School of Public Health and Community Medicine

Transcription

1 The acceptability of a family based alcohol intervention to Indigenous clients of a rural Aboriginal Community Controlled Health Service and Drug and Alcohol treatment agency. Bianca Calabria, Anton Clifford, Anthony P Shakeshaft, Christopher M Doran, Julaine Allan, Miranda Rose, Komla Tsey, Rod MacQueen. School of Public Health and Community Medicine

2 Aims This presentation will: 1. Describe the rationale for and process of developing a survey to examine rural Aboriginal Australians perceptions of the acceptability of a family-based alcohol program; and 2. Describe the demographics and perceived levels of acceptability among Aboriginal survey participants.

3 Alcohol harms 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Current drinkers Low risk Hazardous Harmful Rates of harms (Calabria et al., 2010): Indigenous 3 x higher than general population; and Indigenous 7 x higher than general population. Positive interaction with family members has been indicated as the most important aspect for behavioural change in Indigenous Australians (Nagel and Thompson, 2010). urban ATSI population* urban general population** *1994 National Drug Strategy Household Survey: Urban Aboriginal and Torres Strait Islander Peoples Supplement. **1993 National Drug Strategy Household Survey. The CRA and CRAFT programs have been identified as having the greatest potential to be tailored for Indigenous people (Calabria, et al., under review ).

4 Intervention programs CRA CRAFT For problem drinkers. One-on-one counselling to reduce alcohol-related harms experienced by the drinker, their family and their community. Using social, occupational and community positive reinforcers. Support to cut down or stop drinking alcohol. For family members or friends of problem drinkers. One-on-one counselling to reduce alcoholrelated harms experienced by the drinker, their family and their community. Increase own personal safety and wellbeing. Remove positive reinforcement for drinking behaviour and increase positive reinforcement for non-drinking behaviour.

5 Method Survey development Consultation with health service staff, drug and alcohol researchers and Indigenous researchers. Sample recruitment Drug and alcohol rehabilitation and withdrawal service, Orange, NSW ACCHS, Forbes, NSW Procedure Self-complete survey Group discussion Data analysis

6 Sample Sample size (n) 116 Gender (%) Male Female Not specified 48% 51% 1% Age (years) Range Mean years 39 years Work (%) Don t work Full time Part time Casual Not specified 49% 20% 14% 7% 10% AUDIT score (%) Non-drinker Drinks within recommended limits At-risk drinker High-risk drinker Not specified Family member who drinks too much alcohol? Yes No Not specified 12% 28% 10% 40% 10% 72% 23% 5% Non drinker Recommended limits No At risk drinker Yes High risk drinker

7 Community Reinforcement Approach (CRA) Overall acceptability rated on a 5 point scale (1=very bad, 5=very good): Score of 5 (82%) Score of 4 (13%) Most acceptable for delivery after withdrawal (87%). Counsellor characteristics (% endorsed): Someone I know and trust (66%) Experience working in local community (69%) Aboriginal person/doesn t matter (52%/45%) Gender doesn t matter (60%) Five or more session for detailed information (43%). Less acceptable to talk about alcohol harms caused by the drinker and things making them want to drink.

8 Community Reinforcement and Family Training (CRAFT) Overall acceptability rated on a 5 point scale (1=very bad, 5=very good): Score of 5 (71%) Score of 4 (17%) Most acceptable for delivery with those who want to help a relative/friend start alcohol treatment (90%). Counsellor characteristics (% endorsed): Someone I know and trust (58%) Experience working in local community (66%) Aboriginal person/doesn t matter (51%/46%) Gender doesn t matter (62%) Five or more session for detailed information (46%). Consistently high endorsements for CRAFT session topics: helping a relative to continue to drink less, setting boundaries and learning to help the community stay strong.

9 Ranking CRA CRAFT 100% 100% 90% 80% 70% 60% 50% Practicing how to resolve alcohol related problems Learning how to reslove alcohol related problems 90% 80% 70% 60% 50% Practicing how to support your family member/friend to cut down or stop drinking Learning how to support your family member/friend to cut down or stop drinking 40% 30% 20% 10% Setting goals to reduce alcohol related harms Talking about your drinking behaviour 40% 30% 20% 10% Learning how to communicate with your family member/friend about his/her drinking Talking about your family member's/friend's drinking 0% 0%

10 Qualitative data Follow-up support Follow up support or ongoing (CRA) I think there should be a few follow ups to see how people are coping (CRAFT) Young people There needs to be a program for under 18's as well (CRA) Needs to also be something available for the younger ones in the family as well...a referral system for the younger ones (CRAFT)

11 Recommendations Overall, the CRA and CRAFT programs were acceptable for delivery in routine healthcare. Intervention therapists should be known and trusted by the clients and have experience working in the local community. Detailed session should be provided, rather than brief intervention. Care should be taken when discussing alcohol-related harms with problem drinkers. Talking about alcohol-related problems and learning skills should be the focus of sessions.

12 Bianca Calabria National Drug and Alcohol Research Centre Painting by Michael J Connolly Munda-gutta Kulliwari, Dreamtime Kullilla-Art