This project will examine the cost-effectiveness of a community empowerment and positive reinforcement intervention for reducing alcohol-related injury and violence among Aboriginal people in two rural locations in NSW. Investigators will work with local Aboriginal Medical Services (AMSs) to implement and evaluate the intervention in both of the locations.
Mr Jamie O’Neill
Lower Lachlan Community Services
Associate Professor Melissa Haswell-Elkins
Muru Marri Indigenous Health Unit, UNSW
Griffith Aboriginal Medical Service
Murrin Bridge Aboriginal Health Service
Professor Christopher Doran
Hunter Medical Research Institute, University of Newcastle
Dr Anton Clifford
School of Population Health and Community Medicine, University of Queensland
Aboriginal Australians experience a disproportionately high burden of alcohol-related injury and violence compared to the general population: alcohol-related violence is 6 to 9 times higher for Aboriginal males and up to 6 to 20 times higher for Aboriginal females, compared to the general Australian population. Injury and violence are two main contributors to alcohol-related mortality among Aboriginal Australians, which is a main contributor to the overall health gap between Aboriginal and non-Aboriginal Australians. These elevated rates of alcohol-related harm among Aboriginal Australians require a targeted approach. Evaluations of Aboriginal-specific alcohol interventions have typically been supply reduction or education strategies. Less than one quarter of published evaluations of alcohol interventions conducted in Aboriginal communities specifically targeted reductions in injury and violence and few were implemented in rural communities. Of those evaluations, few studies have employed randomisation or a comparison group in their methodology. As such, there is a need for rigorous cost-effectiveness evaluations of interventions targeting reductions in alcohol-related injury and violence in geographically diverse Aboriginal communities.
To quantify the cost-effectiveness of an integrated community empowerment and positive reinforcement intervention for reducing alcohol-related injury and violence among Aboriginal people in two rural locations in NSW.
More specifically, in both target locations, the intervention aims to:
- Reduce the proportion of Aboriginal people admitted to hospital for alcohol-related injury
- Reduce the proportion of Aboriginal people arrested for alcohol-related violence
- Reduce the proportion of Aboriginal people experiencing alcohol-related injury or violence
The intervention will be evaluated using a multiple baseline (interrupted time series) design. The two participating locations will be allocated to commence the intervention at 6 and 12 months. Baseline data on community level alcohol-related injury and violence will be collected. The intervention will comprise strategies decided by an implementation committee that includes local representatives from the AMS, council, police, hospital, Medicare Local, and Local Health District.
The intervention will be delivered to individuals, families and population groups most likely to benefit from participation. Routinely collected data will assess changes in alcohol-related hospital admissions, emergency department presentations, and crime. Group interviews with community members and key stakeholders will assess experiences of alcohol-related injury and violence. The cost-effectiveness analysis will adopt standardised methods that are international best-practice.
A literature review has been conducted and published on community-based programs in Australian Indigenous communities, which assessed the quality of research methods used and the extent to which community members participated in the project.
Baseline routinely collected data has been requested and analysed, and baseline community surveys have been conducted in all the three locations.
Extensive community consultations have taken place over the past 12 months with all locations, resulting in decisions on the specific programs in two of the three locations and ongoing discussions in the final location.
Programs are currently being implemented in all three communities, which include: a Midnight Basketball program (targets youth 12-18 on Friday nights: they have dinner, do a workshop and play basketball), Case Coordination program (aims to provide more integrated service delivery to at risk Aboriginal clients) and Family Wellbeing empowerment program (Staff from a local Aboriginal Health organisation have been trained in this Aboriginal-specific empowerment program and are now starting to run their own groups with at risk clients). These programs are now successfully taking place and over the next 6 months further programs will be added to these activities.
Three local staff have also been hired in each community to engage the communities further in each program and to coordinate the implementation and evaluation of the program on the ground.
Snijder, M., Shakeshaft, A., Wagemakers, A., Stephens, A. and Calabria, B. (2015). A systematic review of studies evaluating Australian indigenous community development projects: the extent of community participation, their methodological quality and their outcomes. BMC Public Health 15: 1154. DOI 10.1186/s12889-015-2514-7
Shakeshaft, A. (2015) Keynote address at the 2015 NSW Rural Health and Research Congress.
Snijder, M., Shakeshaft, A., Stone, C. and Calabria, B. (2015). The systematic development of multi-component community-based interventions to reduce alcohol related harms among Aboriginal people in three rural towns in NSW. Oral presentation at 2015 NDARC Annual Symposium and 2015 Postgraduate Symposium
Snijder, M., Shakeshaft, A., Wagemakers, A., Stephens, A. and Tsey, K. (2014). Community development to ‘close the gap’ between Indigenous and non-Indigenous Australians. Poster presented at the 2014 NDARC Annual Symposium and the AIATSIS National Indigenous Studies Conference 2014
Snijder, M., Meredith, S., Shakeshaft, A. and Calabria, B. (2014). Community development and partnerships to close the gap between Indigenous and non-Indigenous Australians. Oral presentation at the National Indigenous Drug and Alcohol Council Conference 2014.
December 2014: “Project targets alcohol related violence” – Narrandera Argus 2014. http://www.narranderaargus.com.au/ArticleDetails/tabid/65/ArticleID/1342/Project-targets-alcohol-related-violence.aspx
January 2015: “Support sought for Midnight Basketball initiative in Griffith” – ABC 2015. http://www.abc.net.au/news/2015-01-15/midnight-basketball/6018180
February 2015: “Project targets violence” – Narrandera Argus 2015. http://www.narranderaargus.com.au/ArticleDetails/tabid/65/ArticleID/1398/Project-targets-violence.aspx
June 2015: “New Chapter for Grads” - Griffith Area News 2015, about Family Wellbeing facilitators. http://www.areanews.com.au/story/3128014/new-chapter-for-grads/
August 2015: “Riverina research project aiming to reduce alcohol related violence in Aboriginal communities” – ABC News 2015. http://www.abc.net.au/news/2015-08-24/griffith-alcohol/6719070
September 2015: “Midnight Basketball Returns to Griffith” – Griffith Area News http://www.areanews.com.au/story/3387420/midnight-basketball-returns-to-griffith/
Improved wellbeing of Aboriginal people in NSW; greater knowledge about effective approaches for reducing injury in Aboriginal populations.