The Fresh Tracks program at Wathaurong was one of seven programs that participated in an evaluation of case management and care coordination models in Victoria. The video highlights some of the key findings of the evaluation, applied in practice at the local community level.

CLARE: For the evaluation we spoke to lots of people, so we spoke to various practitioners at Wathourong, we spoke to external agencies, we spoke to clients. If you pull out one theme from all of them it is the fact that the Fresh Tracks program really works with each individual to meet their needs.

PAUL: We identified that within the community that there was a large group of men that needed to do behaviour change program and also address their mental health needs. We use an assertive outreach model of care coordination (of) case management, which means meeting the people in their own environment and helping them to identify their goals and hopefully navigate through the system. And I also use the Australian Indigenous Psychologists Association's principles of connectedness which means connecting to land, culture, community, kinship, ancestry, spirituality and physical wellbeing and mental wellbeing.

CLARE: Most people just need one or two sessions. And then there's a small group of people who have really complex needs, and really need a lot of support -- it could be over at least one or two years. Paul can go and see people at home, he can meet them out in the community, he can take them to Wurdi Yuang, go for a drive, go for a walk around the lake here. All of those sorts of options are available, but you know it really is driven I suppose by what's appropriate and what's needed by that client at that time.

PAUL: So we use a site called Wurdi Yuang which has significant cultural and ancestral properties. It's a really important site for helping Aboriginal people to heal.

CLARE: One of the really key aspects of Fresh Tracks is that it comes from a professional framework that's (offers) a professional understanding of case management and the purpose of case management. What's key here as well is that the program's placed within an organisation that's got really strong management support, so it's got the support of CEO's, the support of senior managers. Which is really important when you really require that level of trust from the organisation.

PAUL: I think one of the crucial things in regard to being supported to do the role is having professional supervision with an Aboriginal psychologist by the name of Graeme Gee. I can talk to him about the intricacies of working within an Aboriginal community and how that impacts on me and how I manage the stress and burden of the role and the challenges that I face.

CORMACH: So yeah I study at VACCHO (The Victorian Aboriginal Community Controlled Health Organisation) and they can give us all the tools and resources we need from working in the clinic to mental health to social and emotional wellbeing. From my experiences from when I work with my clients is just letting them know that I'm there and it's good for them to have someone from community so they can feel safe and comfortable. Me and Paul pretty much catch up once a day and just go through all our clients and make sure they are getting all their needs met and looked after properly. The biggest thing is following up the clients to make sure they are going to all their appointments and getting all the right services that they need -- pretty much just getting looked after properly.

DEAN: He changed my life, like if it wasn't for Paul, I'd be dead or in jail by now. Yeah Paul helped me get this employment. At the start when I first met Paul I didn't have the confidence to do anything like I wouldn't even go for a job interview let alone work. And Paul's slowly just helped me build up my confidence by taking me out and, you know, doing the fishing programs and just, you know, stuff like that and just hanging out with people. He's built my confidence up slowly and slowly. Yeah so he's helped me with that as well.. he's been great!

CLARE: On of the key messages that we found from talking to a range of clients is that they were in a much better place after having the support from Fresh Tracks.

DEAN: The best thing about it is feeling accepted. Just having, you know people to connect with like, that's the best thing out of I think.