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Abstract:
Background: Risky levels of drug and alcohol-related harm among Aboriginal Australians are both a consequence of, and contribute to, the disproportionate health and social gap between Aboriginal and non-Aboriginal Australians, especially in rural and remote Australia. High quality Aboriginal drug and alcohol residential rehabilitation services are an important form of treatment for Aboriginal substance users and are therefore making a vital contribution towards the Government’s target to close the life expectancy gap within a generation. However, limited available evidence exists about the models of care being delivered, client characteristics and the range of data being collected. Orana Haven Residential Rehabilitation Service (OH) is a 3-month voluntary rehabilitation program for Aboriginal males. OH is a dynamic Aboriginal Community Controlled Health Organisation that has been in operation since the 1980s and is the only service of its kind in Western NSW. The National Drug and Alcohol Research Centre (NDARC) have been invited to partner with Orana Haven Residential Rehabilitation Service (OH), located in remote western NSW, to work with them to evaluate, tailor and monitor their program from 2015-2017. Aims: Outline the OH Model of Care; Describe the demographic and client characteristics of OH between 2011 and 2016; and Analyse perceptions of staff and clients about their experience of the OH program, especially in relation to OH’s primary purpose of providing culturally safe drug and alcohol treatment. Methods: This research adopted a mixed methods approach to evaluate the program, including the analysis of five years of demographic, referral and service utilisation characteristics of clients, and semi-structured interviews with staff and clients to understand the perceptions of the program. Results: The Model of Care was developed in consultation with OH staff and clients. The program is defined by three guiding principles (strong governance, skilled staff and effective and culturally safe service delivery) and five core components (consistent routine and rules, counselling and case management, groups, culture and identify and learning and development of skills.) From 2011-2016, the service had a total of 329 clients (average age 36 years) access treatment, with the median length of stay of 55 days. A total of 84% of clients identified as Aboriginal or Torres Strait Islander and 77% were referred from Corrective Services. Themes from the qualitative analysis included: hopes for the future, impact of substance abuse for both clients and staff, the positive perception of the rehabilitation being located in a remote location and the importance of culture and spirituality that is embedded within the program. Conclusions and implications: This is the first evaluation of this kind focusing on defining and strengthening a remote Aboriginal drug and alcohol rehabilitation service in Australia. The implications of this research is to highlight the value of Aboriginal residential treatment to clinicians, academics, policymakers and senior bureaucrats more broadly, as well as make recommendations to strengthen the OH model of care to ensure it continues to be leading service in the field of Aboriginal substance abuse treatment, both in Australia and internationally.
