that participants were better able to cope with adversity, change and therefore attain self-reliance; course reinforced feelings of connectedness and belonging

• Anecdotal evidence that the course could benefit the whole community with the potential to change the way the Indigenous social and health issues are addressed

• Provided a safe and supportive environment for learning

Alignment with Suicide Prevention Strategy The Family Wellbeing Program is aligned with Action Areas 1, 2, 5, & 6 and outcomes 1.1–1.5, 2.1–2.3, 5.4, 6.1–6.4

NMHRC Evidence classification Pre/post case series (C1)


In the assessment against the meta-evaluation analysis framework, the Family Wellbeing Program received the following scores:



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Table 5.10: Family Wellbeing Program – Meta-evaluation Assessment

















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Score for quality evaluation assessment component 12








3.4 Triangulation of findings Conforms, based on published information 2 Different data sets – and interpretation of that information –

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should support the same conclusion.

3.5 ‘Did it work?’ assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what worked and what did not as a result of the program.The precise impact of the program on suicide outcome indicators needs to be clarified.





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Case Study 8: Wesley LifeForce Suicide Prevention Training for Indigenous Community Workers



Program Description

This case study is an example of an innovative initiative to adapt an existing mainstream suicide prevention program led by experienced Aboriginal community consultants using culturally responsive and reciprocal learning processes. In 2014 the Wesley Suicide Prevention Services engaged The Seedling Group to adapt the Wesley LifeForce Community Suicide Prevention Training, to be culturally responsive for facilitators working with Indigenous peoples and to develop a resource for use by Indigenous and non-Indigenous community workers. A key outcome required was the documentation and provision of a program design with content options informed by theory, research and cultural protocols, underpinned by professional practice and documented program logic. The initiative took place over a six-month period.

Objectives

The key aims of the project were to:

• Develop a culturally responsive training model in development and design, while adapting the existing Suicide Prevention Training in both the 4-hour and 6-hour community workshops.

• Develop a resource to encourage the inclusion of collective healing and knowledge exchange, through the development of a training model, which is both culturally appropriate and responsive to the individual or collective Indigenous community members attending.

Outcomes

The outcomes of the project were:

• The development of recommendations, protocols and curriculum for a culturally responsive training package to deliver suicide prevention training to Aboriginal and Torres Strait Islander community workers;

• Feedback was obtained from community members who would receive the training and represent the end user. This enabled cultural diversity to be incorporated into the integrated framework. Indigenous communities all gave their voice to guide the development of the project. Communities participated in the focus groups and also a pilot training program;

• Community members identified the best people to attend the groups;• The consultants spent time in the community before and after the training and focus groups, to provide

further information and exchange of knowledge as part of a reciprocal learning process;• Consultations for the adaptation took place in three sites based on the community’s needs and on the team’s

existing connections and relationships with community members on a personal and professional level in Katherine, Northern Territory; Halls Creek, Western Australia; and Thursday Island, Queensland;

• Evaluation of the focus groups and the pilot training were conducted at the end of each session. Certificate of participation in focus groups and training were provided to members who attended. Follow up of participants by the team, or by agreed community members, was carried out following each session; and

• Based on the consultations and evaluation follow-up, the Indigenous research consultants identified the key features considered essential for effective community suicide awareness workshops and training. This included the key elements involved in the facilitation, delivery and evaluation.

Facilitation• Relationships built with key community members before introducing the training into the community;

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• A key Aboriginal or Torres Strait Islander local training assistant who is a recognised member of the community engaged to recruit community members for the training so that appropriate people are included on invitation lists;

• Local Aboriginal and/or Torres Strait Islander businesses utilised where possible for venue and catering purposes, accommodation and transport within the community;

• Care needs to be taken to ensure culturally appropriate opening and closing protocols are observed; • The trainer and the local Indigenous training assistant review the presentation before the group training to

ensure it is acceptable for that community;• Group work is encouraged, as it is a cultural way of sharing knowledge and learning. This also ensures those

less articulate in SAE or the less confident members of the group can be heard and ask questions of peers. Small groups working together offer safety and were requested by focus groups; and

• Housekeeping to include how to proceed if the training is distressing participants in any way. It is likely that Aboriginal and Torres Strait Islander participants in this training will have been affected first-hand by suicide.

DeliveryKey learnings were:

• Spend time on introductions – it is critical when facilitating this training in community. This step is paramount to building trust with participants;

• Training to be given in a more informal ‘yarning circle’ or ‘roundtable’ setting;• Sharing of knowledge, rather than imparting of knowledge and allowing time for participants to add cultural

content as a part of the training should be allowed and encouraged;• In communities where English is the second, third or even the fourth language, an interpreter (could be

someone in the community) should be engaged to translate the information; and• Include groups like Police and Community Youth Centres which have a strong relationship with some homeless

groups in a number of communities.

Evaluation• Pre-training evaluations and post-training evaluations carried out to measure effectiveness for different

population groups; and• Using the qualitative evaluation process of ‘most significant change’ to see how this training influences

changes over time.

Evaluation Findings

The key findings from this process provide important insights into the design and delivery of any program and service.

• The project was planned with the concepts of community capacity building, community engagement and culturally acceptable knowledge sharing protocol as its core features;

• The project was planned to include full and fair participation of, and input from, the community members. This is considered not only an ethical and moral research practice, but a basic human rights practice;

• The critical importance of developing a resource that is very different from just an adaptation of an existing program. The developed program incorporates existing knowledge from the old program; however, it is grounded in collective healing knowledge and a reciprocal learning focus. It is intended to improve the range and quality of suicide prevention knowledge skills, training material, and programs available to the Aboriginal and Torres Strait Islander peoples; and

• The reciprocal learning within the training model enables the training to be effective in any community. A problem with other training packages is the lack of interaction and ability for each community to raise their community needs and direct the knowledge transfer to best suit their needs. The inclusion of a community co-facilitator adds strength to the reciprocal learning for the community, as well as offering a small strategy of ‘continued or after-care’ response to support the participants and community members following the training.

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It is also a critical step in building sustainable relationships with service providers like the Wesley Mission and community members. It is also a real example of culturally responsive reciprocal practice.

ATSISPEP Assessment

Summary Comments

Although the community training program was only recently launched in 2015, the program was developed on the basis of informed community perspectives. Many of the people who participated in the consultation to ensure the training was culturally responsive were Elders and families with lived experience who spoke directly to their needs. This is consistent with recommendations in the Suicide Prevention Australia position. There is considerable evidence that confirms that community-led, grassroots suicide prevention practices are more successful in reducing trauma and death than programs designed and implemented by external agencies. Therefore, the need for training specific to Indigenous communities is critical (Silburn et al., 2014). This adapted program includes elements that have been identified in both the national and international research in Indigenous suicide and the Strategy as essential for effective practice (Culture is Life, 2014).

The inclusion of Indigenous community consultants in suicide prevention training and the inclusion of a ‘continuity care’ strategy and partnership increase the ability of Wesley Lifeforce suicide prevention service to get traction in communities where it is implemented. The generic program is rolled out nationally.




In the assessment against the meta-evaluation analysis framework, the Wesley LifeForce Suicide Prevention Training project received the following scores:

• Weak conformity against the community engagement assessment component (a score of 4 out of a possible 6)• Non- conformity against the quality evaluations assessment component (a score of 0 out of a possible 12)• Poor conformity against the impact assessment rigour component (a score of 4 out of a possible 12)• A total score of 8 (out of a possible score of 30), which was categorised as poor conformity with the overall



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Table 5.11: Wesley LifeForce Suicide Prevention Training – Meta-evaluation Assessment




1.1 Reason for program development Other: mainstream organisation adapting a generic suicide prevention program so it has greater applicability to the needs of Aboriginal and Torres Strait Islander communities

Not applicable


1.2 Who led the program implementation Community-controlled organisation involved, but not leading (e.g., local mainstream health service led)

1 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people




The program is yet to be fully implemented in Aboriginal and Torres Strait Islander communities – the adaption of the generic program has only recently been completed





2.1 Values interpretation Does not conform / no published report 0 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

2.2 Report clarity Does not conform / no published report 0 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes,

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procedures, and findings, so that essential information is provided.

2.3 Disclosure of findings Does not conform / no published report 0 A full set of evaluation findings, along with limitations, is accessible to persons affected by the evaluation.


2.5 Impartial reporting Does not conform / no published report 0 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.








3.3 Counter-factual specified: method for Some evidence, but not strong 1 Comparison groups are available to reduce or remove

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comparing ‘with program intervention versus without’ identified to support causal attribution

selection bias and avoid the risk of contagion.

3.4 Triangulation of findings Some evidence, but not strong 1 Different data sets – and interpretation of that information – should support the same conclusion.

3.5 ‘Did it work?’ assessment provided Does not conform / no published report 0 There should be an explicit assessment of what worked and what did not as a result of the program.

3.6 Learning assessment provided Does not conform / no published report 0 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.




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Case Study 9: EK Youth Services Network: A Comprehensive Sustainable Model (East Kimberley, WA)



Program description

In 2011, the WA Government provided $43.8 million from the Royalties for Regions initiative to establish and expand specialist youth justice services in the Kimberley and Pilbara regions. More than 60 staff employed across the two regions and services provided management of young people on community orders, an extended hours family support service, extended hours bail service, emergency short-stay accommodation for young people, a dedicated juvenile justice team and psychological support. The introduction of East Kimberley Youth Justice Services has provided specialist support to the East Kimberley Youth Services Network (EKYSN).

Prior to the establishment of the EKYSN, youth services were delivered within the East Kimberley on an ad hoc basis by a small number of service providers with limited resources. Service providers saw the positive youth outcomes that had been achieved in particular communities from successful programs.

Objectives

The EKYSN was initiated to address issues with East Kimberley youth including offending, alcohol issues, volatile substance use and youth suicide, through capacity strengthening activities and a more coordinated and structured approach.

The EKYSN aims to:

• Expand the diversity and availability of existing youth services; • Identify service delivery gaps; • Implement new youth activities; • Facilitate community capacity building to support ongoing activities; and • Engage and support young people to transition from childhood into productive adulthood in East Kimberley

communities by significantly increasing access to and engagement in meaningful structured activities.

Outcomes

• Provision of activities that provide opportunities for youth workers to supervise and work with children and young people, and in doing so, identify and potentially address other issues and risk factors such as substance misuse, domestic violence, social withdrawal and disengagement from school, mental health and suicide, marijuana use, nutrition and other general health and wellbeing issues;

• Activities included: facilitation of camping, hunting and development camps; after-school sporting programs; transportation to and between communities for camps and sporting carnivals; assisting with school attendance; supervision of activities run out of youth centres; and monitoring of network gaming and computing;

• Training of youth workers to support the complexity of social issues being faced by youth in remote communities (for example, family violence);

• Employment of both male and female youth workers in each community;• Providing youth workers with opportunities for training in first aid, suicide prevention, volatile substance and

cannabis use, trauma, mental health and domestic violence; and• Youth worker forums had a significant impact on strengthening relationships between youth workers and

providing support. Following the forum, youth workers identified a number of key areas for further training, including cultural awareness, suicide awareness and prevention, and mental health.

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The evaluation team recommended a number of changes for ongoing improvements including a more intensive approach to induction to adequately prepare youth workers. This led to the development of The Boab Book – a ‘live’ resource that youth workers can refer to daily. This was used to address induction and handover issues, and include community-specific information (provided by youth workers themselves) as well as core information on a range of topics including:

• Guidance on how to prevent burnout;• Practical information about working in remote locations;• Activity ideas; and• Contact details for local service providers.

ATSISPEP Assessment

Summary Comments

The program provides evidence of a program for young people which responds to the need for a clear definition and understanding of the local level needs and issues together with the broader social context surrounding youth at risk. It adheres to a model that employs and supports young people involving youth workers, mentors and peer support and role models.




In the assessment against the meta-evaluation analysis framework, the EKY Youth Services Network project received the following scores:

• Weak conformity against the community engagement assessment component (a score of 3 out of a possible 6)• Non conformity against the quality evaluations assessment component (a score of 0 out of a possible 12)• Poor conformity against the impact assessment rigour component (a score of 4 out of a possible 12)• A total score of 7 (out of a possible score of 30), which was categorised as poor conformity with the overall



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Table 5.12: EK Youth Services Network – Meta-evaluation Assessment




1.1 Reason for program development Other: driven by availability of funds through the Royalties for Regions program but responsive to unmet needs of youth in the region, including high levels of youth suicide.

Not applicable





Multiple sub-regions across the East Kimberley 1 Application of the program across broader geographies has several benefits:Reduces the risk of selection biasIncreases the chance of demonstrating scalability


Some evidence, but not strong at this stage 1 People affected by an evaluation should be identified and given the opportunity to provide feedback. The degree of stakeholder involvement also affects the degree of support for scalability of a program beyond the geography where a program is implemented.





2.2 Report clarity Does not conform / no published report 0 Evaluation reports should clearly describe the program

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3.3 Counter-factual specified: method for comparing ‘with program intervention versus

Some evidence, but not strong 1 Comparison groups are available to reduce or remove selection

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without’ identified to support causal attribution bias and avoid the risk of contagion.







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Case Study 10: Aboriginal Mental Health First Aid (AMHFA) (National program)

Primary Source of Information for the Evaluation CommentsKanowski, Jorm & Hart (2009)

Program description

Aboriginal Mental Health First Aid (AMHFA) training has been shown to be effective in developing knowledge about symptoms and behaviours linked with help-seeking.

This program appears to be well organised, comprehensive, and provides a sound cultural adaptation of a more general program in order to assist Aboriginal and Torres Strait Islander people who may be experiencing psychological distress. Between 2007 and 2008, 199 Aboriginal Instructors were trained through one of the 17 five-day Instructor Training Courses held around Australia. Since November 2008, a revised 14-hour AMHFA course has been run 155 times with 1,115 people attending.

Evaluation details

An evaluation framework to inform and guide the implementation of the program was established at the commencement of AMHFA, in 2007. The evaluation report by Kanowski (2009) outlines an initial evaluation of the AMHFA course, and presents information around its uptake and acceptability as an adaptation for Aboriginal and Torres Strait Islander people. Two types of data were collected: quantitative data around uptake of the course, and qualitative data on attributes of the course such as strengths, weaknesses and recommendations for the future.

Evaluation findings

• Trained Instructors were more likely to run AMHFA courses if they had previous experience with teaching and were provided with follow-up support from one of the Trainers of Instructors;

• Analysis of the qualitative data showed the both the Instructor Training Course and the AMHFA course are ‘culturally appropriate, empowering for Aboriginal people, and provided information that was seen as highly relevant and important in assisting Aboriginal people with a mental illness’ (Kanowski 2009, p. 1);

• Need for future courses to refine the structure and content that has been implemented, such as completing a 14-hour AMHFA course before Instructor Training, and increasing the Instructor training over more days to help with the uptake of information and greater understanding of how to run the AMHFA course;

• The majority of participants have found the content and training approach culturally appropriate although the need for teaching resources to be suitable for course participants with limited standard English literacy, and for hands-on learners. Ways to address this include: having a pictorial flip-chart, more DVDs involving Aboriginal people, and greater use of role playing. Post-training support was suggested for Instructors to strengthen their confidence to run an AMHFA course; along with opportunities for debriefing sessions and accessing advice for particular issues that may arise during course delivery.

Two further evaluation reports have since been produced along with a set of Aboriginal Mental Health First Aid guidelines and culturally appropriate guidelines for providing mental health first aid to an Indigenous person who is experiencing problems with drinking or drug use (e.g., abuse or dependence). The development of these guidelines used the same process with twenty-eight Aboriginal health experts participating across two independent Delphi studies. This methodology facilitated a rigorous process where participants were able to reach consensus regarding guidelines for culturally appropriate mental health first aid. The Delphi consensus method was identified as a useful consultation tool for Indigenous peoples gauging culturally appropriate best practice in mental health services.

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ATSISPEP Assessment

Summary comments

It is evident from the feedback from the information survey and the literature that the Aboriginal and Torres Strait Islander Mental Health First Aid training is a particularly valuable type of initiative to build community capacity. The program aligns with community consultations regarding the need to enable people to talk and share with one another and build social connectedness. Concurrent action to address stigma and create safe community environments to achieve the former are also consistently identified by communities. There was strong support from the Aboriginal and Torres Strait Islander respondents who answered this question – 63.83% found the program increased knowledge and skills.

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Aboriginal Mental Health First Aid (AMHFA) training program

Training in early recognition and intervention of mental illness in peers. Program adapted with local input for use with Indigenous clients through a process of cultural sensitivity training and expert reference groups.

Young people and adults

Kanowski et al. (2009)

Evaluation based predominantly on feedback from participants in workshops and interviews (post-training)

• Qualitative data indicated that the courses are culturally appropriate, empowering for Indigenous people, and important in assisting Indigenous people with a mental illness

• Other evaluations (not Indigenous-specific) have highlighted improvements in knowledge, attitudes and first aid behaviours (initially; maintained over a 6-month follow up); positive effects on mental health.

• Some difficulties in evaluating program (problems obtaining information about the recipient of the first aid, as distinct from the person providing first aid).

Alignment with Suicide Prevention Strategy The Aboriginal Mental Health First Aid (AMHFA) training program aligns with Action Area 2 and meets several of the outcomes focused on developing knowledge about symptoms and behaviours linked with help-seeking by Indigenous people experiencing mental illness, as well as increasing individual and community understanding of suicide prevention.

NMHRC Evidence classification Post-case intervention series – a single group of subjects are exposed to an intervention; only interventions after the intervention are recorded; no comparison can be made. (C2)


In the assessment against the meta-evaluation analysis framework, the Aboriginal Mental Health First Aid program received the following scores:

• Weak conformity against the community engagement assessment component (a score of 3 out of a possible 6)• Strong conformity against the quality evaluations assessment component (a score of 12 out of a possible 12)• Weak conformity against the impact assessment rigour component (a score of 8 out of a possible 12)

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• A total score of 23 (out of a possible score of 30), which was categorised as strong conformity with the overall meta-evaluation assessment criteria.


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Table 5.13: Aboriginal Mental Health First Aid – Meta-evaluation Assessment




1.1 Reason for program development Other: consultations with stakeholders, including Aboriginal and Torres Strait Islander service providers

Not applicable


1.2 Who led the program implementation Not clear / not able to determine 0 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people.










2.2 Report clarity Conforms, based on published information 2 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures,

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and findings, so that essential information is provided.











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Some evidence, but not strong 1 Comparison groups are available to reduce or remove selection bias and avoid the risk of contagion.


3.5 ‘Did it work?’ assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what worked and what did not as a result of the program.The impact on suicide prevention is not explicitly explored.



Summary assessment for impact assessment rigour Partially effective evaluation


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Case Study 11: QAIHC Suicide Prevention Project: Lighting the Dark (QLD)


Project team interviews with stakeholders, including feedback with the project sponsor.

Program description

In 2013, Queensland Aboriginal and Islander Health Commission (QAIHC) was successful in securing a funding agreement with the then Department of Health and Ageing (DoHA) to develop and deliver an Aboriginal and Torres Strait Islander targeted suicide prevention project, under the Supporting Communities to Reduce the Risk of Suicide (Aboriginal and Torres Strait Islander Component) program.

This QAIHC Suicide Prevention Project worked with local communities to raise individual, family and community capacity to be able to identify and respond to the issue of suicide. QAIHC identified the importance of increasing individual, family and community knowledge and awareness of suicide, its risk factors and symptoms, and appropriate strategies and interventions to assist those people at risk. This direction aligns with emerging research and a national government position, which recognises the importance of strengthening community resilience to be able to respond to these issues locally and in a manner that is appropriate to the often unique circumstances of that community.

Objectives

The QAIHC Suicide Prevention Project key objectives are to:

(5) Promote help-seeking behaviours, positive lifestyle choices and resilience; (6) Promote local responses to suicide and other related issues within communities; (7) Facilitate greater networks between service providers and local communities; (8) Contribute to the development of local community capacity to identify and respond to these types of

issues; and (9) Facilitate access by communities around Queensland to appropriate service providers.

The key stages of the project involve:

• Development and production of the DVD, Lighting the Dark;• Planning and coordination of community forums;• Delivery of community forums; and• Overall evaluation of all elements of the project.

Ten communities were identified as pilot sites for the community forums. These communities represented urban, regional, rural and remote communities in Far North Queensland (FNQ), North Queensland and Southern Queensland, including the southwest and southeast. QAIHC provided suicide prevention and facilitation training for Social and Emotional Wellbeing workers involved in the program. The project was conducted in partnership with Titans 4 Tomorrow (T4T) program, which supports young people throughout Queensland and Northern New South Wales through the delivery of health and education programs. T4T Ambassador, Preston Campbell, was actively involved in the suicide prevention project, working closely with QAIHC to lead the development of the DVD titled Lighting the Dark that was delivered in conjunction with the community forums. Preston Campbell attended 5 of the 10 community forums delivered.

Outcomes

The internal project evaluation confirmed that the project objectives were achieved and the following outcomes highlight the effectiveness of this program across the targeted Aboriginal and Torres Strait Islander Queensland communities. The table below shows the program objectives and outcomes achievement.

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Objective Outcomes

(1) Promote help-seeking behaviours and positive lifestyle choices

• Self-reported increase in awareness across the communities of suicide and its impact on individuals, families and broader community.

• Identified by participants as a valuable tool in humanising the issue of suicide.• Participants highlighted that the program was an opportunity to share their own

stories and experiences as a healing process in itself and building personal resilience.

(2) Promote local responses to suicide and other related issues within communities

• Created an opportunity to build capacity with a pool of individuals who had lived experience and knowledge of suicide and its impact.

• Informal network of people within communities with a shared lived experience. • Provided the Lighting the Dark resource (DVD) to be used by local community to

commence the conversation to address suicide prevention.

(3) Facilitate greater networks between service providers and local communities

• Provide the Lighting the Dark resource to 26 Aboriginal and Islander Community-controlled Health Services across Queensland.

• Provided the resource to a number of non-government organisations (for example, Wesley Lifeforce; Suicide Prevention Network).

• Resource was used as a training tool across various communities and organisations within Queensland.

(4) Contribute to the development of local community capacity to identify and respond to these types of issues

• Empowered individuals to become community ambassadors and champions of the Lighting the Dark resources.

• Creating a pool of local resources to respond and contribute to raising awareness of suicide.

(5) Facilitate access by communities around Queensland to appropriate service providers

• QAIHC SEWB Workforce Support Unit provided training to 20 SEWB workers across Queensland in suicide prevention skills and facilitation training.

• Through the provision of providing the DVD resource to 26 AICCHS this has increased access for individuals, families and communities to culturally appropriate service provision.

As a result of these findings, QAIHC has developed a set of minimum standards that it will use to influence and inform all future policy and program design of community-based suicide prevention programs for Aboriginal and Torres Strait Islander people.

ATSISPEP Assessment

Summary comments

This case study reflects the critical importance of leadership and collaboration across state and federal governments, service providers and community in addressing Indigenous suicide. It embeds the role and importance of community engagement and participation in the design, promotion, delivery, and evaluation of the program and the importance of supporting social and emotional wellbeing to achieve Indigenous health and mental health outcomes. It fosters strong local governance and leadership at local, regional and state level, and high quality and targeted training to ensure competent and skilled facilitation and program delivery.

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Target Group

Author Evaluation methodology Evaluation findings

QAIHC Suicide Prevention Project: Lighting the Dark

QAIHC aims to promote help-seeking behaviours and positive lifestyle choices for people by contributing to a community’s capacity to provide local responses and initiatives to suicide

Aboriginal and Torres Strait Islander community members in Queensland

Queensland Aboriginal and Islander Health Council (2015) [internal evaluation]

A qualitative research approach was used to conduct the evaluation components, which comprised: semi-structured interviews which were conducted with the project’s key personnel for the process evaluation; and fieldwork visits were made to five of the ten participating communities, composed of semi-structured interviews and focus groups with community members who were in attendance at the forum.

• Increased the awareness of suicide, and an opportunity to increase personal resilience through sharing stories

• Built capacity, informal networks, and possibilities to have conversations around suicide

• Feedback endorsed the structure of the project as culturally appropriate, and,

• Suggested that participant knowledge and awareness of suicide and issues such as signs and symptoms, self-management strategies and help-seeking was increased.

• There were recommendations that future forums could be helpful for specific target groups, such as men, women, or LGBTQI.

Alignment with Suicide Prevention Strategy Aligns with Action Areas 1–4 and 6 and outcomes 1.1–1.5, 2.1–2.5, 3.2–3.5, 4.1–4.4, 6.1–6.3

NMHRC Evidence classification Anecdotal qualitative study – qualitative data is collected and reported without methodological rigour. No formal data analysis was undertaken. (Q2)


In the assessment against the meta-evaluation analysis framework, the QAIHC:Lighting the Dark program received the following scores:

• Strong conformity against the community engagement assessment component (a score of 5 out of a possible 6)• Poor conformity against the quality evaluations assessment component (a score of 1 out of a possible 12)• Poor conformity against the impact assessment rigour component (a score of 3 out of a possible 12)

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• A total score of 9 (out of a possible score of 30), which was categorised as poor conformity with the overall meta-evaluation assessment criteria.


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Table 5.14: QAIHC Suicide Prevention Project: Lighting the Dark – Meta-evaluation Assessment



Analysis component 1: degree of community engagement in the evaluation in the evaluation





Multiple sub-regions within a jurisdiction 1 Application of the program across broader geographies has several benefits:Reduces the risk of selection biasIncreases the chance of demonstrating scalability







2.1 Values interpretation Some evidence, but not strong [no published report] 1 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

2.2 Report clarity Does not conform / no published report 0 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures,

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2.4 Justified conclusions Does not conform / no published report 0 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.


2.6 Evaluation impact Does not conform / no published report 0 Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.




3.1 Key evaluation questions specified Does not conform / no published report 0 Evaluation questions ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected.





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3.5 ‘Did it work?’ assessment provided Some evidence, but not strong 1 There should be an explicit assessment of what worked and what did not as a result of the program.





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Case Study 12: National Empowerment Program


(Cox, Dudgeon, Holland, Kelly, Scrine, & Walker, 2014)

Program description

The National Empowerment Project (NEP) is an Aboriginal-led community empowerment project that works with Aboriginal and Torres Strait Islander communities to develop, deliver and evaluate a program that works to promote positive social and emotional wellbeing (SEWB) and address social determinants of health and reduce suicide. Using participatory action research (PAR) the NEP engaged eight Indigenous communities across Australia in 2012–2013, and a further three sites in 2013–2014, to identify risk and protective factors influencing mental health and social and emotional wellbeing of these communities; and develop strategies to respond to these issues through a focus on individuals, families and communities, using the SEWB framework (Social Health Reference Group, 2004; Gee et al., 2014).

The NEP evolved from the Kimberley Empowerment, Healing and Leadership Project in 2012. This identified the need for programs in Indigenous communities that build on cultural strengths, work towards healing at an individual, family, and community level, and facilitate active community leadership to address the broader issues that impact on community wellbeing and are precursors to suicide (Cox et al 2014).

NEP had dual aims: to increase resilience and reduce the instances of psychological distress and suicide among Indigenous peoples by the promotion of positive SEWB factors, and the empowerment of communities to take affirmative action to address the social determinants that contribute to psychological distress, suicide and self-harm. This was carried out with strong Aboriginal governance using a community-led and community based model (Cox et al., 2014; Dudgeon et al., 2014).

An independent process evaluation of NEP was undertaken in 2014 by Walker & Scrine, which sought to determine whether the stated aims and objectives of the program were met in agreement with evidence based and culturally informed consultation and development including the Support, Training, Advocacy and Research (STAR) component.

Objectives

The key objectives of the NEP program were in two phases:

(1) Phase One aims to:

• Identify the main challenges impacting the social and emotional wellbeing of individuals, families, and the community along with strategies to strengthen cultural, social and emotional wellbeing to build resilience in facing these challenges through extensive community consultations; and

• Conduct a two-day workshop to strengthen cultural, social and emotional wellbeing for community members by identifying strengths within each SEWB domain, as well as actions to increase their connection to these protective factors.

(2) Phase Two aims to:

• Design and deliver a program to implement the community identified strategies to strengthen social and emotional wellbeing, to address the social determinants, as well as social and emotional wellbeing problems that exist in the community such as family violence and substance abuse; and

• Assist communities to secure funds to implement the program(s) (Cox et al., 2014; Dudgeon et al., 2014).

As the NEP was developed, further key stages included:

• A NEP National Advisory Committee was established, comprised of leading Indigenous experts in mental health, suicide prevention and social and emotional wellbeing to ensure that Indigenous communities have an

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equal and empowered position within the research. The National Advisory Committee oversaw all aspects of the work of the NEP team, including the securing of ethics approval for the project;

• The NEP team established strong relationships with community members and formal relationships with Aboriginal partner organisations in each community and maintained ongoing liaison and engagement with community stakeholders; and

• Employ community consultants as co-researchers in each community and provide training and support through the NEP team, to conduct community consultations in each site that involving focus groups and interviews (Cox et al., 2014; Dudgeon et al., 2014).

Outcomes

This process of community consultations took place in eleven diverse communities across Australia. While the socioeconomic and geographic characteristics of these communities differed widely, they all had a significant Indigenous population, a readiness to engage in community capacity building, and the ability to undertake a community consultation and deliver a short program. Other requirements included the presence of a functional community controlled organisation and/or a Registered Training Organisation. (Dudgeon et al., 2014). The NEP sites by state or territory are as follows:

• Western Australia: Geraldton, Narrogin, Northam/Toodyay, Perth;• Northern Territory: Darwin;• Queensland: Cherbourg, Kuranda;• New South Wales: Toomelah, Redfern, Sydney;• Victoria: Mildura; and• South Australia: Mt Gambier.

An independent evaluation process and an outcome evaluation were undertaken to determine whether:

• the key deliverables of phase one and two were met;• the recommendations from previous evaluations were implemented;• the key principles underpinning NEP had been successfully enacted;• there were any identified gaps/areas for improvement; and• the outcomes of the key deliverables of Phase Two were evident (Walker & Scrine, 2014, p. 20).

Evaluation findings

Key Findings included:

• The importance of community based research with Aboriginal and Torres Strait Islander people leading the direction, development, implementation and accountability of strategies in their own communities. Capacity building and support, training, and ongoing mentoring are critical factors in this aim;

• The NEP community consultations have produced a large amount of data about issues around impacts on Indigenous mental health and wellbeing contributing to the evidence base regarding both the effectiveness of adopting a CPAR research approach as empowering; and the importance and effectiveness of community based programs aimed at improving Indigenous mental health and social and emotional wellbeing;

• The critical need for continuing the Support, Training, Advocacy and Research (STAR) for the community co-researchers who work in communities experiencing high levels of trauma and distress. The support of the NEP team was highly advantageous and provided co-researchers with an ability to share their stories and debrief, and support each other in their roles as NEP researchers and frontline personnel involved in suicide prevention;

• The NEP reports crystallised the findings for communities including an overview of the identified issues in their communities, as well as plans to move forward;

• Formalised processes for communication and dissemination at each site with relevant agencies greatly assisted the effective response of these agencies to community needs;

• The STAR concept has great potential to assist NEP in achieving its goals; and

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• The support of partner organisations is a critical determining factor in the effectiveness of the community consultants and the ongoing progress of NEP (Walker & Scrine, 2014).

Recommendations for Phase Three:

• To undertake in-depth qualitative research to understand the long term impact of the NEP on people’s lives in order to further demonstrate over time the links between the underlying principles (such as supporting self-determination, promoting context-specific solutions, incorporating Aboriginal knowledge and concepts regarding health and wellbeing; and acknowledging the pivotal role of family and culture) in developing and implementing programs that facilitate community transformation and empowerment (Walker & Scrine, 2014, p. 9).

ATSISPEP Assessment

Summary comments

The processes of the NEP community consultation and engagement align strongly with the guiding principles of the National Aboriginal and Torres Strait Islander Suicide Prevention Strategy. This is enhanced by the planning, implementation, community evaluation and feedback processes.

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Target Group Author Evaluation methodology

Evaluation findings

The National Empowerment Project

The National Empowerment Project (NEP) is an Indigenous-led empowerment project that promotes positive social and emotional wellbeing and addresses social determinants of health using a participatory action research approach (PAR).

Individuals, families and communities

Walker & Scrine (2014)

A process and outcome evaluation was undertaken using a mixed methods design and included: systematic and detailed observations, semi-structured interviews (face-to-face and by email), and an audit of documents and other NEP media including media statements and website information. This comprised interviews with staff and workshop participants and a review and analysis of qualitative data.

• A critical factor of NEP was its emphasis on community-based research with Indigenous people leading the direction of the research and its outcomes within their communities. Capacity building and mentoring was seen to be crucial to this outcome

• NEP collected a large amount of specific data about Indigenous mental health and wellbeing issues contributing to the evidence base in an empowering way supporting community-based programs

• The need for continuing support for community co-researchers was identified as they engage with communities experiencing high levels of trauma and distress

• The NEP provided a plan for future action for each community and highlighted specific community issues

• Crucial to the ongoing progress of NEP is the support of partner organisations

Alignment with Suicide Prevention Strategy NEP aligns with outcomes 1.1 to 1.6 in Action Area 1 and outcomes 2.1, 2.2, 2.3 in Action Area 2 and outcomes 3.1, 3.4, 3.5, in Action Area 3 and outcomes 4.2, 4.4 in Action Area 4 and outcomes 5.3 to 5.6, in Action Area 5 and outcomes 6.1 to 6.4 in Action Area 6

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Evaluation findings

NMHRC Evidence classification Mixed methods – qualitative and quantitative data is methodically collected, analysed and reported (M1)


In the assessment against the meta-evaluation analysis framework, the NEP received the following scores:



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Table 5.15: National Empowerment Program – Meta-evaluation Assessment














Assessment component 2: findings – conformity with evaluation standards relating to quality evaluations 2.1 Values interpretation Conforms, based on published information 2 Perspectives, procedures and rationale used to interpret the

findings should be carefully described.


2.3 Disclosure of findings Conforms, based on published information 2 A full set of evaluation findings, along with limitations, is

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accessible to persons affected by the evaluation.












3.4 Triangulation of findings Conforms, based on published information 2 Different data sets – and interpretation of that information –

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POSTVENTION PROGRAMS Postvention relates to what actions are taken after a suicide has occurred. It deals with the trauma for those who are bereaved by suicide, as well as for someone who has attempted to take their life by suicide. Postvention programs offer mental health and public health services to those affected by suicide and works with people who are in need of support after suicide has occurred. Arguably the results of postvention should measure the quality of care that the users of this service receive, rather than the reductions of suicide, although there is a strong case for suggesting that postvention is a form of prevention in situations where there has been an elevated number of suicides in an area or time period.

Postvention generally involves a whole community, to ensure a culturally safe response after losing someone through suicide, and to manage the subsequent trauma experienced by family, friends and community members. A key focus of the response is supporting the community to cope with the associated grief and loss using postvention healing strategies in an effort to prevent suicide clusters, echo clusters and dangerous levels of psychological distress and trauma. The role of first responders such as police, ambulance paramedics and Indigenous mental health workers, community gatekeepers and natural helpers are also a crucial part of a wider integrated strategy to strengthen and support community capacity and recovery.

Case Study 13: Suicide Story (Alice Springs, NT)

Primary Source of Information for the Evaluation CommentsLopes, Linderman, Taylor & Grant (2012)

Program Description

Suicide Story was officially launched in March 2010 at the Alice Springs Town Council. Suicide Story was funded by the NT Government Department of Health & Families to support Indigenous communities and workers living in remote communities. Suicide Story was adapted from the Mental Health Association of Central Australia, Life Promotion Program (LPP), which delivers ‘gatekeeper training’ to workers and community members who might encounter people at risk of suicide. A two-day Living Works ASIST (Applied Suicide Intervention Skills Training) workshop was first adopted by the NT in 2001, and has consistently been in demand among those working in the community sector in Alice Springs. It was found that the original model for the resource support did not address some of the core issues central to the needs of Aboriginal people, especially those living in remote regions and town camps. Over time, and in extensive consultation with Aboriginal people and discussions with other related services, the LPP team started to further develop the resources and style of training to create Suicide Story.

Utilising a community development and action research approach, Suicide Story is an Indigenous-developed, -led and -delivered community suicide awareness training program developed by central Australian Aboriginal people for Central Australian Aboriginal people. The Suicide Story is run by the Mental Health Association of Central Australia. Over 7 years the content and delivery of the program has been reworked and adjusted through a continuous cycle of participatory action research and quality improvement processes according to the extensive feedback from facilitators and participants. This has ensured the program’s effectiveness and ability to be applied in a number of communities and language groups. The program incorporates the use of a DVD made up of short films that feature the voices of Indigenous people, combined with animation, art work, music, pictures/posters to generate scenarios, and lots of conversations/discussion. The DVD focuses on nine topics relevant to suicide, and accompanies ten modules that are completed over a full 3-day training program.

• Should we talk about suicide?• Why is suicide a problem in Aboriginal communities?• How big is the problem?

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• How would you know if someone was at risk of suicide?• What leads to people thinking about suicide?• What can families and communities do to create a suicide-safer community?• What gets in the way of helping?• What are good ways to support people at risk?• How might people heal after a death by suicide?• How can we keep the helper safe too?

The aim of Suicide Story is to provide tools to communities who want to make changes in their community, and to support those communities to address the issues in their own way. They conduct a pre- and post-evaluation with participants. This is designed for participants to be able to see for themselves what they have learnt and how they have grown and this is also incorporated into the program’s evaluation.

Core elements of the program are described below.

Listening ... sharing ... learning Through listening, sharing and learning from the stories of Aboriginal people to develop a relevant contextual picture of the issue of suicide, Suicide Story contains more meaningful training material respectful of the people, culture, language and context of people’s lives in Central Australia including Alice Springs, Santa Teresa, Yuendumu, Tennant Creek and also Gove Peninsula. It includes drawings, animation and film to enhance this unique, culturally developed training resource, which was officially launched at the Alice Springs Town Council on 3 March 2010.

Use of local artwork In 2006, some women from the remote community of Santa Teresa painted two banners for World Suicide Prevention Day. The artwork portrays a local understanding of some of the causes of suicidal behaviour and ways to care for people who are displaying such behaviour. This artwork and story features throughout Suicide Story to give meaning to ‘impersonal’ statistics and data about suicide to remind everyone that this issue is about ‘raw and real’ experiences. It is based on the hope that the ‘best chance of reducing the rates and the pain of suicide for Aboriginal people is to understand their experience of it and bring new learnings to them in a proper way.’

Culturally sensitive approachThe aim of this program is to offer a culturally sensitive approach to the understanding of the issue of suicide, as well as improving skills to work with people at risk, and building a sense of hope for Aboriginal communities of Central Australia.

Objectives

Suicide Story aims to:

• explore impulsive suicide, suicide as a threat, blame and payback in people’s cultural and local context;• recognise the importance of learning through sharing stories from other Aboriginal communities;• share learnings through recognisable symbols, images and language; • explore the history of social injustice and legislated change and the consequent losses that are relevant to the

current problem of suicide; • accommodate varying levels of English literacy and different ways of leaning among Aboriginal communities;• The program facilitators will only deliver Suicide Story in a community that is considered ready for change –

and formally requests the program through the Elders of the community, the belief being that without people really wanting them to come and without endorsing it from the highest authority, it won’t work;

• raise awareness for individuals and community – the interactive workshops are designed to generate conversations and awareness by exploring how grief and trauma has become a problem in their communities, and how historical and social factors have impacted their communities. They assist people to recognise the

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seriousness of what is happening (sense among many of the elders and smaller communities that threats of suicide, especially by young people, is just kids ‘mucking up’). The program seeks to overcome a lack of experience and understanding among some communities about the pain some people are in – especially in the smaller communities and homelands where there are small numbers of people who are not that exposed to a broader societal context. They examine issues of skin groups and how disruption of these systems can contribute to problems, and also impact who people can talk to about their issues. The message to participants is that there are no right or wrong answers and everyone needs to feel safe;

• Train the Trainer: The program facilitators seek to identify and support networks of appropriate people in these traditional communities. They get people to nominate if they want to be trained and then continue working in their own regions/communities, which facilitates a more localised approach and ensures the work continues; and

• The program encourages communities to develop plans to identify what the issues are, what is required, and how this can be mapped with service providers and existing programs. They encourage service providers to attend the program.

Program Outcomes

• The DVD helps communities to see that there are many Aboriginal people who are willing to ‘talk up strong on suicide’ because they have lost too many family members.

• Communities and individuals are supported to work together to map out what is required in their lives and community to help improve the understanding among their people and the need to learn skills that will help families to stop deaths by suicide.

ATSISPEP Assessment

Summary comments

Suicide Story drew on a strong theory base of what works in suicide prevention training. The program has been adapted to be culturally responsive. This is a very organised, well-structured and designed program with a clear set of deliverables and reflexive practices. The program is flexible, dynamic and accommodates different learning styles, languages, traditions, issues, levels of readiness and still progresses through the nine stages. It is designed on a program logic and approach that adheres to the need for alignment with culture, localised approaches, utilisation of local people, respect for elders, spiritual and cultural values. It seeks to empower communities and individuals to identity the issues in their communities and lives and the ways to address them, including the service providers and programs already in their communities. It establishes a network across the region that ensures the outcomes are sustained. It seeks to work with and support other service providers.

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Suicide Story A three-and-a-half-day suicide prevention workshop structured around nine topics covered in the accompanying DVD aimed at community-based helpers

Aboriginal and Torres Strait Islander community members

Lopes et al., (2012) Interviews were conducted about the effectiveness and usability of the DVD and about perceptions of the delivery of the DVD within a workshop formatAlso, direct observations were undertaken by an external observer to provide additional context around the delivery of the workshop and DVDThe observation information was fully disclosed to the participants

• Data analysis from the interviews and observations revealed five key themes: knowledge and understanding, confidence, implementation, relevance, and future directions

• Key factors to the success of the training resource included employing local cultural consultants and Indigenous implementers in the delivery of the workshop

• Cultural safety principles were also a factor that contributed to program appropriateness and effectiveness

Alignment with Suicide Prevention Strategy The three main elements of the program and the DVD resource achieve outcomes in Action Areas 1, 2, and 3 and Outcomes 1.1–1.5, 2.1–2.5, 3.2, 3.3

NMHRC Evidence classification Methodological qualitative study – qualitative data is methodologically collected, analysed and reported. (Q1).


In the assessment against the meta-evaluation analysis framework, the Suicide Story project received the following scores:

• Strong conformity against the community engagement assessment component (a score of 6 out of a possible 6)• Strong conformity against the quality evaluations assessment component (a score of 12 out of a possible 12)

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• Strong conformity against the impact assessment rigour component (a score of 9 out of a possible 12)• A total score of 27 (out of a possible score of 30), which was categorised as strong conformity with the overall meta-evaluation assessment criteria.


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Table 5.16: Suicide Story Resource Kit for Postvention Support – Meta-evaluation Assessment



Analysis component 1: degree of community engagement













2.2 Report clarity Conforms, based on published information 2 Evaluation reports should clearly describe the program

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Score for findings quality evaluations assessment component 12






3.3 Counter-factual specified: method for comparing ‘with program intervention versus

Some evidence, but not strong 1 Comparison groups are available to reduce or remove

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without’ identified to support causal attribution selection bias and avoid the risk of contagion.







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CRISIS RESPONSE There are a number of distinctions between postvention response and critical response to trauma and suicide and emergency disaster response. Critical response is an immediate reaction in relation to suicide, and other critical incidents and traumatic events, which include death (actual or threatened), assaults (physical, sexual and/or psychological), accidents, and witnessing traumatic events. Responses to critical incidents require first responders (police and paramedics), counselling, and the implementation of a postvention plan to manage trauma and prevent self-harm and suicide. Currently there is not a national protocol for critical response although Suicide Prevention Australia released a Position on the Crisis Response and the Role of the Emergency Service and First Responders to Suicide and Suicide Attempts in June 2010. This recommends that gatekeeper training should be provided widely in the community, to emergency services and medical professional community gatekeepers (who are most likely to become first responders) and carers (families and friends) of suicidal persons. In additional, crisis response services need to be recognised as vital infrastructure for suicide prevention in Australia, because of their ability to provide appropriate crisis response, including linkages to safety interventions for persons in suicidal crisis. There is evidence to confirm that crisis response services are effective in attracting suicidal persons who are seeking help.

Suicide Prevention Australia also recommends that:

• Mental health services, including ‘step up and step down care’ should be available and accessible in the community to reduce incidences of suicide, and also to provide appropriate sites of crisis care for people who become suicidal. The coordination and interagency collaboration of mainstream, mental and allied health services are essential for the provision of effective and accessible care.

• Emergency services such as triple zero operators, police, ambulance and emergency departments should be recognised as service providers in suicide prevention on the basis of their involvement in interventions to uphold personal safety, and should accordingly operate within national protocols to define the intersection of emergency services and other suicide crisis support services.

• The establishment of personal support services in emergency departments and hospitals and during transitions between care require consideration. These services would work alongside mental health and medical care, ensuring suicidal patients receive emotional support and are not left alone. Established crisis services are well positioned to administer this type of service.

Other recommendations include:

• trialling short-term residential community care for suicidal people, following models developed in other countries;

• providing training and support for first responders to suicide and suicide attempts; they are exposed to high risk, stressful and challenging situations and need support to manage their own needs as well as the needs of those they respond to; and

• the establishment of a National Accreditation Body to monitor and accredit training providers, services, and programs to maintain the quality of all suicide prevention activities;

• finally, they stress the need for suicidal, suicide-bereaved people and suicide attempt survivors to be involved in all levels of policy development and service provision, and be supported in these roles.

As Silburn et al. state:

The trauma and additional stresses associated with suicide may also require emergency additional mental health intervention, as well as consultative support and back-up for ‘front-line’ community workers and family members caring for suicidal individuals.(2014, p. 158)

Silburn stresses the critical need for a culturally appropriate, crisis response in Indigenous contexts if they are to be successful. He outlines three key elements for an effective suicide prevention/postvention response in Indigenous communities:

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• Preventative early intervention for individuals in distress;• Longer term prevention promoting resilience; and• Proactive bereavement support and containment of suicide clusters

Case Study 14: STANDBY Critical Postvention Response (Geraldton, WA)


Visser, Comans & Scuffham (2014)

Program Description

The National StandBy Response Service is recognised as one of Australia’s main suicide postvention programs established to assist people and communities affected by suicide. It is located in seventeen regions around Australia providing postvention support in a range of different communities and contexts. A key goal is to support communities impacted by suicide and respond to emergent community needs. StandBy has also developed the short term Critical Postvention Response (CPR). This brief rapid response model is intended for communities where there are concerns about high incidence of suicide and its effects on the community.

Community Support for Critical Postvention Response (CPR)Promotion of in-service and community information and training events was planned and arranged via in-kind support from Child and Adolescent Mental Health (CAMHS), South West Development Commission (in Western Australia), cultural and service provider networks. This included dissemination of information and identified representatives and speakers at the Pathways to Care Workshop and Crossing the River suicide bereavement skills training which form the main focus of the StandBy CPR.

The Pathways to Care workshop identified the various responders and potential support available from within the community to those bereaved by suicide loss utilising an interactive format. Contribution from local emergency, acute, social and personal support services as well as community groups and agencies provided in depth local knowledge about the impact of suicide loss and the types of support required. This investment by local community groups and individuals built on existing community strengths and increased sustainability of the initiative.

The Crossing the River postvention workshop provided brief suicide bereavement response skills training to enable attendees to respond appropriately to the needs of those affected by suicide within the Geraldton area and to build confidence and competence in the delivery of an integrated whole of community postvention response. Utilising local emergency responders, funeral services, coronial representation, stakeholders and community members’ contributions ensured future postvention responses would be guided by in-depth local knowledge and coordinated via a single point of contact.

Objectives

• The project delivers direct support to people bereaved by suicide and training for emergency and community responders;

• Conducts workshops to provide communities with the capacity to plan, lead and sustain strategies to promote community awareness around suicide and implement community suicide prevention plans;

• Provides or identifies appropriate materials and resources to meet local needs of Indigenous peoples in diverse community settings;

• Links with local gatekeepers and ‘natural helpers’ monitoring communities with high levels of suicide and self-harm to facilitate a planned response (see also outcome 5.3);

• Assists communities to plan and implement a comprehensive response to suicide and self-harm including both short-term and long-term early intervention and prevention activities; and

• Ensures the local mental health services and community organisations are able to provide appropriate postvention responses to support individuals and families affected by suicide.

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Outcomes

Based on extensive community consultation and community requests, Standby’s CPR was delivered to Geraldton in the mid-west region of Western Australia from February 2015 until late March 2015 in response to the widespread concerns about the higher than average incidence of suicide and its effects on the local community. The CPR was supported by the Australian Government, in partnership with WA Country Health Service Midwest, Mental Health Services and a number of local community organisations and local Standby CPR Advisory Group members including Geraldton Mental Health Services, Yellow Ribbon, STAY, local government and representatives from the local Aboriginal community.

Feedback received from areas such as education, health services and community based organisations suggested the CPR had been very productive and beneficial in the town. The CPR team also received many comments from training participants indicating that knowledge gained at the various workshops regarding trauma, grief and loss, caring for themselves and others following trauma:

• Enhanced feeling of safety from understanding of their own grief and trauma reactions;• Increased confidence in being able to approach and help people following suicide and other trauma/loss;• Increased confidence that people will have assisted access to qualified and known Pathways to Care via the

After Suicide Community Response Plan; and• Greater sense that the load is shared throughout the community and the response does not have to fall to

only one resource (United Synergies 2015).

A report produced by United Synergies outlines several key elements that confirm the effectiveness of the CPR. These include:

• the confirmed widespread support and acknowledgement of need for coordinated postvention response in the community and to strengthen community understanding of postvention readiness;

• general willingness of service providers to refer, share information and to work collaboratively; and,• discussion and information about self-care when supporting or training with agencies in response to

indications of cumulative stress amongst service providers.

Report findings The report states that, as the program became more embedded in the community, more information was gained about the circumstances and reactions to suicide events within the community. The use of social media and other interactions raised some concerns about creating a risk of contagion amongst some of the young people. Some community members reported that suicide attempts had occurred and community anxieties were high. Other factors initially impacting on community cohesiveness and the program outcomes include some community perceptions about lack of dedicated postvention and prevention services, with a few more well known services and individuals ‘carrying most of the load’.

Both workshops had exceedingly high attendance rates and the workshop evaluation findings suggested that an overwhelming majority had learnt much from the scenario presentations and appreciated the input from the emergency responders and felt that it drew people together.

Key learnings and recommendationsThe feedback from the local stakeholders and participants confirmed the importance of:

• A suitable recognised and well regarded community organisation to foster early acceptance of the program and its facilitators;

• Establishing a commitment from a lead agency early in the commencement of the program;• Clear understanding of CPR team roles and responsibilities prior to commencement of the program;• Early engagement of key stakeholders (e.g., police, ambulance and key community members for building

credibility and access within the community;• Establishing a committee that is representative of the community, with genuine commitment from the partner

agency, to ensure sustainable outcomes for the program to be accepted and embedded in the community;

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• Further training about crisis intervention practice to allow staff and others to be able to offer basic crisis intervention if required; and

• Further support and interest from the West Australian Mental Health Commission.

Importantly the National Standby CPR identified the need for, and committed to follow-up support for, the Committee to be able to identify agenda items to complement the postvention plan. This was to provide a ready guide to be passed to any nominated lead agency to ensure consistent approach when implementing the plan and to provide a basis for ongoing committee activity. The trauma kit will also be provided by the National StandBy Response Service for any future postvention needs.

A study by Visser et al (2014) of the StandBy Response Service indicates that it is a program that is readily adaptable to different settings. Currently in Australia, this service operates in metropolitan, rural, and remote settings. Given the same principles apply to the CPR, it is reasonable to suggest it is also equally effective.

ATSISPEP Assessment

Summary comment

Based on analysis of the final report and interviews with key Geraldton stakeholders, the team consider the Standby model to be promising evidence of effectiveness and good practice. It was considered both culturally appropriate and well accepted by the Geraldton community. It was effective in building awareness and strengthening the community’s capacity to respond to the devastating trauma and bereavement impacting Geraldton after a series of suicides, accidental deaths and suicidal behaviours.


A description of the evaluation activities prepared by the ATSIPEP project team is provided in the table below. It is noteworthy that the evaluation evidence did not specifically address the needs and expectations of Aboriginal and Torres Strait Islander communities. Its applicability to Aboriginal and Torres Strait Islander communities in a range of settings (e.g., remote communities) requires further consideration and evaluation.

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Standby Critical Postvention Response (CPR)

• Deliver:– Pathways to Care

workshop to identify the various responders and potential support available from within the community to those bereaved by suicide loss

– Crossing the River postvention workshop, providing brief suicide bereavement response skills training to enable attendees to respond appropriately to the needs of those affected by suicide within a local area

Communities affected by relatively high numbers or recent suicides.

Visser, V. S., et al, (2014)

This study aimed to evaluate the effectiveness of a suicide bereavement support service in reducing adverse health and social outcomes for people bereaved by suicide. Retrospective cross-sectional design, comparing clients of the service with a control group of bereaved people who had not had contact with the program. Participants were assessed on quality of life, psychological distress, suicidality, health care usage, and productivity.

• Clients have significantly lower levels of suicidality. There was a trend to higher quality of life and lower psychological distress. Clients had slightly higher productivity and lower health care service usage than the control group, although these differences were not statistically significant. This article demonstrates that an intervention program for people bereaved by suicide can be effective at reducing suicidality and may have a positive effect on other health and social outcomes.

Alignment with Suicide Prevention Strategy StandBy CPR aligns with Action Areas 1 and has the potential (where communities are ready) to facilitate Outcomes 1.1 to 1.6

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NMHRC Evidence classification Pseudo randomised controlled trial – subjects are allocated to intervention and control groups using a non-random method and outcomes compared (B2).


In the assessment against the meta-evaluation analysis framework, the Standby CPR project received the following scores:

• Weak conformity against the community engagement assessment component (a score of 4 out of a possible 6)• Strong conformity against the quality evaluations assessment component (a score of 12 out of a possible 12)• Strong conformity against the impact assessment rigour component (a score of 11 out of a possible 12)• A total score of 27 (out of a possible score of 30), which was categorised as strong conformity with the overall meta-evaluation assessment criteria.


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Table 5.17: StandBy CPR (Geraldton, WA) – Meta-evaluation assessment














Summary assessment engagement Partially effective evaluation



2.2 Report clarity Conforms, based on published information 2 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures,

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3.6 Learning assessment provided Some evidence 1 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.This initiative was developed as a generic program. Its applicability to Aboriginal and Torres Strait Islander communities in a range of settings (e.g., remote communities requires further consideration and evaluation.




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Case Study 15: You me Which way Aboriginal and Torres Strait Islander Suicide Bereavement Training (National program)


Project team interviews with stakeholders, including feedback with the project sponsor. An evaluation of the program is still in progress/not yet published.

Program Description

This is a one-day community based training program to address and ‘yarn’ about suicide bereavement and loss. You me Which way is a training package developed in response to an identified need for a focused and culturally appropriate response to the high rates of suicide within Aboriginal communities. It is designed for delivery to Indigenous community members and service providers, caregivers and volunteers who provide care to Indigenous people. It was developed and piloted by United Synergies, a Queensland based not-for-profit organisation that provides postvention suicide prevention programs that aim to ensure community respect, understanding and support for the health and wellbeing of people bereaved by suicide.

Objectives

The workshop aims to improve and enhance knowledge of cultural requirements when providing responses after suicide loss and to build sustainable capacity within communities to respond to the needs of Aboriginal and Torres Strait Islander community members, and to enhance and further develop good practice and effective care by increasing knowledge through experience. The current training package is generic in nature and needs to be tailored to reflect the cultural and geographical differences of each region it is delivered in.

Two different workshops are developed:

• one for service providers and non-Indigenous people to assist in increasing knowledge of historical practices and impacts on Indigenous people;

• a second for Indigenous people to assist in recognising the influence of past injustices, intergenerational grief, loss and trauma to assist in developing community action plans.

The project was guided by an Expert Advisory Group. Trialling of the training occurred in Far North Queensland and Tasmania. Training was delivered in a range of settings including – Men’s Group; Women’s Group; Aboriginal community members; combined Aboriginal community members and service providers; and the broader community. Feedback from these trials indicated a high level of interest with a number of requests for additional sessions to occur; significant or anticipated increases in knowledge and understanding about suicide, trauma and related issues from an Indigenous perspective.

Outcomes

The pilot program was trialled in the West Kimberley (Broome and Derby) and the East Kimberley (Kununurra) prior to a more formal trial in Far North Queensland (Napranum, Mossman and Cairns) and North Tasmania (Smithton). The project team (United Synergies) is currently partnering with the Hunter Institute of Mental Health in Newcastle to further evaluate the project.

The feedback from the pilot project in 2012 with Indigenous communities in Napranum and Mossman Gorge indicates:

• appreciation of a safe place to talk about suicide and suicide bereavement; • greater awareness of practical skills to support community members bereaved by suicide; acknowledgement

and tips for self-care and resources both in local community and in the wider community; and• remains responsive to Napranum’s request to conduct Women’s and Men’s Group sessions.

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The pilot program shows promising results in terms of significant/anticipated increases in knowledge about Indigenous culture from an historical perspective and the impacts of suicide, suicide bereavement, trauma, grief and loss on Indigenous communities.

Participants indicated this knowledge would be used to inform approaches when working with Indigenous communities. Indigenous participants indicated improved understanding of the historical impacts on Indigenous communities’ health and wellbeing, greater understanding of the effects of transgenerational trauma, grief, loss and suicide bereavement with cultural contexts.

ATSISPEP Assessment

Summary comments

Based on analysis of the report and interviews with the Standby team, the ATSISPEP assessment consider the StandBy model and its adaptation – You me Which way – to be promising evidence of effectiveness and practice. You me Which way is a good example of a mainstream organisation and program working effectively in a culturally responsive way to produce an adapted program that meets local community needs and cultural protocols. This program recognises the need to simultaneously support local Indigenous groups as well as non-Indigenous service providers. It is working to empower Aboriginal people to access the services they want and need while building the cultural competence of local service providers and staff. This is a good case study highlighting what is required for larger service providers to deliver services that are effective for Aboriginal people with complex needs across a range of diverse cultural, geographic and community contexts.




In the assessment against the meta-evaluation analysis framework, the Standby CPR received the following scores:

• Weak conformity against the community engagement assessment component (a score of 4 out of a possible 6)• Poor conformity against the quality evaluations assessment component (a score of 0 out of a possible 12)• Poor conformity against the impact assessment rigour component (a score of 0 out of a possible 12)• A total score of 4 (out of a possible score of 30), which was categorised as poor conformity with the overall



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Table 5.18: You me Which way Postvention Crisis Response – Meta-evaluation Assessment

















2.2 Report clarity Does not conform / no published report 0 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.

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2.4 Justified conclusions Does not conform / no published report 0 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.


2.6 Evaluation impact Does not conform / no published report 0 Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.




3.1 Key evaluation questions specified Does not conform / no published report 0 Evaluation questions ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected.


Does not conform / no published report 0 Program theory (also referred to as program logic) documents the causal (or results) chain from inputs to outcomes in a program intervention. Theory-based evaluation allows assumptions underpinning the program logic to be tested and avoids a ‘black box’ evaluation (identify an impact, but do not enable an explanation as to why).



3.4 Triangulation of findings Does not conform / no published report 0 Different data sets – and interpretation of that information –

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HEALING PROGRAMS Healing initiatives focus on recovery and healing from stress and trauma and promote the ability of children, young people and families to heal and cope with the effects of abuse, grief, trauma and toxic levels of stress. Many of these programs appear to have beneficial outcomes in terms of reducing the effects of stress and trauma, improving relationships, and supporting people to deal with the challenges of daily life and live a healthier lifestyle.

The important role of healing in reducing suicide

The ATSISPEP literature review identified a comprehensive body of research which confirms the importance and need for healing services informed by Indigenous concepts of wellbeing, that address the physical, emotional, social, spiritual and cultural needs of our community members, and that acknowledges the history and collective experience of Indigenous people (Atkinson et al., 2014; Caruana 2010; Gee et al., 2014; Grieves et al; 2009).

There is extensive research to show that the trauma experienced by Indigenous people as a result of colonisation and subsequent policies, such as the forced removal of children, has had devastating consequences (Atkinson 2002; Atkinson et al., 2014; Krieg 2009). The disruption of Indigenous culture and the negative impacts on the cultural identity of Indigenous people has had adverse, transgenerational effects (Bamblett & Lewis 2007; Carson et al., 2007; Swan & Raphael 1995). The cumulative effect of historical and intergenerational trauma severely reduces the capacity of Indigenous peoples to fully and positively participate in their lives and communities, contributing to widespread disadvantage (Hunter & Lewis 2006). Despite this devastating disruption, Indigenous people continue to practise culturally distinctive ways of healing from trauma and loss to restore the harmony and balance ‘that comes from participating more fully in family and community life in healthy, safe and confident ways’ (Healing Foundation 2013; Milroy et al., 2014).

Case Study 16: The Healing Foundation


Healing Foundation (2012; 2013; 2014)

Chandler & Lalonde (2008)

Program Description

The Healing Foundation has a critical role in supporting the healing and reconnection to culture for Indigenous individuals, families and communities – which is arguably a national priority to reduce the high rates of suicide in Australia. By funding locally driven, culturally strong healing initiatives across the country, the Healing Foundation is enabling Indigenous peoples to more effectively participate in employment, education, parenting, cultural and community life and self-determining health and wellbeing outcomes. As part of its overall evaluation and performance reporting process, the Healing Foundation requires all funded projects to provide data on agreed national outcomes and associated indicators. It also collects in-depth information through case studies. This data and the case studies provide a picture of the healing work and its effectiveness. A number of projects also undertake more in-depth evaluations with external organisations.

The Healing Foundation (HF) funds a large number of projects across Australia that aim to address the impacts of social determinants on social and emotional wellbeing of individuals, families and communities at key points across the life course. For example, they support parents and carers to create healthy, positive environments for children and they support young people to reconnect with schooling or prepare them for entering the workforce. Several projects work in partnership with government and community organisations to ensure communities are safe by supporting families to address the role that violence, gambling or substance misuse

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plays in their lives. All projects contribute to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples by creating healing from pain, suffering and trauma.

Objectives

A core aspect underpinning best practice in programs funded through the Healing Foundation (HF) is the notion of cultural continuity and identity in Aboriginal communities. Cultural continuity is enabled where communities have an understanding and access to their past and share and have ownership of a common future. The HF supports the delivery of services that are:

• founded on strong culture and traditional ways of healing from trauma and loss;• enabling self-determination;• building stronger health, education and social services;• working with women to participate in leadership and governance roles; and• supporting language.

The HF draws heavily on international suicide prevention research, which has compelling evidence to show that culture, cultural continuity and self-determination act as protection against youth suicide (Chandler & Lalonde 2008).

Outcomes

• Increased the number of people who have understanding and access to a wide range of healing services; • 137 Aboriginal and Torres Strait Islander people employed in 17 projects; • 100% of projects designed, developed and delivered by Aboriginal and Torres Strait Islander people ensuring

contextually appropriate healing services for participants; • 2,465 children, young people, families, men, women and Elders participated in healing activities,

demonstrating the need for and importance of healing work; • almost 650 cultural activities provided, helping people reconnect with culture and support, strengthening

cultural identity and pride; • 99% of participants reported improved physical, emotional, social, spiritual and cultural wellbeing as a result of

participation in the healing projects; • development of strong organisational partnerships and linked-up service delivery, allowing for holistic services

and interventions; • positive publicity that has celebrated Aboriginal and Torres Strait Islander culture and educates the wider

community about healing; and • significant contributions to the Closing the Gap agenda in the areas of health, economic participation, safe

communities and governance and leadership (Healing Foundation 2013).

ATSISPEP assessment

Summary comments

The Healing Foundation provides high quality integrated services; culturally appropriate community activities; engages youth; builds cultural strengths; supports leadership, life skills and social competencies; meets many objectives with regard to life promotion and resilience-building strategies and emotional wellbeing; addresses racism; supports partnerships with community organisations.

The Healing Foundation is committed to developing an evidence base and disseminating information on best practice as described in a number of healing programs and initiatives available on their website.

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ATSISPEP Assessment


A description of the evaluation activities prepared by the ATSIPEP project team is provided in the table below.



The Healing Foundation

Supports the healing and reconnection to culture by funding locally driven, culturally strong healing initiatives across the country enabling effective participation in employment, education, parenting, cultural and community life, and self-determining health and wellbeing outcomes

Indigenous individuals, families and communities

Gilmour (2013) An international literature review was commissioned and a set of 8 reliable indicators/elements of a quality Indigenous healing program developed from formal and informal literature sources on programs in the United States, Canada and New ZealandProject data and case studies were also analysed to produce an internal body of evidence in line with Australian and international research

• The Healing Foundation program measured at 82% of the indicators /elements of a quality healing program from the international literature review

• Further attention was needed in the application of evidence and theory, and incorporating strong evaluation frameworks at the program level

• Internal project data and case studies were thematically analysed and 10 recurring themes were identified around the importance of culture, pride, hope for the future, connection with land, country and history, strengthening community capacity, local leadership, respect for self and others, space to grieve and heal, and spirituality

Alignment with Suicide Prevention Strategy The Healing Foundation aligns with all six Action Areas and Outcome 1.2, 2.3, 3.2, 5.5, 5.6, 5.7

NMHRC Evidence classification Methodological qualitative study (Q1) and anecdotal qualitative study (Q2).


The meta-evaluation assessment has not been applied to this case study. The meta-evaluation assessment framework was designed to assess the effectiveness of evaluations applying to suicide management programs at a service provision level, not organisations that are managing the provision of grants.

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Case Study 17: Red Dust Healing: Healing the Impacts of Colonisation


Cull (2009)

Kickett (2014)

Powell, Ross, Kickett & Donnelly (2014)

Program description

Red Dust Healing is an Aboriginal cultural healing program working with Indigenous male offenders, those at-risk of offending, as well as Indigenous individuals and families. The program was originally designed in response to the founder’s work in, and frustration with, the contemporary juvenile justice system. The program identifies a model of oppression and how this oppression worked to remove the four core values (identity, responsibilities, relationships and spirituality) from the individual. The program addresses oppression in ways that seek to reverse the colonisation process in terms of men’s views of themselves, their roles and responsibilities and their actions. The program offers an innovative approach to assisting men and women in their efforts to heal and make better choices for themselves and in their relationships. Like other contemporary Aboriginal healing programs, Red Dust Healing explores the role of history and historical trauma and invokes Aboriginal culture and spirituality as the core elements of the therapeutic process in an individual’s transformative journey.

Objectives

The main objectives of Red Dust Healing are to:

• restore the role of Indigenous men in their families and communities by providing an understanding of rejection and an avenue for healing;

• provide Indigenous people with an understanding of identity, to equip them with self-evaluation skills, to develop future role models and fathers, and to restore family relationships; and

• to equip Indigenous people with the tools to confront the problems that are relevant to their own lives and address any ongoing patterns of negative behaviour.

It achieves these objectives in a range of diverse community settings and with different population groups addressing specific needs. Red Dust Healing only works with communities that have requested their assistance. They have delivered the program directly in response to community suicide and self-harm as well addressing the precursors of suicide including alcohol and substance misuse, incarceration, family violence and community wellbeing.

Red Dust Healing examines the intergenerational effects of colonisation on the mental, physical, and spiritual wellbeing of Indigenous individuals and families. It addresses issues and the determinants of wellbeing directly. It provides a culturally safe environment, mechanisms for healing, a shared discourse and language, and tools to enable people to gain a sense of understanding and control over their lives. The program encourages individuals to confront and deal with the impact of rejection, hurt, and anger in their lives. The program facilitates the understanding of rejection as the foundation of all hurt. Participants examine the hurt and rejection they have experienced in their lives while growing up and whether they are repeating the same tactics. Participants are encouraged to examine their own personal hurt in order to heal it themselves and as the first step in addressing the hurt they inflict on others in their family and in personal relationships and in patterns of violence and abuse.

Engagement of participants with contemporary forms of Aboriginal knowledge and reconnection with aspects of culture that strengthens their sense of self and their Aboriginal identity and reorient them to a new meaningful existence. Cultural knowledge is seen as the mechanism for Aboriginal people to understand their actions, their work and how to live their life. There is an emphasis on taking personal responsibility for making the best

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possible choices as essential to the healing process and transformation of the individual, and facilitates self-respect and meaningful connections to others.

The program is designed to acknowledge the need to approach the healing journey in an individualised and personalised manner so that participants can apply the tools and learnings to their own circumstances.

Red Dust Healing links the impact of colonisation on Indigenous men with the loss of their:

• Identity – their image of who they were was distorted through the harsh practices of assimilation; • Responsibility – men were stripped of their traditional roles which saw them once respond with the ability to

provide by hunting, making tools, and shelter; and• Relationships – men and women were taken away from their families, and the results of this today have left

many men not knowing how to show emotion and build relationships within their own families and amongst other men.

The program promotes the importance of individuals being empowered to define their own solutions. One of the key tools is POUCH – a solution-based, problem solving concept that allows participants to deal with the issues and difficulties in their own lives. It stands for what Problems u have, what Options U have, what Choices u have and How are u going to deal with them. Discussing this tool encourages participants to look at solving some of the concerns they may have and helps put the responsibility back on the person without blame.

Outcomes

• The program has been successfully used to engage men and address family violence and the factors underpinning much reoffending and family violence (Powell et al., 2014; Cull 2009);

• Enhanced access to healing services with over 5,500 participants in over 300 different communities in rural, remote, regional and urban areas across Australia;

• Central significance accorded reclaiming and reconnecting to an Aboriginal spirituality that emphasises living in harmony is a critical factor; and

• Acknowledgment of the impact of colonisation, understanding history as necessary to acknowledging ‘who we are and from where we came’ and to know ‘where we are going’ are central to the effectiveness of the program and its appeal to a range of Indigenous participants (Kickett 2014).

ATSISPEP assessment

Summary Comments

Red Dust Healing was rated very highly as strong evidence of effectiveness and good practice. It is a program that has integrity and immediate impact on participants, the effects of which appear to be sustained over time. It is culturally responsive, based on a cultural program logic and terms of reference, and supports Indigenous social and emotional wellbeing and self-determination. It provides an example of how a holistic and informed approach can achieve lasting change in the lives of Indigenous people to the benefit of their families and communities. It is also a unique example of an Indigenous run initiative that aims to equip Indigenous people with the skills to reassert their Aboriginal identity, responsibilities and roles in the context of their relationships in a postcolonial society.

The Mowanjum case study that follows is an excellent example of where this impact of Red Dust Healing has occurred. The program was invited to assist the community in response to a number of suicides that had occurred within a short period. The program has been conducted on two occasions with a large number of Elders and highly regarded, nominated members of the community. The first workshops focused on community healing and wellbeing and the second focused on training members of the community as potential natural helpers in the community. Interviews and correspondence with five independent, key stakeholders involved in delivering services in the Mowanjum community attribute many of the positive, restorative activities being determined and undertaken by the community to Red Dust Healing. They point to activities such as those discussed in the case as strengthening cultural identity (particularly those focused on young people) as well as the community’s engagement in economic initiatives including re-establishing a pastoral lease.

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Evaluation findings

Red Dust Healing Group healing program that examines the intergenerational effects of colonisation on mental, physical and spiritual wellbeing of Indigenous families and provides tools for individuals to confront and deal with the problems, hurt and anger in their lives

Adults Powell et al. (2014)

Cull (2009)

Participant feedback and survey pre- and at 4–6 weeks post-intervention.

Multiple qualitative research methodologies were used to address the research questions

• Responses overwhelmingly indicate that the content and tools were useful and effective. Some evidence of positive impact on people’s social and emotional wellbeing sustained after participation

• Confirmed by ATSISPEP survey monkey as worthwhile, receiving 60.7% from Indigenous respondents who had involvement with this program, and also measured 50% culturally relevant with the same respondents

• The high level of satisfaction with the program experienced by past participants meant they were eager to share their experience of Red Dust and discuss how it had changed their lives

Alignment with Suicide Prevention Strategy Red Dust Healing strongly aligns with Action Areas 1 and 2, and is meeting the Outcomes 1.2, 2.1, 2.2, 2.3, 3.4

NMHRC Evidence classification Pre/post intervention case series – a single group of subjects are exposed to intervention, outcomes are measured before and after completion (C1)


In the assessment against the meta-evaluation analysis framework, the Red Dust Healing program received the following scores:

• Strong conformity against the community engagement assessment component (a score of 5 out of a possible 6)• Weak conformity against the quality evaluations assessment component (a score of 8 out of a possible 12)• Poor conformity against the impact assessment rigour component (a score of 4 out of a possible 12)• A total score of 17 (out of a possible score of 30), which was categorised as weak conformity with the overall meta-evaluation assessment criteria.

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Table 5.19: Red Dust Healing Program – Meta-evaluation Assessment

Meta-evaluation assessment fr

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amework

Evaluation Meta-Evaluation


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Scoring Rationale Applied


1.1 Rea

Other: d

Not applicable There is an underlying level of suicide in most communities. Higher levels of suicide are not a positive.

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son for program development

esigned to promote cultural healing

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but delivered in communities in re

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sponse to high levels of suicide

1Co

1 Programs led by community-controlled organisations have a greater degree of acceptability to Aboriginal and Torres Strait Islander people.The Red Dust program is delivered in response to invitations for delivery from locally based organisations.

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.2 Who led the program implementati

mmunity-controlled organisation inv

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onolved, but not leading (e.g., local

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mainstream health service led)

1.

M 2 Application of the program across broader geographies has several benefits:Reduces the risk of selection biasIncreases the chance of demonstrating scalability

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3 Where implemented (locality / jur

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isdiction/s)

1.4 Stakeholder / com

Strongly supportive an


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munity perspectives obtained

d actively engaged in the evaluatio

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n (e.g., focus groups and community

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forums)

Score for community engage

5 (compared to maximum score for component of 6)

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ment assessment component

Summary a


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ssessment engagement


2.1 Values i

Conforms, bas

2 Perspectives, procedures and rationale used to interpret the findings should be carefully described.

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nterpretation

ed on published information

2.2 Re

Conform

2 Evaluation reports should clearly describe the program evaluated, including its context, and the purposes, procedures, and findings, so that essential information is provided.

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port clarity

s, based on published information

S 1 A full set of evaluation findings, along with limitations, is accessible to persons affected by the evaluation.

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2.3 Disclosure of findings

ome evidence, but not strong

2.4 J

Some e

1 Conclusions reached in an evaluation should be explicitly justified, so that audiences can assess their validity.

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ustified conclusions

vidence, but not strong

2.5 Impart

Some eviden

1 Reporting procedures should guard against distortion caused by personal feelings and biases to any party to the evaluation, so that evaluation reports fairly reflect the evaluation findings.The main evaluation report includes the program presenters as authors.

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ial reporting

ce, but not strong

2.6 Evaluation i

Some evidence, b

1 Evaluations should be efficient and produce information of sufficient value so that the resources can be justified.

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mpact

ut not strong

Score for quality eva

8

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luations assessment component

Summa


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ry assessment for quality evaluatio

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ns


3.1 Key evaluation questions s


1 Evaluation questions ensure there is an explicit link between the evaluation objectives, the evaluation design and the type of data collected.

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pecified

3.2 Clear program theory

Some evidence, but not str

1 Program theory (also referred to as program logic) documents the causal (or results) chain from inputs to outcomes in a program intervention. Theory-based evaluation allows assumptions underpinning the program logic to be tested and avoids a ‘black box’ evaluation (identify an impact, but do not enable an explanation as to why).

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/ program logic specified

ong

3.3 Coun

Does not

0 Comparison groups are not available to reduce or remove selection bias and avoid the risk of contagion.

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ter-factual specified: method for c

conform

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omparing ‘with program intervention

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versus without’ identified to supp

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ort causal attribution

3.4 Triangu

Does not con

0 Different data sets – and interpretation of that information – should support the same conclusion.

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lation of findings

form

3.5 ‘Did it wor

Some evidence, b

1 There should be an explicit assessment of what worked and what did not as a result of the program.

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k?’ assessment provided

ut not strong

3.6 Learn

Some evide

1 There should be an explicit assessment of what learnings emerged from the program to inform questions about future program design replicability and scalability.

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ing assessment provided

nce, but not strong

Score for i

4

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mpact assessment rigour component

SIneffective evaluation

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ummary assessment for impact assess

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ment rigour

OVERALL SCORE FOR META-

17 Partially effective evaluation

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EVALUATION ASSESSMENT

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WORKFORCE TRAINING

Case Study 18: The Djirruwang Aboriginal Mental Health Worker Education and Training Program


Charles Sturt University (2013)Brideson, Havelka, McMillan & Kanowski (2014)

Program Description

The Djirruwang Aboriginal and Torres Strait Islander Mental Health Worker Education and Training Program (The Djirruwang Program) pioneered the establishment of a clinically based tertiary level mental health course in Australia designed for Indigenous people. It was the first course to incorporate the National Practice Standards for the Mental Health Workforce (The Practice Standards) and embed the Aboriginal and Torres Strait Islander Mental Health First Aid Certificate within its curriculum structure (Havelka, 2008). The program has restricted entry and is designed for Indigenous people to gain high quality knowledge, skills and attitudes in the field of mental health, building on people’s knowledge and combining mental health theory with clinical practice. The program provides the opportunity for people to gain formal mental health qualifications at certificate, diploma and degree levels. The Djirruwang Program is an important example of fostering an Aboriginal mental health workforce to improve Indigenous mental health outcomes, which is one of the four priority areas of the National Mental Health Commission’s ‘A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention’.

Objectives

The key goal of the Djirruwang Program is to develop a skilled Aboriginal workforce within the mental health care system to be able to address the overrepresentation of Aboriginal people with high levels of depression, psychotic disorders and high numbers of suicides in communities. The program has incorporated a mainstream understanding of clinical mental health care together with cultural elements. It seeks to increase understanding of the burden of mental illness and distress, and its negative impacts on Aboriginal social and emotional wellbeing through the lens of the ongoing impact of colonisation still confronting Australia, and the current health and social circumstances (Dudgeon et al., 2014b; Parker & Milroy, 2014).

The program has been developed and refined over many years by key clinicians, Indigenous leaders, organisations, health disciplines and Aboriginal communities working in close partnership and reciprocal learning to produce the national award winning curriculum and delivery. The program emphasises the importance of recognising Aboriginal cultural experiences and knowledge within the mental health curriculum, and providing a culturally safe environment to facilitate effective outcomes (Brideson et al., 2014; Duffy et al., 2010). The program elevates and legitimates the importance of Aboriginal Mental Health Workers (AMHWs) as equally significant as the professions and disciplines of psychiatry, psychology, social work, nursing and occupational therapy in addressing the social and emotional wellbeing and mental health needs of Indigenous people (Brideson et al., 2014). The program coordinators state that failing to acknowledge the important role of mainstream clinical care is inappropriate, and only ‘further exacerbates the stress levels for MHWs and services, and is likely to result in increased complications for clients and their families or, at the extreme end, becomes a matter for coronial investigations’ (Brideson et al., 2014).

The aims of the Djirruwang Program are to:

• Educate and train Aboriginal trainees to develop the appropriate knowledge, skills and attitudes to work as an Aboriginal Mental Health Worker (AMHW);

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• Develop the skills needed to work effectively in a community mental health setting; and• Develop skills to assist communities to identify mental health needs and initiate primary prevention and early

intervention programs (Kanowski & Westerway, 1996; Brideson et al., 2014).

Outcomes

Since its inception, the Djirruwang Program has undertaken a number of significant developments that have contributed to the program’s success. These include:

• Periodic external evaluations to improve and build the evidence base;• Ongoing program review; • Embedding the National Practice Standards for the Mental Health Workforce;• Achieving professional recognition of the qualification of the Bachelor of Health Science (Mental Health) by the

Indigenous Allied Health Australia (IAHA) 2012;• Increasing number of Indigenous graduates in the mental health workforce; and• Increasing understandings of the importance of incorporating both clinical and cultural perspectives in

addressing suicide and mental health issues.

In 2014 there had been 137 graduates, 105 students enrolled in the program, and graduates had gained employment in senior roles in a number of areas across a range of settings.

Evaluation Findings

The program has continually been evaluated by Charles Sturt University with input from the mental health professional sector. Ongoing evaluations of the program have recorded the direction and continual building of evidence. Each evaluation has found the program to be unique, valuable and meeting the needs of health services by developing a well-qualified Aboriginal mental health workforce (Harris & O’Neil, 1998; Brideson et al., 2014). An external evaluation of the Djirruwang Program was undertaken in 2010 and resulted in revisions to the skills, knowledge and attributes of the students to enhance the professionalism of graduates. The review highlighted key areas for engagement with industry partners, the university and the student cohort which has led to informed curricula development and change. This new curricula, which commenced in 2013, includes a greater emphasis on dual diagnosis, pharmacology and understanding of the diversity within the Australian demographics (Charles Sturt University, 2013).

Embedding culture in the curriculumThe Djirruwang Program positively validates and affirms cultural difference in making an ongoing contribution beyond the mental health area. Brideson and colleagues (2014) emphasise the critical importance and value of embedding culture and affirming processes as a key strategy to address the burden of mental health issues and suicide within Indigenous communities, and the role the Vocational and Education and Training (VET) sector can play in this regard. They draw on the findings of an economic review by Dockery which argues that incorporating cultural elements into curricula and models of delivery of education and training which affirm and recognise Indigenous culture is likely to improve outcomes across all sectors, and promote a positive sense of cultural identity for Aboriginal students (Dockery, 2009). Dockery makes the point that:

If a strong sense of continuity of self-identity safeguards young people against taking their own lives, it may also have positive impacts in other domains in which people ‘invest’ in their futures, such as education, health, a career and relationships with family and community.

(Dockery, 2009, p. 10, cited in Brideson et al., 2014).

ATSISPEP Assessment

Summary comments

The program values Aboriginal people’s experiences, and affirms all aspects of culture within the curriculum, structural arrangements and implementation. At the same time, it incorporates clinical guidelines and practices

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to make a significant contribution to health and social services professions and one that values Aboriginal people at the core of all developments. This is an exemplar of mental health workforce training and of significant relevance to supporting mental health and social and emotional wellbeing and reducing suicide and self-harm through the provision of training, skills and professional qualifications at all levels.

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The Djirruwang Aboriginal and Torres Strait Islander Mental Health Worker Education and Training Program

Curriculum developed to:Educate and train Aboriginal trainees to develop the appropriate knowledge, skills and attitudes to work as an Aboriginal Mental Health Worker (AMHW)Develop the skills needed to work effectively in a community mental health setting; andDevelop skills to assist communities to identify mental health needs and initiate primary prevention and early intervention programs

Indigenous students

Charles Sturt University (2013)

Duffy et al. (2010)

Evaluation and accreditation conducted through the CSU Academic Board Periodic evaluationOngoing program review

Surveys, interviews and focus groups with students Qualitative methods

• Quality of teaching staff and a flexible approach to learning and teaching; group identity and cohesion were key issues identified by the students that facilitated their growth as resilient and empowered individuals.

• strong sense of ownership, pride and cohesion which allowed the students to grow as individuals and as an empowered group

• unique in its design, which enables students to:– learn and grow as individuals, developing

and strengthening their cultural identity and sense of community

– facilitates sense of belonging, and promotes respect, resilience and wellbeing.

Alignment with Suicide Prevention Strategy The Djirruwang Program addresses a key component of Action Area 6, which focuses on strategies to enhance standards of practice and high-quality service delivery and improve Indigenous participation in the mental health workforce through

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access to training and qualifications at all levels. In particular, the program meets outcome 6.2 and 5.3.

NMHRC Evidence classification Not applicable


The meta-evaluation assessment has not been applied to this case study. The meta-evaluation assessment framework was designed to assess the effectiveness of evaluations applying to suicide prevention programs at a service provision level, not infrastructure (workforce) development.

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Case Study 19: Wontulp-Bi-Buya College Suicide Prevention Training (Cairns, QLD)


Stephens (2015)

Program Description

Wontulp Bi-Buya College (WBBC) delivers the Indigenous Mental Health (Suicide Prevention) Certificate IV (IMC) as part of the community prevention for high-risk groups’ initiative of the Taking Action to Tackle Suicide (TATS) Package. The IMC has been delivered in two intakes running May to November 2014 and February to November 2015. It is accredited by the Australian Skills Quality Authority (ASQA) and is approved for ABSTUDY assistance for Indigenous students (Stephens, 2015).

Development of the course was undertaken by WBBC’s College Course Advisory Committee in partnership with WBBC Trainer and Course Coordinator, Rev. Leslie Baird. Rev. Leslie Baird previously developed the Strategic Plan for Suicide Prevention in Yarrabah (1995/6), and he worked in consultation with Indigenous leaders to adapt the Indigenous Mental Health strategies for suicide prevention and cultural suitability to fulfil the needs of the Australian Skills Quality Authority (ASQA) (Stephens, 2015).

Currently in the pilot phase, the IMC course works to promote responses to suicide and mental health issues in Indigenous communities that respond to local needs, and has been highly effective in Cairns. The course is transferrable to other locations and communities (Stephens, 2015).

The program has a general entry enrolment with student intakes from a wide selection of communities to provide greater networking opportunities, and the formation of a larger information repository leading to possible funding, employment, public health initiatives, and the development of critical frontline workforce capacity. Importantly, the average level of formal education of the enrolees was Year 10. WBBC’s teaching strategy encompasses the inclusion of continued high support and modified learning plans for all students (Stephens, 2015). This includes an awareness of Indigenous learning styles and the need for cultural appropriateness and acceptability (Stephens, 2014; Stephens, Baird, Turpin, & Tsey, 2012).

Objectives

WBBC’s key objectives are to:

• Promote help-seeking behaviour and positive lifestyle choices; • Promote local responses to suicide and other related issues in communities; • Facilitate greater networks between service providers and local communities;• Contribute to the development of local community capacity to address these issues; and• Facilitate access by communities around Australia to appropriate service providers (Stephens, 2015);

A critical objective of the WBBC is to produce empowered community leaders. It aims to do this by:• Increasing students’ awareness of mental health and suicide and provides ongoing support in the form of

network membership; and• Developing students’ capacity for personal empowerment and control over their own life and circumstance,

which provides the crucial requirement of good mental health and help-seeking behaviours needed to support others.

Graduates of the IMC have worked to achieve verbal and practical skills to working effectively with current health and community service providers. Six of the graduates from the 2014 course are now in full-time employment (Stephens, 2015).

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Outcomes

WBBC was able to achieve a course placement for 60 enrolees who were mostly female with the average age of over 45 in the pilot phase, with 78% of this number completing the course.

Evaluation A two-year evaluation of the delivery and outcomes of the IMC was undertaken by Dr Anne Stephens of James Cook University and was designed to measure the delivery of the IMC and its outcomes measured against the key objectives of the work plan, using an action research approach to underpin its methodology. Qualitative data was collected to explore the pedagogical processes that led to the recorded outcomes. The research was grounded in participant experiences of students and trainers with data obtained over two years of continuous observation and data collection.

The methods of data collection were:

• Interviews with current trainers, other relevant staff/stakeholders conducted over two years;• Enrolment file audit;• Focus groups and individual semi-structured, face-to-face and telephone interviews conducted with over 26

students at intervals determined by attendance at teaching and learning blocks in Cairns;• Evaluation questionnaire in training module workbooks; and• Researcher observation (Stephens, 2015, p. 7).

All data was stored and thematically analysed using the NVIVO software package. The findings were reported and categorised under three emergent themes: student recruitment and implementation; learned strategies for suicide prevention; and post-course student outcomes.

In post-course follow-up, telephone interviews with 10% of course graduates of the 2014 cohort were conducted 9 months after completion of the course.

Evaluation Findings

The summarised findings of the evaluation under the three core themes were:

Student recruitment and implementation:

• A higher number of students were recruited to undertake the IMC course than was originally envisioned, coming from a diverse range of communities. This was seen as a result of employing a general recruitment strategy rather than targeting specific communities for student intake.

• Ranging in age from 24 to 75, students were mainly female, and most had medium to high literacy needs. Two students had a degree qualification, with the average highest level of education being Year 10. There were 60 enrolees, with 78.7% completing the course.

• Three main reasons for enrolling in the course were recorded: to enhance community leadership and mentoring skills, to gain employment in a relevant sector and to expand awareness and understanding of suicide prevention and mental health.

• The course is delivered in four residential blocks in Cairns and is between 500–550 hours over one year. It covers many aspects of Indigenous community-wide mental health with an emphasis on a holistic perspective.

Learned strategies for suicide prevention (four themes emerged for this section):

• Individual skills development for employment or volunteering;• Personal development, leadership and mentoring;• Community networking; and• Integrated community plans and planning (Stephens, 2015, p. 12).

Post-course outcomes:

• Former students were found to be active in suicide prevention planning and implementation;• Six graduates went on to secure full-time employment;

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• All of the post-course interviewees were engaged either in paid or unpaid work;• Other benefits beyond employment and skills were recorded, including a sense of achievement, personal

development, being a role model for others, networking opportunities, as well as an increased awareness of the causes of suicide and general mental health issues;

• Relating to work skills, interviewees identified counselling as a core role;• High levels of student satisfaction were recorded, as well as further suggestions to improve the IMC; and• Overall, satisfaction with the trainer was high.

There were five statements outlined in the work plan that the evaluation findings were measured against. For the first, to promote help-seeking behaviour and positive lifestyle choices, students developed a wide range of skills during the course. These included an increase in empowerment and a sense of mastery and control in their lives.

The second, relating to the promotion of local responses to suicide and other related issues, found that the IMC achieved highly against this outcome in preparing students to work with communities and an understanding of community problems and reasonable responses to take. The third, to facilitate greater networks between service providers and local communities, is reflected in the success of WBBC in developing a network of Indigenous leaders. The fourth, to contribute to the development of local community capacity to address these issues, was highlighted by the employment outcome for six students. Facilitating access by communities around Australia to appropriate service providers was beyond the scope of this study to address.

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ATSISPEP Assessment





Wontulp Bi-Buya College

Wontulp Bi-Buya College (WBBC) delivers the Indigenous Mental Health (Suicide Prevention) Certificate IV which works to promote local responses to suicide and mental health issues in Indigenous communities. Based in Cairns where this approach has been successful, the course is transferrable to other community settings. WBBC also aims to produce empowered Indigenous community leaders.

Indigenous community members

Stephens (2015) The evaluation of the pilot phase was carried out over a two-year period covering the first two cohorts of students in 2014 and 2015. Semi-structured interviews and focus groups were carried out with current trainers, relevant staff/stakeholders and students, including post-course interviews with 10% of the 2014 course graduates. An enrolment file audit was undertaken, a voluntary evaluation form was included in training module workbooks, along with researcher observation. Thematic analysis was employed using the NVIVO software package to measure against WBBC’s key objectives and aims as set out in its work plan.

• Three core categories were used to order the summarised finding: student recruitment and implementation; learned strategies for suicide prevention; and post-course student outcomes

• There was a recorded increase in student empowerment and a sense of mastery and control in their lives leading to the promotion of help-seeking behaviour and positive lifestyle choices

• The course was shown to produce graduates with an increased understanding of local community issues and appropriate responses to take

• A stronger network between service providers and communities was achieved, and built on networks of Indigenous leaders

• Contributing to local community capacity was highlighted by the full-time employment secured by 6 graduates after the course

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Alignment with Suicide Prevention Strategy The project strongly aligns with outcomes 1.1 to 1.5 within Action Area 1, and outcomes 2.2 and 2.5 in Action Area 2, and outcomes 3.1, in Action Area 3, and outcomes 5.3 to 5.7 of Action Area 5

NMHRC Evidence classification Not applicable


The meta-evaluation assessment has not been applied to this case study. The meta-evaluation assessment framework was designed to assess the effectiveness of evaluations applying to suicide prevention programs at a service provision level, not infrastructure (workforce) development.

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APPENDIX E 37 EVALUATED PROGRAMS NOT INCLUDED IN THE META-ANALYSIS

Name Approach Objective/Aims

Target Evaluation Title

Evaluation methodology Evaluation findings

A community participative singing approach programme

A community arts training course designed to enhance quality of life and social and emotional wellbeing in Indigenous people with chronic diseases

Adults in south-east Qld communities

Sun & Buys (2013) Mixed methods evaluation based on questionnaires (pre-course and 6-month follow-up) and qualitative feedback

• There was statistically significant improvement in resilience scores, social and emotional health, stress, and depression.

• The study concluded that a community-based research approach can foster a sense of self-determination, create greater commitment and can ultimately improve self-esteem and increase a sense of belonging.

AIPA Cultural Competence workshop Cultural competence training for non-Indigenous mental health practitioners

Non-Indigenous mental health practitioners

Walker (2010b) Evaluation based on questionnaires and interviews with workshop participants

• This evaluation was limited to issues of process (and not effectiveness). The training was rated very highly by the vast majority of participants.

• Training successfully integrated cultural competence as a crucial component of effective professional practice. Practitioners had greater confidence in working in culturally diverse environments, and better skills and knowledge to apply in practice.

Allied Psychological Services (ATAPS Tier 2)

Mental health referral service that enables GPs to refer patients with high prevalence disorders (i.e., depression and anxiety) to allied health professionals for low cost evidence based mental health care (most commonly CBT)

Individuals Fletcher et al. (2012) Evaluation based on administrative data and survey of participants (pre- and post-intervention)

• Small increase in number of GPs delivering services for Indigenous and Torres Strait Islander people but, overall, there was not a substantial change in the number of referrals and sessions used.

• Evidence of effect on mental health outcomes could not be ascertained for Indigenous participants because of small sample size.

Allied Psychological Services (ATAPS Tier 2)

Mental health referral service that enables GPs to refer patients with high prevalence disorders (i.e., depression and anxiety) to allied health professionals for low-cost, evidence-based mental health care (most commonly CBT)

Individuals Bassilios et al. (2013) The evaluation used both qualitative and quantitative methods. Data were collected via surveys, forums and interviews, and reports and administrative data were also analysed

• Although the number of referrals of Indigenous people to Tier 2 ATAPS services has increased from 39 in 2009–2010 to 842 in 2012–2013, this is far below what would be expected based on the Indigenous population.

• No data is provided on the mental health outcomes achieved by ATAPS.

ATAPS Suicide Prevention service The pilot project ran from 2008 to 2011, then expanded nationally.

The program provides guidelines to allied health professionals for treatment (within 24-72 hours) and short term support for acute suicide risk (up to 2 months).

Individuals Fletcher et al. (2012) Using a purpose designed Minimum Data Set (MDS), five evaluation questions were analysed addressing participation, uptake, sociodemographic, nature of treatment, and rate of positive outcomes.

The specific outcomes for Aboriginal and Torres Strait Islander participants is unknown

• To December 2011, there were 3877 referrals. Of these 3877 referrals, 2.4% identified as Aboriginal and 0.4% identified as Torres Strait Islander.

• Pre- and post-test data was available for 424 (12%) of consumers using the Depression Anxiety and Stress Scales (DESS), the Kessler 10 (K10), and the Modified Scale for Suicidal Ideation (MSSI).

• Across the three measures the mean difference between pre- and post-treatment scores was statistically significant and indicative of clinical improvement for participants.

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Australian Integrated Mental Health Initiative (AIMhi) training

Short training workshops in culturally appropriate mental health service provision

Regional and rural communities

Nagal et al. (2009) Questionnaires (pre- and post-workshop) • Evidence that the program significantly improved participants’ confidence in assessing and treating Indigenous people with mental illness.

CNAHS (Central Northen Adelaide Health Service) Family and Community Healing Program

Suite of 10 health promotion and intervention programs aimed at developing effective responses to family violence (using courses, activities and groups). Incorporated a range of strategies, including the Family Wellbeing Program, courses at local high schools, a nutrition program and crisis support

Workers and clients at PHC Indigenous outreach services in Adelaide

Kowanko & Power (2008)

This qualitative evaluation was based on interviews and focus groups, and evaluator observations and reflections (at 12 and 24 months post-intervention).

The evaluation provided qualitative narratives based on interviews with staff and course participants.

• Clients and workers were unanimous in their support for the program.

• Beneficial impacts on Indigenous clients, families and community (including increased self-worth, empowerment, coping, trust and peer support)

• Interviews with workers provided many stories of how participation in the AFCH led to increased capacity to support safe families. Clients who had completed the 8-week women’s structured program went on to study at TAFE and gain satisfying employment, and now promote their learnings in their daily lives and through their networks as role models. Similarly, case studies of individuals who had increased sense of self-worth, found employment, addressing other issues in their lives.

• Workers talked about how the ‘client journey’ of being involved in the AFCH Program takes a client from a crisis (usually the trigger for entering the program) through to continued individual support as new issues arise, and development of self-confidence and strategies for family and community safety.

CORES – Community Response to Eliminating Suicide

A one-day training course created and piloted in Tasmania (now in 5 states) as a train-the-trainer model that empowers communities to shape the program delivery A current mainstream program that is building networks with Aboriginal and Torres Strait Islander communities and looking to expand across Australia

Regional and Rural communities

Success Works Pty Ltd

September (2009)

The qualitative evaluation includes a ‘process’ evaluation, a ‘formative’ evaluation and a ‘summative’ evaluation. Data gathered through interviews, focus groups, workshops, an online questionnaire and document evaluation.

• The CORES program was seen to be successful in awareness raising of the risks and social implications of suicide among participants. It builds on the existing social capital within a community through a community ‘champion’, extending networks.

• Sufficient responses indicated that the CORES program had averted possible suicides through a number of people identifying others at-risk and being able to refer them to appropriate services.

• The evaluation also found that CORES was a sustainable program able to be run relatively autonomously at the local level.

• CORES is a community-based and run service, functioning around community capacity building and community ownership; the evaluation found the CORES model to be effective.

• This program was endorsed and recommended by a number of ATSISPEP Survey respondents for survey inclusion, however subsequent data collected was from a very small sample only.

Creative Recovery project A community arts based wellbeing and mental health recovery project

Rural and remote communities

Leenders et al. (2011)

Mixed methods evaluation, including yarning/unstructured interviews, activity reports and the production of documentaries, questionnaire, audio tape recording, unstructured interviews, Indigenous storytelling, record keeping, site visit field notes and workshop reports

• Evidence that the program supported participation and inclusion among people with mental health problems

• The project has resulted in improved mental health among participants, a large body of 300 artworks, 4 major public exhibitions, 8 community launches/exhibitions, and 15 emerging artists generating a regular income from the sale of their work.

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Deadly Thinking A one day mental health literacy workshop designed to provide awareness and basic knowledge for community members and their families to build and maintain social and emotional wellbeing

Community members, leaders and ‘natural helpers’

Robinson, T. (2011) Qualitative and quantitative methods were used in the pilot workshops. Data collected on the impact and dissemination of the workshops utilising facilitator field notes, narratives, semi-structured interviews, video recordings, and participant evaluation regarding the relevance of the workshops to social and emotional wellbeing issues in participating communities and whether participants’ needs were met by the workshop.

• The evaluation confirmed the workshop was well received and addressed important issues.

• Feedback included concerns about the short length; others suggested that it was too long. Pre-site visits could be longer and the workshop could include clearer processes for providing feedback, as well as follow-up workshops.

• Many participants were aware of the Aboriginal Mental Health First Aid (AMHFA) course, and 25% had completed the training. Recommended as a precursor to AMHFA.

• ATSISPEP Survey results of 55 participants: 60% found program worthwhile; 47% culturally relevant and between 35 and 39 % increased knowledge and empowerment.

DRUMBEAT A therapeutic program using drumming to: engage at-risk youth alienated from school; address healthy relationships with others, self-esteem and antisocial behaviour. It combines musical expression and cognitive behaviour therapy (CBT)

Students in Years 6 and 7 in schools in the Wheatbelt region, Western Australia

Faulkner et al. (2012)

A mixed methods evaluation, using informal discussions with staff and participants, observation, questionnaires, and school attendance and behavioural incident records.

Included 60 Year 6 and 7 young people in 3 schools, (approximately 40% were Indigenous). Data were collected immediately pre- and post-intervention, on self-esteem, school attendance and anti-social behavioural levels of co-operation and collaboration

• The results show that a combination of the therapeutic potential of musical expression and basic CBT therapy can be used successfully to deliver a range of social learning outcomes, including emotional control, improved relationships and increased self-esteem, significantly improved attendance rates for students.

• Positive feedback regarding the involvement of an Indigenous DRUMBEAT presenter.

headspace headspace provides support, information and assistance to young people aged 12–25 who are experiencing emotional or mental health issues, including substance abuse

Young people 12-25 years

Muir et al. (2009) Analysis of qualitative and quantitative data including document analysis, interviews and surveys of young people and stakeholders and the analysis of headspace administrative data

• headspace has: increased the number of young people who access mental health services in the early stage of their illness and overall; effective in improving some young people’s mental and physical health, decreasing their alcohol and other drug use; increasing their engagement with education and work. Although 9.5% of clients are Indigenous, there are variable levels of the effectiveness or cultural appropriateness of the service for Indigenous young people with a mental health issue.

• Staff identified need to tailor health promotion materials where many young people found the materials confusing and some sites identified Indigenous young people as hard to reach. Sites that were effective in engaging Indigenous YP generally had active contact with community based services and implemented culturally appropriate strategies which need to be shared with all sites.

• High level satisfaction where there were culturally appropriate services In other sites, staff expressed concerns regarding inability to engage with Indigenous young people.

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Indigenous community gatekeeper training

Aimed to determine long term effects of the Shoalhaven Aboriginal Suicide Prevention Program (SASPP), which used community gatekeeper training as its primary strategy

Community members, leaders and ‘natural helpers’

Deane et al. (2006) The evaluation used a combination of qualitative and quantitative methods, comprising structured interviews with participants on completion of the training and after 2 years. 40 participants participated in the follow-up study, 24 participants agreed to in-depth interviews.

• A 2 year follow-up of 40 participants found that participants’ intentions to help, and confidence in their ability to identify someone at risk of suicide, remained high. 15 participants reported that they had helped someone at risk of suicide since the training.

• A significant relationship between intentions to help prior to the workshop and helping someone at risk of suicide.

• Strong link between intentions to help, and subsequent help provision.

• Not as willing to refer to mental health services – unclear whether workshop attendance contributed to this effect. Future prevention programs need to be customised to specific Indigenous communities to reduce barriers to help-seeking behaviour.

Indigenous Cultural Festivals A wide range of Indigenous cultural festivals across Australia Although these festivals differ in scale they share aims of cultural renewal, reconnection, and celebration , generating pride, dignity, employment, and promoting health and social and emotional wellbeing.

Communities Phipps & Slater (2010)

Qualitative research comprising over 100 structured and informal interviews, observations at 20 festivals, field visits in urban and remote locations and analysis of public statements, policy documents and reports. Social mapping, data collection and empirical and conjunctural analysis

• The evaluation concluded that festivals contribute to the wellbeing of Indigenous communities. The study provided evidence to systematically demonstrate that festivals are generically beneficial to mental health on the basis that they support cultural celebration and identity, reaffirm culture and enable prevention and education messages to be heard.

• Using Indigenous indicators of wellbeing the study asserts the significance of culture as the starting point for addressing education, employment and economic and social and emotional wellbeing and mental health outcomes, linking these to the social processes in organising and participating in cultural festivals.

Indigenous Group Triple P-Positive Parenting Program

Triple P is a behavioural family intervention based on social learning principles.

This group-based version of Triple P was developed for Indigenous families

Indigenous families Turner et al. (2007) Indigenous Group Triple P was evaluated using a randomised clinical trial in four urban sites.

• Indigenous parents who participated in Indigenous Group Triple P reported significant decreases in problem child behaviour in comparison to parents on the wait list.

• Parents were very satisfied with the program and found it to be culturally acceptable in terms of content, resources and format

Indigenous Hip Hop Projects This project fuses traditional culture with hip hop, rap, beat boxing and break dancing to foster positive mental health & leadership skills in remote communities.

A proactive, preventative approach to depression and anxiety

Students aged 5-17 in Pilbara and Kimberley regions

Hayward et al. (2009)

beyondblue (2009)

A qualitative and quantitative evaluation of the program was based on a sample of 76 young people, five community organisations and 17 local stakeholders.

Questionnaires, one-on-one interviews and focus groups were used during, post- and 6-month post-interventions.

• Evaluation highlights myriad benefits, including a better understanding of mental health issues (depression and anxiety; and associated signs (although less evident at 6-months)); impacts on self-esteem, behaviour and respecting each other; the need to talk with friends and family if experiencing tough times; and feeling more comfortable listening to a friend or family member who was experiencing tough times (although still many young people felt uncomfortable with this).

• Indigenous hip hop increased young people’s preparedness to talk to family and friends about their own mental health issues and their ability to identify signs of depression in others.

• Workshops in dance and performance events deliver messages about social and emotional wellbeing, and healthy lifestyles.

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KidsMatter Professional learning program for early child care services workers that aims to improve the mental wellbeing of children from birth to school age

Staff in early child care services in NSW, Qld, NT and ACT

Slee et al. (2012) This is a separate study within a larger evaluation in 111 services, it is based on qualitative case studies in five services where there were more than 25% Indigenous enrolments and in-depth analysis of data interviews at 10 sites with greater than 25% Indigenous enrolments. The review acknowledged the 9 guiding principles.

• Substantial increases in staff abilities to articulate ideas relating to mental health

• Significant increase (46%-82%) in the number of staff reporting substantially improved interactions with children and parents, enhanced knowledge of children’s mental health, fostering children’s mental health and wellbeing, and being more responsive to children experiencing difficulties

• All sites reported that engagement and useability depended on adopting and adapting the KidsMatter Early Childcare Services in culturally appropriate ways, catering specifically for children with extreme learning and behavioural difficulties and participating in two-way learning between Aboriginal and non-Aboriginal staff.

• The adaptation empowered all staff, enabled them to address early childcare issues affecting mental health and wellbeing and was aligned with Aboriginal families and communities.

• Indications that there would be benefits from greater involvement of Aboriginal people in the staff development process

Let’s Start: Exploring Together A trial 10-week parenting and early child developmental program adapted for implementation in the Northern Territory that focuses on the developmental needs of children and their parents’ concerns

Indigenous and non-Indigenous children aged 4-6 in urban and remote schools whose behaviour was a concern

Robinson et al. (2009)

The evaluation used a quasi-experimental design. Children were assessed at referral, on completion of the program and at six months post-completion. Parents and teachers were interviewed at referral and six months after the children completed the program; assessment made according to multiple measures in the mainstream population.

• The evaluation found substantial, statistically significant reductions in problem and risk behaviours among participating children at home and at school. Improvements were found in the mainstream population to have increased at the 6 month post-follow-up. Strong reductions in parental distress

• However, completion rates by Indigenous parents and children were low, especially in urban areas. Less than (18%) of urban and (45%) of remote Indigenous children and parents completed >50% of the program sessions.

• The pilot identified the need to integrate greater cultural understanding and values.

• Highlights the complexity of adapting the program to meet the diverse cultural, geographic and individual needs and at the same time retain program fidelity

• Research provided insight into the critical processes of delivery and a framework for culturally and professionally competent engagement to underpin all future efforts to develop evidence of program effectiveness.

Life Promotion Program/Suicide Story DVD (utilised in workshops)

The Life Promotion Program’s main aims are to reduce suicide and suicidal behaviour by engaging relevant stakeholders in collaborative partnerships; providing community education and training; and ensuring an inter-agency postvention response

Relevant agencies and community members

Lopes et al. (2015) Impact and process evaluations undertaken to assess participants’ perceptions about the Program/DVD A qualitative methodology used a triangulated approach to data collection. Included direct observations, a focus group and semi-structured interviews, and relevant documents. An Indigenous advisor, interpreters and Indigenous researchers assisted with data collection.

• The evaluations indicated that Suicide Story increased trainee’s knowledge and understanding about suicide.

• The DVD was useful in initiating conversations around suicide, and providing positive attributes for trainees in dealing with issues around suicide.

• Integral to the successful delivery of the DVD resource included embedding it within a 3.5 day suicide prevention workshop employing local cultural consultants and Indigenous staff.

• It was found that the Life Promotion Program was well balanced in terms of content and delivery.

Marumali Marumali is a workshop based program that trains counsellors to help Indigenous people who were removed from their families as children

Counsellors Peeters (2010) Analysis of workshop evaluations completed by participants

• The program has provided training for more than 1,000 Indigenous workers and counsellors, almost all of whom (93%) rated the Marumali training as excellent.

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MindMatters Mindmatters is a national mental health promotion program for secondary schools, comprising a kit of resources and professional development for staff

Secondary school staff

Hazell (2006) The national evaluation of MindMatters used both qualitative and quantitative methods, including surveys of participants and key informant interviews and case studies in 15 schools, including a Koori community school and two schools with high proportions of Indigenous students

• A pattern of improvement across the case study schools at the 3-year assessment relative to baseline for ‘autonomy experience’, ‘school attachment’ and ‘effective help-seeking’; and decreased use of alcohol and marijuana at the 3-year assessment than at baseline.

• The case study schools agreed that MindMatters had helped them to focus on student wellbeing by providing a comprehensive framework, training and curriculum resources.

MindMatters MindMatters was introduced to the Nyangatjatjara College through Keeping Safe in 2010. Aṉangu Pitjantjatjara Yankunytjatjara communities with the college use the MindMatters tools and materials to promote mental health and wellbeing with schools, students and communities

Schools, students and communities

Osborne (2012) Descriptive observation

Initial data has been collected through partnership with Ninti One which delivered and collated student mental health and wellbeing surveys using language

• The MindMatters Implementation Model is a key organiser for mental health and wellbeing planning. Greater connections were experienced with medical clinic staff. Students feel more comfortable to report issues and accept referral pathways.

• Regular meeting updates on mental health and wellbeing at staff and leadership meetings. MindMatters and mental health and wellbeing lessons feature as a daily/weekly feature of the school timetable. Policies updated via a mental health and wellbeing lens.

MindMatters MindMatters was adapted to meet the community identified priorities at a school on Palm Island (QLD)

Secondary school staff

Sheehan et al. (2002)

A qualitative evaluation of the implementation of MindMatters at Bwgcolman School on Palm Island was undertaken by a senior Indigenous group, Youngal Yagah; it involved community consultation regarding priorities for the project and their implementation

• Community stakeholders considered the implementation of MindMatters a success. Increased ownership of professional and curriculum development by school staff and informed their behaviour management plan.

• Greater acknowledgement of colonisation and the ongoing impacts such as grief, loss and trauma on the wellbeing and attitudes of community parents and students

• Confirmed the importance of using ongoing action research to evaluate the outcomes of the MindMatters implementation

• The new curriculum unit ‘coping with hard times’ provides a blueprint to ensure new teachers are able to draw on the knowledge now embedded in the unit with respect to dealing with issues of suicide, grief and loss, and bullying.

Motivational Care Planning A culturally adapted Motivational Care Planning intervention for Indigenous people with chronic mental illness using elements of problem-solving, motivational therapy and self-management in a cultural context

Remote island communities of the NT

Nagel et al. (2009a) Mixed methods evaluation, including nested randomised control trials involving 49 health centre clients; 24 clients were randomly allocated to Motivational Care Planning and the remaining 25 clients received treatment as usual

• Evidence that the adaptation was undertaken in a culturally appropriate way, that Indigenous people were involved throughout all phases of the development and evaluation of the trial

• Evidence that program is an effective treatment for Indigenous people with mental illness and provides insight into the experience of mental illness in remote communities

• The evaluation found that Motivational Care Planning improved wellbeing and decreased substance misuse compared with treatment as usual.

• There were corresponding reductions in domestic violence, self-harm behaviour and mental illness and improvements in life skills.

• This improvement was sustained during follow-ups at 6, 12 and 18 months post-treatment.

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Ngaripirliga’ajirri: Exploring Together A 10-week referral program targeting children whose behaviour was a concern

Focuses on child social skills training and parenting management training

Children aged 4–6 (with 1 parent)

Robinson & Tyler (2008)

Parent and teacher-reported questionnaires (validated for use in Indigenous settings) at referral and 6-month follow-up; some qualitative data

• Evidence that program can produce measurable improvements in child behaviour that are sustained at and beyond six months’ follow-up

• Quantitative data also provided evidence of a reduction in parental anxiety after participation in the program.

• Qualitative evidence affirms that most parents have improved communication with child

• Evaluation suggests that intervention strategy needs to be responsive to issues and problems encountered in the Tiwi social and cultural context

Pathways to Resilience: Rural and Remote Indigenous Communities Suicide Prevention Initiative

An initiative that includes a series of 20 (mostly community education) projects

The Initiative promoted the development of local approaches to enhance self-esteem and support people who are at risk of suicide.

6 Qld communities Livingstone & Sananikhone (2010)

Qualitative research methodology, comprising community consultations, focus groups (post-intervention), interviews, site visits, and telephone interviews with key stakeholders

• Vast majority of programs increased community awareness of, and responses to, issues of suicide, including the ability of communities to intervene effectively to Indigenous people who are displaying suicidal behaviour

• Important program components include community ownership and empowerment, culturally appropriate, capacity building focus, community partnerships and networks, and flexibility.

The Mungalli Falls Indigenous women’s healing camp

The camp used a culturally appropriate guided meditation, reconnecting with past generations, and country, narrative therapy and individual counselling, and engage with an analysis of the historical, sociopolitical contexts of their lives

Women Galloway & Moylan (2005)

Interviews with participants • The 17 participants considered the camp to have been effective in increasing their sense of self-worth and assertiveness, feeling reconnected to country and spirituality.

• This had positive impacts on their attitudes to their experiences of violence providing participants with understanding and resolve to overcome negative experiences.

The Social and Emotional Wellbeing Program (Bringing Them Home)

Social and emotional wellbeing services and counselling support for Indigenous individuals and families affected by forced removal

Indigenous individuals and families affected by forced removal

Wilczynski et al. (2007)

Evaluation based on field work feedback, phone interviews, submissions, survey responses and literature review

• The evaluation found that the program had provided culturally appropriate services to a large number of Indigenous clients who were unlikely to have otherwise received services. Indigenous men accessed the program less frequently than women.

• Clients of the program generally reported high levels of satisfaction and positive outcomes. However, wide variation in the skills and qualifications of counsellors and a lack of access to training and professional support, resulted in staff burnout and turnover.

The Stronger Families Safer Children program

An early intervention service to support vulnerable families and prevent family breakdown

South Australian families

Department for Families and Communities South Australia (2011)

• Substantial reduction in rates of contact with the child protection system and a positive impact on functioning for some families and children, although not specific to Indigenous populations

• The evaluation confirmed the value of early intervention and the importance of engaging families before problems escalate or become entrenched. Program model could be refined with greater focus on the needs and characteristics of Indigenous populations.

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The Stronger Families Safer Children program

An early intervention service to support vulnerable families and prevent family breakdown

South Australian Families

Department for Communities and Social Inclusion South Australia (2012)

The evaluation used both qualitative and quantitative methods. Data included interviews with key stakeholders, client exit surveys and a comparison of administrative data pre- and post-intervention. Statistical analysis limited the ability to examine some issues

• The program had a positive impact on functioning for some families and children, with less complex and entrenched problems.

• The evaluation confirmed the value of early intervention and the importance of engaging families before problems escalate or become entrenched.

• Nearly one in three of the families in the targeted early intervention (TEI) and reunification support services (RSS) components of the program and about one in five of those provided with intensive placement prevention (IPP) services were Indigenous.

• Significantly fewer Indigenous families experienced effective outcomes suggesting it may not have been culturally appropriate. Only 50% of respondents agreed they were able to work effectively, 30% thought service was OK and 25% thought they were poor or very poor.

• Difference in quality and appropriate ness of services linked to different workers and locations. The appropriateness of service model for Indigenous families questioned.

• The need for a service model with more permeable boundaries to allow for families with complex and chronic issues to return was noted.

The Take Two programme A developmental mental health service that provides training to Indigenous communities (Yarning up on Trauma) and enlists their participation in providing therapeutic interventions for children who have experienced severe abuse and neglect. It aims to intervene at multiple levels to harness resources available to the children and to build on their strengths.

Children in contact with child protection services

Jackson et al. (2009) Mixed methods evaluation, using a repeated measures design comprising clinical assessments, questionnaires, social network maps and surveys of stakeholders and clinicians

• The evaluation found a significant reduction in trauma related symptoms among Indigenous children, including for anxiety, depression, anger and post-traumatic stress and a reduction in the percentage of children with one or more scales in the clinical range.

Three stage whole of community intervention program

‘Whole community’ workshops which focused on Indigenous youth suicide intervention; Indigenous community (separate men’s and women’s programs) psycho-educative program, and service provider skills training focusing on Indigenous mental health cultural competencies in its implementation.

Service providers, Indigenous community and youth

Westerman & Hillman (2003)

Pre and post-test measures • Nine distinct interventions achieved over 9 months in Mullewa, Laverton and Mowanjum communities. A total of 377 individuals were provided with direct intervention services as a result of Indigenous Psychological Services’ programs.

• There were consistently large improvements in skills, attitudes and beliefs attached to the management and intervention of suicide prevention programs into these Indigenous communities in WA.

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We Al-li program We Al-li is a community-based healing program workshop incorporating Indigenous cultural practices and therapeutic skills to assist participants to recover from transgenerational trauma

Communities Atkinson (2002) Evaluation based on participant feedback (post-intervention)

• Feedback consistently suggests reductions in the trauma symptoms experienced by participants at course completion.

• Strong support for the program’s focus on cultural tools for healing

• The positive effects of We Al-li on the social and emotional wellbeing of workshop participants have been documented.

• There have been no published evaluations of the flow-on effects of the program at the community level.

• It uses traditional ceremonies of healing at sites of cultural significance, combining experiential and cognitive learning practices, reflection and emotional release to allow for the expression of anger and sorrow within a safe and supportive context.

Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice

Textbook, developed as one of five key COAG initiatives to improve mental health workers understandings and cultural competence to ultimately improve assessment, advocacy, referral and access. The book is underpinned by the 9 guiding principles

Mental health workers and students

Walker (2011) Online survey, face-to-face and phone interviews with stakeholders, and submitted feedback from educators, teachers, students and mental health workers

• Over 50,000 copies of the book were distributed to mental health professionals and students. Interview and survey responses from over 1,000 users indicated that 95% agreed or strongly agreed that the book was very valuable.

• Extensive feedback from academic staff and students demonstrated that the resource increased their knowledge and understanding, and enabled them to develop new skills, to be more conscious and have a greater understanding of working with transgenerational trauma, grief and loss.

• Feedback from health professionals and stakeholders in the health sector and social services sectors indicated that they were more confident in making referrals and assessments.

Yarning about mental health Yarning about mental health workshops provide culturally appropriate training in mental health and wellbeing for alcohol and other drug workers

AOD workforce Hinton & Nagel (2012)

Pre- and post-workshop questionnaires were administered to workshop participants

• Participants stated that the workshops had increased their confidence in assessing and treating Indigenous people with a mental illness.

Yarrabah Family Life Promotion Program

A holistic, culturally appropriate approach to suicide prevention, intervention, aftercare and healthy life promotion in the community of Yarrabah

Communities Hunter et al. (2001) Qualitative and quantitative methods, including a longitudinal analysis of the number of suicides

• After the implementation of the program, there were fewer suicides in Yarrabah and also fewer than in the two comparison communities.

• Although the small sample sizes mean that tests of statistical significance are inconclusive and firm conclusions cannot be drawn, the Yarrabah Family Life Promotion Program is a promising approach.

Ynan Ngurra-ngu Walalja: Halls Creek Community Families Program

Prevention and education home visiting program for pregnant Indigenous women and mothers and families with young children, to facilitate information exchange and discussion of parenting ideas and strategies

Families with children aged 0-3 in Halls Creek and surrounds, WA

Walker (2010a) Program assessed using Most Significant Change technique (interviews with participants, program staff and other stakeholders)

Drew on reports and other data

• Evaluation highlights that program staff often able to accurately recognise mental health-related problems, provide immediate and ongoing social support to address a family’s crises or isolation, and then encourage them to link with the appropriate services.

• Important program components include community control, continuity, integration with other services, creating a safe environment, flexibility, a focus on communication, relationship building and development of trust, respect for Indigenous culture and family involvement, good staff training, provision of transport, and provision of childcare or playgroups.

Table 5.20: 37 Evaluated Programs Not Included in the Meta-analysis

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REFERENCES Brideson, T., Havelka, J., McMillan, F., & Kanowski, L. (2014). The Djirruwang Program: Cultural affirmation for

effective mental health. In P. Dudgeon, H. Milroy, & R. Walker, Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2nd edn, pp. 523–532. Canberra: Australian Government Department of the Prime Minister and Cabinet.

Chandler, M., & Lalonde, C. (2008). Cultural continuity as a protective factor against suicide in First Nations Youth. Horizons – A Special Issue on Aboriginal Youth, Hope or Heartbreak: Aboriginal Youth and Canada’s Future, Oct. 1, pp. 68–72.

Charles Sturt University. (2013). Djirruwang Program Review. New South Wales: Charles Sturt University.Con Goo, E. (2003). Self-Development in Order to Improve Community Development: An evaluation of a

personal empowerment pilot initiative in Far North Queensland Indigenous communities. Aboriginal and Islander Health Worker Journal, 27(3), pp. 11–16.

Cox, A., Dudgeon, P., Holland, C., Kelly, K., Scrine, C., & Walker, R. (2014). Using participatory action research to prevent suicide in Aboriginal and Torres Strait Islander communities. Australian Journal of Primary Health, pp. 345–349.

Cull, S. (2009). The Road to Healing: Identity and the overrepresentation of Aboriginal men in the Australian criminal justice system. Sydney: [unpublished].

Culture Is Life. (2014). The Elders’ Report into Preventing Indigenous Self-harm & Youth Suicide. Retrieved March 20, 2016, from Be Part of the Healing: https://bepartofthehealing.org/EldersReport.pdf

Dudgeon, P., Walker, R., Scrine, C., Shepherd, C., Calma, T., & Ring, I. (2014a). Effective strategies to strengthen the mental health and wellbeing of Aboriginal and Torres Strait Islander people, Issues paper no. 12 produced for the Closing the Gap Clearinghouse, AHIW. Canberra: Commonwealth of Australia.

Dudgeon, P., Wright, M., Paradies, Y., Garvey, D., & Walker, I. (2014). Aboriginal social, cultural and historical contexts. In P. Dudgeon, H. Milroy, & R. Walker, Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2nd edn, pp. 3-24. Canberra: Australian Government Department of the Prime Minister and Cabinet.

Duffy, E., Eldridge, R., Crawford, L., Rigby, W., Manners, J., Lyons, L., et al. (2010). Closing the gap: Cultural safety in Indigenous health education. Contemporary Nurse: A Journal for the Australian Nursing Profession, v 21.

Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander Social and Emotional Wellbeing. In P. Dudgeon, H. Milroy, & R. & Walker, Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2nd edn, pp. 55-68. Canberra: Australian Government Department of the Prime Minister and Cabinet.

Harris, R., & O’Neil, S. (1998). Program Evaluation, Djirruwang Aboriginal and Torres Strait Islander Mental Health Education and Training Program. Sydney: Faculty of Medicine, University of Sydney.

Havelka, J. (2008). History of Djirruwang. Beating the drum to a different beat: The MHS Adelaide. Charles Sturt University.

Healing Foundation. (2012). Our Healing Our Solutions, Volume Three, January to June 2012. Canberra: Healing Foundation.

Healing Foundation. (2013). Our Healing Our Solutions – Sharing Our Evidence. Canberra: Healing Foundation.Healing Foundation. (2014). Training and Education: Journey to healing. Canberra: Healing Foundation.Healthcare Management Advisors. (2014). Expert advice on specific challenges for Aboriginal and Torres Strait

Islander peoples’ mental health [unpublished]. Canberra: National Mental Health Commission.Kanowski, L., & Westerway, J. (1996). Koori Mental Health Outreach Workers Training Program, 93/94 Grant

195, RHSET funded project. Goulburn: Goulburn Health Service.Kanowski, L., Jorm, A., & Hart, L. (2009). A mental health first aid training program for Australian Aboriginal and

Torres Strait Islander peoples: Description and initial evaluation. International Journal of Mental Health Systems, v 10.

193

5 APPENDICES

Kickett, D. (2014). Rolling with the red dust. Report on the Red Dust Healing Programs in Rollands, Western Australia. Perth: Anglicare.

Lopes, J., Linderman, M., Taylor, K., & Grant, L. (2012). Cross cultural education in suicide prevention: Development of a training resource for use in Central Australian Indigenous communities. Advances in Mental Health, 10(3).

Palmer, D. (2013). "We know they health cos they on country with old people": demonstrating the value of the Yiriman Project 2010–2013. Yiriman Project.

Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander Mental Health: An Overview. In P. Dudgeon, H. Milroy, & R. Walker, Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2nd edn (pp. 25–38). Canberra: Australian Government Department of the Prime Minister and Cabinet.

Powell, T., Ross, R., Kickett, D., & Donnelly, J. (2014). Red Dust Healing: Acknowledging the Past, Changing the Future. In P. Dudgeon, H. Milroy, & R. Walker, Working Together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice 2nd edn (pp. 373–382). Canberra: Australian Government Department of the Prime Minister and Cabinet.

Saggers, S., & Stearne, A. (2010). Evaluation of the Jaru Pirrjirdi Suicide Prevention Project Final Report. Perth: National Drug Research Institute, Curtin University of Technology.

Silburn, S., Robinson, G., Leckning, B., Henry, D., Cox, A., & Kickett, D. (2014). Preventing Suicide Among Aboriginal Australians. In P. Dudgeon, H. Milroy, & R. Walker, Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice 2nd edn (pp. 147–164). Canberra: Australian Government Department of the Prime Minister and Cabinet.

Stephens, A. (2014). Training for Impact: Building an understanding of community development training and Aboriginal and Torres Strait Island community development outcomes: Wontulp Bi-Buya College 2012– 2014.

Stephens, A. (2015). Training for Life: Supporting Communities to Reduce the Risk of Suicide. The delivery of Certificate IV in Indigenous Mental Health (Suicide Prevention). Wontulp Bi-Buya College. Cairns: James Cook University.

Stephens, A., Baird, L., Turpin, E., & Tsey, K. (2012). Assessing the impact of indigenous community development training: The case of Wontulp Bi-Buya College. Journal of Australian Indigenous Issues, 15(3).

Tighe, J., & McKay, K. (2012). Alive and kicking goals!: Preliminary findings from a Kimberley suicide prevention program. Advances in Meltal Health, 10 (3), pp. 240–245.

United Synergies. (2015). Geraldton District Critical Postvention Response: Final Report. Standby Response Service.

Visser, V., Comans, T., & Scuffham, P. (2014). Evaluation of the effectiveness of a community-based crisis intervention program for people bereaved by suicide. Journal of Community Psychology, 42(1), 19–28.

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