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Henderson A, Shakeshaft A, Allan J, Wallace R, Barker D, Farnbach S. A pilot study examining the impact of a pragmatic process for improving the cultural responsiveness of non-Aboriginal alcohol and other drug treatment services using routinely collected data in Australia. J Health Serv Res Policy 2024:13558196241261800. [PMID: 38870027 DOI: 10.1177/13558196241261800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Objective: Routine health data has the potential to identify changes in patient-related outcomes, in close to real time. This pilot project used routine data to explore and compare the impact of changes to cultural responsiveness on service use by Aboriginal and Torres Strait Islander (hereafter, Aboriginal) clients in Australia.Methods: The New South Wales Minimum Data Set (MDS) for alcohol and other drug use treatment services was provided for 11 services for a period of 30 months from March 2019 to September 2021 (four months prior to two years after the intervention; data were analysed between March 2022 to February 2023). Change in cultural responsiveness was assessed via practice audits of services at baseline and two years. The average change in audit rating was analysed using a linear mixed regression model. Generalised Linear Mixed Models were used to identify changes in service use by Aboriginal clients. Results: All 11 services showed increased audit scores at two years, with a statistically significant mean increase of 18.6 (out of 63 points; b = 18.32, 95% CI 12.42-24.22). No statistically significant pre-to post-changes were identified in: (1) the proportion of episodes delivered to Aboriginal versus non-Aboriginal clients (OR = 1.15, 95% CI = 0.94-1.40), (2) the number of episodes of care provided to Aboriginal clients per month (IRR = 1.01, 95% CI = 0.84-1.23), or (3) the proportion of episodes completed by Aboriginal clients (OR = 0.96, 95% CI = 0.82-1.13). Conclusions: The lack of statistically significant impact on service use outcomes using MDS contrasts to the improvements in cultural responsiveness, suggesting further work is needed to identify appropriate outcome measures. This may include patient-reported experience measures. This project showed that routine data has potential as an efficient method for measuring changes in patient-related outcomes in response to health services improvements.
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Affiliation(s)
- Alexandra Henderson
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, AU-NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, AU-NSW, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, AU-NSW, Australia
| | | | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, AU-NSW, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, AU-NSW, Australia
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Foley C, Allan J, Lappin J, Courtney R, Farnbach S, Henderson A, Shakeshaft A. Utilising the Implementation of Integrated Care to Develop a Pragmatic Framework for the Sustained Uptake of Service Innovations (SUSI). Healthcare (Basel) 2023; 11:1786. [PMID: 37372904 DOI: 10.3390/healthcare11121786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
The provision of integrated care (IC) across alcohol and other drug (AOD) and mental health (MH) services represents the best practice, yet the consistent delivery of IC in routine practice rarely occurs. Our hypothesis is that there is no practical or feasible systems-change approach to guide staff, researchers, or consumers through the complex transition that is required for the sustained uptake of IC across diverse clinical settings. To address this gap, we combined clinical and consumer expertise with the best available research evidence to develop a framework to drive the uptake of IC. The goal was to develop a process that is both standardised by the best available evidence and can be tailored to the specific characteristics of different health services. The result is the framework for Sustained Uptake of Service Innovation (SUSI), which comprises six core components that are applied in a specified sequence and a range of flexible activities that staff can use to deliver the core components according to their circumstances and preferences. The SUSI is evidence-based and practical, and further testing is currently underway to ensure it is feasible to implement in different AOD and MH services.
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Affiliation(s)
- Catherine Foley
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Julaine Allan
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
- Rural Health Research Institute, Charles Sturt University (CSU), Orange, NSW 2800, Australia
| | - Julia Lappin
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
- Department of Psychiatry and Mental Health, University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Ryan Courtney
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Alexandra Henderson
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of NSW (UNSW), Sydney, NSW 2052, Australia
- Poche Centre for Indigenous Health, University of Queensland (UQ), Toowong, QLD 4066, Australia
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3
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Farnbach S, Henderson A, Allan J, Wallace R, Shakeshaft A. A Cluster-Randomised Stepped-Wedge Impact Evaluation of a Pragmatic Implementation Process for Improving the Cultural Responsiveness of Non-Aboriginal Alcohol and Other Drug Treatment Services: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4223. [PMID: 36901233 PMCID: PMC10001979 DOI: 10.3390/ijerph20054223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
There is limited evidence regarding implementing organisational improvements in the cultural responsiveness of non-Aboriginal services. Using a pragmatic implementation process to promote organisational change around cultural responsiveness, we aimed to (i) identify its impact on the cultural responsiveness of participating services; (ii) identify areas with the most improvement; and (iii) present a program logic to guide cultural responsiveness. A best-evidence guideline for culturally responsive service delivery in non-Aboriginal Alcohol and other Drug (AoD) treatment services was co-designed. Services were grouped geographically and randomised to start dates using a stepped wedge design, then baseline audits were completed (operationalization of the guideline). After receiving feedback, the services attended guideline implementation workshops and selected three key action areas; they then completed follow-up audits. A two-sample Wilcoxon rank-sum (Mann-Whitney) test was used to analyse differences between baseline and follow-up audits on three key action areas and all other action areas. Improvements occurred across guideline themes, with significant increases between median baseline and follow-up audit scores on three key action areas (median increase = 2.0; Interquartile Range (IQR) = 1.0-3.0) and all other action areas (median increase = 7.5; IQR = 5.0-11.0). All services completing the implementation process had increased audit scores, reflecting improved cultural responsiveness. The implementation process appeared to be feasible for improving culturally responsive practice in AoD services and may be applicable elsewhere.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
| | - Alexandra Henderson
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Raechel Wallace
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
- Network of Alcohol and Drug Agencies, Woolloomooloo, NSW 2011, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, NSW 2052, Australia
- Poche Centre for Urban Indigenous Health, University of Queensland, Brisbane, QLD 4072, Australia
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4
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Munro A, Shakeshaft A, Breen C, Jones M, Oldmeadow C, Allan J, Snijder M. The impact of Indigenous-led programs on alcohol-related criminal incidents: a multiple baseline design evaluation. Aust N Z J Public Health 2022; 46:581-587. [PMID: 36047847 DOI: 10.1111/1753-6405.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a multi-component, Aboriginal-led strategy to reduce alcohol-related criminal incidents for Aboriginal people in four rural/remote communities in New South Wales (NSW), Australia. METHODS A retrospective multiple baseline design (MBD), using interrupted time series analysis of routinely collected crime data. RESULTS A statistically significant reduction in alcohol-related criminal incidents was observed in one community for both victims of crime (parameter estimate -0.195; p≤0.01) and persons of interest (parameter estimate -0.282; p≤0.001). None of the analyses show level shifts, meaning there were no measurable changes immediately post the introduction of the Breaking the Cycle (BTC) programs. CONCLUSIONS It is not possible to conclude that the program was effective independently of any other community factors, because the statistically significant result was not observed across multiple communities. The statistically significant result in one community has clear practical benefits in that community: a sustained impact over two years would reduce Aboriginal victims of alcohol-related crime from an estimated 56 incidents per annum to 36, and reduce Aboriginal persons of interest in alcohol-related crime from an estimated 68 alcohol-related person of interest (POI) per annum to 40. IMPLICATIONS FOR PUBLIC HEALTH The statistically and practically meaningful result in Community 1 highlights the potential of multi-component, Aboriginal-led strategies to reduce alcohol-related criminal incidents. Earlier engagement with researchers, to identify best-evidence strategies to reduce alcohol harms and to facilitate the use of prospective evaluation designs, would help translate the positive outcome in one community across multiple communities.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, UNSW, New South Wales.,Western NSW Local Health District, New South Wales
| | | | - Courtney Breen
- National Drug and Alcohol Research Centre, UNSW, New South Wales
| | - Mark Jones
- Hunter Medical Research Institute, University of Newcastle, New South Wales
| | | | - Julaine Allan
- National Drug and Alcohol Research Centre, UNSW, New South Wales.,University of Wollongong, New South Wales
| | - Mieke Snijder
- National Drug and Alcohol Research Centre, UNSW, New South Wales.,Institute of Development Studies, UK
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Bhatt SR, Armstrong M, Parker T, Maviglia M, Kass R, Leeman L, Romo P, Ziedonis D. Psychedelic Therapies at the Crossroads of Trauma and Substance Use: Historical Perspectives and Future Directions, Taking a Lead From New Mexico. Front Pharmacol 2022; 13:905753. [PMID: 35833023 PMCID: PMC9273054 DOI: 10.3389/fphar.2022.905753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022] Open
Abstract
Post-traumatic stress disorder (PTSD), a common condition with potentially devastating individual, family, and societal consequences, is highly associated with substance use disorders (SUDs). The association between PTSD and SUD is complex and may involve adverse childhood experiences (ACEs), historical and multi-generational traumas, and social determinants of health as well as cultural and spiritual contexts. Current psychosocial and pharmacological treatments for PTSD are only modestly effective, and there is a need for more research on therapeutic interventions for co-occurring PTSD and SUD, including whether to provide integrated or sequential treatments. There is a current resurgence of interest in psychedelics as potential treatment augmentation for PTSD and SUDs with an appreciation of the risks in this target population. This paper reviews the historical perspective of psychedelic research and practices, as well as the intersection of historical trauma, ACEs, PTSD, and SUDs through the lens of New Mexico. New Mexico is a state with high populations of Indigenous and Hispanic peoples as well as high rates of trauma, PTSD, and SUDs. Researchers in New Mexico have been leaders in psychedelic research. Future directions for psychedelic researchers to consider are discussed, including the importance of community-based participatory approaches that are more inclusive and respectful of Indigenous and other minority communities.
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Affiliation(s)
- Snehal R. Bhatt
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
- *Correspondence: Snehal R. Bhatt,
| | - Maya Armstrong
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Tassy Parker
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
- College of Nursing, University of New Mexico, Albuquerque, NM, United States
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
- Center for Native American Health, University of New Mexico, Albuquerque, NM, United States
- American Indian Health Research and Education, University of New Mexico, Albuquerque, NM, United States
| | - Marcello Maviglia
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
- Center for Native American Health, University of New Mexico, Albuquerque, NM, United States
| | - Rebecca Kass
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Lawrence Leeman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Paul Romo
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Douglas Ziedonis
- Executive Vice President, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Trudgett S, Griffiths K, Farnbach S, Shakeshaft A. A framework for operationalising Aboriginal and Torres Strait Islander data sovereignty in Australia: Results of a systematic literature review of published studies. EClinicalMedicine 2022; 45:101302. [PMID: 35243269 PMCID: PMC8861650 DOI: 10.1016/j.eclinm.2022.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Racial health disparities are only likely to be meaningfully improved by tailoring public health and clinical interventions to the specific needs of Indigenous people and their communities. Accurate tailoring relies on the availability of high-quality Indigenous-specific data. The potential benefits of increased availability of Indigenous data need to be balanced by efforts to ensure those data are collected and used appropriately. This paper identifies characteristics of Indigenous Data Sovereignty (IDS) principles and considers a framework for operationalisation. METHODS A PRISMA compliant search of the literature was undertaken, using methods detailed in the Cochrane Collaboration Handbook on Systematic Reviews of Health Promotion and Public Health Interventions (1). The search strategy comprised two steps: a search of 11 scientific electronic databases and five grey literature sources. The search was limited by date of publication (1 January 2000 to 1 December 2021). The following keywords and subject heading terms were used: (exp Aboriginal and Torres Strait Islander or Aborigin* or Torres Strait Island* or, Oceanic ancestry group) and (exp research or biomedical research or population surveillance or translational medical research or, research design) and (exp data or datasets or data collection or data management or health surveys or information dissemination or, intellectual property) and (exp self-determination or ownership or control or access or possession or OCAP or sovereignty or, ethics) and, (exp Australia). IDS principles: (i) ownership; (ii) control; (iii) accessibility; (iv) custodianship; (v) accountability to Indigenous people; (vi) amplify Community voice; (vii) relevant and reciprocal; and (viii) sustainably self-determining. Using standard data extraction forms, we examined relevant Australian studies to identify key characteristics and frequency with which they cited IDS principles. These findings were consolidated into an operationalisation framework. FINDINGS 34 relevant Australian published studies were identified. The most frequently cited IDS principles were Accountability to Aboriginal and Torres Strait Islander peoples and sustainably self-determining. The least frequently cited principle was Access. A framework to operationalise IDS principles is proposed that is both standardised internationally and able to be tailored to the diverse contexts of Indigenous peoples. INTERPRETATION IDS is emergent in Australia and there is a clear need to establish an agreed set of International IDS principles and a framework for their operationalisation and contextualisation across diverse Indigenous communities and contexts. FUNDING This research project is funded through an Australian Research Council (ARC) Discovery Grant from 2017 to 2022. The National Drug and Alcohol Research Centre (NDARC) is funded by the Australian Government Department of Health. The 1st author (ST) is supported by a scholarship co-funded by NDARC and the Lowitja Institute.
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Affiliation(s)
- Skye Trudgett
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
- Corresponding author.
| | - Kalinda Griffiths
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
- School of Health Sciences, University of Sydney, Sydney, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
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Mutschler C, Junaid S, Tellez C, Franco G, Gryspeerdt C, Bushe J. Community-based residential treatment for alcohol and substance use problems: A realist review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e287-e304. [PMID: 35122344 DOI: 10.1111/hsc.13511] [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: 09/16/2020] [Revised: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 06/14/2023]
Abstract
Research and reviews to date suggest that community-based residential treatments for substance use disorders (SUDs) have mixed effectiveness, with some studies finding positive outcomes while others finding no differences between intervention arms, including inpatient, outpatient, and control groups. In order to understand these mixed findings, reviews have underscored the importance of outlining the active treatment components of residential treatment, as well as treatment mechanisms and outcomes. Further, there is very little research on the underlying theories explaining how and for whom residential treatments are effective. The purpose of the present realist synthesis was to address this gap in the literature by exploring how, why, for whom, and in what circumstances, community-based residential treatments are effective. Following the RAMESES Publication Standards, a search was undertaken for articles examining community-based residential treatments in PsycINFO and PubMed from anytime to January 2020. The search generated 28 articles that met inclusion criteria and were extracted for relevant information. Results of the realist synthesis identified six Context-Mechanism-Outcome (CMO) configurations. Contextual factors that generated subsequent mechanisms and outcomes included substance-related problem severity, psychiatric comorbidities, diverse populations, pre-treatment relationships, lack of structure and lack of coping strategies. These CMO configurations provide important information for clinicians, treatment centres and policy makers, including the specific programme components that need to be offered in treatment to facilitate positive treatment outcomes.
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Affiliation(s)
| | - Sana Junaid
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Carmina Tellez
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Giselle Franco
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Julianne Bushe
- Department of Psychology, Ryerson University, Toronto, ON, Canada
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Resiak D, Mpofu E, Rothwell R. Organic Collaborative Research Partnership Building: Researchers, Needle and Syringe Program Providers, and People Who Inject Drugs. Healthcare (Basel) 2021; 9:healthcare9111417. [PMID: 34828463 PMCID: PMC8620050 DOI: 10.3390/healthcare9111417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: People who inject drugs (PWID) and needle and syringe program (NSP) providers increasingly partner with researchers to explore harm reduction best practice. However, a paucity of research exists regarding how best to engage PWID and community NSP providers to generate the evidence for sustainable harm reduction services. (2) Aim: This study reports on our use of an organic community research partnership-building approach between researchers, NSP providers, and PWID in Canberra ACT, Australia. (3) Method: Survey participants included both PWID (n = 70) and NSP providers (n = 26) across primary (n = 2), secondary (n = 7), and outreach (n = 1) services in Canberra ACT. Applying an organic partnership-building strategy, we engaged with partners and adapted approaches according to information gained in the process of implementation. (4) Results: We found engaging in relationship building around partner priority activities created mutual understanding and trust premised in authenticity of the evolving partnership. Our organic approach, which included a partner audit of the research tools for relevance, resulted in high acceptance and enrolment into the research by NSP providers and PWID. Finally, we observed strong social capital building utilizing an organic approach for the sustainability of the partnership. (5) Conclusions: The results of this study provide evidence for the benefits of organic collaborative research partnership building with NSP providers and PWID for authentic service program implementation. Our approach to research partnership building resulted in strong relationships built on shared goals and objectives, mutual gains, and complementary expertise. We propose the wider use of organic approaches to developing collaborative research partnerships with NSP providers and PWID to enhance consumer responsiveness towards service provision.
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Affiliation(s)
- Danielle Resiak
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Correspondence: (D.R.); (E.M.)
| | - Elias Mpofu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Rehabilitation and Health Services Department, University of North Texas, Denton, TX 76203, USA
- School of Human and Community Development, The University of the Witwatersrand, Johannesburg 2000, South Africa
- Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA
- Correspondence: (D.R.); (E.M.)
| | - Roderick Rothwell
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
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James DB, Lee KSK, Dronavalli M, Courtney RJ, Conigrave KM, Conigrave JH, Shakeshaft A. Predictors of length of treatment, discharge reason, and re-admission to Aboriginal alcohol and other drug residential rehabilitation services in New South Wales, Australia. Drug Alcohol Rev 2021; 41:603-615. [PMID: 34644427 DOI: 10.1111/dar.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Aboriginal clients accessing Aboriginal community-controlled residential alcohol and other drug rehabilitation services in New South Wales, Australia believe they have better outcomes due to culturally appropriate care. However, there is a paucity of published treatment outcome data. This study aims to identify predictors of treatment outcomes based on client characteristics at intake. METHODS A cross-sectional, retrospective, observational study of 2326 admissions to six services between January 2011 and December 2016. The outcomes were: (i) leaving treatment early; (ii) self-discharge or house discharge (by staff); and (iii) re-admission within two years. The predictors examined were Aboriginal status, age, justice system referral and primary substance of concern. Competing risk and Poisson regression analyses were used to identify trends in the data. RESULTS The mean age of clients was 33 years, and the majority (56%) stayed at least 6 weeks. Aboriginal clients whose primary substance of concern was stimulants were almost eight times more likely to re-admitted within 2 years than other clients (risk ratio 7.91; P < 0.001). Aboriginal clients who were also referred from justice were more likely to self-discharge (risk ratio 1.87; P < 0.001). Furthermore, Aboriginal clients who were aged older than 30 were less likely to have a re-admission (risk ratio 0.32; P ≤ 0.001). DISCUSSION AND CONCLUSIONS This study showed client characteristics that are predictive of harmful outcomes include age under 30, justice client, primary substance of use and their interactions. Future research could build on these results to aid ongoing development of residential rehabilitation programs for Aboriginal peoples.
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Affiliation(s)
- Doug B James
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - K S Kylie Lee
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Mithilesh Dronavalli
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Ryan J Courtney
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia.,Burnet Institute, Melbourne, Australia.,Royal Prince Alfred Hospital, Sydney, Australia
| | - James H Conigrave
- Faculty of Medicine and Health, Discipline of Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Sydney, Australia.,The Edith Collins Centre for Translational Research in Alcohol Drugs and Toxicology, Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Anthony Shakeshaft
- School of Public Health and Community Medicine, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Crouse JJ, Morley KC, Buckley N, Dawson A, Seth D, Monds LA, Tickell A, Kay-Lambkin F, Chitty KM. Online interventions for people hospitalized for deliberate self-harm and problematic alcohol use: Lessons learned from the iiAIM trial. Bull Menninger Clin 2021; 85:123-142. [PMID: 34032460 DOI: 10.1521/bumc.2021.85.2.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Deliberate self-harm and suicide affect all age groups, sexes, and regions, and their prevention is a global health priority. Acute alcohol misuse and chronic alcohol misuse are strong, modifiable risk factors, and Internet interventions aiming to reduce alcohol misuse and comorbid mental health problems (e.g., depression) are a promising and effective treatment modality. The research team aimed to evaluate the feasibility and effectiveness of an Internet-based comorbidity intervention primarily aiming to reduce alcohol consumption, and secondarily to reduce readmission for deliberate self-harm and improve psychological outcomes among people hospitalized for deliberate self-harm who also engage in problematic alcohol use. However, due to several barriers to recruitment, the trial could not be completed and was discontinued. The authors present a "Lessons Learned" discussion and describe the Internet Intervention for Alcohol Improvement (iiAIM) trial, discuss the key barriers experienced by the research team, and recommend potential solutions that may help future trials in this area.
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Affiliation(s)
- Jacob J Crouse
- University of Sydney, Youth Mental Health and Technology Team, Brain & Mind Centre, Central Clinical School, Sydney, NSW, Australia
| | - Kirsten C Morley
- University of Sydney, Discipline of Addiction Medicine, Central Clinical School, Sydney, NSW, Australia
| | - Nicholas Buckley
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia
| | - Andrew Dawson
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia
| | - Devanshi Seth
- Royal Prince Alfred Hospital, Drug Health Services, Sydney, NSW, Australia.,University of Sydney, Centenary Institute of Cancer Medicine and Cell Biology, Sydney, NSW, Australia, and the University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Lauren A Monds
- University of Sydney, Discipline of Addiction Medicine, Central Clinical School, Sydney, NSW, Australia
| | - Ashleigh Tickell
- University of Sydney, Youth Mental Health and Technology Team, Brain & Mind Centre, Central Clinical School, Sydney, NSW, Australia
| | - Frances Kay-Lambkin
- University of Newcastle, Centre for Brain and Mental Health Priority Research Centre, Newcastle, Australia
| | - Kate M Chitty
- University of Sydney Faculty of Medicine and Health, Discipline of Pharmacology, Translational Australian Clinical Toxicology Program, Sydney, NSW, Australia
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Farnbach S, Allan J, Wallace R, Aiken A, Shakeshaft A. Formative process evaluation of a guideline-driven process for improving the cultural responsiveness of alcohol and drug treatment services. BMC Health Serv Res 2021; 21:352. [PMID: 33858384 PMCID: PMC8051070 DOI: 10.1186/s12913-021-06367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/06/2021] [Indexed: 05/31/2023] Open
Abstract
Background To improve Australian Aboriginal and Torres Strait Islander people’s access to, and experience of, healthcare services, including Alcohol and other Drug (AoD) treatment services, principles and frameworks have been developed to optimise cultural responsiveness. Implementing those principles in practice, however, can be difficult to achieve. This study has five aims: i) to describe a five-step process developed to operationalise improvements in culturally responsive practice in AoD services; ii) to evaluate the fidelity of implementation for this five-step process; iii) to identify barriers and enablers to implementation; iv) to assess the feasibility and acceptability of this approach; and v) to describe iterative adaptation of implementation processes based on participant feedback. Methods Participating services were 15 non-Aboriginal AoD services in New South Wales, Australia. Implementation records were used to assess the implementation fidelity of the project. Structured interviews with chief executive officers or senior management were conducted, and interview data were thematically analysed to identify project acceptability, and the key enablers of, and barriers to, project implementation. Quantitative descriptive analyses were performed on the post-implementation workshop survey data, and responses to the free text questions were thematically analysed. Results A high level of implementation fidelity was achieved. Key enablers to improving culturally responsive practice were the timing of the introduction of the five-step process, the active interest of staff across a range of seniority and the availability of resources and staff time to identify and implement activities. Key barriers included addressing the unique needs of a range of treatment sub-groups, difficulty adapting activities to different service delivery models, limited time to implement change in this evaluation (three months) and the varied skill level across staff. The project was rated as being highly acceptable and relevant to service CEOs/managers and direct service staff, with planned changes perceived to be achievable and important. Based on CEO/management feedback after the project was implemented at the initial services, several improvements to processes were made. Conclusion The operationalisation of the five-step process developed to improve cultural responsiveness was feasible and acceptable and may be readily applicable to improving the cultural responsiveness of a wide variety of health and human services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06367-7.
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Affiliation(s)
- Sara Farnbach
- National Drug and Alcohol Research Centre UNSW, Sydney, NSW, 2052, Australia
| | - Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2500, Australia.
| | - Raechel Wallace
- Network of Alcohol and Drug Agencies, Woolloomooloo, NSW, 2011, Australia
| | - Alexandra Aiken
- National Drug and Alcohol Research Centre UNSW, Sydney, NSW, 2052, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre UNSW, Sydney, NSW, 2052, Australia
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James DB, Lee KSK, Patrao T, Courtney RJ, Conigrave KM, Shakeshaft A. Understanding the client characteristics of Aboriginal residential alcohol and other drug rehabilitation services in New South Wales, Australia. Addict Sci Clin Pract 2020; 15:27. [PMID: 32727625 PMCID: PMC7388208 DOI: 10.1186/s13722-020-00193-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aboriginal alcohol and other drug residential rehabilitation (residential rehabilitation) services have been providing treatment in Australia of over 50 years. However, there are no studies in Australia or internationally that document characteristics of clients attending Indigenous residential rehabilitation services worldwide. This is the first multi-site paper to describe key client characteristics of six Indigenous (hereafter Aboriginal Australians as the term recommended by the Aboriginal Health and Medical Research Council of New South Wales) residential rehabilitation services in Australia. METHODS All recorded client admissions between 1 January 2011 to 31 December 2016 were considered from six operating services in the Australian state of New South Wales. Data collected were classified into categories based on demographics, treatment utilisation, substance use, mental health and quality of life characteristics. Means, median and percentages were calculated (where appropriate). RESULTS There were 2645 admissions across the six services in the study period, with an average of 440 admissions per year across all services. Participants were aged between 26 to 35 years, with fewest participants aged 46 +. Program length ranged from 12 to 52 weeks (mean of 12 weeks). The completion rates and length of stay for each service ranged from less than two to more than 12 weeks. The principal drug of choice was alcohol and amphetamines in half of the services. Not all services used them, but a range of tools were used to measure treatment, substance use and mental health or quality of life outcomes. CONCLUSION This study is the first internationally to describe the key features of multiple Aboriginal residential rehabilitation services. The variation in tools used to collect client data made it difficult to compare client characteristics across services. Future research could explore predictors of treatment completion, identify opportunities for standardisation in client assessments and validate cultural approaches of care. These efforts would need to be guided by Aboriginal leadership in each service.
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Affiliation(s)
- Douglas B James
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia.
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, VIC, Australia
| | - Tania Patrao
- School of Public Health, University of Queensland, St Lucia, QLD, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katherine M Conigrave
- Faculty of Medicine and Health, Addiction Medicine, NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, The University of Sydney, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Sydney Local Health District, Camperdown, NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales, Sydney, NSW, 2052, Australia
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Hardy LJ, Shaw K, Hughes A, Hulen E, Sanderson PR, Corrales C, Pinn T, Esplain J, Begay RC. Building a Narrative of Equity: Weaving Indigenous Approaches into Community-Engaged Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145148. [PMID: 32708798 PMCID: PMC7400117 DOI: 10.3390/ijerph17145148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Abstract
In 2020, global injustice has taken center stage during the uprising of the Black Lives Matter movement and other social movements. Activists are calling attention to longstanding disparities in health outcomes and an urgent need for justice. Given the global socio-political moment, how can health researchers draw on current critical theory and social movements to create structures for equitable outcomes in health research and practice? Here, we demonstrate principles for effective health research and social justice work that builds on community-engaged approaches by weaving critical Indigenous approaches into structural project designs. Our project, "Health Resilience among American Indians in Arizona", brought new and seasoned researchers together to collect and analyze data on the knowledge of healthcare providers concerning American Indian health and well-being. Four years after the conclusion of the project, the team developed and created a post-project self-assessment to investigate lasting impacts of project participation. In this communication, we discuss the principles of defining and measuring the capacity to build together. This work responds to the call from Indigenous scholars and community leaders to build an internal narrative of change. While we will not present the full instrument, we will discuss building a strong foundation using the principles of engagement for planning and implementing justice and change.
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Affiliation(s)
- Lisa J. Hardy
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ 86011, USA;
- Social Science Community Engagement Lab, Northern Arizona University, Flagstaff, AZ 86011, USA
- Correspondence:
| | - Kevin Shaw
- Center for Research and Evaluation on Education and Human Services, Montclair State University, Montclair, NJ 07043, USA;
| | - Amy Hughes
- Cline Library, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | - Elizabeth Hulen
- Department of Sociology, Portland State University, Portland, OR 97207, USA;
| | - Priscilla R. Sanderson
- Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA; (P.R.S.); (R.C.B.)
| | - Candi Corrales
- Department of Politics and International Affairs, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | - Travis Pinn
- Department of Anthropology, Northern Arizona University, Flagstaff, AZ 86011, USA;
| | | | - R. Cruz Begay
- Health Sciences, Northern Arizona University, Flagstaff, AZ 86011, USA; (P.R.S.); (R.C.B.)
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Dadich A, Moore L, Eapen V. What does it mean to conduct participatory research with Indigenous peoples? A lexical review. BMC Public Health 2019; 19:1388. [PMID: 31660911 PMCID: PMC6819462 DOI: 10.1186/s12889-019-7494-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 08/14/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND To better understand and promote public health, participatory research with Indigenous peoples represents recommended practice, worldwide. However, due to the different ways such research is referred to, described, and used, it is unclear what might (and might not) warrant the term when collaborating with Indigenous peoples. As such, this article expands conceptual understandings of participatory research with Indigenous peoples, across timelines and regions. METHOD Following a systematic search of 29 academic databases in April 2018, a lexical analysis of the methods sections was conducted, which were sourced from 161 publications across 107 journals. RESULTS The active involvement of Indigenous peoples in research that is expressly participatory is limited across all project phases. This might be because the ways in which Indigenous peoples were involved throughout were not reported - however, it might also be because Indigenous peoples were not involved in all project phases. Furthermore, descriptions differ by study location and publication timeframe - notably, studies in the region of the Americas chiefly refer to pandemics, surveyors, and art; and those published in the last two decades have given primacy to artifacts of interest. CONCLUSIONS Findings from this corpus of data suggest participatory research with Indigenous peoples is not always described across different project phases; furthermore, it differs according to study location and publication timeframe. This offers considerable opportunity to further this important research area via alternative methodologies that award primacy to Indigenous expertise and agency.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, 169 Macquarie Street, Parramatta, NSW, 2150, Australia. .,1797 Locked Bag, Western Sydney University, 1797 Locked Bag, Penrith, NSW, 2751, Australia.
| | - Loretta Moore
- Autism Spectrum Australia (Aspect), Building 1, Level 2, 14 Aquatic Drive, Frenchs Forest, NSW, 2086, Australia.,, Forestville, NSW, 2087, Australia
| | - Valsamma Eapen
- Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, Australia.,ICAMHS, L1 MHC, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia.,University of New South Wales Sydney, Sydney, NSW, 2052, Australia
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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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