alice munro, anthony shakeshaft, julaine allan, …...“nothing changes if nothing changes:”...
TRANSCRIPT
“Nothing changes if nothing changes:” Evaluation of a remote Aboriginal Australian residential rehabilitation service
Alice Munro, Anthony Shakeshaft, Julaine Allan, Alan Bennett, Courtney Breen
2
We would like to recognise and pay respects to the Aboriginal and Torres
Strait Islanders as Australia’s first people, and specifically to the
Yirrganydji people as the original owners of the land on which we are
meeting today
3
• Approximately 140 staff
• Officially opened in 1987 – 30 year anniversary
• Recognised internationally as a Research Centre of Excellence
• Graduated over 30 Doctoral students
• Academics supported by a large group of professional staff (e.g. statisticians, librarians, research assistants etc.)
• NDARC’s current Strategic Plan aims to increase engagement with Indigenous research AND work specifically with rural populations - we are trying to build partnerships and learn from rural Aboriginal communities
About NDARC
4
Focus effort on evaluating program effectiveness Indigenous D&A research (Clifford & Shakeshaft, Drug and Alcohol Review, in press)
What sort of research do we need?
Country Years N studies
Measures %
Descriptive %
Evaluation %
United States 1993-2000 40 0 87 13
2008-2014 163 1 91 8
Australia 1993-2000 36 0 81 19
2008-2014 134 6 81 13
New Zealand 1993-2000 4 0 75 25
2008-2014 41 3 87 10
Canada 1993-2000 6 0 83 17
2008-2014 59 0 93 7
Total 656 3 86 11
6
7
Orana Haven
8
• Operating for over 30 years
• Aboriginal Community Controlled Health Organisation
• Aboriginal males
• 3 month voluntary program
• Located on traditional healing country of the Ngemba people
About Orana Haven
9
• Alcohol-related burden of disease is higher for Aboriginal Australians than non-Aboriginal Australians (Calabria et al, 2010)
• No simple way to reduce substance-related harm in Aboriginal communities (Gray et al., 2014)
• Aboriginal people prefer to seek help at Aboriginal-specific services (Brady, 2002)
• Best practice elements for Aboriginal residential rehabilitation services include: sustainability, flexibility, collaboration, good governance, qualified staff and partnerships with researchers(
Brady, 2002; Strempel et al., 2003)
Aboriginal Residential Rehabilitation services: What do we currently know?
10
•A current systematic review identified only eight studies that systematically described Aboriginal resi rehab clients, of which three were Australian (James, Shakeshaft, Courtney, Munro, 2017 , in press)
•Limited evidence currently exists about:
o What models of care are being delivered?
o Who attends, for how long and what for?
o What client and service outcomes are being collected?
o What impacts, if any, do they have on clients and their families / communities?
o Are they cost effective?
What we don’t know…
11
Broad research objective:
• To improve the standardisation of Aboriginal residential treatment services across Australia to evaluate program effectiveness
Specific study aims: 1. Describe the demographic and characteristics of
OH clients from 2011-2016;
2. Analyse perceptions of staff and clients about the OH program, particularly relating to the cultural aspects;
3. Describe a OH Model of Care (MoC); and
4. Partner with other NSW Aboriginal resi rehabs to ascertain routine data collection processes and develop a standardised MoC.
Research objectives
12
Mixed methods community-based participatory research (CBPR) evaluation:
•Analysis of demographic, referral and service utilisation characteristics of clients from 2011-2016
o N = 329
o Multiple regression and univariate analysis
•Analysis of subset of phone intake data in 2015/2016
o N = 51
•Semi-structured interviews with staff and clients to understand the perceptions of the program
o Informed by Indigenist methodology (NHMRC, 2003; Wilson, 2008) and used a “yarning approach” (Bessarab & Ngandu, 2010).
o Thematic analysis using Iterative Categorisation (IC)
Methods
13
Overview of NDARC & OH partnership: 2014-2017
Mar 14 Jan 15 Feb 15
Follow-up meeting
at OH
Strategic planning 1 -
Staff
Strategic planning 2 –
OH Board
May 15
Final 2015-18 Strategic Intent finalised for OH
Board
Oct 15
Phase 1 interviews with clients
/staff
OH passes accreditation!
Nov 15
Phase 2 of interviews with
clients /staff
Jan 16 Feb 16 Aug 16
OH capital works completed: April – Dec 2015
Apr 15 June 15
NDARC attended OH Board meeting
OH wins 2 NIDAC awards!
OH Ethics application: June-
Dec 2014
AHMRC approve ethics
Initial NDARC meeting at OH
Present preliminary data to OH
Board
Oct 16 Apr 17
NDARC present
final results to OH Board
14
NDARC Research team & Orana Haven Board members
Orana Haven Board Meeting - August 2016
Results: 5 years of data
16
Orana Haven has provided a service for 329 clients from
2011-2016
72
58 62
67 70
0
10
20
30
40
50
60
70
80
Year 12011-12
Year 22021-13
Year 32013-14
Year 42014-15
Year 52015-16
No
of c
lient
s Total number of clients
2011-2016
17
The average age of a client is 34 years old
18
Clients stay on average 56 days in treatment
19
33% of clients completed the program 47% of clients self discharged 20% of clients house discharged
77% are referred by criminal
justice system
84% identify as Aboriginal or Torres Strait
I l d
21
What factors predicted length of stay?
Supported and skilled staff
1. Aboriginal status not significantly associated with length of time in treatment
2. Referral from criminal justice system: The majority of clients were referred from the criminal justice system, significantly increasing from 79% (2011/12) to 96% (2015/16) (p<0.001) and these clients were significantly more likely to self-discharge (p<0.001).
3. Age: The age of the clients significantly increased over time (p=0.03), with most aged from 26-35. Older clients were more likely readmit (p<0.002) and stay longer than 90 days (p=0.02).
22
Other key results:*
Supported and skilled staff
* Subset of OH data: N= 51 clients in 2015-16 (Year 5)
Poly substance use (methamphetamines,
alcohol, cannabis, heroin, cocaine, methadone), 36
Alcohol, 8
Methamphetamines, 4
Cannabis, 2
Methadone, 1
Self-reported substances at intake 2015-2016
23
Other key results:*
Supported and skilled staff
Current residence: o 59%: rural or regional NSW o 20%: incarceration o 12% metropolitan NSW o 6%: homeless o 3%: Other
Current income: o 94% receiving government benefit (27% disability,
59% unemployment) o 1 client earning an income
Current mental health status: o 51% self reported current mental health
diagnosis(es)
* Subset of OH data: N= 51 clients in 2015-16 (Year 5)
Results: Interviews with staff and clients
25
Key themes
Orana Haven clients in 2015-16
“I just feel comfortable out here, there’s something about the place, once you get settled in, there’s something about it” (C7). “I love the river. It’s a big relief for me to be on the river – all of a sudden just go for a walk down the river or something and just clear your head, it helps a lot of boys” (C4).
Aboriginal staff member from Orana Haven, 2016
“It makes us feel proud and happy that we’re doing something right, that it’s working…
whatever we are doing”
28
1.Continue to strengthen current data collection processes
2.Investigate, implement and evaluate options for after-care support for OH clients
3.Systematic review of the current best practice for rural Aboriginal residential rehabilitation services
4.Conduct a broader review of all Aboriginal residential rehabilitation services in Australia
5.Ongoing research partnership with NDARC
Key recommendations
29
NARDHAN – Supported by AHMRC
30
• At OH – the average length of time in treatment is 56 days
• At WC – the average length of time in treatment is 32 days
Not including WC’s fail to attend clients, the average time in treatment increases to 44 days
31 34
29 35 33
49
57 58 56 62
0
10
20
30
40
50
60
70
2011-12 2012-13 2013-14 2014-15 2015-16
Year 1 Year 2 Year 3 Year 4 Year 5
No
of d
ays
Average length of time in treatment: 2011-2016
Weigelii Centre
Orana Haven
Any questions?
32
• The OH and WC Board members, staff and clients for their support of the projects
• In particular, Norm Henderson and Alan Bennett (OH) and Danny Jeffries (WC)
• NSW Aboriginal Residential Healing Drug and Alcohol Network (NARHDAN)
• Aboriginal Health and Medical Research Council (AHRMC) for their ethical approval and ongoing support of the project
Acknowledgements
