Identifying the need

Krurungal Aboriginal & Torres Strait Islander Corporation, is a small community-controlled organisation focused on emergency relief, education, cultural safety training and connecting people to services to meet their needs, in the Gold Coast community. Krurungal is highly respected and deeply connected in the local Gold Coast community, and because of this and the diversity of its programs it is often contacted by people and families whose issues do not fall neatly within a single program category.

Recognising that Krurungal was offering essential social and emotional wellbeing support outside of program structures, the Gold Coast Primary Health Network (GCPHN) explored how it could better facilitate this work. The result is the Community Pathway Connector program, which offers clients up to four weeks of culturally safe, non-clinical engagement, with the aim of connecting people with services across the stepped-care model; meeting the needs of individual people.

Krurungal was previously commissioned by GCPHN to provide the Commonwealth Government’s Partners in Recovery (PIR) program (which ended in June 2019). Through this relationship, the GCPHN saw how the strict eligibility criteria for PIR and other government programs could restrict access for many people who most needed support. Krurungal continued to support these people, but this work went unrecorded and largely unfunded.

Co-designing a solution

The GCPHN convened a co-design workshop with Krurungal, local Aboriginal Elder representatives, other community representatives, and the GCPHN Commissioning Manager, focussing on filling this gap. Reflecting on the need, participants were clear that this should not be a crisis or case management service, but a mix of holistic and culturally safe support and advocacy over a limited time period, to help people with complex mental health and social and emotional wellbeing needs reset their engagement with the wider service system.

They decided the Community Pathway Connectors should be a four-week program – long enough to put in place an appropriate mix of services around clients, but short enough for the individual not to become reliant on a short-term intervention program. In scope were employment, education and housing services as well as mental health and AOD, provided by the highly-skilled Kalwun Aboriginal Medical Service or mainstream services.

Resourcing for results

The next issue was how to fund the program. Most funding allocations were provided against particular programs, or with terms too strict to accommodate the Community Pathway Connector model, so the GCPHN’s psychosocial programs team requested support through the flexible funding pool intended to drive mental health reform. The team then had to convince the GCPHN executive leadership group to back the project, even though they had no data that showed specifically how the time and money would be spent.

Community Pathway Connectors began on July 1, 2019 as a one-year pilot with three staff funded through Krurungal, and one staff member through a CALD organisation. The reporting template is as detailed as for most funded PHN programs, but there is much greater flexibility in the activities that are entered in the fields. This allows support workers to – for example – record follow-up phone calls or engagement with family members as legitimate work under the program, to accompany a client to initial appointments and to liaise with mainstream providers about clients’ needs. This ensures a more accurate capture of the nature of Krurungal’s work, and gives greater insights into the needs of clients and what interventions are most helpful.

Community Pathway Connector support can also be provided at varying degrees of intensity. Some clients’ issues can be resolved in a phone call or two; others require more input, especially if staff need to resolve issues that have arisen between different service providers. Krurungal’s strong community and agency relationships generally mean such issues can be resolved efficiently.

The four-week limit ensures there is always capacity for new clients to access the program, and has proven beneficial for the staff, who take satisfaction in moving quickly on complex situations and being able to help a larger number of people. It also creates a problem-solving culture, which in turn prevents people becoming “stuck” in the system.

Outcomes

By early 2020, Krurungal had provided culturally safe and flexible connection, intervention and referral pathways for through the Community Pathway Connector program to more than 80 people aged 12 to 65 and older.

Issues and referrals have included mental health, domestic violence, cultural connection, family support, education, transport, housing and accommodation, physical health, intellectual and cognitive disability, employment, advocacy and legal issues. As well as Kalwun, Krurungal has referred clients to mainstream agencies including the Robina branch of the Queensland Department of Housing and Public Works and emergency housing provider Blair Athol Accommodation and Support Program. For the first time, Krurungal’s work in providing cultural awareness, education and support to mainstream services has been captured in the Community Pathway Connector Program data.

The Community Pathway Connector program is now developing a reputation beyond the official Gold Coast catchment, as people from the wider region’s substantial transient population and from remote locations bring their complex issues to Krurungal. There has also been liaison with agencies as far away as South Australia.

The model will be evaluated in early 2020 ahead of a decision mid-year about whether to extend its operation beyond the pilot phase.

In the meantime, the four-week, flexible approach is already being applied to address system issues for people from culturally and linguistically diverse (CALD) populations, and is under consideration for other groups including older people and those who need palliative care.

By making Krurungal’s work visible and measurable, GCPHN is funding Aboriginal-led services in a way that is compatible with how they are actually delivered, rather than forcing them into a mainstream framework.