A service-level action research intervention to improve identification and treatment of cannabis and related mental health issues in young Indigenous Australians: a study protocol

Abstract

IntroductionRegular cannabis use is associated with negative mental health impacts including psychosis, depression and anxiety. Rates of cannabis use have increased in Aboriginal and Torres Strait Islander communities in northern Australia within the last two decades, presenting a significant increased risk to young people's mental health in these regions. Improved screening, early detection and treatment for cannabis-related mental health issues are urgently required. This paper describes a service-level action research intervention and evaluation protocol for use in the few services where it is possible to engage young Aboriginal and Torres Strait Islander Australians.Methods/DesignThe protocol is being developed in two services where youth mental health is core business: a primary healthcare centre and a youth service in the Cairns and hinterland region, far north Queensland. The protocol calls first for baseline data to be collected using staff and client surveys; network mapping; and analysis of screening, treatment and referral rates. The protocol's intervention phase is driven by service needs identified from baseline data. Intervention strategies focus on implementing/enhancing cannabis screening instruments and processes in line with current best practice; enhancing networks with external drug and mental health services; developing culturally acceptable training and resources; developing activities aiming to reduce cannabis use in young Aboriginal and Torres Strait Islander clients using the services. The protocol requires implementation of the multilevel intervention within each service for 1 year, with follow-up data then collected and compared to baseline. Process evaluation identifies the more effective intervention strategies and documents the challenges to be overcome for full implementation.Ethics and disseminationEthics approval was provided by The James Cook University, Human Research Ethics Committee. Ethics Approval Number H5322. Peer-reviewed publications will also be used to disseminate the finding. Results will also be discussed with stakeholder organisations.

Adolescent and young adult substance use in Australian Indigenous communities: a systematic review of demand control program outcomes

“…They concluded that single‐measure strategies did not have sufficient evidence to be considered effective (although, in part, this was a result of the lack of evaluation). Bohanna et al 23 also proposed a preventative drug intervention protocol for Indigenous Australian youth. Prominent in their proposal was the need to collect baseline data to facilitate periodic evaluation of outcomes.…”

“…Returning to the earlier discussion about the potential utility of the public health approach to program selection, it is clear from this study that this will inevitably rely on the availability of valid data about change − of the type that is simply not available. It is difficult to disagree with the arguments presented by both MacLean et al 24 and Bohanna et al 23 that it is only possible to establish program outcomes when valid and reliable tools are used to assess need, and that baseline data is required to document the extent to which change over time occurs. Even in contexts where randomised intervention trials are not feasible, there is clearly work to be done developing approaches to measurement that have utility in community settings.…”

“Need Everyone Helping to Keep Off Because Everyone Helping to Keep On” – Reducing Harms from Cannabis use in Remote Indigenous Australian Communities Involves More Than Just Users

“…Brief clinical intervention, cognitive behavioral therapies or raising awareness alone are unlikely to reduce cannabis demand and harms in a sustainable way in these populations in the short term. It is widely acknowledged in the face of mounting evidence that individual level interventions are insufficient to address substance misuse in Indigenous communities in Australia (Bohanna et al, 2014;Johnston et al, 2013;. We heard few suggestions that health clinics or schools should play a significant role, suggesting that participants considered these either inappropriate or inadequately resourced for cannabis demand reduction.…”

“…Participants receiving interventions or treatments tend to be defined by the service that will deliver the strategy e.g. "workplaces," "school," and "ante-natal clinic" (Bohanna et al, 2014;Graham, Campbell, West, & Clough, 2017). However, the evidence presented indicates that patterns in the use of and attitudes towards cannabis across the community are not drawn along these institutional lines.…”

“…For individuals in the general population seeking treatment, cognitive-behavioral and motivational enhancement therapy (Copeland et al, 2014) and contingency management (Copeland & Swift, 2009), with treatment for concurrent substance misuse (Banbury et al, 2013;Copeland & Swift, 2009), can support cannabis cessation. In contrast with tobacco smoking, where a focus on individual behavior (Marley et al, 2014), supported in health clinics (Eades, Sanson-Fisher, & Panaretto, 2013), could be effective when oriented towards groups and families (McCalman et al, 2012;Munro & Allan, 2011), few studies have addressed cannabis demand and harm reduction or treatment strategies for Indigenous Australians (Bohanna, Bird, Copeland, Roberts, & Clough, 2014;. To plan for harm reduction approaches and treatments in such settings, improved understandings of the specific social and attitudinal context of substance misuse are essential (Pawson, 2006;Poland, Frohlich, & Cargo, 2009).…”