Vicary and Andrews
Practice Note
how, the time and length of the session, gender, and what subjects
should be avoided in contact with the client (e.g. traditional law).
Engagement (stage 4) with the community or family can be
carried out in a number of ways. If the Aboriginal co-worker has
an existing relationship with the community or family, they can
introduce the non-Aboriginal counsellor to the relevant people
(i.e. elders, parents and grandmothers). If an existing relationship
has been established, the process described below should be car-
ried out when meeting face-to-face with the significant people.
Conversely, if no relationship exists the co-worker may choose to
telephone or write to the community/family concerned and pro-
vide information about the proposed visit. It is important that the
community/family are clear about the reasons for the visit, who
will be visiting and what topics are likely to be discussed. In other
words, the purpose for the visit should be transparent, which al-
lows the clients to select other community/family members they
would like present at the meeting.
The client should also be informed about their therapeutic
options (stage 6). This may present a unique opportunity for
Indigenous and Western methods to be used together and to learn
more about each other’s skills and strengths. When discussing
therapeutic options, the counsellors should also discuss a variety
of Western models and their strengths and weaknesses. The client
is encouraged to select the intervention option they feel most com-
fortable with.As has been stated earlier, maintaining an open thera-
peutic process is likely to reduce any anxiety the clients may have,
and it also helps to demystify interventions. This also empowers
the client to choose the intervention of best fit. The intervention
should continue to be an open process that allows feedback from
the client involved, the workers and other cultural consultants.
Once the intervention has been completed, follow-up (evalua-
tion) (stage 7) should be discussed. This can either be formal or
informal and is dependent upon the client’s choice. For example,
the client may chose a formal meeting time or may decide to dis-
cuss the matter informally when next they see the workers. At this
meeting it is important for the mental health workers to provide
feedback to the client on the intervention’s progress and possible
options available for them should they require future assistance.
Another important element of the follow-up process is for the coun-
sellors to evaluate the service they provided to the client. The inter-
vention process is evolutionary and therefore dependent upon
feedback and evaluation to improve service delivery.
This process is extremely important because it allows clients to
ask questions and offer opinions about the format of the proposed
meeting and intervention (such as the significant people they
would like present at the meeting and why). It is important that
the rationale for the visit and topics to be discussed are identified
at the first contact. No intervention should be conducted at this
time. The family should be provided with their options as to the
intervention of their choice; they should be encouraged to iden-
tify any culturally appropriate means of dealing with the problem
at hand, which should also be incorporated into the intervention.
Choice of culturally appropriate interventions may require the
counsellors to co-work with traditional healers.
Once closure (stage 8) has been achieved, the counsellor needs
to be aware that their ex-clients may continue to discuss family/
community matters when they see the workers. They may also act
as referral conduits to the workers if news of a positive experi-
ence with the counsellor spreads. If the intervention process has
been perceived as beneficial, ex-clients often become a source of
favourable comments and feedback and this in turn can lead to
more Aboriginal clients accessing the service.
The role of the non-Aboriginal mental health worker should
also be clearly delineated with the client at this time. If the client
agrees to the co-workers’ arrangement, it is important that the
non-Aboriginal counsellors make themselves available to visit at
the same time as their consultant and that she/he be involved
until such time as the intervention ceases. It is not advisable to
miss meetings or change meeting times. Consistency in approach
is the key, which allows the community/family to develop a rela-
tionship with the worker and facilitates the development of trust.
The development of the relationship is a key factor in the success
of the intervention. The non-Aboriginal mental health worker
should also discuss their limitations in terms of knowledge of
Aboriginal culture.
The model described in this paper has been developed on the
basis of experience working with individual clients, however the
principles apply equally well at the family or community levels.
The following section illustrates an applied example of the model
in a large-scale community intervention.
The model in practice: a case study
A smallAboriginal community in the north of WesternAustralia
was experiencing numerous negative consequences as a
result of non-organic failure to thrive (FTT).A number of the moth-
ers in the community were very young and had few opportunities
to learn parenting or nutritional skills from either their own moth-
ers or extended family. A local group consisting of ‘grandmothers’
and elderly aunts requested that an FTT parent-training course be
run in the community so the young mothers could learn these skills.
This request was passed to the author, a male, who then followed
the intervention model previously described.
Frequency of contact (stage 5) should be discussed with the cli-
ent. The client should be informed that contact times are negoti-
able and are their prerogative. Sometimes, depending on the type
of intervention, regular contact times are required. This should be
explained to the clients and they should be encouraged to
select the times that suit them but in a more regular time frame.
Clients should be encouraged to make other times if they find their
scheduled meeting time is not suitable.This requires counsellors to
be flexible, especially when co-working with a traditional healer. It
is important to note that once the ground rules have been estab-
lished in the first (and perhaps second) meeting, a time should be
made for the assessment and intervention to commence.
The first step was to examine the referral/request (stage 1) and
assess the appropriateness of undertaking the work. The assessment
of the request was conducted in collaboration with Aboriginal
colleagues who felt that, given the community had requested that the
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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH
2001 VOL. 25 NO. 4