Matua Raḵi August 2016 newsletter

Mirror HQ in Dunedin is one of two New Zealand exemplar services developed under the Prime Minister’s Youth Mental Health and Addiction programme. Exemplar services are designed to be youth and CEP (co-existing problems) focused, making it easier for young people living with mental health, alcohol and drug issues to get the help they need. Mirror HQ is available for 12 to 22 year-olds who self-refer or are referred by a professional. 

As a development requirement, the Ministry of Health commissioned an evaluation of Mirror HQ to assess how it is being delivered against its service design. This took place in October 2015 and involved 39 qualitative interviews with providers, health and social services, community stakeholders, and young people and their families/whānau. Documentation and policies were also reviewed, and anonymous data from Mirror HQ and PRIMHD were analysed.

Mirror HQ director Deb Fraser says she’s really pleased the service has had its first evaluation.

“It’s great that the Ministry has done what it proposed, and this has helped us understand whether we’re on track and whether we’re making a difference in our own area and to the youth AOD sector as a whole.”

The evaluation assessed Mirror HQ across four broad areas of best practice: youth friendliness, evidence-based interventions, collaboration and integration, and workforce development. Rating levels were: strong alignment, some alignment, weak alignment or no alignment. It was acknowledged that it would be unrealistic to expect Mirror HQ to receive strong ratings against all design features as it is only 18 months into its implementation.

In fact, Mirror HQ received a strong alignment rating for youth friendliness, with young people found to be very much at the centre, including having representation on the policy and management committees. Mirror HQ displayed “a depth of understanding of young people’s AOD and mental health needs relevant to their developmental age”. More young people are accessing the service including “Māori young people and whānau with intergenerational substance abuse issues.”

A strong alignment rating was also given for Mirror HQ’s broad range of evidence-based interventions. The focus was found to be very deliberately on developing a CEP service to meet service users’ wide ranging, complex and inter-related needs.

“We’ve been very deliberate about the CEP focus of the new service,” says Deb.

“It’s really important every one of our clinicians takes a CEP approach. And what’s interesting is that we’re seeing other services starting to shape themselves from what we’re doing; their language is changing and we’re seeing attempts at changing practice.”

Mirror HQ received a some strong alignment rating for collaboration and integration. The evaluation noted it had systematically engaged with other youth AOD primary care services. Following initial concerns “relationships have been rebuilt and there is evidence of both collaboration and integrated service delivery”.

Deb clarifies why there were some initial concerns at first.

“This was a new contract coming into the district at a time when money was tight, so it was hard for the community to get settled. But we kept saying this was not centred on us, but on what young people need, and that this was a chance to do things differently. I think once people got on board with that all the concerns dropped away.”

A strong alignment rating was received for workforce development with the evaluation noting that Mirror HQ is contributing both internally and externally to systematically building a CEP workforce. Ongoing training and cultural supervision are provided and Mirror HQ has “successfully mentored other agencies to enable better outcomes for young people and whānau.”

Perhaps most importantly, the evaluation says Mirror HQ has made a significant contribution to sector development at a national level.

“I think it’s our willingness to be widely involved that has helped us share our journey,” Deb says.

“We’ve contributed to national advisory committees, presented at forums and helped other DHBs with their youth CEP service development. We’ve had a lot of phone and email contact and shared quite a few documents. We’ve been discussing our experiences and what we think is working. We really hope we can continue this, but we acknowledge we’re not the only contributors to this national discussion.”

Deb says the service is looking pretty much as was intended at this stage so she’s pleased but not completely surprised at how well the evaluation went. 

“I expect we would know by now if we weren’t doing a good job and we would know what we need to do, but it really helps to have an independent and external confirmation that things are truly on track.”

Deb acknowledges there are still some things to work on – such as how to support rural services more consistently because they’re the ones that feel it the most in terms of what’s available.

“There are always communities we need to engage with better such as the Pacific community and I think we’re still working out what the client contact ratio needs to be. We want to be well-planned, where every intervention has an intention, so we’ve really built that into our culture. I think that’s what made a difference – building the culture from the ground up, making sure people know what they want in terms of their workplace and how things work.”

Deb thinks another thing that has really helped has been a willingness to go the extra mile to see what’s happening elsewhere. 

“I was recently in Los Angeles for a conference, for example, and I was able to see what youth services are doing there."

"Seeing how other services are running can give us a better idea of how we are doing, and can provide opportunities for us to learn and develop.”

Read the executive summary of the Mirror HQ evaluation.

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