Indigenous Australians experience a disproportionately high burden of alcohol-related harm relative to non-Indigenous Australians. These alcohol-related harms are typically cumulative, extending beyond the individual to the family and community. The number of Indigenous-specific intervention programs to address these harms appears less than optimal, and there have been few rigorous evaluations of Indigenous-specific alcohol interventions that have been implemented. There is evidence from empirical studies that family-based approaches can be effective for reducing alcohol-related harms among high-risk drinkers and the negative effects of alcohol misuse on other family members. Family relationships have always been vital to the cohesion and wellbeing of Indigenous communities. What happens at the family level shapes the social functioning of Indigenous Australian communities and the wellbeing of individuals. The potential strength of relationships between Indigenous individuals, their families and communities suggests that family–based approaches are likely to be appropriate and effective for reducing alcohol related harm among Indigenous Australians.
This study aims to assess the acceptability, feasibility and likely cost-effectiveness of the individually-focused Community Reinforcement Approach (CRA) and family-focused Community Reinforcement and Family Training (CRAFT) for Indigenous Australians with alcohol use problems, delivered in the context of routine Indigenous-specific health care services.
A demonstration project, using a pre/post intervention study design, to evaluate the feasibility, acceptability and likely cost-effectiveness of CRA and CRAFT for individuals who use alcohol problematically and their concerned family members, delivered by a rural Indigenous community-based health service in partnership with a regional AOD clinical service.
An acceptability survey to assess the acceptability of CRA and CRAFT for delivery to Aboriginal Australians has been completed and survey findings have been used to identify specific components of CRA and CRAFT that required modification to optimise their uptake during the intervention phase of the project.
A training package (combining two clinical manuals and a program of training and outreach support), to support health care providers to deliver the CRA and CRAFT programs to their clients in routine health care, has been developed by researchers in collaboration with health care providers from an Aboriginal Community Controlled Health Service and a drug and alcohol treatment agency.
Health care providers who deliver the interventions have completed an internationally recognised certified program for CRA and CRAFT. Two health care providers have also completed a CRAFT supervisor certification program and will provide ongoing supervision for health care providers delivering CRA and CRAFT.
Recruitment into CRA and CRAFT begun in March 2013 and was completed in December 2013. Follow-up assessments continue until mid-2014.
Presentations
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Kate Conigrave, Lynette Simpson, Donna Bliss and Julaine Allan. AUDIT-C and AUDIT-3 cut-off scores for Aboriginal Australians for the NDARC Seminar Series, November 2012: Sydney.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran, Julaine Allan, Miranda Rose, Komla Tsey, Rod MacQueen, Adapting a family-based approach to reduce alcohol-related harms among Indigenous Australians, at the AIATSIS National Indigenous Studies Conference, September 2011: Canberra.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran, Julaine Allan, Miranda Rose, Komla Tsey, Rod MacQueen, A family based approach to reducing alcohol-related harms among Aboriginal Australians in rural New South Wales, at the NDARC Annual Symposium, August 2011: Sydney.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran, Julaine Allan, Miranda Rose, Komla Tsey, Rod MacQueen, The acceptability of a family based alcohol intervention to Indigenous clients of a rural Aboriginal Community Controlled Health Service and Drug and Alcohol treatment agency, at the University of New South Wales, School of Population Health and Community Medicine Research Symposium, August 2011: Sydney.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran, Julaine Allan, Miranda Rose, & Rod MacQueen, The acceptability of a family based alcohol intervention to Indigenous clients of a rural Aboriginal Community Controlled Health Service and Drug and Alcohol Treatment Agency, at the 3rd Aboriginal Health Research Conference, Coalition for Research to Improve Aboriginal Health (CRIAH), May 2011: Sydney.
Bianca Calabria, Development and evaluation of a family-based intervention to reduce alcohol-related harms among Indigenous Australians: acceptability and study design, for the NDARC Seminar Series, April 2011: Sydney.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran Julaine Allan, Miranda Rose, Komla Tsey. Family-based approaches to reduce alcohol-related harms among Indigenous Australians, at Australian Professional Society on Alcohol and Other Drugs (APSAD), November 2010: Canberra.
Bianca Calabria, Family-based intervention for Indigenous people who have alcohol use problems, for the NDARC Seminar Series, May 2010: Sydney.
Posters
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Katherine M Conigrave, Lynette Simpson, Julaine Allan, Identifying risky and dependent Aboriginal drinkers using AUDIT-C and AUDIT-3 , at the NDARC Annual Symposium, August 2012: Sydney.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran, Julaine Allan, Miranda Rose, Komla Tsey, Rod MacQueen, The acceptability of a family based alcohol intervention to Indigenous clients of a rural Aboriginal Community Controlled Health Service and Drug and Alcohol Treatment Agency, at the NDARC Annual Symposium, August 2011: Sydney.
Bianca Calabria, Anton Clifford, Anthony Shakeshaft, Christopher Doran. Reducing alcohol related harms among Indigenous Australians: a systematic review of family-based approaches, NDARC Annual Symposium, August 2010: Sydney.
Publications
Calabria, B., Clifford, A., Shakeshaft, A., Allan, J., and Doran, C. (2012). “The acceptability to Aboriginal Australians of a family-based intervention to reduce alcohol-related harms”. Drug and Alcohol Review, 32(3): 328-332. DOI: 10.1111/j.1465-3362.2012.00525.x
Calabria, B, Clifford, AC, Shakeshaft, AP & Doran, CM. (2012) 'A systematic review of family-based interventions targeting alcohol misuse and their potential to reduce alcohol-related harm in Indigenous communities', Journal of Studies on Alcohol and Drugs, vol. 73, no. 3, pp. 477 - 488.
Munro, A., and Allan, J. (2011). “Can family-focused interventions improve problematic substance use in Aboriginal communities? A role for social work” Australian Social Work. Vol 64 (2): 169-182.
At the service level the primary benefit of the CRAFT intervention is its potential to strengthen the overall role of Yoorana Gunya to support Aboriginal families and individuals who are dealing with alcohol problems. This will be achieved firstly, through training Yoorana Gunya Aboriginal and other health practitioners to employ a range of evidence-based approaches to treat clients with alcohol problems, and secondly, through the utilisation of existing structured frameworks to improve processes and support the integration of CRAFT into Yoorana Gunya’s routine service provision. At the community level the benefit of CRAFT will be to individuals with alcohol problems and families who participate in training and acquire skills and knowledge to reduce alcohol- related harm. Benefits to these groups are also likely to result from the strengthened role of Yoorana Gunya in health service delivery and the increased capacity of health staff to employ evidence based approaches to treat and manage clients with alcohol problems.