Julaine Allan

Mother blaming: A covert practice in therapeutic intervention

In this article I will discuss the continuing discursive support for idealised motherhood, describe some ways mother blaming is practiced within therapeutic intervention and discuss the implications of this for social work practice. The article is based on a qualitative study of professionals who provide therapeutic intervention for sexually violent children and their families. The case examples discussed come from this study and describe the roles attributed to mothers in causing and maintaining their childrens sexual violence.

Identifying Aboriginal-specific AUDIT-C and AUDIT-3 cutoff scores for at-risk, high-risk, and likely dependent drinkers using measures of agreement with the 10-item Alcohol Use Disorders Identification Test

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is a 10-item alcohol screener that has been recommended for use in Aboriginal primary health care settings. The time it takes respondents to complete AUDIT, however, has proven to be a barrier to its routine delivery. Two shorter versions, AUDIT-C and AUDIT-3, have been used as screening instruments in primary health care. This paper aims to identify the AUDIT-C and AUDIT-3 cutoff scores that most closely identify individuals classified as being at-risk drinkers, high-risk drinkers, or likely alcohol dependent by the 10-item AUDIT.MethodsTwo cross-sectional surveys were conducted from June 2009 to May 2010 and from July 2010 to June 2011. Aboriginal Australian participants (N = 156) were recruited through an Aboriginal Community Controlled Health Service, and a community-based drug and alcohol treatment agency in rural New South Wales (NSW), and through community-based Aboriginal groups in Sydney NSW. Sensitivity, specificity, and positive and negative predictive values of each score on the AUDIT-C and AUDIT-3 were calculated, relative to cutoff scores on the 10-item AUDIT for at-risk, high-risk, and likely dependent drinkers. Receiver operating characteristic (ROC) curve analyses were conducted to measure the detection characteristics of AUDIT-C and AUDIT-3 for the three categories of risk.ResultsThe areas under the receiver operating characteristic (AUROC) curves were high for drinkers classified as being at-risk, high-risk, and likely dependent.ConclusionsRecommended cutoff scores for Aboriginal Australians are as follows: at-risk drinkers AUDIT-C ≥ 5, AUDIT-3 ≥ 1; high-risk drinkers AUDIT-C ≥ 6, AUDIT-3 ≥ 2; and likely dependent drinkers AUDIT-C ≥ 9, AUDIT-3 ≥ 3. Adequate sensitivity and specificity were achieved for recommended cutoff scores. AUROC curves were above 0.90.

The acceptability to Aboriginal Australians of a family-based intervention to reduce alcohol-related harms.

INTRODUCTION AND AIMS Cognitive-behavioural interventions that use familial and community reinforcers in an individuals environment are effective for reducing alcohol-related harms. Such interventions have considerable potential to reduce the disproportionately high burden of alcohol-related harm among Aboriginal Australians if they can be successfully tailored to their specific needs and circumstances. The overall aim of this paper is to describe the perceived acceptability of two cognitive-behavioural interventions, the Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT), to a sample of Aboriginal people. DESIGN AND METHODS Descriptive survey was administered to 116 Aboriginal people recruited through an Aboriginal Community Controlled Health Service and a community-based drug and alcohol treatment agency in rural New South Wales, Australia. RESULTS Participants perceived CRA and CRAFT to be highly acceptable for delivery in their local Aboriginal community. Women were more likely than men to perceive CRAFT as highly acceptable. Participants expressed a preference for counsellors to be someone they knew and trusted, and who has experience working in their local community. CRA was deemed most acceptable for delivery to individuals after alcohol withdrawal and CRAFT for people who want to help a relative/friend start alcohol treatment. There was a preference for five or more detailed sessions. DISCUSSION AND CONCLUSIONS Findings of this study suggest that CRA and CRAFT are likely to be acceptable for delivery to some rural Aboriginal Australians, and that there is potential to tailor these interventions to specific communities.

Building Relationships with Aboriginal People: A Cultural Mapping Toolbox

Abstract This article describes a cultural mapping tool developed specifically for working with Aboriginal people experiencing mental health problems. The tool has broad scope, drawing from ecological and systems approaches. It will assist social workers to understand cultural and family obligations and build relationships with Aboriginal service users. Students learning about cultural diversity have expressed concern about asking culturally-sensitive questions. Australian human service workers typically state they feel inadequate in addressing Aboriginal culture in their practice approaches. The three components of the cultural mapping toolbox, (a) the social and emotional wellbeing cluster map, (b) the community and cultural diversity map, and (c) the migration map, provide social workers with a way of supporting a culturally connected lifestyle in contemporary society.

What is health anyway? Perceptions and experiences of health and health care from socio-economically disadvantaged rural residents

Abstract The divide between rich and poor in Australia is starkly apparent in health status statistics; the poorest Australians have the poorest health, and many live in rural Australia. However, little is known about financially deprived rural citizen’s perceptions of their own health and their expectations of health care services. As a result, exploratory in-depth interviews were conducted with eleven rural residents dependent upon government income support. Ten of the eleven participants had chronic health problems, and these were being addressed symptomatically. The children of the participants also required interventions for a range of physical, emotional and mental problems. The participants relied on local services and local practitioners to provide suitable interventions and to direct them to other services if required. They had minimal knowledge, control or choice in the type of intervention or outcomes. In this group, poor health was normalised and future health not considered. Thus, those with most to gain from health promotion and prevention activities and social inclusion programs are unlikely to benefit because they may normalise poor health. Concepts of good health, health literacy, informed consent, choice of intervention or practitioner are meaningless in this rural context of deprivation. These findings suggest that the population who endure the burden of ill-health will be by-passed by current and popular public health techniques of health promotion because rural people with poor health have low expectations of their own health and health care. Similarly, health service providers have high expectations of health and the rational choices of the population they serve. Thus, there is a major disconnect between the expectations of both.

The role of context in establishing University Clinics

Healthcare systems have a vested interest in employing work-ready graduates. The challenge for universities is to find ways to provide workplace learning that incorporates student education and high quality patient care. Inland areas of Australia, similar to other rural locations globally, experience additional challenges including a relatively high incidence of ill health, increasing demand for health services, chronic workforce shortages and ageing of the existing rural health workforce. In this paper, we conceptualise and describe the research findings related to context from a consultative enquiry into university clinics conducted in 2008. Interview participants were drawn from twenty university clinics in Australia and New Zealand. A consistent theme throughout the interviews was tensions that arose between the role of education and healthcare provision within university clinics. Many interview participants described ways they managed these tensions to meet the expectations of students, educators and the community. The patient supply is the most critical factor in the context of university clinic operations. It is vital to both the educator and the healthcare provider roles. In inland areas with sparse populations a number of strategies, such as outreach clinics, hospital or health centre- based clinics and multi-disciplinary sites, will have to be developed if university clinics are to operate effectively for students and patients.

Riding the rural radio wave: The impact of a community-led drug and alcohol radio advertising campaign in a remote Australian Aboriginal community

OBJECTIVE Aboriginal people experience a higher burden of disease as a consequence of drug and alcohol (D&A) abuse. Although media campaigns can be a popular tool for disseminating health promotion messages, evidence of the extent to which they reduce the impact of substance abuse is limited, especially for rural Aboriginal communities. This paper is the first to examine the impact a locally designed D&A radio advertising campaign for Aboriginal people in a remote community in Western NSW. DESIGN A post-intervention evaluation. SETTING The radio campaign was implemented in Bourke, (population 2465, 30% Aboriginal). PARTICIPANTS Fifty-three community surveys were completed. MAIN OUTCOME MEASURE(S) The self-reported level of awareness of the campaign and the number of self-referrals to local D&A workers in the intervention period. RESULTS Most respondents (79%) reported they listen to radio on a daily basis, with 75% reporting that they had heard one or more of the advertisements. The advertisement that was remembered best contained the voice of a respected, local person. There was one self-referral to local health services during the intervention timeframe. CONCLUSION The community-led radio advertising campaign increased community awareness of substance abuse harms, but had limited impact on formal help-seeking. This paper highlights the value of radio as a commonly used, trusted and culturally relevant health promotion medium for rural communities, especially when engaging local respected Aboriginal presenters.

The prevalence and characteristics of homelessness in the NSW substance treatment population: implications for practice.

This study examines the prevalence and characteristics of homelessness episodes in Australian substance misuse treatment. A dataset containing all closed substance treatment episodes in NSW, Australia from July 2006 to June 2011 was used. Statistical analysis was used to determine any relationships between demographic and treatment variables and homelessness. Of the 213, 129 treatment episodes in the dataset 12.8% have some form of homelessness. Non-government and residential services have the highest prevalence of homelessness. Sex, age, and drug type have weak relationships with homelessness. Leaving against the advice of the treatment provider is more common in episodes where homelessness is a factor. Homelessness is a problem experienced by a significant proportion of the substance treatment population and treatment providers have an opportunity and an obligation to address it in their treatment delivery.

Can Family-Focussed Interventions Improve Problematic Substance Use in Aboriginal Communities? A Role for Social Work

Abstract Problematic substance use is a significant concern for Aboriginal communities across Australia. Most approaches to intervention are individualised, locating the problem and the solution in the substance user. When problematic use is common within a family and community, individual treatment is likely to be ineffective. A literature review of family-focussed and culturally specific drug and alcohol interventions was conducted to inform the development of family-focussed interventions in the community setting. The review supports the development of family-focussed interventions, suggesting this approach will be culturally appropriate and effective for Aboriginal communities. The potential role of social work in working with Aboriginal communities on problematic substance use, and likely barriers for the profession, are discussed.

Understanding remote Aboriginal drug and alcohol residential rehabilitation clients: Who attends, who leaves and who stays?

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 clients 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.