Dr Anna Williamson1
Prof Sally Redman1
Prof Sandy Eades3
Prof Beverly Raphael 4, 5
1 The Sax Institute
2 Aboriginal Medical Service Western Sydney
3 University of Sydney
4 University of Western Sydney
5 Australian National University
Project completion year
Aims and objectives
There is currently almost no evidence as to what works in improving Aboriginal child and adolescent mental health. The ‘Rites of Passage’ study set out to address this gap and pioneer the development of culturally appropriate intervention and support through an Aboriginal community-designed and led social and emotional wellbeing service.
The current study sought to build on and extend the opportunity created by the Aboriginal Medical Service Western Sydney (AMSWS) receiving funding for a male youth worker to run the Rites of Passage program for boys at the service by:
a) extending the program to females by employing a female Aboriginal Youth Mental Health Worker, and
b) creating new knowledge about what works in Aboriginal youth mental health promotion by evaluating both the Rites of Passage programs (male and female) to determine:
i. the feasibility, acceptability and costs of the pilot project and
ii. whether there is sufficient initial evidence of impact to suggest a larger scale study might be of value.
Children attending the AMSWS were eligible to participate if: their GP referred them to the Aboriginal Youth Mental Health Worker or a mainstream mental health specialist; they were aged between 8-16 years; and they identified as Aboriginal or Torres Strait Islander. Children who attended the resilience building camps must also have been diagnosed with a depressive or anxiety disorder by the AMS psychiatrist in order to be eligible to attend.
The Rites of Passage program was led by a male and a female Aboriginal Youth Mental Health worker. In keeping with Aboriginal protocols, the male Rites of Passage worker worked with male clients and the female worker worked with female clients. The centrepiece of the intervention was the resilience building camps. The camps utilised a ’positive peer model’. Young people attended the team building camps with local elders. They were given the opportunity to develop further community supports, be culturally safe, build skills and engage in activities designed to increase resilience amongst Aboriginal young people.
Each camp concentrated on activities that participants expressed interest in at the camp planning get-together held in the weeks prior to each camp. The camps also provided an informal venue for attendees to address issues around mental health, sexual health, parenting, alcohol and other drug use and education.
Aboriginal Health Workers from WSAMS who specialise in each of these areas led the discussions. Attendees took part in informal catch-up sessions with the Rites of Passage worker in the month after the camp. A final session was held three months after the camp. At this time, the Strengths and Difficulties Questionnaire was re-administered along with a brief questionnaire.
As the Rites of Passage program is a pilot, the primary focus is on feasibility, acceptability and costs, with impact data being collected as a secondary outcome.
73 participants took part in the Rites of Passage program (35 males and 38 females, average age 13 years, SD: 1.84, range:8-16 years). Of these, all were invited to attend a camp and 62 (85 per cent) did attend. At intake, participants reported a range of difficulties including emotional (53 per cent), behavioural (54 per cent) and social (39 per cent) problems, problems at home (34 per cent) and experiencing current or recent stressful life events (34 per cent).
Participants reported sources of support in their lives including supportive parents (61 per cent), other relatives (44 per cent), foster/adoptive parents (33 per cent), friends (27 per cent) and elders/mentors (21 per cent). Youth workers identified a range of strengths in all participants and sought to enhance these throughout the program. Strengths identified included: good social skills (77 per cent), good self esteem (56 per cent), enjoying or being good at artistic things (44 per cent), enjoying or being good at sport (49 per cent), having dreams and goals for the future (56 per cent) and having a strong Aboriginal identity (69 per cent).
The Rites of Passage pilot study was designed and led by the Aboriginal community. It has demonstrated that this ambitious project was feasible (though challenging), highly acceptable to participants and the community more broadly and likely to have made a positive impact both to those who participated and to the Aboriginal community more broadly by developing capacity in mental health program evaluation. Rites of Passage has increased the number of children receiving mental health services at the Aboriginal Medical Service Western Sydney from 0 to 73 and has already resulted in the creation of two new social and emotional wellbeing projects. The results of this pilot study demonstrate sufficient evidence of feasibility and acceptability to warrant a large scale study examining the impact of the program.
Rites of Passage cost approximately $3,000 per participant. A cost-benefit analysis is not within the scope of this project.
Translation of the findings into practice
Some of the key learnings from Rites of Passage have been translated into practice through the development of new projects at the AMS Western Sydney. For example, one of the key observations of Rites of Passage staff was the great need for education about social and emotional wellbeing, self care, sexual health, drug and alcohol issues, dental health and the Stolen Generation amongst participants. It was observed that there was little such information currently provided to Aboriginal young people at school. In response to this, the ROP team adapted the P4P program (a sexual health program created for Aboriginal adults in Townsville) to the needs of Aboriginal young people in Western Sydney and created P4APS3. P4APS3 is a 10-week program for Aboriginal young people aged 16 years and up that the AMS has commenced running in local schools.