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Table 3 Service implementation barriers, facilitators and future improvement strategies

From: Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers

 

Agency staffa

Referrersb

Professionalsc

Implementation barriers

ATAPS model limitations:

• Need for GP referral

• Accommodating client engagement and complex cases in session limit

• Limited capacity to provide outreach or transport

• One-on-one model

• Challenging timelines in vast areas with transient populations

Other barriers:

• Establishing Indigenous community or service relationships

• Shortage of Indigenous mental health and male professionals

• Non AMS clients

• No shows

• Limited funding

• Referrer /AMS turnover

• Primary health reform

• Non-identification of Indigeneity

• No barriers

• Demand management restricting referral

• Confidentiality of faxing client referrals

• No shows

• Relationship building with Indigenous communities and health services

• Limited funding to provide culturally appropriate (outreach) services

• Central intake

• Limited local/ cultural knowledge of ATAPS Suicide Support Line

• Lacking clinical service support

• Qualification requirements precluding Indigenous health workers from facilitating CBT-groups

• Occasional waiting lists

Implementation facilitators

• Good Indigenous service relationships

• Experienced professionals in communities

• Indigenous workers from Closing the Gap and Indigenous primary healthcare teams

• ATAPS funding

• Indigenous ATAPS staff

• Good referrer relations

• Service demand

• Alignment with existing Indigenous services

• Willingness to learn how to work with Indigenous people

• Service availability

• Streamlined referral

• Referrer support

• Clinician availability and engagement

• Payment for no shows

• Lack of a gap payment

• Good governance

• Good relationships with Indigenous communities and services

• Co-location with Indigenous health services

• Good relationships with Medicare Locals

• Funding

• Project officer role

• Skills and experience

• Cultural awareness training

• Provision of client transport

• Flexible interventions

• Provisional referral and priority appointments

Future improvement strategies

Cultural appropriateness:

• Cultural awareness training and supervision

• After-hours suicide line

• Outcome measures

• Indigenous mental health workers and outreach

• Service guidelines

Service engagement:

• Service promotion and referrer awareness

• AMS or NGO linkages

• Target AMS non-engaged groups

Enhanced service flexibility:

• GP referral and treatment plan

• Session limit

• Session duration

• Interventions

• Client self-referral

• Suicide timelines

• Transport allowance

Funding:

• Non-session time (liaison work)

• Rural/remote services

• Pool ATAPS funding to flexibly meet demand

• Maintain or increase funding

Integration and responsiveness:

• AMS co-location

• Build community capacity to respond to suicidality

• Involve Indigenous communities in delivery

• Provide mental health first aid training for Indigenous primary care workers

• Increased availability

• Client progress and wait list feedback

• Referrer engagement

• More sessions

• Indigenous community engagement

• No improvement required

Service flexibility:

• Referral pathways (Indigenous health workers, self-referral)

• Session limit / duration

• Session time / location

• Training and supervision funding

• Indigenous health workers as providers

• No shows

• Service access for low income earners

• Non-CBT interventions

• Diagnosis requirement

• Outreach

Other strategies:

• Cultural supervision / mentoring

• Frequent remote visits

• Funding increase

• Paid consultation time

• Direct AMS funding

• Provide transport

  1. Acronyms: AMS Aboriginal Medical Service, ATAPS Access to Allied Psychological Services, CBT Cognitive behaviour therapy, GP General practitioner, NGO Non-government organisation
  2. aincludes ATAPS administering agency staff of Medicare Locals and subcontracted provider agencies
  3. bincludes eligible ATAPS referrers
  4. cincludes eligible mental health professionals delivering ATAPS