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Table 4 Common enablers and barriers to implementing culturally responsive activities reported by CEOs’ and managers’

From: Formative process evaluation of a guideline-driven process for improving the cultural responsiveness of alcohol and drug treatment services

Enablers

Description

Timing of project with service changes or setting up new programs

New services/programs or those undergoing internal changes (e.g. re-structuring, strategic planning, or developing/implementing Reconciliation Action Plans) were well positioned to implement changes to culturally responsive practice.

“The specific service that was being looked at is actually a new program for us and we’re still actually yet to officially start the program. So, it was very useful to actually have [the auditor] come in actually just before we actually commenced service delivery and actually look at where we are in terms of our … cultural intelligence and cultural competence … and where we’re at as a service, before we actually start commencing service delivery.” Manager, Service J

Interest in the project from multiple levels within services

Buy-in from CEOs/managers and direct service staff who attended project activities led to a productive environment which supported action around culturally responsive practice.

“I have made sure that staff was able to network, because there was a large networking component in terms of the seeking integration with the local [Aboriginal] services, really setting up those relationships. So basically, I ensured that both on the frontline level as well as core coordinator level such as myself that multiple levels of staff were involved with that initiative.” Manager, Service K

Resources/staff time available to progress activities

Staff had adequate time and funding with which to dedicate to activities supporting action around culturally responsive practice.

“I think it’s great to have somebody that’s dedicated to that work [cultural responsiveness] that could be doing it for us as well, because I think people just get caught up in the day-to-day and they get caught up in crisis, and those really, that work that requires time and for, and relationship building sometimes gets left aside unfortunately.” Manager, Service F

Barriers

Description

Limited access to funding and time to progress activities

Funding was not readily available to support specific activities (developing resources, community engagement) or for positions which focused on work around cultural practice (including clinical, community engagement and project roles, particularly of dedicated roles for Aboriginal staff). It was sometimes challenging to allocate staff time to complete project activities around busy existing workloads and competing service demands.

“I think identified positions are really important and we know we need more identified positions. Just finding the funding for that is the difficult part.” Manager, Service H

Challenges hiring Aboriginal staff or culturally responsive staff

Challenges hiring appropriately skilled staff to identified and non-identified positions, especially in rural/remote areas. Sometimes when roles were advertised, there were no Aboriginal staff applications for extended periods, or in other cases, applicants were over or under qualified. Sometimes managers decided not to hire people because they did have strong cultural skills, meaning that clinical positions took longer to fill.

“I’m always trying to get funding to get an identified Aboriginal worker. We advertise. We do advertise for frontline workers. We put in the advert that we really want Aboriginal people to apply and it’s open to Aboriginal people. We’ve put that in as a clause. Unfortunately, we’re not getting much.” Manager, Service I

The need to balance the needs of varied population groups

Services often had clients from multiple ethnic, cultural, and religious backgrounds, which required them to be responsive. This resulted in some services having a limited capacity to tailor specific workflows and processes to Aboriginal clients.

“I think for our organisation … we span over quite a diverse geography … so we actually have services on lots of different country. What we’re finding to be somewhat difficult is how do we as an organisation support cultural competency from an organisational level, to then actually pay respect to the nuances of the different communities that we’re in.” Manager, Service L

Difficulty adapting activities to different service delivery models

Services differed with respect to their delivery models, geographical locations, and organisational size, which meant that activities had to be adapted or in some cases, were not feasible for specific settings. Some larger state and national organisations had internal processes which required longer timeframes to implement activities, and in some instances, proposed activities were not feasible because of these processes/policies (e.g. including Aboriginal board members).

… the other activity that we’d planned was around trying to have a stronger connection with the local Aboriginal community. Again, that’s challenging I think … because all of our services are outreach services.” Manager, Service B

Limited time (3 months) to implement change

The timeframe was too short to show sustained change or implement activities, such as developing new relationships with Aboriginal representatives. The 3-month follow-up audit was useful because it motivated staff to continue working towards achieving their planned activities before the follow-up audit.

“I had to manage all the staff leave and annual holidays, Christmas itself, so even though we had three months, it really, when you shook it down, it was more like two months but it was broken up over, it was all very disjointed.” Manager, Service A

Varied skill level across staff

Some staff had extensive skills working with Aboriginal people, others required additional time to develop their skills and knowledge. Providing training to staff sometimes slowed down implementation.

“When you’re getting these things, you don’t know what you don’t know, so it’s really difficult. You know, they didn’t know about … Land Councils, they didn’t know about how to engage with elders, they didn’t know that you can get flags from the local federal minister, from their office. So, the little things that you know about, they didn’t know that there was a cycle of the Aboriginal model of the cycle of behaviour change. So, all those things that were sort of just bread and butter when you’re working in AMS [Aboriginal Medical Service], when you step over to mainstream, people have just not been exposed to it.” Manager, Service F