Prevention – Programs and Servicesalyka2020-01-22T11:02:39+08:00
Effective prevention programs and services
The most promising programs and services for strengthening Indigenous SEWB and contributing to suicide prevention were those that promote the guiding principles outlined earlier. A systematic review by Dudgeon et al. (2014), and the ATSISPEP report (2016) found that the most effective culturally responsive programs and services that strengthen SEWB and mental health of Aboriginal people are those that:
have partnerships with Aboriginal Community Controlled Health Services (ACCHs) and local communities
take an interdisciplinary approach
provides outreach services and transport
adopt Participatory Action Research (PAR) approaches involving Indigenous families and communities in developing, implementing and evaluating programs
Programs that adopt PAR tend to be more culturally responsive to local contexts and foster a culturally safe environment for program participants.
Engaging in cultural activities is an indicator of positive cultural identity that is associated with better mental health among Indigenous Australians.
Community-focused, holistic and integrated approaches to suicide prevention along with intervention strategies reduce the likelihood of suicide and related problems over the life-span.
Aboriginal Mental Health First Aid (AMHFA-National)
Aboriginal Mental Health First Aid (AMHFA) is a national program designed to train participants to assist Aboriginal or Torres Strait Islander adults with mental health issues or crises until professional help is available or until the crisis is resolved. The course is offered routinely across Australia.
Aboriginal Mental Health First Aid was informed by strategic guidance from a similar Canadian program, First Nations Mental Health First Aid (CMHFA). Evaluations of CMHFA reported that participants experienced gains in knowledge, self-efficacy, skills and decreased self-stigma. To make the program appropriate for Aboriginal and Torres Strait Islander (hereafter just Aboriginal) communities in Australia, after consultation with expert reference groups, stakeholders and local community members, the CMHFA was adjusted for cultural factors, to produce the AMHFA.
From 2007-2008, 199 Aboriginal Instructors were trained through one of the 17 five-day Instructor Training Courses held around Australia. Since then, over 600 Aboriginal people have become AMHFA Instructors, with 200 Aboriginal people currently active as accredited AMHFA Instructors. Since the launch in 2007, a revised 14-hour AMHFA course has been run approximately 2,700 times across all states and territories to over 50,000 members of the community.
Courses have been informed by a range of Delphi consensus studies drawing on the expertise of Aboriginal people with lived or professional experiences across Australia. Through these consultations, the 14-hour AMHFA Course is now in its third edition. Additional programs have also been developed to supplement the 14-hour course. These are:
A four-hour course for accredited AMHFA Instructors who have completed the 14-hour AMHFA Course to refresh their knowledge and skills three years after completing their training
A five-hour ‘Talking About Suicide’ course which focuses on teaching skills on how to provide mental health first aid to an Aboriginal person experiencing suicidal thoughts and behaviours
A five-hour ‘Talking About Gambling’ course which focuses on teaching skills on how to provide mental health first aid to an Aboriginal person experiencing gambling problems
A five-hour ‘Talking About Non-suicidal Self-injury’ course which focuses on teaching the skills of providing mental health first aid to an Aboriginal person engaging in non-suicidal self-injury
A Youth AMHFA course which focuses on teaching adults how to provide mental health first aid to an Aboriginal adolescent
The overall vision of those who have developed and implemented the AMHFA is of a community where many people have the skills to support those with mental health problems. To achieve this vision, the objectives are to:
Provide high quality, evidence-based mental health first aid courses to train community members to become accredited AMFA instructors
Provide refresher courses to accredited AMHFA Instructors
Consult regularly with Aboriginal communities regarding course updates
Update the courses according to these consultations
Aboriginal Mental Health First Aid focuses on developing knowledge about symptoms and behaviours linked with help-seeking by Aboriginal people experiencing mental illness, as well as increasing individual and community understanding of suicide prevention. Accredited AMHFA Instructors were more likely to run AMHFA courses if they had previous teaching experience and were provided with follow-up support from one of the program trainers. Overall, AMHFA has been shown to be effective in improving trainees’ knowledge of mental illnesses, their treatments and appropriate first aid strategies and increasing their confidence in providing first aid to a person experiencing a mental health problem. Other participant outcomes are decreases in stigmatising attitudes and increases in the amount and type of support which they are able to provide to others1.
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 et al. (2009)1 presented information on its uptake and acceptability for Aboriginal people based on quantitative and qualitative data. Analysis showed that both the Instructor Training Course and the AMHFA course were culturally appropriate, empowering and provided relevant and important information for training to assist Aboriginal people with a mental illness2.
A later evaluation3 confirmed that program attendance led to an improvement in the recognition of mental disorders, confidence in the value of treatment, decreased social distance from people with mental disorders, increased confidence in providing help and an increase in the amount of help provided to others, which was shown to be sustained for up to six months after program completion.
Aboriginal Mental Health First Aid was rated as strong evidence of effectiveness and best practice. It is evident from survey feedback and literature pertaining to AMHFA that the program is a valuable initiative to build community capacity. The program aligns with community consultations and enables people to talk, share with and build social connectedness. Concurrent action to address stigma by creating safe community environments was consistently identified.
A review of psycho-social programs3 to improve social and emotional well-being in Aboriginal people scored 16 interventions for strength of evidence. Aboriginal Mental Health First Aid was ranked first as having the strongest evidence with a 100% score. There was strong support from the Aboriginal respondents with 64% of the respondents finding the program increased knowledge and skills3.
The program is constantly evaluated and improved using the Delphi consensus method with 28 Aboriginal health experts participating across two independent Delphi studies.
This method was identified as a useful consultation tool for Aboriginal people gauging culturally appropriate best practice in mental health services. The AMHFA guidelines and culturally appropriate guidelines for providing mental health first aid to an Aboriginal person who is experiencing problems with alcohol or drug misuse have been updated. Furthermore, a trial of the latest edition of the 14-hour AMHFA Course and the ‘Talking About Suicide’ course is being planned to evaluate its efficacy.
A review of the program evaluations confirm that the AMHFA program is well-organised, comprehensive and provides a sound cultural adaptation of a more general program to assist Aboriginal people experiencing psychological distress. Importantly, this program is in accord with best practice guidelines and has been developed and managed by Aboriginal people.
Aboriginal Mental Health First Aid builds strengths and capacity in Aboriginal communities, especially by providing materials and resources that are appropriate for the needs of Aboriginal people in diverse community settings. It also offers access to community-based programs to improve suicide awareness among “gatekeepers” and “natural helpers” in communities affected by self-harm and suicide through contextualised delivery of programs to people in the community. It also builds strength and resilience in individuals and families through culturally appropriate, life-promoting, resilience-building and sustainable strategies that are tailored specifically for Aboriginal people. The program focuses on developing knowledge about symptoms and behaviours linked with help-seeking by Aboriginal people experiencing mental illness, as well as increasing individual and community understanding of suicide prevention. Aboriginal Mental Health First Aid was rated very highly as strong evidence of effectiveness and best practice.
It is evident from the feedback from the informational survey and the literature that the AMHFA training program 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.
Kanowski LG, Jorm AF, Hart LM. 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 2009;3(1):10.
Day A, Francisco A. Social and emotional wellbeing in Indigenous Australians: identifying promising interventions. Australian and New Zealand Journal of Public Health 2013;37(4)
Alive and Kicking Goals! Peer-led Approach (Broome, WA)
Alive and KickingGoals is an Indigenous-led program from the Kimberley which aims to prevent youth suicide through football and peer education, one-on-one mentoring and counselling.
Alive and Kicking Goals (AKG) is a program designed to respond to local needs and interests, and to effectively engage young people. Operating under the Men’s Outreach Services and through peer education, this program is within the framework of suicide awareness and prevention. It takes a strengths-based approach by seeking to enhance protective factors such as capacity, confidence, competence and self-esteem and encourages positive help-seeking behaviours. Further, this program seeks to dismantle stigma by opening discourses around depression and suicidality. This is a community-based, community-developed and community-driven, peer-led, suicide awareness and prevention program which is grounded in continual learning.
In response to high rates of suicide among young people in the Kimberley, AKG was developed to provide a way for the community to work towards more effective prevention and a better understanding of protecting youth from suicide. Participants are shown that dreams are possible through hard work and passion. Services are based in Broome and workshops are conducted in nine other Indigenous communities across the Kimberley region. These are Derby, Fitzroy Crossing, Halls Creek, Looma, Bidyadanga, Beagle Bay, Djarindjin Community, One Arm Point and Lombadina.
A Steering Committee oversees AKG and key personnel are a Project Mentor (PM) and Peer Educators (PEs). The initial model of delivery was developed with the Broome Saints Football Club (BSFC). This club was established in 1960 and has a predominance of Aboriginal members and a very high standing in the community. Initially, weekly meetings were held after Football Practice. At these meetings were the Project Mentor (PM) and the youth sub-committee who were well-respected sportsmen and training to be volunteer youth leaders. This training included the development of leadership skills along with suicide awareness and prevention. From these weekly meetings, emerged workshops where the young men from the youth sub-committee emerged either as 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 and by the conclusion of the pilot, there were 16 PEs1. Under the AKG program, PEs conduct holistic mini workshops which look at both protective and risk factors of Aboriginal suicidality. Participants learn healthy coping strategies and help-seeking behaviours for themselves and to impart to others. A safe space is provided where the young participants can discuss sensitive topics of importance to them.
A DVD and associated workshop were developed to train PEs to implement the AKG program. Trainees reported that the content of the DVD were relevant and appropriate within the Kimberley context. Many of the trainee PEs reported that the narrators of the DVD told stories that they could relate to. They could see themselves using ideas from the DVD to make aspects of their workshops more tangible and relevant to participants.
The DVD and associated workshop was well-received by participants who responded positively to the use of local narrators and content specific to their community. Almost 45% of the pre- and post-workshop survey participants demonstrated a positive change in attitude towards talking about suicide, their feelings, and help-seeking. In the focus group for participants aged 16 years and older, those who had attended the workshop and watched the DVD provided confident and detailed answers about how to deal with a person with suicidal ideation as compared with those who had not attended the workshop.
The program is embedded in the community where it is delivered
There are two types of workshops: one for those aged 16 years and older, and another for those aged 10-15 years
The space where the workshops took place was safe so members were able to discuss sensitive issues of importance
In total, 449 people completed at least part of the pre-/post-workshop surveys with 255 (57%) answering all questions of each survey
The pre/post-workshop surveys indicated that most of the participants rated the DVD and workshop positively
All participants noted positive changes which indicated a positive impact of the DVD on attitudes and knowledge
Many participants had been touched by suicide
Link to thirty-minute documentary about AKG: Part 1
Link to Thirty-minute documentary about AKG: Part 2
Tighe and Mackay1 conducted an evaluation of AKG during the period from November 2010 until 2012. A process and impact evaluation using participatory action research with largely qualitative data was chosen as the most effective and feasible way to evaluate the program. During the collection period, all AKG workshop participants were invited to participate in the evaluation. For the 16+ year group, both pre- and post-workshop surveys were taken, as well as a focus group. Participants aged 10-15 years were invited to attend a focus group at school after the workshop. In addition, principals and teachers were invited to participate in a survey to express their perceptions of the AKG workshops. By utilising a combination of surveys and focus groups with varied participants, a greater contextual understanding was obtained.
The various evaluation tools showed that 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. The impact evaluation looked at participant measured change in attitude and knowledge about suicide after the workshop.
Two significant findings emerged from the evaluation. First, there was the way in which some participants constructed their responses around the recognition of someone who was feeling down or depressed. There was more a sense of physical presentation of the susceptible person, about how the person looked (face and body) and their physical and emotional isolation from their 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 care-givers do not take care of themselves, they put themselves at risk of burn-out, and worse. While well-intentioned, these participants need to take care of their own well-being.
Three critical factors were found which underpinned the effectiveness and success of the program. These were:
Initiative is embedded within the contexts in which it is working.
The program is community-based
The space where meetings took place was safe for participants
Alive and Kicking Goals building strengths and resilience in youth by:
The provision of culturally appropriate community activities to engage youth, build cultural strengths, leadership, life skills and social competencies
The development of life promotion and resilience-building strategies
Improving access to well-being services among Aboriginal and Torres Strait Islander males
Using long-term, sustainable prevention strategies that build resilience and promote social and emotional well-being which have been specifically developed for Aboriginal and Torres Strait Islander youth
The provision of services that engage Aboriginal and Torres Strait Islander youth and are appropriately linked with culturally competent services
Providing counselling and therapeutic support, including services for families who have experienced suicide or traumatic bereavement
In summary, AKG is promising evidence of effectiveness and practice. It is a program designed to respond to local needs and interests and to effectively engage young people. It takes a strength-based approach focusing on enhancing protective factors and working to dismantle stigma, open a discourse around depression and suicidality, and encourage positive help-seeking among young people.
Tighe J, McKay K. Alive and kicking goals!: preliminary findings from a Kimberley suicide prevention program. Advances in Mental
Deadly Thinking is one of four programs developed by Rural and Remote Mental Health (RRMH) specifically for Aboriginal and Torres Strait Islander people – Deadly Thinking, Deadly Thinking Youth, Deadly Thinking, Train the Presenter and Creative Livelihoods. Using artwork to stimulate discussion, Deadly Thinking addresses emotional wellbeing (anxiety, depression) and suicidal behaviours and thoughts as well as substance abuse in Aboriginal and Torres Strait Islander people living in remote and rural Australia.
Deadly Thinking is a culturally tailored, readily manualised program that comprises three phases: (I) train-the-trainer (TTT); (II) delivery of community workshops to Aboriginal and Torres Strait Islander community members in rural and remote Australia; and (III) ongoing support resources and networks (e.g. Facebook forums). Deadly Thinking is a suicide prevention program that also addresses social and emotional wellbeing for Aboriginal and Torres Strait Islander people and communities. Deadly Thinking uses a strengths-based model to develop skills to be able to yarn with others about topics such as anxiety, depression, suicidal ideation and substance abuse.
The program was developed by Aboriginal and Torres Strait Islander people in 2010 through Rural and Remote Mental Health (RRMH) who also offer mainstream programs for vulnerable groups (farmers and fly-in-fly-out workers) in the agricultural and resource sectors in rural and remote areas. Recurrent funding is grant-based and through enterprise contracts.
According to the Pilot Evaluation Report ‘The workshops were designed for all community members and particularly, Elders, those with leadership roles, ‘natural helpers’ or those with an interest in promoting awareness and discussion about social and emotional wellbeing issues. They aimed to elicit two-way understanding about emotional wellbeing problems and protective factors and to provide a framework for community leaders to facilitate ongoing discussion and information sessions.2
The program can be contextualised to meet the specific language and cultural needs of the community and ensures that existing community networks are included as a reference group. The program delivery is led by a trained Aboriginal and Torres Strait Islander facilitator with lived experience who engages small groups (10 to 20 participants) to participate in activities using art as a medium for generating discussion.
Participants are given materials to use and take with them with Deadly Thinking branding. The materials are designed to promote health literacy. Videos are used to present some of the content which features (amongst other aspects) yarning, staying strong, being proactive and maintaining a connection to country and culture. A focus of the workshops is establishing a culturally safe, confidential environment so that participants are comfortable to tell their own stories and share their personal experiences.
The program usually is delivered over six hours at a cost of around $200 per attendee but may increase depending upon the location of the session and travel costs.
Deadly Thinking Youth
Adapted from the adult Deadly Thinking program, Deadly Thinking Youth is for younger people aged between 12 and 17. While the program content is similar to that of the adult version, it is presented in a way that is sensitive and safe for a younger audience. Trained facilitators incorporate activities, such as artwork, sport, music and filming, into the program to engage young people in the Deadly Thinking material.
The program aims to help young Indigenous people to:
• Learn the importance of yarning with family and friends
• Be more aware and understanding what causes depression, anxiety and suicide
• Understand how life changes can contribute to stress
• Understand their own worries and how to deal with them – topics covered include cyber-safety, bullying and body image
• Develop plans to help deal with challenges to their social and emotional wellbeing and,
• Connect to culture and country as a source of strength.
The program has been designed for flexible, group-based delivery, either as a single one-day workshop, 2–3 half-day workshops or as individual units over a number of days or weeks.3
Deadly Thinking Train-the-Presenter program is a two-day program which allows communities to develop their own team of Aboriginal or Torres Strait Islander presenters.
Creative Livelihoods can be adapted and delivered to your chosen location by our professional and friendly team.
Ongoing support. Online support via Deadly Thinking Facebook group for members and regular social media posts providing information for trainers, organisations and past attendees.
Printed support materials Social and emotional wellbeing booklets, posters and passports. See online at: rrmh.com.au
The objectives of the workshops are to use a holistic approach to address social and emotional wellbeing, increase the community knowledge of mental health issues, particularly suicide prevention using a range of strategies and care pathways to accomplish this goal.
Deadly Thinking has as initial objectives:
• Increasing mental health literacy and knowledge about promoting emotional wellbeing and knowledge of where to go and what to do to access mental health services
• Increasing community participation and community empowerment
• Identifying and building the capacity of local champions and community leaders to facilitate informal learning about mental health within their communities and,
• Increasing community capacity to make informed choices about their mental health and wellbeing.
In addition, the Deadly Thinking workshops identified the following objectives for participants:
• Learn the importance of yarning with family and friends
• Provide some plans and pathways to help deal with social and emotional wellbeing issues for individuals, families and their community
• Raise awareness and improve understanding of depression, anxiety, Ngarlu and suicide
• Understanding change and how it contributes to stress and,
• Identify community members interested in and able to undertake more advanced programs such as the Aboriginal Mental Health First Aid course.
Additionally, Deadly Thinking provides contextualised, evidenced-based information about suicide and substance abuse. Participants learn how to proactively problem solve, seek help and stay strong. The program encourages the development, strengthening and maintenance of social and emotional wellbeing support networks within the community and amongst peers. Participants are also made aware of the need to be able to appropriately refer to other resources or pathways.
Deadly Thinking is a suitable entry program to more advanced programs such as the Aboriginal Mental Health First Aid course.
The evaluation of the Pilot study in five communities across Australia confirmed that the workshops effectively address:
• those things that give rise to stress, anxiety, depression and substance abuse, with particular regard to the Indigenous context
• how to recognise the symptoms in yourself and others
• information about suicide
• the affects of substance misuse
• self-help techniques, help-seeking behaviours and their effectiveness
• how to build social and emotional wellbeing support networks
• problem solving
• how to develop and utilise change management skills
• referral processes/pathways to care (which are accessible by remote Indigenous individuals and communities) and,
• the identification of community members interested in and able to undertake more advanced programs such as the Aboriginal Mental Health First Aid course.
Many participants were aware of the Aboriginal Mental Health First Aid (AMHFA) course, and 25% had completed the training.
In 2015, the Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project (ATSISPEP) Summary of Promising Programs conducted a review of the survey with 55 participants with the following results 60% found program worthwhile; 47% found it culturally relevant and between 35 and 39 % identified increased knowledge and empowerment.
Deadly Thinking sessions have been attended by over 420 attendees from 40 locations across Australia in Queensland, South Australia, Western Australia and the Northern Territory in the past ten years. Deadly Thinking has achieved a longevity that many programs have been unable to match. Rural and Remote Mental Health has maintained a commitment to this program as well as other specific programs for Aboriginal and Torres Strait Islander people and youth.
This evaluation1 also shows that the program overwhelmingly assists the participants to be able to address their personal health and wellbeing issues. There is strong evidence1 that the program allows the participants to normalise yarning about health and wellbeing thereby removing barriers to early and proactive suicide prevention.
An independent evaluation was completed in 2018, a total of 413 attendees from 40 locations across Australia completed the Deadly Thinking program evaluation1. This evaluation showed that there is the opportunity for the developers of the program to consider a men-only program due to the lower number of male participants. The program is acknowledged by the participants as being culturally relevant however the authors caution that the program may not be changing the target behaviours long term.
In a pilot evaluation, the authors tested the use of well-considered, mainstream measures to evaluate the efficacy of the program in order to provide data that could be compared to mainstream programs but these were found to be too complex for the participants and subsequently modified.
A recent evaluation1 shows that just under three-quarters of the participants are women with around two-thirds of these women identify as being Aboriginal and Torres Strait Islander. The relative absence of men from this program may not provide the community with the proportional necessary skills to address social and emotional wellbeing within the population of men.
In summary, the evaluation found that the overwhelming majority of participants stated that the Deadly Thinking workshop:
• was highly acceptable and helpful (90%)
• produced a positive change in their attitude to mental health (94%) and,
• would help them understand and deal with their own worries (100%).1
A summary of the recommendations from the 2018 evaluation1 include:
1. consideration should be given to providing male-only workshops;
2. more attention should be made to follow-up activities to determine if long-term changes in behaviour, knowledge retention and reduced rates of suicide are occurring; and,
3. development of standardised, culturally appropriate instruments to measure outcomes that are reliable and valid.
4. Pre site visits could be longer and the workshop could include clearer processes for providing feedback, as well as follow up workshops.
5. Recommended as a precursor to AMHFA.
Deadly Thinking has demonstrated its relevance to its target audience and has grown into a well-rounded set of programs for many Aboriginal and Torres Strait Islander people. The program has been developed by Aboriginal and Torres Strait Islander people and has engaged in independent review to ensure a continuous quality improvement process. The program strengthens indigenous governance and helps build capacity within the communities in which the program is run. The program also allows for individuals to further build their understanding of referral processes through the Aboriginal Mental Health First Aid program.
The program is able to be contextualised and adapted to local community needs. Additionally, Aboriginal and Torres Strait Islander facilitators bring a culturally safe environment to the delivery of the course. CBPATSISP has assessed this program as being a promising program.
Dream It Forward is an innovative small grants program for Aboriginal and Torres Strait Islander Communities in Western Australia. 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 visionary 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 results1. 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 Dream 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.
A key objective of the Dream It Forward Program is to add to the evidence that grassroots programs that strengthen culture and build social and emotional wellbeing competencies are a complement to mainstream services and encourage a “ground shift” toward local solutions and local ownership.
Dream It Forward embeds the imperative of connection to country, culture, spirituality, family and community in healing and wellbeing. Good practice has resulted in community embracing Dream It Forward’s upstream and place-based approach which activates culture and builds local leadership capacity. With the benefit of four years building relationships with community, the model results in project legacy and meaningful benefit.
GREATS Youth Services consists of core programs delivered by Malala Aboriginal Health Service. These are an impressive range of community-determined programs and services for Aboriginal and Torres Strait Islander youth.
GREATS (Great Recreation, Entertainment, Arts, Training and Sport) Youth Services [GYS] is a core service provider of Malala Aboriginal Health Service and provides a range of services for Aboriginal and Torres Strait Islander (hereon Aboriginal) youth aged from 10-20 years. This provider commenced operation in 2009 and its range of programs and activities have been in response to a serious of suicides, self-harming and petrol sniffing incidents in the community.
Current programs include a range of activities encompassing sport, art, on-country events, culturally-based workshops and sessions on digital technology. Workshops are held from Monday to Saturday and examples are a workshop for young men and another for young women which include life skills, eating a healthy diet, and living a healthy lifestyle. Others include bush camps for at-risk young people where they are exposed to similar skills while removed from the community so that their harmful behaviour may be addressed. In another activity, young men experience woodwork and painting with community Elders. Importantly, school-aged children are not permitted at the Youth Centre during school hours.
A Saturday activity is a barbecue and drop in session with outdoor volleyball. Each day from six to nine pm, there is also a drop-in service at the Youth Centre for up to 75 children and youth. Other services for youth include a crisis-safe house and a Youth Patrol and Outreach Program. Four times a year, there are school holiday programs and an annual National Youth Week celebration. Workshops targeting substance misuse and suicide interventions are conducted on a needs basis. The community is involved at all stages of program development with a bi-annual consultation with the Maningrida community to inform future programming. Youth workers are involved in on-going suicide prevention training.
GREATS Youth Services trains and employs only local young people from across the clan groups as youth workers, sexual health officers, youth diversion officers and peer support workers. In this way, GYS provides a pathway to training and employment opportunities for local Aboriginal youth, along with mentoring roles for young parents in the community. As well as delivering cross sector case management of Aboriginal youth identified as at-risk, GYS provide the opportunity for their high level of engagement within the community. Concurrently, different agencies are brought together to plan and coordinate this approach.
Malala Aboriginal Health Service conducts regular community assessments across the clan groups to ensure that the services of GYS are responsive to the needs and concerns of the community. There is also an ongoing review of suicide prevention planning.
In a formal report1, GREATS Youth Services was assessed as strongly aligned with building strengths and capacity in Aboriginal communities, building strengths and resilience in individuals and families and a targeted suicide prevention service. In addition, there was evidence of the development of governance and infrastructure and the capacity for planning to support the regional and local co-ordination of suicide prevention. Another identified outcome was the existence of comprehensive plans to develop and support the participation of Aboriginal people in the suicide prevention and wellbeing workforce. Another two outcomes were the development of standards for community engagement and cultural awareness in wellbeing services and for early intervention plans for Aboriginal people, families and communities. In summary, GYS was rated very highly as strong evidence of effectiveness and best practice and as an example of community determined, led and governed programs and approaches to addressing the issues facing its young people1.
Walker R, Scrine C. The Aboriginal and Torres Strait Islander Suicide Evaluation Project: summary of promising programs, services and resources in Aboriginal suicide prevention and postvention. Perth, Australia: Telethon Kids Institute, UNiversity of Western Australia, 2015.
Healthcare Management Advisors. 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. 2016. https://www.atsispep.sis.uwa.edu.au/resources.
Life for Koori Kids (Redfern, Sydney NSW)
Life for Koori Kids (LFKK) is an Australian not-for-profit voluntary organisation that supports children of Aboriginal heritage in Sydney’s inner city to overcome challenges and realise their potential.
LFKK provides an open network of support for families within the community, whether it be through education and training programmes, sporting activities, medical and dental support or strengthening Aboriginal cultural heritage.
The Mowanjum Aboriginal Art and Cultural Centre is a creative hub for the Worrorra, Ngarinyin and Wunumbal tribes, who make up the Mowanjum community outside Derby, Western Australia. These three language groups are united by their belief in the Wandjina as a sacred spiritual force and the creators of the land. They are the custodians of Wandjina law and iconography.
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 that loss will have on their children’s health and wellbeing.
The 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 – for current and future generations. Multi-media and digital archives are two of the engagement strategies in the program with digital film and 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 in which they choose 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 is then stored for safekeeping, sharing and teaching.
Junba 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 practice 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 programs’ rationale is to keep culture strong through the engagement of Mowanjum’s young people working closely with Elders to achieve intergenerational knowledge translational and sharing. Training in managing the digital collection addresses community unemployment rates and creates culturally relevant jobs 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.
• 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 is developing a repository of cultural knowledge and is developing 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, the sustainability of the program and the staff that has resulted in an increased response to the activities and involvement of young people
• Community have come to value the program and recognise the difference it is making to young people and children
• Relationships of trust established between the program staff and 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
• Fostering 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 mediums
• Promotes the planning, implementation and production of local initiatives that can then be stored and preserved for intergenerational teaching and learning
• 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
These programs were rated very highly as evidence of promising evidence of effectiveness and practice. They are culturally embedded, responsive, based around a clear program logic, supports Indigenous social and emotional wellbeing and self-determination and pathways for young people.
Stronger Smarter Yarns for Life
Stronger Smarter Yarns for Life is an early suicide prevention program that develops the skills of Aboriginal and Torres Strait Islander and non-indigenous people to understand the unique issues impacting First Nations People’s mental health and well-being and assists in recognising the signs of distress and to engage in yarning to support vulnerable community members.
In 2016 ConNetica Consulting collaborated with OzHelp and Chris Sarra, 2016 NAIDOC Person of the Year to develop the training program Stronger Smarter Yarns for Life. The program was piloted with and incorporated feedback from local elders and Aboriginal and Torres Strait Islander people in Bundaberg, Sunshine Coast and Canberra prior to completion. This program is delivered across Australia in metropolitan, rural and remote locations and includes a Participant Program and a Train the Trainer Program. ConNetica works with local communities to develop their abilities to provide suicide prevention training programs in line with community directions.
The program incorporates Chris Sara’s strengths-based approach to these yarns and provides learners with an understanding of the impact of intergenerational trauma and the effects of colonisation upon Aboriginal and Torres Strait Islander peoples and communities wellbeing. ConNetica contributed to the program their mental health, suicide prevention and program design expertise.
This is a one-day program early suicide prevention program that is designed to build the skills, knowledge and confidence of Aboriginal and Torres Strait Islander people and non-indigenous people to have early yarns with First Nations’ people who are vulnerable and or experiencing a personal crisis.
The program is evidence-based using the disciplines of population health, health promotion, suicide prevention, social marketing, change management and adult learning principles. All facilitators must be accredited and ongoing mentoring is provided. Programs are always delivered by 2 facilitators, with at least one being an Aboriginal or Torres Strait Islander facilitator. This training provides participants with:
an awareness of the prevalence of mental illness and suicide in Australia generally and for Aboriginal and Torres Strait Islander people
a strengths-based approach to social support and suicide prevention
an understanding of the unique factors contributing to thoughts of suicide for Aboriginal and Torres Strait Islander people
the skills and knowledge to identify signs and debunk social myths
tailored Indigenous mental health conversation planning tools
yarning practices and
list of suitable referrals, support options and resources at local and national levels.
The resources can be amended to meet local conditions and history. Base-line and completion evaluations are completed by the participants. Independent Australian National University – Centre for Mental Health Research has completed independent evaluations of the program which show statistically significant increases in suicide prevention knowledge, skills and willingness to have these important yarns.1 The program can be used as a preliminary session for other more detailed programs such as Aboriginal Mental Health First Aid.
The program is designed to introduce participants to early suicide prevention activities by being able to recognise:
the effects of colonisation
distress and substance abuse in Aboriginal and Torres Strait Islander people at the community level.
Those who undertake this program would be working or living within a community. Therefore they would have first-hand knowledge of the community’s history and members. Participants are given an opportunity to develop skills in:
recognising when yarning is necessary
finding an appropriate moment to start the yarn
maintaining respect through a non-judgemental interaction
helping the person develop a plan to address their concerns and
if needed, be able to refer the person to other supports and resources.
Theories underpinning the program include:
stronger smarter philosophy
social marketing and
adult learning and community development
While the program is an early suicide prevention program, the skills of yarning can be used to discuss other health-related and everyday personal matters.
The program has been delivered to more than 10 regional Queensland towns, and in Derby in the Kimberley, as well as in Canberra and Melbourne to a cross section of participants including traditional owners, community members, social workers, youth workers, teachers, police and health professionals.2 Participants do not need to have a pre-requisite knowledge of suicide prevention however they are required to have an interest in learning the knowledge and skills that lead to early suicide prevention interventions. The program has been delivered to over 400 people with attendees aged primarily between 21 and 50 years.
Participants are able to develop skills in recognising when yarning or intervention is required and based upon pre-and post-evaluations it appears that their confidence in their skills is greatly enhanced as a result of this program. The process of developing a yarning plan is given specific attention and is central in the program. There is little reference to formal psychological concepts in the learning materials as the language is kept to everyday language that resonates at a local level (such as ‘suss it out’) and focuses on positive action rather than diagnosis.
The program has been evaluated by the Australian Nation University’s Centre for Mental Health Research in July 2019 using both qualitative and quantitative techniques.1 The evaluation included an assessment of acquired knowledge and skills including the capacity for action (willingness) to engage in a yarn to reduce the suicide risk of a person, knowing when a yarn is required, and when to find the right moment to engage in the yarn, help another person express their thoughts and feelings, to adopt a respectful approach, to follow practical steps and take action if needed and, finally, to refer the person for help. They also asked participants how much they learned from the course.
The analysis of data from pre-and post-course evaluations showed the program was regarded as being very helpful to the participants. With the researchers reporting that Stronger Smarter Yarns for Life program achieved “outstanding results”.
Participants commented positively on the ‘simplicity of the resources’ which used lay language to communicate suicide prevention concepts, having ‘greater confidence in discussing sensitive issues with others, and the ‘relevance of the course to their community or professional work’.
The pre-and post-course evaluations showed a statistically significant difference between the two measures used in all of the areas on the self-assessment. The evaluation team concluded that:
“The majority of participants reported a statistically significant increase in their knowledge about the prevention of suicide. They reported improved skills to engage in a yarn to reduce the suicide risk of a person, including knowing when a yarn is required, to find the right moment to engage in the yarn, help another person express their thoughts and feelings, to adopt a respectful approach, to follow practical steps and take action if needed and, finally, to refer the person for help. Moreover, most participants were willing to engage in the yarn, to work out the practical steps learnt and take action if needed, and to refer the person for help.”p.221
While the evaluation team noted that the scope for improvement was limited given the results of the assessment were extremely positive they did suggest further work may need to be done in the program to help build the participant’s confidence in developing referrals to other supports and resources.
Stronger Smarter Yarns for Life demonstrates many of the guiding principles underpinning CBPATSISP which build on those identified in the ATSISPEP report Solutions that Work.3 Specifically, the program was co-developed by an Aboriginal and Torres Strait Islander person with expertise in education and leading experts in suicide prevention and Aboriginal community members with lived experience in consultation with community members. The team recruits and trains local Aboriginal and Torres Strait Islander people to deliver the program in Aboriginal communities. The program ensures that the local community is involved in the preparation and delivery of the program so that it meets local needs. The program is delivered in a culturally safe manner and is able to be adapted to meet local needs. The program uses data to measure its effectiveness and ensures that improvements and enhancements are made. CBPATSISP has rated this program very highly and as strong evidence of effectiveness and best practice.
Joe is a proud Wiradjuri Aboriginal man born in Cowra and raised in Wagga Wagga NSW. Joe played in the National Rugby League before switching to professional boxing in 2009. He has won world boxing titles, along with awards for suicide prevention. In 2015, Joe was awarded the title Wagga Wagga Citizen of the Year for his work in community mental health and suicide prevention. In 2017, he was a finalist in the National Indigenous Human Rights Award for his work with suicide prevention and his fight for equality for Aboriginal people. The following year, Joe was conferred the highest honour of Suicide Prevention Australia’s LIFE Award for his outstanding work in suicide prevention in communities across Australia.
Enemy within comprises core programs of Walu-Win Gundyarri. These programs are focused on suicide prevention, healing and strengthening social and emotional well-being of people within communities across Australia. Walu-Win Gundyarri sessions have been delivered in over 300 communities since the inception of Enemy within in 2014. Participant numbers since inception has reached many tens of thousands of people all ages, across Australia, NZ and USA.
Walu-Win Gundyarri programs are open to all, regardless of age or race. There are variations of delivery depending on age dynamic and with sessions specifically dedicated to Aboriginal and Torres Strait Islander (hereon just Aboriginal) audiences. Enemy Within caters for males and females of any age and from a variety of communities.
Programs are often developed in partnership with the community so that the program is tailored to its needs. To achieve this, Joe talks in depth and works closely with stakeholders, Elders and leaders within community. Joe reaffirms the importance of role modelling and looks to mentor young people in becoming the best version of themselves. Joe is almost always head facilitator, unless stepping back from this role is seen as empowering the community to develop its own outcomes. Joe has the ability to connect and deliver with individuals in diverse situations, whether one-on-one, small or large groups, classroom settings or yarning circles.
Joe delivers a variety of workshops with the type delivered depending on the needs of the community. Often, Joe delivers to schools, sports clubs and community groups. Sometimes the delivery comprises a camp and various presentations of Enemy Within consisting of topics around addiction, substance misuse, wellbeing and trauma. There are also cultural programs for Aboriginal audiences only, which deal with identity, connection, generational trauma and healing by practising culture.
The Enemy Within website has gained traction in communities across the country and internationally. New invitations from communities to deliver Enemy Within are generated from news of the positive impacts left in communities where these programs have been delivered. The Enemy Within programs, are sought as both prevention and postvention measures in reducing and healing from suicides.
This program addresses disconnection, cultural wellbeing, suicide prevention and the impacts of trauma. It also helps break down the stigma associated with talking about mental health challenges and reconnects individuals to themselves, family and community.
In 1997, the Yiriman Project (Yiriman) was initiated by Aboriginal Elders in the West Kimberley out of a deep concern regarding the large numbers of young people engaging in drug and alcohol misuse associated with anti-social behaviour and infringement of the law as well as self-harm and suicide. The primary aim of Yiriman was to take young people on-country in order to develop a sense of their cultural heritage to enhance their self-esteem and self-identity in order to prevent suicide. The Elders followed long-established traditions by setting up an organisation that would take young people, Elders and other community members on trips to country to hunt and collect food, meet others, interact with Elders, take care of country and walk as a way to learn stories and Aboriginal songs1, become healthy, build skills and respect traditions. Yiriman began in the Jarlmadangah Burru Aboriginal Community, approximately 100 kilometres south-east of Derby, Western Australia (WA) and has continued to operate under the clear direction of the Elders. Yiriman is an intergenerational, on-country, cultural program, conceived and developed directly by Elders from four Kimberley language groups: Nyikina; Mangala; Karajarri; and Walmajarri, the four cultural blocks of the West Kimberley region. Occasionally, Yiriman is involved in supporting similar projects in the North and East Kimberley regions. Yiriman is backed 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.
Yiriman 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. Yiriman trips vary in length, with some lasting only a couple of days to others which take a couple of weeks depending on the destination, the work done and the time of the year. Programs focusing on youth caring for country last a little over a month to offer longer diversion programs for youths, especially young men, to remove themselves from negative influences such as alcohol, drugs and crime.
The key aim is to ‘build stories in young people’ and keep them alive and healthy by re-acquainting them with country. There are four main cultural groups Nyikina; Mangala; Karajarri; and Walmajarri with similar cultural, geographical, language and kinship ties spanning 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 WA.
The Yiriman model aims to provide young people with opportunities to participate more fully in community events and in life, but also to enable their inclusion in a range of other events. These include land-care, cultural education, fire management, scientific and economic development, healthcare and education, tourism, training for employment and language regeneration.
Through the Yiriman Project, young people have been able to spend increasing time on country. Many have spent periods of two weeks on country learning culture from their elders. For example, on the Karajarri Women’s Cultural Camp in 2018, over 80 women and girls attended, along with 20 staff from eight different service providers. During the course of the camp, there was a range of workshops providing information and hands-on experience with bush medicines, bush dyeing, seeded jewellery-making and the likes. From these emerged the exchange of knowledge and activities between different age groups and cultural exchange generally.
Opportunities for participation in culture and life have been provided by the Walmajarri Women’s Tuesdays which began in August 2013 and continue. These workshops are held in partnership with Ngurra Art Centre and Marninwarntikura Women’s Resource Centre. These workshops have focused on art, jewellery making, seed and plant collecting day trips, artefact making workshops. These activities are held in the Ngurra Art Centre and other venues in the surrounding areas.
Picture book reports are regularly produced to show what has happened on trips using digital images, language, direct quotes and limited text. These picture books are also a way of publicising the Yiriman projects.
In 2016, a report2 from a three-year evaluation of the Yiriman project was published online. This report provides strong evidence of its effectiveness. Community members are respectful and supportive and Yiriman, with the support of Elders, has continued to conduct on-country trips and to support the cultural development of young people from the communities over four language groups. In 2015, Yiriman was recognised nationally with the award of Reconciliation Australia’s Indigenous Governance Award. Professor Mick Dodson, a member of the selection board summarised:
There is good evidence that taking young people and members of older generations on country is important for their health. There are definitely immediate healthy effects of taking young people away from their poor diets and living conditions. There is also evidence that Yiriman has assisted in the campaign to minimise young people’s involvement in the justice system.
He added that Yiriman’s achievements over almost two decades, demand the attention of government, philanthropic organisations and the broader community2.
In the Report of the Inquiry into Aboriginal Youth Suicide in Remote Areas, it was recommended that Yiriman be funded so that it could be used as a model across the Kimberley and in other areas3.
The Yiriman Project builds strengths and capacity in Aboriginal communities and resilience in individuals and families. In communities, it promotes the capacity to initiate, plan, lead and sustain strategies to promote community awareness and to develop and implement community suicide prevention plans. It also provides materials and resources appropriate for the needs of Aboriginal peoples from diverse community settings.
The Yiriman Project also identifies high levels of suicide and self-harm in communities and facilitates a planned response. It also provides culturally appropriate community activities that engage youth, build cultural strengths, leadership, life skills and social competencies through on-country trips, resulting in life promotion and resilience-building. The project is specifically developed for Aboriginal families and children and is founded on long-term, sustainable prevention strategies that build resilience and promote social and emotional well-being.
The Yiriman Project has undergone a robust 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 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 from the remote regions. Yiriman was rated very highly as strong evidence of effectiveness and best practice and was also recommended in the Western Australian Coroner’s Report released in March 2019.
Wesley LifeForce Suicide Prevention Training for Indigenous Community Workers (National)
The Wesley LifeForce Suicide prevention training is a culturally responsive suicide prevention resource and training package with protocols and the curriculum specifically adapted for Aboriginal and Torres Strait Islander community workers.
The Wesley LifeForce Suicide Prevention Training is an exemplar of an innovative initiative to adapt an existing mainstream suicide prevention program led by highly 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 Program to be culturally responsive for facilitators working with Indigenous peoples and to develop a resource for use by Indigenous community workers. The group consulted with local communities in Halls Creek in The Kimberley, Katherine in the Norther Territory and Thursday Island in the Torres Strait to receive feedback in order to develop a program that would be culturally appropriate for the participants. 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 months period.
The program has been designed to be adaptable to individual communities rather than ‘one size fits all’. The basis of the program is respectful knowledge sharing rather than facilitator led presentations. Starting in 2015, Wesley LifeForce carried out a series of suicide prevention workshops led by Aboriginal mental health workers. The aim of the workshops is to equip the participants with adequate knowledge about the high incidence of suicide in Australia, especially among Aboriginal and Torres Strait Islander people, and factors contributing to suicide. More importantly, the training improved participants’ confidence in identifying warning signs of suicide and intervening accordingly.
Wesley LifeForce is currently rolling out a Train the Trainer program: The Aboriginal and Torres Strait Islander Suicide Prevention Training project. This will equip Indigenous community workers to become a suicide prevention resource in their communities and facilitate suicide prevention workshops.
Develop a culturally responsive training model in development and design, while adapting the existing Suicide Prevention Training program
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. Discussions are held as yarning circles to enhance community capacity and engagement, to help increase community strength and resilience
Develop an evaluation framework to evaluate the efficacy of the program in suicide prevention
Recommendation, protocols and curriculum for a culturally responsive training package were developed 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 training and focus 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 communities’ 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 in the Torres Strait
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 attendees. Follow-up of participants by the team, or by agreed community members, was carried out following each session
Based on the consultations and evaluation follow-up, the Seedling Group 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
Relationships built with key community members before introducing the training into the community
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 allows those less articulate in Standard Australian English or less confident members of the group to be heard and ask questions of peers. Small groups working together offer safety and were requested by focus groups
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, so the trainer should be trained to handle these situations during facilitation
Spend time on introductions – it is critical when facilitating this training in community. This step is paramount to building trust with participants
Training should be given in a more informal ‘yarning circle’ or ‘round table’ setting
Sharing of knowledge, rather than imparting of knowledge; emphasising reciprocal learning
The opportunity 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 (e.g. someone in the community) should be engaged to translate the information
Include groups like Police and Community Youth Centres who have a strong relationships with some homeless groups in a number of communities
Pre-training evaluations and post-training evaluations carried out to measure effectiveness for different population groups
Using the qualitative evaluation process of “most significant change” to see how this training influences changes over time
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 and training material and programs available to the Aboriginal and Torres Strait Islander Peoples
The reciprocal learning within the training model enables the training to be effective in any situation
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 knowledge to support the participants and community members following the training. 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
Through the pre and post workshop evaluations, there was a strong increase in participants’ knowledge regarding the incidence of suicide in Australia and factors contributing to suicide. The participants also demonstrated an improved ability to identify suicidal behaviours, communicate with a suicidal person and conduct a suicide intervention. This provides evidence for the training’s capacity to improve people’s competence in addressing suicide in their community. Its aim is not only to increase awareness around suicide in the Aboriginal and Torres Strait Islander communities but also increase participants’ confidence in suicide intervention
The Wesley LifeForce training adapted model strengths and capacity in Aboriginal and Torres Strait Islander communities and resilience in individuals and families. Specifically, it promotes the communities to have the capacity to initiate, plan, lead and sustain strategies to promote community awareness and to develop and implement community suicide prevention plans. It also provides materials and resources appropriate for the needs of Aboriginal and Torres Strait Islander peoples in diverse community settings. The training program also improves suicide awareness among “gatekeepers” and “natural helpers” in communities affected by self-harm and suicide.
The evaluative assessment is based on several in-depth interviews and email correspondence with the two Indigenous practitioners involved in adapting the training program. Although the community training program specifically for Aboriginal and Torres Strait Islanders community workers 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 is culturally responsive were Elders and families with lived experiences who spoke directly to their needs. This is consistent with recommendations in the Suicide Prevention Australia position (2010) and The Fifth National Plan. There is considerable evidence that confirms that community-led, grass roots 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).
It is rated as promising evidence of effectiveness and practice. 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 which is rolled out nationally to provide effective culturally responsive practice providing all of the identified elements identified and reported by Kelleigh and Tujagu (2015) are implemented in all Indigenous community suicide prevention training.
Yuendumu/Warra-Warra Kanyi (Warlpiri, NT)
This is a comprehensive program of youth development and leadership, diversion, respite, rehabilitation and aftercare throughout the Warlpiri region in the Northern Territory.
Warlpiri Youth Development Aboriginal Corporation (WYDAC) began in 1993 due to the efforts of Elders from the Yuendumu Community in the Warlpiri region of Central Australia. Their program, Warra-Warra Kanyi (WWK) is a counselling and mentoring service that combines formal, tertiary counselling skills with a local Warlpiri approach to target high-risk behaviours in Warlpiri people aged from 12-25 years. It targets a variety of risks, most notably relationship issues, family violence, substance misuse (alcohol and cannabis) and suicidal and other self-harming behaviours. Members of the WWK team have one of four roles: the WWK Coordinator/Counsellor, the WWK Youth Mentor, a team of Trainee Mentors, and the WWK Senior Cultural Advisor.
Trainee Mentors are young people who had participated in the Youth Development Project and who had demonstrated a clear interest and capacity for helping at-risk peers. They are casually employed and operate under the close supervision of the WWK Counsellor (and sometimes a WWK Youth Mentor). Trainees are matched with clients according to important local and cultural factors such as gender, family group and skin name. This ensures that trainee mentors are well-placed and in frequent contact with their at-risk peers. Trainee mentors sometimes report ‘early warning’ signs and represent the crucial link between a developing crisis and professional assistance. Usually, trainee mentors have struggled with and resolved their own issues. Hence, their mentorship is relevant and effective.
Senior Jaru Pirrjirdi members are employed as WWK youth mentors to work with a WWK Counsellor to target critical youth issues. These mentors are young Warlpiri people who have demonstrated strength, skill and capacity in caring for their at-risk peers. The WWK youth mentors work very closely with and report to the WWK counsellor, who in turn supervises them and supports their development. The WWK youth mentors are active collaborators in the care of their clients. Youth mentors will often have genuine, direct, honest and insightful advice on preventative behaviours, coping strategies and positive pathways. The Counsellor is always available to community members. Clear on-call protocols ensure that during periods of annual leave, gaps are covered by other WYDAC staff members. The WWK team engage with youth issues such as alcohol or other substance abuse, sexual health, relationship breakdown, domestic violence, depression and grief, and suicidal behaviours.
The WWK Project has five main elements:
Prevention and education
Peer mentoring and counselling
Community and family engagement
Re-engagement with the youth development project
This is a significant underlying factor in reducing suicide risk for Warlpiri young people. This aspect of the program utilises the Mt Theo Outstation. The physical site of Mt Theo has enormous significance as a cultural site for Warlpiri people. Any young person who is misusing cannabis has the opportunity of cultural rehabilitation and detoxification supported by experienced Warlpiri carers at Mt Theo. This assists Warlpiri youth to deal with cannabis misuse through respite from 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. Hence, a strong, positive, healthy Warlpiri identity is forged, promoted, practised and imparted.
Counselling and mentoring services take place in the bush and out of community, perhaps while hunting or sitting together waiting for the kangaroo to cook. Weekly young men’s mentoring trips in the bush to hunt are regular events that involve the youth mentors, trainee mentors and at-risk young men.
Elders are involved, provide support and are Senior Cultural Advisors, particularly for the non-Warlpiri staff of WWK, other WYDAC and external agency staff. A Senior Cultural Advisor plays an important outreach and support role to the Mt Theo Outstation and to other Warlpiri communities requesting support. Finally, Senior Cultural Advisors play an important supervisory role in the development of culturally relevant Warlpiri mentoring and counselling resources.
Experience enables the WWK team to identify critical periods or situations when a risk is likely to develop. This ability is crucial in developing a ‘local calendar’ which highlights high-risk nights, weeks or periods of the year. This allows preparation of resources, and early preventative work by staff with families and peers and external agencies such as the police.
The WWK is a clinical and culturally safe program that provides extensive wrap-around services and rapid, local crisis responses to prevent suicide attempts from becoming completed suicides. The WWK is an accepted support for youth who have had suicidal issues over a sustained period. It also deals with the problems underlying these issues and moves young people forward towards positive and meaningful pathways.
The program is now a comprehensive program of youth diversion, development, leadership and rehabilitation throughout the Warlpiri region. Most critically Warlpiri people themselves created the program, and its ownership, design and growth remain under the control of the governing committee of Warlpiri people.
The factors crucial to the program’s success are:
The employment of a permanent, locally based, tertiary qualified counsellor and a second qualified person to provide relief, ensuring a 24 hour on-call service
The peer mentoring system which is critical in raising awareness during a crisis
Its local nature in the developing of responses to local needs under the direction of local people, employing local people and relying on Elders to ensure cultural safety and to provide cultural direction
Addressing suicidal behaviour by working to address cannabis misuse
Having a holistic view of youth development which includes education, development, well-being and diversion.
Having responsive, local and informed people available in the community on a permanent basis to successfully address suicide attempts
The overarching aim of the WWK– Mt Theo Program is to create meaningful and positive futures for Warlpiri youth.
Key objectives are to:
1. Decrease the incidence of suicide attempts by building resilience to protect against suicidal ideation and self-harming behaviours
2. Strengthen the program structure as part of a systemic and culturally appropriate solution to underlying issues within the community
3. Develop a pool of strong, trained and confident young mentors who can deal with community issues of suicidal ideation and other harmful behaviours
4. Graduate program participants into employment and positions of strategic power in the community
The Program achieved unprecedented success in successfully ending chronic petrol sniffing in Yuendumu, through a two-step focus. The first step was the consistent removal of any petrol sniffers to the remote Mt Theo Outstation for one or two months of cultural respite and rehabilitation under the care of Warlpiri Elders. The second step was creating a seven 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 reason for removal to the Mt Theo Outstation broadening beyond petrol sniffing to other substance abuse, or indeed any risk issues. The following year, there was a deepening of the basic youth program beyond an entertainment and diversion focus. The youth diversion activities continued but were extended to build a more comprehensive program incorporating education, training, cultural activities, mentoring, leadership, group project work, bush trips, career pathways and crisis response for Warlpiri youth from 16-25 years.
The success of the Project in Yuendumu resonated loudly in other Warlpiri communities. At the express invitation of these communities, youth diversionary programs began in Willowra (2005), Nyirrpi (2008) and Lajamanu (2009). As with the Yuendumu Program, these services grew from an initial diversionary base to broader, more comprehensive development programs. In 2008, services were again augmented by the creation of the Warra-Warra Kanyi (WWK) Counselling Program in Yuendumu.
The Warra-Warra Kanyi Project was rated very highly as strong evidence of effectiveness. It 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 wrap-around services and rapid, consistent, accessible, local and informed crisis response to address suicide attempts thereby preventing them 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 on a positive and meaningful pathway.
The impacts of the program are sustained. It supports inclusion and engagement across the community and is underpinned by local governance and community control. Building strong cultural identities in young people also builds their sense of connection and confidence. This has proved highly effective in enabling them to move away from cycles of violence, self-harm and suicide, substance misuse, and criminal behaviour. The program has grown significantly since its inception into a comprehensive program. It is an example of the importance of a team comprised of people with local knowledge and qualified experience who are responsive, local, informed and available in the community on a permanent basis. The program also emphasises the ability of families and community to recognise suicide risk, respond and communicate concerns as early as possible.