alice munro, anthony shakeshaft, julaine allan, …...“nothing changes if nothing changes:”...

“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

THANK YOU

For more information contact

Alice Munro: Email: a.munro@unsw.edu.au