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Take the Best from Both Cultures: an Aboriginal Model for Substance Use Prevention and Intervention

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Take the Best from Both Cultures: an Aboriginal Model for Substance Use Prevention and Intervention Take the Best from Both Cultures: An Aboriginal Model for Substance Use Prevention and Intervention FIONA NICHOLS PhD, affiliated with the National Drug Research Institute, Curtin University of Technology, CUCRH (Combined University Centre for Rural Health) ABSTRACT co-residence would be encouraged. Detailed operational Objective guidelines include staff selection criteria, assessment To identify the key components of an Aboriginal model for procedures, program content and operation, rules, follow–up, alcohol (and other drug) harm prevention and intervention. management, budget, evaluation (discussed in a separate Method paper), and local agency support. Core program components Part of a wider, two-year, Aboriginal-initiated study into the are presented, with further details available via weblink. context and Indigenous perceptions of Aboriginal alcohol Conclusions and implications use and intervention, using a descriptive, grounded theory, Among the study’s remote area Aboriginal participants, participatory action study design. A demographically recommendations for substance misuse prevention and comprehensive sample of 170 Aboriginal people participated intervention differ markedly from options generally available in qualitative, semi-structured interviews within three types of to them. In contrast with the substance use symptom-focus participant groups—the ‘model planning group’ progressively of most programs, participants detail instead a cause- distilling all participants’ proposals into the intervention focused approach addressing issues of identity, economic model described here. and daily-life opportunity, and a sense of hope for the future. Results These findings have relevance for understandings of cultural The model proposes a remotely located, multi-component, appropriateness, Aboriginal-perceived social determinants youth and family-focused residential Bush College program and the design of culturally meaningful substance misuse with integral ‘cultural’, vocational/life skills and follow- prevention and intervention strategies. up support components. The program would be staffed by Keywords a network of permanent on–site Aboriginal staff, language Aboriginal model; substance use; participatory action group elders in residence for ‘cultural teaching’ components, research; prevention; intervention; social determinants; and visiting accredited vocational trainers. Family and peer capacity building; culture; vocational training; support. ‘Culture’ is printed in inverted commas throughout the article shown little effect 2-4 and remain scarce 5,6. At the time, the region’s to reflect the variety of perceptions about its meaning. In this Indigenous population was estimated to be 55% of a total regional article it is used in the sense described by study participants population of 7,171, with over half of this Aboriginal population living and refers to land (‘country’) based knowledge and belonging outside the two regional towns.7 The area’s post-European contact – including stories, language, kin and skin group relationships history spans approximately 130 years, with pastoral and pearling and bush knowledge and skills. industry expansion, mission- and government-run institutional This research was part of a wider in-depth study, undertaken residence, and commercial and social service provision having at local Indigenous instigation, into the context and patterns dramatically impacted the lives of the region’s Indigenous people. and Aboriginal perceptions of Indigenous alcohol misuse and Indigenous employment and median income levels remain well intervention. A full study description is available on http://adt. below those of the non-Indigenous population 8,9. Aboriginal and curtin.edu.au/theses/available/adt-WCU20040120.094316/. non-Aboriginal people and a host of government and commercial The study provides an example of Indigenous Research Reform bodies identify substance misuse as a major regional problem, Agenda recommendations for Aboriginal priority-driven research, with a range of local and State agencies providing endorsement research brokerage, participatory methodologies, community and written offers of operational assistance for the intervention development objectives, and quality control including the model described here. transfer and dissemination of research findings 1:53 and was granted an Indigenous Research Methodology award at the Method 2005 Public Health Association of Australia conference. The study was based on a descriptive, grounded theory, The research was based in the Derby area of the West Kimberley participatory action design. Procedures followed are in region of north Western Australia. It originated with requests to the accordance with National Health and Medical Research Council author (then Acting Kimberley Regional Coordinator with the WA guidelines 10. A variety of sampling strategies (purposive, Alcohol and Drug Authority) from local Aboriginal people frustrated opportunistic and snowball) resulted in a demographically with the ineffectiveness of existing programs, for an ‘Aboriginal comprehensive, although not fully representative, sample of 170 style’ alcohol intervention program. As elsewhere, evaluations of Aboriginal people comprising community and cultural leaders, existing substance misuse intervention programs in the area had identified community groups and a wide range of general 10 ABORIGINAL & ISLANDER HEALTH WORKER JOURNAL MAY/JUNE 2010, VOL 34 – NUMBER 3 community members. Qualitative, semi-structured interviews Aboriginal staff would be recruited using selection criteria were held with three types of participant groups (individuals, focusing on proven ‘cultural’, personal and professional skills one-off community focus groups and serial model-planning and qualities. Program components would relate to past, focus groups). Intervention model-building proposals from all present and future issues. The program’s foundation in a groups were discussed, debated and selectively adopted for ‘cultural’ context – including the strengthening of bonds with the final model by the latter group over 13 meetings and two family, land and other ‘cultural’ knowledge – was seen as a years. Membership of this group remained open, with a total means to address issues of disrupted identity. of 82 participants and an average of 15 people per meeting. The program would be non-custodial, with some of the earliest A full description of the model-building process is available confirmed proposals being that ‘no-one is forced to go there, online 11:220. and no-one is forced to stay there’. Magistrates likely to refer offenders to the Bush College would be warned that ‘staff are not Measurements prison officers’ and that ‘it’s not up to staff to force anyone to stay Data for the final model derived from the publicly written and at the college’. Residents’ daily programs and activities would be verified record of the model-planning group’s iterative debate largely self-selected, although certain components, such as the and decision-making process. Content analysis was performed ‘code of conduct’ summarised below, would be compulsory. using both QSR NUD.ist (Revision 4) software and collation Client numbers would be kept to a maximum of sixteen at any of the process recordings, combined with some statistical one time, with the addition of accompanying family and elders. description. Reliability, validity and triangulation were addressed Residents could stay at the program for up to a year, but would via the variety of methods and sources; methodological validity possibly average a four- to six-month stay. Health services at checks; and investigator, participant-observer and participant- the Bush College would be provided by visiting medical staff analyst reliability cross-checking. and Bush College staff with healthworker qualifications. Local medical and allied health agency participation in the program, Results much of which was offered in writing by the respective agencies Key features of the model at the time of the research, would include town-based pre- The planning process resulted in a model tentatively named the admission screening, on-site clinics and follow-up services. ‘Derby Aboriginal Bush Camp and Bush College’ (abbreviated Emergency medical assistance would be provided through radio here to the ‘Bush College’). It is a three-pronged intervention communication with the regional hospital and access to the approach based on the strengthening and maintenance Royal Flying Doctor Service. of Aboriginal identity and ‘cultural’ knowledge, vocational and life-skills, and a sense of hope for the future. The aim of Location participants’ program components was to ‘take the best from The Bush College would be established some distance from the both [Aboriginal and non-Aboriginal] cultures’ and to address regional centre but adequately close for emergency assistance. the perceived causes of alcohol (and other drug) misuse rather Following a lengthy process of proposal, discussion and debate, than its symptoms. an Aboriginal-owned cattle station, four hours drive from Derby The model’s focus is on young people and primary intervention, on a reasonable all-seasons access road and with station although people of all ages and stages of substance misuse would airstrip, was chosen by the group as the preferred location at be eligible for the program. At-risk youth, accompanied by families, the time of the research. The station is in remote country with peers and elders, would be encouraged to go to
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