“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

Abstract

BackgroundThe 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.MethodsThis 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.ResultsA 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.ConclusionThis 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.

Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences

“…Included studies reflected the well-established notion that health is conceptualised by Aboriginal and Torres Strait Islanders differently to Western traditions [ 59 ]. For example, patients in nine of the studies alluded to the importance of being on Country 1 when receiving healthcare to their overall patient experience [ 35 , 47 , 54 , 60 – 65 ]. Being away from Country was seen as significant for many reasons including; missing important cultural events and ceremonies (funerals (sorry business), passing on of stories and customs (lore), and initiation ceremonies from childhood to adulthood), having competing priorities [ 38 , 42 , 56 , 60 , 61 , 66 ], not feeling comfortable using resources on someone else’s Country [ 61 ], scared of dying off Country due to the spiritual connotations [ 61 – 63 ], and ultimately because of the importance of Country to wellbeing [ 35 , 47 , 54 , 60 – 65 ].…”

“…This led to negative experiences including patient’s missing fundamental requirements of informed consent for tests and procedures [ 67 ] or a lack of awareness of reasons for admission [ 45 ]. Receiving health education material that was not culturally relevant [ 56 ] or the use of medical jargon by staff members also impacted negatively [ 56 , 69 , 72 – 74 ], effects which resolved or reversed when culturally relevant and competent interactions occurred [ 31 , 33 , 47 , 51 , 58 , 68 , 75 – 78 ]. Some patients also reported positive experiences in seeing Ngangkari - who are Aboriginal traditional healers [ 45 ].…”

Māori Men’s Experiences of Rehabilitation in the Moana House Therapeutic Community in Aotearoa/New Zealand: A Qualitative Enquiry

“…Residential therapeutic communities (TCs) for the treatment of drug addiction were developed in the mid-20th century and are well established in the United Kingdom, Western Europe, and the United States (Glaser, 1981). Each TC differs in its treatment goals and how it operates (Glaser, 1981; see also Adamson, Deering, Hinerangi, Huriwai, & Noller, 2010; Chen, Elisha, Timor, & Ronel, 2013; Munro, Allan, Shakeshaft, & Breen, 2017; New Zealand Department of Corrections, 2009; Smiley-McDonald & Leukfeld, 2005). Some TCs have a short duration of treatment (e.g., three months) and others are longer in duration (e.g., 3 years; Gowing, Cooke, Biven, & Watts, 2002).…”

“…Past qualitative research has explored the experiences of TC residents (Byers, 2002; Janeiro, Ribeiro, & Lopez Miguel, 2017; Munro et al, 2017) and their family members (Chen et al, 2013). Janeiro et al (2017) analysed residents’ therapy worksheets from a TC in Spain and discovered distinct processes of change at each stage of the TC’s programme moving through self-observation, self-valuing, and self-understanding.…”

“…Research involving interviews with parents who had a son in a TC in Israel demonstrates the benefits of TCs for family members and the role of family members in the process of recovery (Chen et al, 2013). Munro et al’s (2017) research involving interviews with indigenous residents of a TC in Australia revealed the importance of reconnecting with culture.…”