Uptake of the Instructor Training Program
The inaugural 5-day AMHFA Instructor Training Course commenced on 5th March, 2007. By 1st November 2008, 199 Aboriginal Instructors had been trained in 17 Instructor Training Courses, which were held across the country. In addition, the AMHFA Training Program had run two 3-day training courses for non-Indigenous, previously accredited, MHFA Instructors. At the census date, there were 8 accredited non-Indigenous AMHFA Instructors.
Uptake of the 14-hour AMHFA courses
As of November 2008, 155 14-hour AMHFA courses had been run, with 1,115 people attending. The analyses presented here include the 14-hour courses that were run between June 25th 2007 and November 30th 2008. Of these 115 courses, 58 (50%) were presented in a co-facilitation format, where two or more Instructors shared the presenting, and 14 courses (12%) involved a co-facilitator who was a non-Aboriginal person. Four of those 14 courses involved a co-facilitator who had completed the 3-day AMHFA Instructor course, while the other 10 courses involved a co-facilitator who had completed the 5-day standard MHFA Instructor course only. There was one 14-hour AMHFA course that was presented by two non-Indigenous AMHFA accredited Instructors, with no Aboriginal Instructor present.
Predictors of conducting courses
The analyses of predictors of conducting a course included only the 165 Instructors who were trained between March 2007 and the end of August 2008. More recently trained Instructors had not had sufficient time to have prepared for and presented a 14-hour AMHFA course in their communities.
Of the 165 Instructors who were trained between March 2007 and August 2008, 67 (40%) had run one or more courses. The main factor associated with whether or not a course was taught was time since training. Figure 1 shows the percentage of Instructors who had run a course as a function of when their training took place. It can be seen that the percentage is quite high for those Instructors who attended the earliest Instructor Training Courses.
In order to assess if there were any characteristics of Instructors that may have predicted whether or not they presented a course, a series of logistic regression analyses was performed. The length of time Instructors had between completing their 5-day training and the census date was the most reliable predictor of whether or not an Instructor had run a course. For each week since the Instructor Training Course, the odds ratio was 1.04, P < 0.001.
A set of further analyses were performed, controlling for time since Instructor training, to see if any other variables could increase the likelihood that an Instructor would run a course. These further analyses found that the number of years of prior teaching or training experience significantly increased the likelihood of presenting a course (OR = 1.39, P = 0.017). The only other variable that predicted course presentation was whether or not an Instructor had had contact with a Trainer of Instructors (OR = 2.75, P = 0.007). In particular, having face-to-face contact with a Trainer was a strong predictor of course presentation (OR = 3.52, P = 0.001). All other predictors were non-significant, including whether the Instructor worked in a health-related role and the remoteness of where they worked.
While anecdotal evidence from Instructors during their contact with Trainers of Instructors suggested that the level of encouragement and support from their employing organisation was more likely to facilitate courses being conducted, the evaluation procedure was not able to directly quantify "organisational support", as it was a requirement of all organisations to provide a letter of support upon the Instructor's application to train. In order to overcome this difficulty, the type of employer (e.g. health, university, government) and the type of job the Instructor was employed in was evaluated (e.g. case manager, lecturer, community support officer). It was hypothesised that where Instructors were employed in positions that directly involved the delivery of AMHFA courses as part of their position description, such as Education Officer, they would be more likely to present a course. It is therefore interesting to note that neither type of employer nor position of employment reliably predicted the number of courses taught.
The set of predictors that were significant at the P < .10 level were next included in a simultaneous multiple logistic regression analysis. The only predictors which remained significant when all other predictors were adjusted for were time since training and the Instructor having had face-to-face post-training contact with one of the Trainers of Instructors.
Qualitative findings
Eight focus groups were held in locations across Australia, with a total of 56 participants: 34 Instructors and 22 course participants. Instructors were asked to comment on their perceptions of both the Instructor Training Course, as well as the structure and materials of the AMHFA course they were to present in their communities. Course participants were asked to comment on how they found the course, the information presented, and how confident they felt about providing mental health first aid to an Aboriginal or Torres Strait Islander person. In addition, individual interviews were conducted with AMHFA staff to evaluate staff attitudes towards the program.
The overwhelming response from all Trainers of Instructors, Instructors and 14-hour course participants was that the 5-day Instructor Training Course and 14-hour AMHFA course are culturally appropriate, empowering for Indigenous people, and provided information that was seen as highly relevant and important in assisting Aboriginal people with a mental illness.
A number of suggestions for changing the course were put forward consistently:
1. The qualitative data supported the idea of spreading the Instructor training over more days with a break in between. One suggested way of implementing this idea was to require Instructors to do the 14-hour AMHFA course first before applying to become an Instructor. This would give potential Instructors a clearer idea of what an Instructor is expected to do. If there was a gap between the 14-hour course and the Instructor training week, it would also allow more time for them to absorb the material and space out the learning of the large amount of information that Instructors are presented with.
2. There was widespread support for the cultural appropriateness of the training approach and the training materials. Nevertheless, some areas were identified as needing strengthening. A particular need is more adaptations of the materials to suit less literate course participants and those who learn by doing rather than by reading. While the AMHFA workbook was developed with this in mind, it is evident that it has not met this need. One idea put forward was for a pictorial flip-chart. There were also suggestions for greater use of role playing. Other areas for improvement that were suggested were developing DVDs involving Aboriginal people, incorporating more Aboriginal statistics and incorporating more local information on services etc. The issue of DVDs has already been covered by the development of AMHFA films involving Aboriginal people, which were released in late 2008, after the census date.
3. Instructors mentioned that they needed post-training support initially to give them confidence to begin and that there were sometimes workplace barriers that had to be overcome. They also reported the need to debrief and to seek specific advice on issues that arose following teaching a course.