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Allan J, Snowdon N, Thapa S, Ahmed KY. Study protocol for the family empowerment program: a randomized waitlist-controlled trial to evaluate the effectiveness of online Community Reinforcement and Family Training (CRAFT) on the wellbeing of family members with a relative experiencing substance dependence and mental illness. BMC Psychiatry 2024; 24:43. [PMID: 38200508 PMCID: PMC10782775 DOI: 10.1186/s12888-023-05487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Systematic reviews consistently show that family-focused interventions are effective at improving substance treatment engagement and outcomes across the lifespan. Yet, Australian substance use treatment services rarely incorporate family members and concerned significant others. Testing of family focussed interventions in the Australian context is required. METHODS The trial is a randomized wait-list control trial assessing the effectiveness, feasibility and acceptability of online CRAFT with a parallel group. Participants will be randomised to receive either online CRAFT or to a wait-list control group who are provided with CRAFT related reading material during the waiting period. Outcomes will be assessed at baseline and then at 6- and 15-weeks post baseline. The primary outcome will be improved wellbeing of participating family members. The trial reporting will comply with SPIRIT guidelines. DISCUSSION This study will focus on people living in rural areas. Substance treatment programs are limited in rural Australia. The provision of the Family Empowerment Program (CRAFT) online should make family focused substance treatment support accessible and attainable for the first time in rural areas. The outcomes of this trial could have meaningful implications for the future funding and support of family focused substance treatment services that are inclusive of people with mental health conditions. TRIAL REGISTRATION ANZCTR, ACTRN12623000796684p, Registered 26 July 2023. Prospectively registered with protocol version 3.
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Affiliation(s)
- Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia.
| | - Nicole Snowdon
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia
| | - Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia
| | - Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Leeds Parade, Orange, NSW, 2800, Australia
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2
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Magin P, Paulson A, O'Brien C, Patsan I, Fielding A, van Driel M, Klein L. Educational models, participant experience and outcomes of a diploma course in practice management for Aboriginal Medical Services: a qualitative study. Aust J Prim Health 2023; 29:349-357. [PMID: 36482758 DOI: 10.1071/py22202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/10/2022] [Indexed: 08/15/2023]
Abstract
BACKGROUND Practice managers and other administrative and management staff in Aboriginal Medical Services operate in a highly specialised cultural, social and administrative environment requiring a unique skill set. The TAFE NSW Diploma in Practice Management for Aboriginal Medical Services (DPMAMS) addresses the need for training in these skills. This study sought to explore DPMAMS graduates' experiences of having undertaken the diploma course, and the effects on their subsequent work practice and career. METHODS A qualitative study utilising individual, semi-structured interviews conducted via videoconference and employing a thematic analysis approach was performed. RESULTS Ten DPMAMS alumni participated. At the time of DPMAMS completion, two participants were Aboriginal Medical Services practice managers, two were reception staff, five were in non-practice manager administrative or management roles and one was in a clinical role. Principal themes in the study findings were related to (1) the rich and singular learning environment with emphasis on peer-to-peer learning (which also facilitated 'communities of practice' extending the collaborative learning model to post-DMAMS peer learning and support); (2) knowledge and subsequent professional and personal confidence (leading to taking on increased workplace responsibility including post-DPMAMS mentoring roles); (3) translational effects on personal work and professional performance; (4) translational effects on work processes at the participants' Aboriginal Medical Services; and (5) the permeating influence of Aboriginal culture and commitment to Aboriginal communities. CONCLUSIONS The DPMAMS is an education/training program of perceived high value and fitness for purpose. The findings of utility of education that is empowered by culture, values and peer support may be applicable in wider settings.
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Affiliation(s)
- Parker Magin
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2380, Australia; and GP Synergy, Regional Training Organisation (RTO), NSW and ACT Research and Evaluation Unit, Level 1, 20 Mclntosh Drive, Mayfield West, NSW 2304, Australia
| | - Anthony Paulson
- GP Synergy, Regional Training Organisation (RTO), Aboriginal and Torres Strait Islander Cultural Education Unit, Level 1, 20 Mclntosh Drive, Mayfield West, NSW 2304, Australia
| | - Christopher O'Brien
- GP Synergy, Regional Training Organisation (RTO), Aboriginal and Torres Strait Islander Cultural Education Unit, Level 1, 20 Mclntosh Drive, Mayfield West, NSW 2304, Australia
| | - Irena Patsan
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2380, Australia; and GP Synergy, Regional Training Organisation (RTO), NSW and ACT Research and Evaluation Unit, Level 1, 20 Mclntosh Drive, Mayfield West, NSW 2304, Australia
| | - Alison Fielding
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2380, Australia; and GP Synergy, Regional Training Organisation (RTO), NSW and ACT Research and Evaluation Unit, Level 1, 20 Mclntosh Drive, Mayfield West, NSW 2304, Australia
| | - Mieke van Driel
- University of Queensland, General Practice Clinical Unit, Faculty of Medicine, Level 8, Health Science Building, Royal Brisbane and Women's Hospital, Brisbane, Qld 4029, Australia
| | - Linda Klein
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2380, Australia; and GP Synergy, Regional Training Organisation (RTO), NSW and ACT Research and Evaluation Unit, Level 1, 20 Mclntosh Drive, Mayfield West, NSW 2304, Australia
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3
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Rudzinski K, O'Leary W, Perri M, Guimond T, Guta A, Chan Carusone S, Strike C. Community reinforcement approach (CRA) supported with structured recreation therapy: Experiences of people living with HIV in a pilot substance use treatment program at a specialty hospital. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 147:208974. [PMID: 36804349 DOI: 10.1016/j.josat.2023.208974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Community reinforcement approach (CRA) is a behavioral intervention that has demonstrated favorable treatment outcomes for individuals with substance use disorders across studies. CRA focuses on abstinence; however, abstinence is not a desired goal among all people who use substances. Previous research has called for harm reduction-oriented treatment programs, especially within hospital settings. We examined the feasibility of a pilot CRA program, "Exploring My Substance Use" (EMSU), that integrates a harm-reduction perspective with structured recreation therapy at a specialty HIV hospital in Toronto, Canada. METHODS The 12-week EMSU program was delivered alongside a feasibility study that ran for 24 weeks (including an additional 12 weeks after program completion). We recruited hospital in/outpatients with moderate to severe substance use disorder to participate in the program and study. The EMSU program combined weekly substance use groups with weekly recreation therapy sessions. We collected data at five timepoints throughout the study; this article focuses on qualitative data from the final (24-week) interviews, which examine participants' experiences of the program-an under-researched element in CRA literature. We conducted thematic analysis in NVivo12 and descriptive statistics in SPSSv28. RESULTS Of the n = 12 participants enrolled in the EMSU program, six completed the 12-week intervention. All participants completed the 24-week study interview. The average age of participants was 41.5 years; eight identified as cis-male; most identified as white, experienced food insecurity, and were unstably housed. All participants valued the program, including opportunities to learn new skills and examine function(s) of their substance use, and would enroll if it were offered again. Participants discussed the benefits of leisure activities introduced through recreation therapy, which fostered social connections and provided inspiration/confidence to try new activities. Participants cited a lack of support for those experiencing health/personal challenges and overly strict program attendance rules. To improve the program, participants suggested more tactile activities and incorporating incentives. CONCLUSIONS Our findings support the feasibility of a CRA-based program with an integrated harm reduction and a recreation therapy component within an outpatient setting. Future programs should consider building in more flexibility and increased supports for clients dealing with complexities as well as consider COVID-19 related contingencies.
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Affiliation(s)
- Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St 5th floor, Toronto, ON M5T 3M7, Canada.
| | | | - Melissa Perri
- Dalla Lana School of Public Health, University of Toronto, 155 College St 5th floor, Toronto, ON M5T 3M7, Canada.
| | - Tim Guimond
- Department of Psychiatry, University of Toronto, 250 College St 8th floor, Toronto, ON M5T 1R8, Canada.
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry St, Windsor, ON N9A 0C5, Canada.
| | | | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St 5th floor, Toronto, ON M5T 3M7, Canada.
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4
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Gendera S, Treloar C, Reilly R, Conigrave KM, Butt J, Roe Y, Ward J. 'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs. Drug Alcohol Rev 2022; 41:1428-1439. [PMID: 35639622 PMCID: PMC9546040 DOI: 10.1111/dar.13481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022]
Abstract
Introduction First Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood. Methods We conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms. Results Findings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing. Discussion and Conclusions First Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.
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Affiliation(s)
- Sandra Gendera
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health and Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rachel Reilly
- Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Katherine M Conigrave
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Julia Butt
- National Drug Research Institute, Curtin University, Perth, Australia.,Psychology and Criminology, School of Arts and Humanities, Edith Cowan University, Perth, Australia
| | - Yvette Roe
- College of Nursing & Midwifery, Charles Darwin University, Brisbane, Australia
| | - James Ward
- Poche Centre for Indigenous Health, School of Public Health, The University of Queensland, Brisbane, Australia
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5
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Finlay-Jones A, Symons M, Tsang W, Mullan R, Jones H, McKenzie A, Reibel, Cannon L, Birda B, Reynolds N, Sargent P, Gailes H, Mayers D, Elliott EJ, Bower C. Community Priority setting for Fetal Alcohol Spectrum Disorder Research in Australia. Int J Popul Data Sci 2020; 5:1359. [PMID: 34036178 PMCID: PMC8130797 DOI: 10.23889/ijpds.v5i1.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). FASD research is a rapidly growing field that crosses multiple disciplines. To ensure research is relevant and meaningful for people living with FASD, their families, and the broader public there is a need to engage community members in setting priorities for research. Objectives Our primary objective was to formally identify the views of people living with FASD, their parents/caregivers, service providers, and the general community on the research priorities for FASD and alcohol use in pregnancy in Australia. Our secondary objective was to provide an overview of current research in the highest priority areas identified. Methods The approach for this study involved two community surveys and a consensus workshop, followed by a rapid literature review. Survey responses (n = 146) were collected and grouped using qualitative thematic analysis. The themes identified were then ranked in a second survey (n = 45). The 22 highest ranked themes were considered in a workshop with 21 community members, and consensus on the top ten priority areas was sought. The priority areas were grouped into conceptually similar topics and rapid literature reviews were undertaken on each. Results A diverse range of priorities was identified within key areas of prevention, diagnosis, and therapy. On request from participants, separate priority lists were developed by Aboriginal and non-Aboriginal participants. Conclusion There is need for a national network of researchers to take forward the research commenced by the Centre of Research Excellence, FASD Research Australia, in addressing community priorities. Key Words Community, priorities, FASD, rapid review, Australia.
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Affiliation(s)
- A Finlay-Jones
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - M Symons
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - R Mullan
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - H Jones
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | - A McKenzie
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Reibel
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - L Cannon
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
| | | | | | | | | | | | - E J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - C Bower
- Telethon Kids Institute, NHMRC FASD Research Australia Centre of Research Excellence, Nedlands, Western Australia, Australia
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6
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Purcell-Khodr GC, Lee KSK, Conigrave JH, Webster E, Conigrave KM. What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada. Addict Sci Clin Pract 2020; 15:31. [PMID: 32811549 PMCID: PMC7437002 DOI: 10.1186/s13722-020-00204-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background First Nations peoples of Australia, New Zealand, the United States of America (USA) and Canada are more likely to be non-drinkers than other people in these countries. However, those who do drink may be at greater risk of alcohol-related harms (at a population level) due to the ongoing impacts from colonisation and associated oppression. Addressing unhealthy drinking (drinking above recommended limits including alcohol use disorders) in primary care settings is one important way to increase accessibility of treatment. Methods This systematic review identifies peer-reviewed studies of alcohol treatments delivered in primary care or other non-residential settings for First Nations peoples of Australia, New Zealand, USA and Canada. Literature searches were conducted in seven academic databases from their inception until March, 2020. We assessed evidence of treatment or implementation effectiveness, perceived acceptability or accessibility, and the study quality as assessed by the AXIS tool and by a measure of community participation in the research process. Results Twenty-eight studies were included, published between 1968 and 2018. Studies reported on a range of alcohol treatments, from brief intervention to ambulatory withdrawal management, relapse prevention medicines, and cultural therapies. Brief intervention was the most studied approach. Cultural healing practices and bicultural approaches were a key theme amongst several studies. Four studies measured treatment effectiveness, including one randomised controlled trial (naltrexone vs naltrexone plus sertraline vs placebo) and two uncontrolled trials of disulfiram. Of the six implementation studies, three were (hybrid) effectiveness-implementation designs. Most of the remaining studies (n = 21) focused on treatment accessibility or acceptability. Community participation in the research process was poorly reported in most studies. Conclusions Research evidence on how best to care for First Nations peoples with unhealthy alcohol use is limited. Trials of naltrexone and disulfiram presented promising results. Cultural and bicultural care were perceived as highly important to clinical staff and clients in several studies. More effectiveness studies on the full scope of alcohol treatments are needed. Greater community participation in research and more transparent reporting of this in study methods will be key to producing quality research that combines scientific rigour with cultural appropriateness.
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Affiliation(s)
- Gemma C Purcell-Khodr
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.,Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - James H Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia
| | - Emma Webster
- Faculty of Medicine and Health, School of Rural Health, The University of Sydney, Dubbo, NSW, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine; NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Camperdown, NSW, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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7
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Calabria B, Shakeshaft AP, Clifford A, Stone C, Clare PJ, Allan J, Bliss D. Reducing drug and alcohol use and improving well‐being for Indigenous and non‐Indigenous Australians using the Community Reinforcement Approach: A feasibility and acceptability study. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2019; 55 Suppl 1:88-95. [DOI: 10.1002/ijop.12603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/13/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Bianca Calabria
- Centre for Mental Health Research, Research School of Population Health Australian National University Acton ACT Australia
- Research School of Psychology Australian National University Acton ACT Australia
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | | | - Anton Clifford
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | - Chiara Stone
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | - Philip J. Clare
- National Drug and Alcohol Research Centre UNSW Australia Sydney NSW Australia
| | | | - Donna Bliss
- Yoorana Gunya Family Healing Centre Forbes NSW Australia
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8
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Geia L, Broadfield K, Grainger D, Day A, Watkin-Lui F. Adolescent and young adult substance use in Australian Indigenous communities: a systematic review of demand control program outcomes. Aust N Z J Public Health 2018; 42:254-261. [PMID: 29697886 DOI: 10.1111/1753-6405.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/01/2018] [Accepted: 03/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Identifying preventative approaches to substance use in Indigenous communities is the foundation for developing evidence-based responses. This study reports the findings of a systematic review of the published literature evaluating the impact of substance use programs on Australian Indigenous youth. METHODS Evidence about the impact of substance use programs for Indigenous young people was identified from a systematic review of the literature conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS Only four original studies that met the inclusion criteria were identified, although a further 19 papers that described characteristics of programs that may be associated with improved outcomes were reviewed. CONCLUSIONS Evidence relevant to the outcomes of demand control programs that target Australian Indigenous youth substance use is both weak and inconsistent. There is a need to support the type of evaluation activity required to better understand program effectiveness and build the Indigenous knowledge base. Implications for public health: These findings are discussed in relation to the development of evidence-based practice and the type of knowledge that is likely to be of most use to those seeking to address problems associated with youth substance use.
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Affiliation(s)
- Lynore Geia
- Indigenous Education and Research Centre, James Cook University, Queensland
| | - Kirstie Broadfield
- Indigenous Education and Research Centre, James Cook University, Queensland
| | - Daniel Grainger
- Indigenous Education and Research Centre, James Cook University, Queensland
| | - Andrew Day
- Indigenous Education and Research Centre, James Cook University, Queensland
| | - Felecia Watkin-Lui
- Indigenous Education and Research Centre, James Cook University, Queensland
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9
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Munro A, Shakeshaft A, Breen C, Clare P, Allan J, Henderson N. Understanding remote Aboriginal drug and alcohol residential rehabilitation clients: Who attends, who leaves and who stays? Drug Alcohol Rev 2018; 37 Suppl 1:S404-S414. [PMID: 29349855 PMCID: PMC5969080 DOI: 10.1111/dar.12656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/18/2017] [Accepted: 12/10/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS Aboriginal residential rehabilitation services provide healing for Aboriginal people who misuse substances. There is limited available research that empirically describes client characteristics of these services. This study examined 5 years of data of a remote Aboriginal residential rehabilitation service. DESIGN AND METHODS Retrospective analysis of 329 client admissions to Orana Haven Drug and Alcohol Rehabilitation Centre from 2011 to 2016. Multinomial and binary logistic regressions were conducted to identify trends in the data. RESULTS There were 66 admissions recorded annually, of which most identified as Aboriginal (85%). Mean length of stay was 56 days, with one in three (36%) discharging within the first month. A third (32%) completed, 47% self-discharged and 20% house-discharged from the program. Client age significantly increased over time (P = 0.03), with most aged from 26 to 35. Older clients were significantly more likely to readmit (P < 0.002) and stay longer than 90 days (P = 0.02). Most clients were referred from the criminal justice system, significantly increasing from 79% (2011-2012) to 96% (2015-2016) (P < 0.001) and these clients were more likely to self-discharge (P < 0.01). Among a subset of clients, most (69%) reported concerns with polysubstance use and half (51%) reported mental illness. DISCUSSION AND CONCLUSIONS The current study makes a unique contribution to the literature by empirically describing the characteristics of clients of a remote Aboriginal residential rehabilitation service to more accurately tailor the service to the client's needs. Key recommendations include integrating these empirical observations with staff and client perceptions to co-design a model of care, standardise data collection, and routinely following-up clients to monitor treatment effectiveness.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Courtney Breen
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | - Philip Clare
- National Drug and Alcohol Research CentreUniversity of New South WalesSydneyAustralia
| | | | - Norm Henderson
- Orana Haven Drug and Alcohol Rehabilitation CentreGongolgonAustralia
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10
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Munro A, Allan J, Shakeshaft A, Breen C. "I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service. Subst Abuse Treat Prev Policy 2017; 12:49. [PMID: 29208008 PMCID: PMC5718008 DOI: 10.1186/s13011-017-0135-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff. METHODS This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program. RESULTS A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process. CONCLUSION This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
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11
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Knight A, Havard A, Shakeshaft A, Maple M, Snijder M, Shakeshaft B. The Feasibility of Embedding Data Collection into the Routine Service Delivery of a Multi-Component Program for High-Risk Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020208. [PMID: 28230751 PMCID: PMC5334762 DOI: 10.3390/ijerph14020208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
Background: There is little evidence about how to improve outcomes for high-risk young people, of whom Indigenous young people are disproportionately represented, due to few evaluation studies of interventions. One way to increase the evidence is to have researchers and service providers collaborate to embed evaluation into the routine delivery of services, so program delivery and evaluation occur simultaneously. This study aims to demonstrate the feasibility of integrating best-evidence measures into the routine data collection processes of a service for high-risk young people, and identify the number and nature of risk factors experienced by participants. Methods: The youth service is a rural based NGO comprised of multiple program components: (i) engagement activities; (ii) case management; (iii) diversionary activities; (iv) personal development; and (v) learning and skills. A best-evidence assessment tool was developed by staff and researchers and embedded into the service’s existing intake procedure. Assessment items were organised into demographic characteristics and four domains of risk: education and employment; health and wellbeing; substance use; and crime. Descriptive data are presented and summary risk variables were created for each domain of risk. A count of these summary variables represented the number of co-occurring risks experienced by each participant. The feasibility of this process was determined by the proportion of participants who completed the intake assessment and provided research consent. Results: This study shows 85% of participants completed the assessment tool demonstrating that data on participant risk factors can feasibly be collected by embedding a best-evidence assessment tool into the routine data collection processes of a service. The most prevalent risk factors were school absence, unemployment, suicide ideation, mental distress, substance use, low levels of physical activity, low health service utilisation, and involvement in crime or with the juvenile justice system. All but one participant experienced at least two co-occurring domains of risk, and the majority of participants (58%) experienced co-occurring risk across four domains. Conclusions: This is the first study to demonstrate that best-evidence measures can feasibly be embedded into the routine data collection processes of a service for high-risk young people. This process allows services to tailor their activities to the most prevalent risks experienced by participants, and monitor these risks over time. Replication of this process in other services would improve the quality of services, facilitate more high quality evaluations of services, and contribute evidence on how to improve outcomes for high-risk young people.
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Affiliation(s)
- Alice Knight
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, NSW 2052, Australia.
| | - Alys Havard
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, NSW 2052, Australia.
- Centre for Big Data Research in Health, University of New South Wales, Randwick, NSW 2052, Australia.
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, NSW 2052, Australia.
| | - Myfanwy Maple
- School of Health, University of New England, Armidale, NSW 2351, Australia.
| | - Mieke Snijder
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Randwick, NSW 2052, Australia.
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Fitts MS, Palk GR. 'Hero to Healing' drink-driving program for Indigenous communities in Far North Queensland. Health Promot J Austr 2017; 27:74-79. [PMID: 26857181 DOI: 10.1071/he15069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/14/2015] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Alcohol-related road crashes are a leading cause of the injury burden experienced by Indigenous Australians. Existing drink driving programs are primarily designed for the mainstream population. The 'Hero to Healing' program was specifically developed with Indigenous communities and is underpinned by the Community Reinforcement Approach (CRA). This paper reports on the formative evaluation of the program from delivery in two Far North Queensland communities. Methods Focus groups and semistructured interviews were conducted with drink driver participants (n=17) and other Elders and community members (n=8) after each program. Qualitative content analysis was used to categorise the transcripts. Results The CRA appealed to participants because of its flexible nature and encouragement of rearranging lifestyle factors, without specific focus on alcohol use. Participants readily identified with the social and peer-related risk and protective factors discussed. Cofacilitation of the program with Elders was identified as a key aspect of the program. More in-depth discussion about cannabis and driving, anger management skills and relationship issues are recommended. Conclusions Participants' recognition of content reinforced earlier project results, particularly the use of kinship pressure to motivate younger family members to drink drive. Study findings suggest that the principles of the CRA are useful; however, some amendments to the CRA components and program content were necessary. So what? Treating drink driving in regional and remote Indigenous Australian communities as a community and social issue, rather than an individual phenomenon, is likely to lead to a reduction in the number of road-related injuries Indigenous people experience.
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Affiliation(s)
- Michelle S Fitts
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Queensland University of Technology, Kelvin Grove, Level 4, K-Block, 130 Victoria Park Road, Qld 4059, Australia
| | - Gavan R Palk
- Centre for Accident Research and Road Safety - Queensland (CARRS-Q), Queensland University of Technology, Kelvin Grove, Level 4, K-Block, 130 Victoria Park Road, Qld 4059, Australia
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