Table 2

Illustrative quotations

ThemeIllustrative quotation
Availability and use of tools in practice
 Valuing training“…I’ve done a lot of generalist, but not specific to Aboriginal kids, I don’t think there’s much out there.”
“…when you do courses and that, it’s mainly aimed at adults and there’s nothing really specific or put in for adolescents and younger children. So, yeah, I think it’s needed big time.”
 Desire for tools and pathways Well, it’s hard to use things like your K10s [Kessler psychological distress scale, 10 items] and your DASs [Depression, Anxiety and Stress Scale] on kids. If there was a guideline for kids, it would be great.”
“If there were clinical pathways that led somewhere, they could be useful. But there always needs to be the flexibility to not follow them directly.”
Targeting the ideal care pathway
 Initiating care This is my personal feeling that all these people from the home, your parent, adolescent, I think if their first contact was with an Aboriginal health worker, I think that they would feel better to do that.”
“I think a GP is a good point of contact for parents to raise concerns but I do think that the Aboriginal Health Workers can have a big impact on supporting the GP with regards to communication with the parents and the carers and I think ideally if you can have an Aboriginal Health Worker purely looking after—you know, social wellbeing of kids that would be a really good thing to have, which is something we don’t have in this service.”
 Guiding youth through care“We’re going back to the Aboriginal Health Worker. They play a pivotal role, or youth worker—they play the pivotal role between GP and parents and community, school. They’re going to be there and they’re going to be the ones that are going to answer all the questions in a way that the parents and the community’s going to understand and not be bamboozled by all these big words. They need to be included in the care plan. The health worker and your GP, youth worker—they’re very important people.”
“If they didn’t understand what they (the GP/specialist) were talking about I’d do it most times (sit in the appointment with the client). Because they (the client) would get in there and they just won’t say anything. They’ll just nod their head.”
“I am actually am working with an 18 year old at the moment, and her thing is that she wants to go to the appointments but she just doesn’t want to get up. So I’ll start ringing her, alright, get ready, we’ll go and grab some lunch and then we’ll go. Oh, I don’t really want to go. Come on, you know how good you feel after it. Like—do you know what I mean? So it’s just that. Sometimes with kids they don’t have that because mum has got three or four other kids needing things too. So yeah, that’s hard.”
Influencing the care pathway
 Adversities affecting access to care“The first thing I’d think of is transport as a barrier. I think of money. If they don’t have money to catch a bus they’re not going to get here. … Yeah and that’s where everything breaks down there.”
“I think it’s really hard. I’ve seen families here that have lots of issues. I can think of one family where there was a lot of stuff going on. I think they’ve been able to slightly pull through with a lot of support from services, a lot of support, but there’s other families— and I think they’re lost to the health system that hasn’t done the right thing by them.”
 Adapting the care pathway“I think if they had that contact with the Aboriginal Health Workers, it’s going to be less of a shock to the person, because the Aboriginal Health Workers, they’ll go and sit in with the consult or things like that. I’ve done it many times and my clients have said, oh thank you, because I wouldn’t have even gone. The Aboriginal Health Worker is the most valuable tool within the whole organisation, because they’re that first step for that person who’s in crisis.”
I’ve had a client that was on heroin, ice and marijuana. It took three years. Three years you know and it was just that ongoing, you can’t shut the door on them. You’ve got to have—every contact you have with that person, you have to look at them with hope, whether it may be like two years down the track and they’re still doing the same thing, that’s what adolescents do, they do the same thing whether you like it or not. Yeah, you’ve just got to keep working at it. Eventually, you’ll get there.”
“Too often the health system penalises people for going to the wrong entry point for the problem that they turn out to have, and I think that’s a problem. People should be able to go to where they feel is appropriate, and be navigated around the system by people who know what they’re doing. Their first port of call should be able to do some sort of assessment and say ah, I think the problem is in this area. Come and meet my friends here who are excellent, I’ll take you to them. That sort of atmosphere. Again, GPs, health workers, practice nurses are good at doing that, but if someone’s presenting to Emergency they’ll do that less well, but they ought to be doing that well.”
Assessing future need
 Appraising service availability“We need to have some sort of a CAMHS [Child and Adolescent Mental Health Service] team, even if it’s one worker, two days a week. We need that person to be able to come in and to be able to talk with the kids in a way that they’re going to feel comfortable and want to continue with treatment, or go to therapies. We need it, but it’s not available at this point. That’s my wish list. ”
“There’s a gap in paediatric mental health. It seems to be—if they’re more of the high teenagers and there’s headspace* that’s not a problem. You can go there. But that younger group, there really is a serious lack of where you can go.”
  • *Headspace centres are a network of enhanced primary care services where young people (12–25 years) with mild to moderate mental health problems can access a broad range of in-house services or be connected to complementary services within the community.