Tailoring a family-based alcohol intervention for Aboriginal Australians, and the experiences and perceptions of health care providers trained in its delivery

Abstract

BackgroundAboriginal Australians experience a disproportionately high burden of alcohol-related harm compared to the general Australian population. Alcohol treatment approaches that simultaneously target individuals and families offer considerable potential to reduce these harms if they can be successfully tailored for routine delivery to Aboriginal Australians. The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT) are two related interventions that are consistent with Aboriginal Australians’ notions of health and wellbeing. This paper aims to describe the process of tailoring CRA and CRAFT for delivery to Aboriginal Australians, explore the perceptions of health care providers participating in the tailoring process, and their experiences of participating in CRA and CRAFT counsellor certification.MethodsData sources included notes recorded from eight working group meetings with 22 health care providers of a drug and alcohol treatment agency and Aboriginal Community Controlled Health Service (November 2009-February 2013), and transcripts of semi-structured interviews with seven health care providers participating in CRA and CRAFT counsellor certification (May 2012). Qualitative content analysis was used to categorise working group meeting notes and interview transcripts were into key themes.ResultsModifying technical language, reducing the number of treatment sessions, and including an option for treatment of clients in groups, were key recommendations by health care providers for improving the feasibility and applicability of delivering CRA and CRAFT to Aboriginal Australians. Health care providers perceived counsellor certification to be beneficial for developing their skills and confidence in delivering CRA and CRAFT, but identified time constraints and competing tasks as key challenges.ConclusionsThe tailoring process resulted in Aboriginal Australian-specific CRA and CRAFT resources. The process also resulted in the training and certification of health care providers in CRA and CRAFT and the establishment of a local training and certification program.

The Dissemination of Alcohol Interventions for Indigenous Australians: A Mixed Studies Review Using Narrative Synthesis

“…The types of alcohol intervention targeted by the remaining four studies included family-based interventions [42,43], community outreach [44], case management [45], and residential rehabilitation [46]. Design and methods: Seven studies employed a pre-post study design without a control group.…”

“…Qualitative data were collected using the following methods; individual (n=6) and group (n=3) semi-structured interviews; participant observation (n=2); focus groups (n=2); descriptive surveys (n=3); and questionnaires (n=3). Setting and participants: Studies were conducted in: urban [22,42,47] and rural [43,44] (and both) [10,11,29] geographical regions across Australia, including in New South Wales [10,11,21,22,[42][43][44]47] the Australian Capital Territory [45], Western Australia [48], and the Northern Territory (NT) [13,14]. One study was conducted in various urban, rural and remote locations across Australian states and territories [29].…”

“…One study was conducted in various urban, rural and remote locations across Australian states and territories [29]. The majority of studies were conducted in Primary Health Care settings (PHC) [10,11,21,22,43,49], followed by community settings [42,44,47,48] and tertiary care [13,14]. One study was conducted over multiple settings [29].…”

“…Health care staffs were the target of implementation strategies, which included training and/or education to facilitate delivery of a culturally tailored alcohol intervention. Studies examined the process of implementation using qualitative [43], quantitative [45] or mixed methods [13]. The methodological quality of implementation studies was moderate to strong according to MMAT criteria.…”

“…Strategies evaluated included a community reinforcement (and family training) approach [43], ASBI [10], and Indigenous specific guidelines for the management of alcohol related problems in primary care [29].…”