Commissioning, Brokerage, PartneringLyn Van Rooy2020-04-01T11:06:45+08:00
Commissioning, Brokerage, Partnering
Dream It Forward
Dream It Forward is an innovative small grants program for Aboriginal and Torres Strait Islander communities administered by Connect Groups in WA. The program began in 2015 and has funded 65 projects through the Mental Health Commission.
Dream It Forward is a small grants program which brokers funding to community initiatives that address the social and emotional wellbeing of Aboriginal and Torres Strait Islander people, families and communities in Western Australia based on needs identified by the community.
Dream It Forward is a bottom-up grassroots model that empowers community leadership, capacity, participation and co-production to achieve a range of outcomes related to suicide prevention. Recognition that Aboriginal and Torres Strait Islander communities have a holistic, whole-of-life approach to mental health, health, spirit and culture drives its methodology and engagement with elders and community leaders. Strengthening culture and cultural identity is at the heart of all funded projects.
Successful grant projects cover a wide variety of place-based tools, methodologies and services to engage communities and address trauma and healing by activating and strengthening cultural identity and connection to Country.
A key to Dream It Forward’s acceptance within community is its decolonising methodology. Recognition of the impact of transgenerational grief and trauma caused by colonisation, dispossession and the successive government policies which have resulted in persistent disadvantage and distress underpins the program.
As informed by best practice, stakeholder engagement and available literature, Dream It Forward projects consider the following three-branched approach:
Address the underlying social and emotional wellbeing issues impacted by intergenerational trauma and grief at a community level which is contributing to family and community breakdown, dislocation from culture and Country, suicide rates and disadvantage.
Develop culturally secure divisionary opportunities on and off community, particularly for youth and at-risk groups that:
Compliment mainstream treatments
Promote community strength and wellbeing
Reconnect people back to family, community and Country
Promote investment to develop micro-enterprises based on community aspirations and to promote local leadership and skillsets, particularly among women.
Dream It Forward is further informed by the National and Torres Strait Islander Suicide Prevention Strategy (2013) respecting Action Areas 1 and 2, the National Empowerment Project, and the Education and Health Standing Committee “Learnings from the Message Stick – The report of the inquiry into Aboriginal youth suicide in remote areas”.
As a place-based initiative, which capacity builds local leadership, Dream It Forward also aligns to the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) Final Report recommendations of community leadership being important as responses cannot be standardised across differing communities but must reflect local needs.
Strengthening culture and cultural identity is at the heart of all funded projects as best practice and available literature indicates that cultural legacy and social and emotional competencies are preventative of suicide.
The Dream It Forward model operates as an intervention tool delivering primary and secondary mental distress prevention initiatives to Aboriginal and Torres Strait Islander people, families and their communities by disrupting risk factors and as a social and emotional wellbeing activity by increasing protective factors at a community level.
As a primary prevention initiative, an outcome of the model is to prevent the onset of mental distress at a whole-of-community level, by strengthening communities to take action, and filling a gap where services have either been inaccessible or delivered from top-down. Projects are co-produced by Elders and community leaders who identify where the social and emotional wellbeing needs are the greatest and address them directly within community.
Dream It Forward operates within a holistic decolonising framework that recognises the impact of underlying trans-generational grief and trauma which have resulted in persistent disadvantage and distress while respecting the imperative of connection to Country, culture, spirituality, family, and community in healing and wellbeing.
As a primary prevention initiative, an outcome of the model is to prevent the onset of mental distress at a whole-of-community level, by strengthening communities to take action and filling a gap where services have either been inaccessible or delivered from the top-down. Projects are co-produced by elders and community leaders who identify where the SEWB need is the greatest.
Projects advancing secondary prevention strategies add value to the work being delivered through existing Aboriginal Community Controlled Organisations (ACCOs), and service providers, to at-risk communities and groups by promoting new initiatives, program sustainability, early intervention and on-going recovery.
The response to Dream It Forward increased as the program gained traction as an effective and needed model for community-led, place-based initiatives around positively impacting Aboriginal social and emotional wellbeing and healing.
Dream It Forward has awarded 65 projects in the past five years and has published the results. (link to references: https://connectgroups.org.au/resources/dream-it-forward-booklet/) Participants include the entire community or are specific to families, children, young adults, men and women. The location of the programs range throughout Western Australia and include Perth metropolitan programs, small town programs and remote camps. An example is the Bidydanga Community Men’s Health and Wellbeing Group which aimed to improve the health and resilience of men in this area through camping on their land.
Another example is the established Kapululangu Aboriginal Women’s Law and Cultural Centre using funding from Dream it Forward to hold on-country workshops where senior law women instructed younger elders and young women. The workshops allowed for yarning about mental and physical health and strengthened the relationships between these women.
Dream It Forward has been formally evaluated internally. As part of its funding, Results-based Accountability (RBA) is applied across all project cycles. RBA is a planning, evaluation and continuous improvement methodology applied to the community sector which supports measuring outcomes for each funded project and service provided to stakeholders. The evaluation framework ensures that the program remains responsive to both stakeholders and program KPIs, relevant to community and best practice, and is effective.
There are seven mutually non-exclusive areas that applicants can choose upon which to base their projects. Nearly all (9 in 10) projects focus on social and emotional wellbeing with three-quarters including strengthening individual, family, kinship and community wellbeing as well as prevention and early intervention of psychological distress. Few are specifically targeting CBPATSISP assessment areas of suicide prevention or training however it is acknowledged that these projects are building the capacity and resilience of individuals and the community.
There are 31 Primary Health Networks (PHNs) across Australia whose role is to adopt a commissioning based approach to planning local health services with the aim of improving the health and wellbeing of all people living in their region. Each PHN has a responsibility to work collaboratively with stakeholders across the health and social care economy to set the strategic direction, drive service improvements and achieve system change. This is particularly essential with respect to enhancing the health and social and emotional wellbeing of Aboriginal and Torres Strait Islander people.
Commissioning for Aboriginal and Torres Strait Islander suicide prevention and SEWB and Mental Health via PHNs requires a strategic process of establishing a best practice governance process and working with relevant stakeholders including ACCHS and Elders to co-design, co-deliver and manage services to meet the needs and improve outcomes for Indigenous populations within the most culturally responsive, effective and efficient manner.
According to Dudgeon et al (see PHN governance report) when commissioning elements of integrated approaches, a PHN should aim to employ local and community people as much as possible.
Where service gaps are identified and when commissioning suicide prevention activity, a PHN should aim to build community capacity (including ACCHS and other community-controlled organisational capacity) as much as possible, including as an important part of committing to the empowerment of communities in the context of suicide prevention.
An effective way of exploring potential untested elements in any integrated approach is by Participatory Action Research (PAR) methodologies.
PAR-based evaluations and processes should be disseminated to help build an increasing evidence base for Indigenous systems approaches to suicide prevention and suicide prevention in general, and should support the expansion of integrated approaches to suicide prevention in Indigenous communities across Australia.
Primary Health Network Commissioning Principles
These Principles have been designed by PHNs in consultation with the Department of Health, to assist in meeting the strategic objectives of the PHN Program.
Understand the needs of the community by analysing data, engaging and consulting with consumers, clinicians, carers and providers, peak bodies, community organisations and funders.
Engage with potential service providers well in advance of commissioning new services.
Putting outcomes for users at the heart of the strategic planning process.
Adopt a whole of system approach to meeting health needs and delivering improved health outcomes.
Understand the fullest practical range of providers including the contribution they could make to delivering outcomes and addressing market failure and gaps, and encourage diversity in the market.
Co-design solutions; engage with stakeholders, including consumer representatives, peak bodies, community organisations, potential providers and other funders, to develop evidence-based and outcome-focused solutions.
Consider investing in the capacity of providers and consumers, particularly in relation to hard-to-reach groups.
Ensure procurement and contracting processes are transparent and fair, facilitating the involvement of the broadest range of suppliers, including alternative arrangements such as consortia building where appropriate.
Manage through relationships; work in partnership, building connections at multiple levels of partner organisations and facilitate links between stakeholders.
Develop environments high in trust through collaborative governance, shared decisionmaking and collective performance management.
Ensure efficiency, value for money, and service enhancement.
Monitor and evaluate through regular performance reports; consumer, clinician, community and provider feedback, and independent evaluation.
National Safety and Quality Health Service Standards User Guide for Aboriginal and Torres Strait Islander Health
The Australian Commission on Safety and Quality in Health Care has developed a user guide to ensure health providers provide safe and high-quality health care for Aboriginal and Torres Strait Islander people within the National Safety and Quality Health Service Standards. The Commission has identified six actions to help address the inequities in access and care experienced by Aboriginal and Torres Strait Islander people to improve health outcomes. These actions were defined following a comprehensive consultation process. Their implementation will help position the health system to provide all Aboriginal and Torres Strait Islander people with the culturally safe and clinically responsive health care they need. This user guide provides practical strategies and examples on how to implement these six actions in health and mental health service organisations.