2021-22 Family Life - Connect - Performance and Impact Report

FamilyLifeConnect

Performance and Impact Report 2021

Research, Outcome Measurement & Evaluation (ROME) Unit

Contents

Executive Summary

3

Introduction

4

Program Description

5

Methodology

6

Aim of the report

6

Data collection and analysis process

6

Limitations

6

Service Delivery

7

A responsive and integrated service with community at its heart

7

Promoting inclusion and addressing inequities

9

Re-established confidence through prioritisation and collaboration Contemporary and adaptable

12 13

Impact of the CONNECT program

16

Case Study: Fatima’s story

18

Conclusion

19

Acknowledgments

19

References

20

2

CONNECT - Performance and Impact Report | 2021

Executive Summary

Our mental health enables us to “achieve a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”1 Approximately 20% of Australians experience mental ill-health. The COVID-19 pandemic continues to present immense challenges for people with mental health concerns, and, in a system where healthcare service coordination is already lacking, restrictions presented by COVID-19 have placed people at increased risk of worsening mental and physical health2. It has been suggested that mental health promotion, prevention and early intervention strategies, including peer support initiatives, may produce the greatest positive impact on people’s health and well-being3.

Family Life’s Connect Program (initially piloted by Beyondblue) provides a low-intensity service to people with or at risk of mild to moderate depression and/or anxiety. Peer mentors support program participants through a range of avenues including phone and email support, one-on-one and group education and wellbeing sessions, online forums and a self-management toolkit. Peer mentors also support clients to navigate the mental health service system, facilitating access to higher intensity services when required. The Connect program has been designed to meet the specific needs of residents of the Greater Dandenong area, which has high rates of socioeconomic disadvantage and cultural diversity, and a high level of mental health needs, in conjunction with lower than average levels of help seeking and service utilisation4.

This report describes Family Life’s journey in supporting individuals and families via the Connect program during the last financial year (2020-2021).

http://origin.who.int/features/factfiles/mental_health/en/.

Nieweglowski & Sheehan (2021).

Colizzi et al (2020).

4 Siggins Miller (2018).

5 Miletic (2020, p.1).

In summary: • T he CONNECT program is a unique service filling a significant gap in the area of low intensity mental health support, in particular for CALD communities including migrants, refugees and asylum seekers.

• T he key vulnerabilities experienced by clients include: mental health concerns and emotional support; isolation, loneliness or limited support networks; financial constraints; and settlement challenges.

• T he quality of service provision is aligned with the four key themes and areas of reform that emerged from the Royal Commission into Victoria’s Mental Health System (2021).

The COVID-19 pandemic “has amplified some of the existing barriers for CALD communities due to challenges in access to accurate, timely information, disruption in trusted community networks, and lack of culturally responsive mental health services and supports”5. The Connect program is a flexible, person-centred approach that can be tailored to suit the needs of specific communities and has the potential to be used across all points of mental health consumer streams, from primary care through to intensive treatment approaches. The Connect program offers a model that may be utilised as a stand alone intervention focused primarily on peer support, information provision and engagement, or as an additional component to a holistic, mulit-faceted intervention plan.

1 2 3

3

Introduction

“Good mental health and wellbeing is not just the absence of mental illness; it is the ability to fully and effectively participate in society. This means attention must be paid to a range of factors related to poor mental health—psychological, biological and social—all of which can change over a person’s life...Victoria needs to be a place where people look out for one another, build social connections, and treat others with empathy.” 6 Victoria (64.5% of the population in the area speak other language than English at home)7. Therefore, the majority of clients are from a CALD (culturally and linguistically diverse) background. The CONNECT program is a holistic program, based on peer support from someone with lived experience, flexible access and engagement, and person-centred care.

Family Life is a specialised child and family services organisation with a well-established footprint across the south eastern suburbs of Melbourne through over fifty years of service delivery. Family Life’s purpose is to create capable communities, support children and young people and strengthen families. Our long connection to the local community has created an extensive network of community partnerships and connections which enhance the mental health and wellbeing of the community.

CONNECT is a low intensity mental health peer support program for individuals 16 years and above. The program works with adults experiencing significant stress, anxiety, grief, sadness and related emotions, who would benefit from low intensity culturally experienced peer mentor support. It is based in the Greater Dandenong Local Government area which is one of the most culturally diverse areas in

4

6 7 8

State of Victoria (2021a, p. 3).

State of Victoria (2018).

Australian Government (2019).

9 10 11

Whilst approximately 20% of Australians experience mental ill-health, 40% have never accessed mental health services8. Generally, immigrants, refugees and asylum seekers have lower rates of mental health service utilisation than the Australian-born population; this due to stigma, limited knowledge of the services, quality of care received, communication difficulties, confidentiality concerns and lack of trust in service providers, and service discrimination9. Within CALD communities, refugees and asylum seekers are at greater risk of developing mental health problems and suicidal behaviours; as they are exposed to additional negative experiences such as prolonged detention, human rights violations, exposure to violence and threats, on-going temporary protection visas and experience of premitration trauma10.

Identifying risk factors and addressing mental health problems early wherever possible is key to reducing the social, emotional and financial costs of mental illness.11 The CONNECT program supports individuals during this early stage. The program fills a significant gap in the area of peer support mental health and wellbeing, supporting individuals who may not engage with more clinical mental health services due to lack of understanding of mental health, lack of knowledge about the system and stigma, where they would otherwise slip through system gaps.

While CONNECT has provided mental health support for over two years, this report provides an overview of the performance and impact of the program during the last financial year (2020-2021).

Youssef & Deane (2006); Minas et al (2013).

Minas et al. (2013).

Australian Government (2019).

CONNECT - Performance and Impact Report | 2021

Program Description

Developed through a co-design process, the CONNECT program is a low intensity mental health program which connects people with mild depression and anxiety with peers who have had a personal experience of these conditions themselves, to share their stories of recovery. This model is based on the National Framework for Recovery Oriented Mental Health Services (2013) which identified the need for an increase in input in mental health services by those with expertise through experience, and in doing so embrace and support the development of new models of peer-run programs and services12.

The main program’s objectives are: • T o promote and support mental health and wellbeing for residents of Greater Dandenong.

• T o increase knowledge/awareness of mental health and wellbeing in the community.

• T o promote the prevention of mental illness through increasing ease of access to services early in the trajectory of emerging mental illness in order to improve the chances of recovery and longer-term health, wellbeing, participation and productivity.

• T o help to address stigma associated with mental health.

The recent Royal Commission into Victoria’s Mental Health System (2021) highlighted the importance of a lived experience perspective which, in the case of mental health services, includes those with personal experience of mental ill-health and recovery and family members and/or carers who have experience in supporting a person living with mental illhealth and recovery. The Royal Commission heard powerful evidence from the personal experiences of people living with mental ill-health, their families, and carers and learned of the positive impacts of services designed and delivered by people with lived experience. The research shows improved outcomes and experiences when a service is developed and operated by the people who use it13.

The service provides individual support, advocacy and assistance, and community capacity building around mental health in community settings using non-clinical, peer support workforce; which enables more people to access low intensity interventions. The Connect program allows for a staged care approach,

12 13 14

Commonwealth of Australia (2013).

State of Victoria (2021a).

Kezelman, C.A & Stavropoulos P.A. (2019).

recognising that individual needs will change over time and therefore, the intensity, frequency and duration of support required may need to be carried out. The CONNECT program’s short term outcomes are: • I ncreased knowledge and awareness of mental health and wellbeing in the community.

• P articipants experience hope/confidence that they can make choices to improve their health and well being.

• P articipants have learnt strategies to manage their mental health.

• I ncreased access to services early in the trajectory of emerging mental illness.

Family Life’s Trauma Informed Approach Family Life is a trauma informed organisation and trauma informed principles and procedures provide the foundation for the delivery of safe, effective personcentred care at Family Life. Our trauma-informed approach aligns with other important approaches and considerations including evidence-informed practice, culturally sensitive practice and intersectionality.

We understand and integrate concepts of community trauma, ecological systems theory and attachment theory within our trauma-informed approach and recognise the correlation between adverse (traumatic) experiences across the lifespan and mental health concerns. We also understand that client’s previous experiences of the mental health service system may, in and of themselves, have been traumatic.

Family Life has developed a set of core concepts, trauma-informed guidelines and practice principles (Family Life Trauma Informed Care Framework).

Our practice principles, adapted from the Blueknot Foundations Guidelines for the Treatment of Complex Trauma (2019)14, emphasise facilitating client safety at all times, and provide guidance in relation to promoting stabilisation, regulation and developing internal and external resources for healing and recovery. Peer support workers from the Connect Program are supported by this framework and by practitioners with expertise in the provision of traumainformed care, including certification in Dr Bruce Perry’s Neurosequential Model of Therapeutics (NMT), accreditation as mental health practitioners and access to regular clinical supervision with practice leaders.

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Methodology

Aim of the report

Limitations

The aim of this report is to provide an overview of the performance and impact of the CONNECT service provided by Family Life in alignment with the Royal Commission recommendations into Victoria’s Mental Health System. In particular, in the following key reform areas:

While the methodology aimed to capture the perspective of a diverse group of stakeholders, limitations need to be acknowledged and should be considered when reading this report:

• A responsive and integrated system with community at its heart.

• Monitoring data: Missing data in some variables.

• Group participant feedback survey: Response rate 64%.

• I nternal families progress reports:. The level of depth was limited to the data available; and data outside the period reviewed are not included in this report.

• A system attuned to promoting inclusion and addressing inequities.

• R e-established confidence through prioritisation and collaboration.

• O utcomes Measurement tool (K10): Data compares progress at the beginning and at the end of the service which is not the same for each family.

• Contemporary and adaptable services.

Data collection and analysis process A mixed methods approach, combining a range of qualitative and quantitative methods, was used to obtain a detailed picture of the CONNECT program and allow for triangulation of information to confirm and support findings.15

• F ocus group and case study: Possibility of bias is acknowledged regarding participants’ own involvement in the service and the qualitative nature of the data.

Descriptive analysis of monitoring data: (n= 426 individual support clients)

Content analysis of a sample of internal families progress reports: (n= 20)

Descriptive analysis of participant feedback survey: (group work) (n=63)

Statistical analysis of outcomes measurement tools: K10 (n=192)

Descriptive and thematic analysis of a community engagement survey and interviews (n=32)

hematic analysis of a focus group T with the CONNECT team (n=4)

6

15

Case study

Triangulation refers to the practice of using multiple sources of data or multiple approaches to analysing data to enhance the credibility of a research or evaluation study.

CONNECT - Performance and Impact Report | 2021

Service Delivery

The work of the Connect service aligns with the four key themes and areas of reform that emerged from the Royal Commission:

A responsive and integrated service with community at its heart

Individual support

326 individuals

The CONNECT program delivers a community-based model of care, with presence, place and impact in local communities. Services are provided via individual and group sessions, delivered through assertive outreach to clients in the community (the Greater Dandenong area).

through the provision of individual support. To provide this support, CONNECT staff made:

994 calls

To illustrate the reach of the CONNECT program, from July 2020 to June 2021 the following support was provided:

Time in the service The average service duration was

video conferences

0 face to face appointments

16

Group sessions for the community

85 days.

Group Work is a major part of the Connect program and the community has benefited from groups delivered in-language and in culturally appropriate ways addressing different topics related to mental health and wellbeing. During the last financial year, 95 members of the community participated in 10 Group Programs that included 60 sessions (6 sessions per Group Program) of 90 min to 2 hrs each.

31% 27%

7

24.8%

13.2%

The sector

70 people who worked in the sector participated in 3.9% 1 month 2 months (n=110) (n=96)

3 months (n=88)

4 months 5 months (n=47) (n=14)

Demographics From the 421 individuals who participated in the Connect program...

16 17 18

an online community of practice led by Family Life and the CONNECT program to provide insights into the topic of Mental Health within CALD Communities, in particular during the COVID-19 context.

98.6%

identified as CALD17

mainly from Afghanistan

(63%)

66%

are female

33%

are male

18

Due to COVID19 restrictions, face to face appointments were not possible during this financial year. his data is based on 76.34% of the total individuals supported during the financial year.

T Monitoring data (n=196).

7

Previous research has pointed out that some of the contributing factors to increased risk of mental health issues in CALD communities are: Low proficiency in English, separate cultural identity, loss of close family relationships, stress of migration and adjustment to the new country, limited knowledge of the system, trauma exposure before migration, racism, and limited opportunity to appropriately use occupational skills19 - listen from a client about these challenges. CONNECT delivers support to community members who are experiencing a range of these contributing factors, as illustrated below.

Diversity in the way people experience mental health Individuals who get support through CONNECT experience different vulnerabilities. From those who engaged in the service (n=19), the following primary vulnerabilities were identified in at least 20% of the cases20:

Mental health concerns and emotional support

(89%)

Isolation, loneliness or limited support networks

Financial constraints

(32%)

(53%)

Settlement challenges

(21%)

This data is confirmed by the monitoring data21 (n=326) which suggests that the primary reason for 46% (n=194) of the clients referred is anxiety symptoms and 44% (n=187) stress related.

Complexity of issues While the majority of individuals come to the CONNECT service mainly due to mental health concerns and emotional support, a review of internal family progress reports suggests that the majority have between 1 and 2 support needs (74%). Around a quarter of clients have between 3 and 4 support needs.

This data confirms the low intensity mental health focus of the program; and the suitability for peer support workers.

8

19 20 21

An example of an individual accessing the CONNECT service with 2 support needs: ental health concerns and emotional support: M “Client presented with stress and frustration over the phone due to his current COVID19 situation...Client stated that he was stressed and anxious.”

Settlement challenges: “Client stated that he felt disappointed in himself as he had different dreams, expectations and point of views to lifestyle and his future in Australia, but his expectations have not met since arrival due to settlement challenges… He hasn’t been able to study or work since his arrival.”

Minas et al (2013).

Content analysis of a sample of internal families progress reports (n= 20).

Monitoring data (n=408). Clients could have more than one reason to come to our service.

CONNECT - Performance and Impact Report | 2021

In a stepped care approach, individuals will be more likely to receive a service which more optimally matches their needs, does not under or over service them, and makes the best use of workforce and technology. This approach provides the right service at the right time, with lower intensity steps available to support individuals before illness manifests. Staging models attempt to understand what ‘stage’ of illness people are experiencing at a particular point in time and how this may progress in subsequent ‘stages’. This approach emphasises the need for more preventive services delivered in earlier stages of illness22. The CONNECT program has implemented a blended model of both: stepped and staged care, that delivers in the community, and ensures that people who need higher levels of care are ‘stepped up’ to specialised services as needed. This is illustrated by a CONNECT client and peer support worker below:

Promoting inclusion and addressing inequities

“Since I came to Australia my Case manager referred me to the Family Life Connect program. I have had 4 sessions till now and I’m really happy with my peer mentor. I was also linked with Foundation house for counselling services.”

Dignity, respect and social inclusion

Family Life’s CONNECT practice framework is grounded in principles of peer support underpinned by a key set of values: Hope and recovery

Self-determination

Empathetic and equal relationships

Integrity, authenticity and trust

(Community engagement survey participant)

Health and wellness

“We are at the button of the model. If someone has a condition that requires special care, as soon as we get info, we refer them to the funding provider and connect them with the psychological support program.“

Lifelong learning and personal growth

(Focus group participant)

Unique perspective and an equal, and empowering relationship.

Always balancing encouragement with patience.

Several of these values have been included in the recent “National Lived Experience Workforce Development Guidelines” as common values of peer/ lived experience work.23

22 23

S tate of Victoria (2021b).

Byrne et al (2021).

9

Internal families progress reports provide information about how clients were supported. The data24 suggests that 17% of the individuals (n=3) were supported using between one and three different strategies; 67% of the individuals (n=12) were supported with four or five different strategies; and 17% of the individuals (n=3) were supported using six or more different strategies. From those who engaged in the service (n=18), the following strategies were identified in at least 20% of the cases:

mpowerment and support E (89%, n=16): “The worker encouraged the client to see the positive side of life, plan for her future and pray as she is a religious person.”

nderstanding client needs U (61%, n=11): “Client informed that she feels very sad and lonely which impacted on her learning English process and planning to go back to Canberra… worker listened and shared his own settlement story.”

Self-care strategies (33%, n=6): “The worker encouraged the client to have some quality time for herself to relax (walking , listen to Afghan music & have enough time to sleep at night).”

10

24

25

mpowerment to access E support services or networks (83%, n=15): “The worker shared the local organisations details such as CMY and SMRC Dandenong and encouraged him to contact them for further support.”

elf-regulation, self-control S and coping strategies (56%, n=10): “The worker and client discussed stress management techniques like exercising, socialising and mindfulness.”

kills building-goal setting S (22%, n=4): “Peer support worker engaged client in conversation about SMART goal setting as he seemed confused and stressed about what to do.”

Data from internal families report (sample size 20). Information of 2 individuals was not included in the analysis as they disengaged at early stages of the service.

Byrne et al (2021).

Information provided (61%, n=11): “The worker discussed the differences of medical system and cultural point of view to health, especially mental health and encouraged the client to contact the GP ASAP if required.”

eferrals from other R services (39%, n=7): “The worker referred the client to the Envision Program at CMY Dandenong with the consent of the client.”

CONNECT - Performance and Impact Report | 2021

The findings suggest that the strategies used are aligned with the peer support values listed above and tailored to the specific needs of the clients - which are mainly CALD communities from migrant and refugee and asylum seeker backgrounds. The strategies illustrated above are testimony of the CONNECT model which is focused on human connection and different from a clinical service delivery. This model was described in the “National Lived Experience Workforce Development Guidelines” as part of the scope of the peer/lived experience work25. This was supported by the peer workers during the focus group (see quote below) and the clients.

lense, nutrition and its linkage with mental health, stressors that come with studying and employment in a new environment, among others.

“I had no idea before, but after I have had the wellbeing CONNECT session I now have some information about some services like GP & local services.”

(Community engagement survey participant)

This confirms CONNECT’s flexibility to adapt to new and changing inequities, supporting those who may be experiencing disadvantage - in the case of the CONNECT clients is related to lack of knowledge of the system, stigma around mental health and lack of culturally appropriate services. The following quotes illustrate how the CONNECT program is responsive to the needs of their target communities.

“Sometimes people are afraid to access these services because of fear of being misjudged, stigmatised or even not knowing where to go and who to ask. Difficulty sharing private information could be one of the obstacles too.”

(Community engagement survey participant)

“They talk to you without any barriers. With you, they feel safe. they feel free. Because we speak their language and we know their culture.”

(Focus group participant)

“We put the person at the centre by respecting the people; treating them like human beings, and having a human touch.”

(Focus group participant)

In addition, the CONNECT service offers targeted group support based on the needs of the clients. The group sessions provide overall information on mental wellbeing and importance of having a good mental health and could work as a pathway for individual support/sessions. While all of the group sessions are focused on mental wellbeing, we also cater for the community’s needs. For example, CONNECT has provided sessions on mental health from a cultural

25

Byrne et al (2021).

“This program has to be delivered in my language and made to support my own needs.

As an Afghan woman I need people who support me to understand my culture and norms so I can benefit from their help and be able to share with them private information.”

(Community engagement survey participant)

“During the lockdowns, we were the only voice they heard in days and we gave them hope.

Some of them just arrived and then they were in lockdown. They were confused. When you speak their language, that means a lot to them.

We also gave them practical tips about services that they didn’t have any idea about.”

(Focus group participant)

11

Re-established confidence through prioritisation and collaboration The CONNECT team has established strong working relationships with several organisations which enables referrals for clients to other services where required. These include:

AMES Australia and their Humanitarian Resettlement Program

Centre for Multicultural Youth

Wellsprings for Women

ERMHA

Komak program at Uniting

The Connect program has recently established working relationships with:

Catholic Care

Jobs Advocates within different organisations such as Jesuit Social Services and Settlement International

Family Life strives to provide an integrated organisational model of service. This ensures that the CONNECT program sits alongside a suite of other related psychosocial and trauma-informed services that assist a child and family’s mental health and wellbeing. See an example below of how the CONNECT team utilised other services within Family Life.

“Individual work but sometimes more than one member of the family and if that is a problem we allocate that member to another worker.

If we see there is a child who might need support we refer them to the SHINE team within Family Life.”

(Focus group participant)

12

Chisholm Tafe

Part of our strategy to enhance mental health and prevent suicide is to provide training to our staff in trauma-informed practice approaches and suicide intervention. Family Life has their own registered suicide intervention trainer within the organisation.

This role provides strong suicide intervention support through the regular provision of ASIST (Applied Suicide Intervention Skills Training), ASIST tune up sessions, safeTALK (Suicide Awareness for Everyone) training, in addition to Suicide Intervention Community of practice sessions, coaching and consultation. Most of the CONNECT team has received ASIST training.

CONNECT - Performance and Impact Report | 2021

Contemporary and adaptable As previously mentioned, generally immigrants, refugees and asylum seekers have lower rates of mental health service utilisation than the Australian-born; this due to stigma, limited knowledge of the services, quality of care received, communication difficulties, confidentiality concerns and lack of trust in service providers, and service discrimination26. The CONNECT service tries to reduce these factors by providing culturally relevant services to the community we serve. During the last financial year, we conducted a survey with members of the community to understand the community’s awareness and needs regarding mental health and wellbeing. In total, 32 members of the community participated in a survey.

Profile of the survey respondents

72% individuals were between 30 and 59 years old

97%

19% 30 and 39 38% 40 and 49 16% 50 and 59

78%

are female

22%

are male

of the respondents were from Afghanistan

Some of the barriers mentioned for people to take care of their mental health are: ack of understanding and knowledge: L “Struggle to accept and understand mental health due to cultural barriers and the knowledge of service available” tigma and shame: S “Stigma of telling people about mental issues. The community has no clue about mental health and mental wellbeing” ack of culturally appropriate services and language L barriers: “Not having someone to talk to who could understand my language and culture” oneliness, lack of support and lack of networks: L “Lack of trusting others to share my concerns”

26

Youssef & Deane (2006); Minas et al (2013).

We also asked the community what the “perfect” mental wellbeing program looks for you. The main themes identified were: ulturally appropriate service: C Language, women or men only, culture and customs, life experience (n=17) tructure: S Combination of social activities (fun) and individual support (n=15) Topics: Relevant to my needs (e.g. mental health awareness, methods of recovery, services, stressful family conflicts) (n=8) Structure: Include strategies and activities to do at home/daily basis (n=7)

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The CONNECT workforce is adaptable to the needs of the clients and provides culturally relevant service and reduces the barriers for people to take care of their mental health. To do this, the CONNECT workforce has a range of cultures and experiences and provides services in following languages: Dari, Hazaragi, Pashto, Urdo/ Hindi, Persian, Arabic and English. It also considers the gender of participants when delivering the group sessions and provides material to do activities at home. This is aligned with the significant areas of knowledge for lived experience work; which include for example: understanding of intersectionality and culture; understanding of social exclusion, and importance of community and meaningful connection; understanding of the role of trauma and impact on mental emotional wellbeing and mental health/symptoms/diagnosis; understanding of the mental health system; and understanding of community/alternative services27.

According to the peer support workers who participated in the focus group, the main elements of the CONNECT program which makes it unique and relevant to the clients are:

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Person-centred based

Culturally relevant

In language (most of the cases)

Lived experience

Social model (instead of clinical)

Strength-based approach

Power balance

Timely response

Byrne et al (2021)

14

CONNECT - Performance and Impact Report | 2021

See a quote below from a participant of a group session who describes her satisfaction with the culturally relevant service provided.

“The worker explained everything very well and knew a lot about our culture. It made the sessions very relevant.”

(Group participant feedback)

To support the CONNECT workforce, Family Life has developed and embedded practice frameworks and procedures in the organisation. These support the work of peer support mentors and ensure consistency of care across Family Life.

Clinical governance framework: Supports the commitment to achieving the best possible outcomes for our clients - safe, effective, connected and person-centred services for every client, every time. The framework outlines the foundations and scaffolding for “how we do what we do” to achieve best quality outcomes.

rauma-informed care framework: T Promotes a shared understanding of trauma and its impacts across the organisation, highlighting that the provision of trauma informed care is a shared responsibility and one where everyone plays a role (see quote below).

Reflective practice: Monthly sessions with the service leadership team reflecting on key practice topics, for example, vicarious trauma, dissociation, personality disorders and family centred practice. Service leadership then disseminates information to practitioners through team meetings, professional development sessions and sharing of resources.

omplex case panel: C Opportunity to present complex cases to a panel of staff with expertise in the presenting problem areas and with decision making authority to move the case forward.

ocused clinical supervision with F practice lead: Monthly individual supervision sessions focusing on specific practice themes or cases with an experienced clinical supervisor.

“We have been through traumainformed practice and we understand what it is and how to communicate.

E.g. war zone, family violence. We are mindful of these triggers. If needed, we provide referrals to professional services and we walk with them until they are in good hands.”

(Focus group participant)

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Impact of the CONNECT program

To understand the impact of CONNECT, different methods28 were used. Triangulation29 of the data was done to confirm and support the findings. The presentation of the findings are based on the program’s outcomes and data source (see legend image).

Outcome There is an increased knowledge and awareness of mental health and wellbeing in the community.

K1030 tests • 9 0.1% (n=173) experienced an improvement in their psychological distress score.31 Internal families progress report • Improved wellbeing (33%) Group sessions client feedback • 100% of respondents of the “wellbeing” group sessions (n=51) agreed or strongly agreed that after the session they understand the factors/triggers of stress and anxiety.

•

88% of respondents of the “wellbeing” group sessions (n=46) agreed or

strongly agreed that after the session they understand the impacts of stress and anxiety on wellbeing.

•

100% of respondents of the “Understanding the link between food and

mood” group session (n=10) agreed or strongly agreed that after the session they understand the negative impacts that poor nutrition can have on health.

Focus group with peer support workers • “Connect is not just providing services for the participants; but we go beyond that. We tackled mental health stigma in the CALD community, in particular for male.”

• “ The wellbeing group sessions are very successful with the community.

Most of our clients are now husband and wife. All of them participate freely about their experience. This helps them understand, for example about anxiety, depression. They are communicating with each other and creating a community.”

Participants experience hope/confidence that they can make choices to improve their health and well being.

Internal families progress report • Improved management of emotions (40%) Group sessions client feedback • 9 4% of respondents of the “wellbeing” group sessions (n=48) agreed or strongly agreed that after the session they feel more confident in using stress management techniques/methods to manage stress and anxiety.

Focus group with peer support workers • “At the beginning they sound stressed, emotional, some of them even crying.

At the end of the session they are different people. They feel they have emptied the weight on their shoulders. They feel lighter.”

28

29

Content and thematic qualitative analysis of internal families progress report (sample size n=20; however the percentages are based on those who have reported outcomes n=15), group sessions client feedback (n=63), focus group with peer support workers (n=4), statistical analysis K10 test (n=192).

Triangulation refers to the practice of using multiple sources of data or multiple approaches to analysing data to enhance the credibility of a research or evaluation study.

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30

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The K10 is a measure of general distress without identifying its cause. It is a screening instrument to identify people in need of further assessment for anxiety and depression.

This was demonstrated by a decrease in their K10 score from beginning to end of service. The scores’ means for the K10 between time 1 (29.2 - “Likely to have a moderate mental disorder”) and time 2 (20.11 - “Likely to have a mild disorder”) do differ statistically significantly, t(191) = 18.045 p = 0.001. A large effect was found, meaning that the result has a practical significance (d=1.302, 95% CI[1.109 - 1.494]).

CONNECT - Performance and Impact Report | 2021

Outcome Participants have learnt strategies to manage their mental health.

Internal families progress report • Implementing learned strategies (40%) Group sessions client feedback • 9 2% of respondents of the “wellbeing” group sessions (n=46) agreed or strongly agreed that after the session they have a better awareness of coping strategies for sustainable self-management.

•

100%

of respondents of the “understanding the link between food and mood” group session (n=10) agreed or strongly agreed that after the session they know how to include healthy food options to achieve optimal physical and mental health.

Focus group with peer support workers • “We provide that safe space and emotional support. We help them to reflect on their wellbeing and learn strategies (e.g. deep breathing, exercise).”

There is an increase of access to services early in the trajectory of emerging mental illness.

Internal families progress report • Accessing support groups, networks or other services (67%) Focus group with peer support workers • “Clients are coming back to our sessions. They said to us: with you I can talk about things I can’t talk about with my closest relationships (e.g. mum, sister, partner, etc.).”

An example of an individual with four outcomes supported by the CONNECT service ccessing support groups, networks A or other services: “Client informed that practitioner from the SHINE team is in regular contact with her and her son and they are hopeful for positive outcomes as they are trying to refer the son to a psychologist.”

I mplementing learned strategies: “Client discussed that she applies some of the stress management techniques when required.”

I mproved management of emotions: “Client tries to stay positive, more importantly she does not blame herself or her husband for their son’s mental health and well-being.”

Improved wellbeing: “Client was thankful and stated that she feels more hopeful and confident after speaking with the peer support worker/Connect program.”

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Case Study: Fatima’s story Arriving in Australia was a dream come true for 28 year old Fatima32, her mother and her older brother and sister.

Fatima and her family had experienced trauma in their homeland. The family hoped that relocation would allow them to close the chapter of horrific past experiences and build a new life in another country. Fatima’s family describe her as a well-educated, lively and highly ambitious person, holding a degree in Science.

Adjusting to a new way of life was challenging and Fatima experienced a sense of isolation and disconnection from the community. At times she felt overwhelmed by feelings of grief and loss due to the death of her father, approximately two months prior to the families’ relocation. This was followed by the breakup of a long term relationship with her fiance with whom she had experienced a stable and loving relationship. Unfortunately these struggles were exacerbated by the COVID-19 outbreak in Australia and the lockdown that resulted.

How did the CONNECT program support fatima?

The peer support worker used an array of strategies when working with Fatima to address her emotional state.

These included: ssisting Fatima to acknowledge A and understand her feelings; allow some time to reflect on them and then let them go and share them with a trusted person.

mpowering Fatima to use her E existing skills to rebuild her self-confidence.

uggesting some relaxation S techniques, such as meditation, aromatherapy and praying.

uggesting further counselling S support and shared with her some online available services.

eing empathetic and showed B understanding of Fatima’s immense feelings of grief and sadness and continuously normalised her sense of loss, providing her with guidance and support. This included drawing on best available theories and practises such as explaining the stages of loss and grief.

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eferring to the SMART goal R model and encouraging Fatima to set priorities and not to look at the whole picture to minimise the risk of being overwhelmed by her various concerns.

Please note that the name has been changed in this story to protect the privacy of the individual involved.

What did Fatima achieve?

Fatima gained trust in her support system and disclosed previous thoughts of suicide and services collaborated to develop plans to help her to stay safe. With links to an effective and responsive support system Fatima has gained confidence in seeking help when needed and has expressed gratitude for the work of the Connect team in navigating many difficult life transitions and experiences.

CONNECT - Performance and Impact Report | 2021

Conclusion CONNECT is a unique program which provides low intensity mental health intervention to individuals to people with or at risk of mild to moderate depression and/or anxiety using peer support workers. The current report demonstrates that the service has provided support to individuals who might not use the traditional mental health services due to stigma, limited knowledge of the services, quality of care received, communication difficulties, confidentiality concerns and lack of trust in service providers, and service discrimination. CONNECT’s model of service prioritises a flexible, responsive and person-centred approach, engaging and supporting harder to reach communities. Therefore, a key aspect of the success of this program is that it is culturally relevant and increases understanding of mental health and the system. It also utilises the strong relationships we have with other organisations to provide a more relevant service and to make sure clients receive the appropriate level of support. Integral to the program efficacy has been staff lived experience and knowledge of another language in the provision of this service.

The findings suggest that the CONNECT program has achieved its program objectives. These findings translate into individuals using strategies to support their mental health and wellbeing, improved

wellbeing and management of emotions, increase confidence to make positive choices about their health, and increase access to mental health services.

The service model has demonstrated efficacy with a diverse client cohort suggesting reliable outcomes through culturally relevant service delivery. Mental Health services risk over clinicalisation, reduced community accessibility and siloed service responses.

This program is particularly relevant during current times as COVID-19 has worsened the mental health of the community, in particular of migrants, refugees and asylum seekers. This suggests a much larger future increase in the number of mental health demands in the system. Therefore, peer support programs like CONNECT can both alleviate the saturation of the system and support those early in their trajectory before their mental health deteriorates. The findings of this report, suggests that the model of service developed could be utilised with any cohort (e.g. parents, young people, adults). This would enable earlier mental health intervention within currently funded family services creating greater reach and economic efficiency. The CONNECT program offers a conduit to such an approach.

Acknowledgments Family Life’s Research, Outcome Measurement and Evaluation (ROME) team would like to acknowledge the support and contributions made to this report: • T he CONNECT clients who participated in the surveys, and for so generously giving their time and sharing their personal experiences. Family Life acknowledges their bravery and determination to take care of their mental health.

• T o the Founder - South Eastern Melbourne Primary Health Network (SEMPHN) and the Leadership group for their commitment to such a necessary service.

• T he CONNECT peer support workers for contributing to data collection and measuring outcomes, for being transparent and honest during the team focus group, and for being very caring with all the individuals they support.

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