IWC's whole-of-person model of care - offering hope and transformation

Indigenous mum-of-four Susan (not her real name) arrived at IWC as her life hit rock bottom.

Recently released from jail, she headed for Bundaberg to seek out her children, who were living with foster carers.

Of the four, the only one she was allowed by Child Safety to visit was her eldest teenage daughter. Even special events for her younger children were off-limits to her.

Susan also was thrown into emotional turmoil as she hit brick wall after brick wall, being passed around by agencies and ending up living in a lonely motel room.

"None of them (the agencies) could really help me – that’s what I kept being told,” she said. "I’d been hearing that for seven or eight years, so I thought that was how it was.”

Feeling lost and out of control, Susan turned to Ice and alcohol – substance addictions she had battled prior to prison. Her life plummeted further.

But through her eldest daughter, who asked her mother to accompany her to IWC for a medical appointment, Susan came into contact with the IWC whole-of-person services that have put her on a pathway of hope.

"It’s been amazing,” said Susan. "Everyone here has been amazing.”

When Susan accompanied her eldest daughter to the IWC Health& Wellbeing Community Centre for a doctor’s appointment, she found an integrated care model that met all of her needs.

Susan met with a member of the Child and Family Support (CFS) team, and self-referred to the program.

From there, the IWC’s "smooth referrals” process kicked in, and team members from the CFS, Indigenous Engagement & Participation (IEP) and Alcohol and Other Drugs (AOD) programs were all able to work together for the client’s benefit, delivering a whole-of-person case management process which helped Susan get on track.

"Susan made it clear she was ready to change her life, and we were there to assist," said the CFS team.

The IEP team arranged housing, Centrelink and other welfare support, integrating Susan into the support networks in the Bundaberg region community.

"We were able to trouble-shoot for the client, liaising with the wide range of agencies she needed to connect with and making sure they all aligned to assist her,” said the IEP team. "We also got her into her own home, and ensured it was suitably furnished and equipped.

"This client’s situation around housing was further complicated by the fact that to undergo rehabilitation, she would have to leave the area for a period of six months. While we identified that it was vital that IWC assist the client into rehabilitation, it also was important that she had that home to come back to at the end of that period. We worked to ensure that happened.”

The AOD team worked to get Susan into rehabilitation – and was successful despite major challenges due to a lack of available places at suitable facilities.

"The client had a long history of substance abuse, and the pressures of the situation she was facing – no home, no access to three of her children, no prospects of employment – led her to fall back into the addiction to Ice, alcohol and a range of other drugs,” said the AOD program manager. "It was crucial that, once the client had decided to clean up her life, a full rehabilitation program was provided for her.”

IWC transported the client to the program, which had to be outside the region because there is no rehabilitation facility in Bundaberg.

Meanwhile, the CFS team worked with Susan around building her parenting skills, and liaised with Child Safety to help her get access to her other three children. She also has been receiving counselling from both the AOD and CFS program.

During this period, Susan also became a patient of the IWC’s health and wellbeing services, which include case management through an Indigenous Health Practitioner.

Today, Susan is in a six-month rehabilitation program, and receiving visits from IWC.

She has no doubt that life is on the up for her.

The IWC’s IEP and AOD programs have arranged for Susan to enter accredited job-related training through a local agency, with a pathway to work experience in a real-work environment.

She also will be able to access the IWC’s rolling drug and alcohol Relapse Prevention initiative.

As Susan left the IWC Health & Wellbeing Community Centre to start the journey to the rehabilitation facility, she was smiling and excited.

"It’s great,” she says. "I can see a future.”

As for the IWC … it is another example of how the whole-of-person model of care works to deliver successful and sustainable outcomes with a focus on Indigenous peoples, the vulnerable, disadvantaged and at-risk.

The CFS team said: "Susan told us that if not for the support of the whole IWC organisation, she would not be where she is now.”

The IEP team said: "We know there is always hope – that’s what IWC offers our clients, through an integrated care model that deals with all of the issues, including the underpinning ones. As an organisation, IWC is able to deliver a level and type of compassionate but practical care that problem-solves and creates lasting change for clients.”