Way Forward program - video transcript

Michelle Combo
Hi, my name is Michelle Combo, I'm the team leader for WayForward. We are the Indigenous mental health and addictions team for Metro South, our team consists of nine positions and a team leader. It used to be a research project, just to see if we could do things a little bit differently with an indigenous led model. And now it's a permanent team. In previous years, the way that our data was collected, especially using CIMHA, the only appropriate POSing we could do was under cultural support and interventions. And we realised in the last couple of years of reviewing that, that the majority of our work for the Way Forward staff gets put down under cultural support. And unfortunately, that title, and that label is much too broad and generic. So it wasn't really describing what the staff are doing on the ground, and also not giving us much support or validity for how important the work is that the way forward staff actually does with their clients. So working with our MIMs, rep, we have been able to go a little bit deeper and introduce some new research variables, as well as new program specific items to just provide more detail about what it is that we specifically do for our indigenous clients. And being able to show how important that work actually is for their recovery and their well being. As well as you know, the need for more identified roles and more indigenous staff to help cover that need for our district.

Way Forward team meeting
So this one is our average length of stay, it's not per diagnostic related group, its just in general, average length of stay ...

Way Forward team meeting
I don't know, but I can't stress enough that seven day follow up for blackfellas. With blackfellas been involved, it's not done enough.

Way Forward team meeting
Not even the follow up, this is where the issue of the Friday. Friday, because there's no follow up, the 48 hour follow up.

Way Forward team meeting
If you have a look at the readmission rates, I wonder if there's any correlation because potentially they didn't stay long enough in the first place. You have to dive deep, so what was the purpose of first of all being discharged, some of that data when we're engaging with family but only ever community data for inpatient?

Michelle Combo
We were looking at the longer term future for the team about how we're going to keep building our resources, getting more staff, and also getting more recognition, more validity for the work that the team do. Because we still have that issue with everyone being considered non-clinical, even though they actually are doing a lot of clinical work. When we were doing our reports where it was like the majority of our staff were saying cultural support and interventions. And then, you know, obviously, the funding bodies and the two branches in town, were saying, well, that's not really enough information, we need to know what does that mean? What does that look like in practice? And then we started talking to you what can we do about that.

Tanya
Oh, yeah. So CIMHA has those two functions? You've got your research variables, which would be used for your referral data, numbers for a start. Yes, at the top level, we could see that there are internal referrals, but where from because we can't show that anywhere else on CIMHA either.

Michelle Combo
And I think it does tell us a lot to that, who is actually utilising the team. Yes. That was another reason that we wanted to try and drill down a bit more for where the referrals are coming from. So you know, being able to see who's actually got clients open and who's involving us and referring to us, gives us a lot of information about where our connections are and where they need to be.

Moana
I think yeah, outreach and doing home visits is important. And but making those community connections, especially in a small community, like Inala, everyone knows everyone. So you know, when we have connections, like, we know where this person's most likely going to be, you know, they're not going to be at home, they're probably going to be at auntie's house, or we know they hang out, you know, down at this park with these people. So yeah, it's the community engagement and connection is important in that in our roles.

Tanya
The other thing we set up was those programs specific items, but that's the biggest number and it's cultural support and interventions, but it's just so general and broad; there is a definition. But even so, it's just just so general and broad.

Michelle Combo
I remember we were all very purposeful and specific about choosing those particular terms, trying to make sure that we were keeping it, you know, as limited options as possible, but as descriptive as we could, for the types of work that everyone's actually doing on the ground with the clients and their families. Otherwise, it'll just get swallowed up in that broad generic term of cultural support and interventions. And, you know, unfortunately, doesn't do much for the stereotypes about, you know, indigenous staff just going around having yarns with people that don't hold any meaning clinically, which they actually do hold a lot. And this is what that involves. So, yeah, I think that's still we're quite happy, like a few months down the track was what we've all come up with.

Michelle Combo
Personally, I think a lot of the extra issues that come with not understanding indigenous clients and indigenous mental health completely, really has to do with the lack of understanding about racial discrimination and racial trauma. It's not a clinical diagnosis at this point in time it might be in the future. But there's definitely an understanding that all indigenous people who live in this country right now are dealing with varying levels of intergenerational and transgenerational trauma. That's unavoidable. That's just our history. But there's also lots of incidence of individual trauma that people suffer throughout their lifetime. And there is growing evidence now around the world for this concept of racial trauma, where specific incidence of discrimination and prejudice actually do affect people like another trauma incident, and those do accumulate over time. So there's a big fear for a lot of the community saying I'm either gonna get a bad response, or if I do get in that I might not get out. And that's not what they want, either. Because then you get into that whole restrictive, you know, punitive side of, it's not healthcare, it's actually punishing, you know, what someone else perceives to be bad behaviour. And this is where the security guards and the police officers and all that kind of stuff can get brought in. And again, really bad history for our people when it comes to that stuff. So most of our clients and most of their family members don't want to risk it. So we're often supporting the family too, to try and manage, even if someone is becoming really unwell, or if they've relapsed with their drug abuse, and we're trying really hard to help them get back on track. We're supporting the family to do that from the community as much as we can, because they don't want to contact emergency services, knowing about the really bad stuff that can happen to indigenous people when those people get involved.

Michelle Combo
So there's people from all across the state who have got similar sort of issues where they've got indigenous mental health workers who are not valued as being clinical and who have restricted practice, but who also do a lot of work and a lot of very important work for a very high risk population. So when I tell them about these things that we've got, everyone gets really interested and they say, oh that sounds really great. We didn't know you could do that because most people again don't know that you can add these things like us to change CIMHA and make it suit your needs. So they go, that sounds really really great, can you please share that with us? Can we get some ideas on how we can do that in our districts? Some people have asked can they look at replicating the whole Way Forward team model, which you know, it's out there in research, you can definitely have a look at that if they want to. But even just the practical things like how you record on CIMHA and what that actually looks like, definitely a lot of interest all around the state from people about that.

Michelle Combo
If you would like more information about Way Forward and the changes that we have implemented for mental health and addictions here in Metro South, you can have a look at the Clinical Excellence Showcase website.