Academic journal article Australian Health Review

Walan Girri: Developing a Culturally Mediated Case Management Model for Problematic Alcohol Use among Urban Indigenous People

Academic journal article Australian Health Review

Walan Girri: Developing a Culturally Mediated Case Management Model for Problematic Alcohol Use among Urban Indigenous People

Article excerpt

Introduction

Australian Indigenous people have experienced significant displacement from traditional lands since colonisation in 1788. Many were relocated to Government reserves or church missions. Active assimilation policies existed into the late 1960s, where mixed race children were removed from parents and placed in training facilities comprising domestic services for women and agricultural labour for men.1,2 Although this practice was widespread, oral traditions of storytelling ensured many Indigenous people retained some knowledge of where their country was and what tribal group or subgroup they belonged to. A process of cultural revival is currently taking place among some groups, although there is much debate concerning its form and appropriateness.3 Even today, when two unacquainted Indigenous people meet for the first time, there are two questions often asked before any further discussion: 'Who's your mob?' and 'Where's your country?' The concepts of 'mob' and 'country' are fundamental to Indigenous identity, particularly the willingness and capacity of Indigenous Australians to interact with others.4 'Mob' generally refers to the cultural or linguistic groups from which an Indigenous Australian's lineage can be traced. 'Country' refers to the geographic location from where that language group originated. Being able to identify one's mob and country is increasingly seen as a way of verifying and taking pride in one's Indigenous heritage.4 Recognising the role that these concepts can play in a holistic approach to Indigenous health and wellbeing is important, especially in relation to building rapport and trust. Despite the existence of cultural safety plans and cultural competency frameworks,5 developing a way that engages Indigenous people in the nexus between their Indigenous identity and the healthcare setting has been difficult. Culturally mediated service delivery may be framed within cultural safety; that is, provision of a safe environment for people where there is no assault, challenge or denial of their identify, who they are and what they need.6

Ample evidence exists to demonstrate the harmful effects of alcohol on Indigenous individuals, families and communities.7-11 However, it is important to note that, compared with other Australians, a smaller proportion of Indigenous people consumes alcohol, although a greater proportion does so at harmful levels.12 Several barriers and challenges limiting the use of appropriate screening instruments and brief interventions for alcohol problems among Indigenous clients have been identified, including factors related to the clients themselves, instruments and interventions, training, service providers undertaking the screening or providing the interventions, and the setting in which they are administered.13 Factors for poor uptake of screening instruments include reluctance to address alcohol issues14 and limited experience, education and confidence in dealing with alcohol-related problems.15 A lack of evidence supporting alcohol screening instrument use among Indigenous clients is also likely to be a major contributor to poor uptake. In this regard, the Alcohol Treatment Guidelines for Indigenous Australians advocates the use of screening instruments and brief interventions in primary care settings16 and recommends the Alcohol Use Disorders Identification Test (AUDIT).17 However, the AUDIT has not been validated for use with Indigenous people.

The background to this project at Winnunga Nimmityjah Aboriginal Health Service ('Winnunga'; Canberra's only Aboriginal community controlled health organisation) has been described elsewhere.18 Briefly, Winnunga's intention to introduce a case management model fortuitously coincided with the following three treatment intervention measures identified through the National Drug Strategy's Aboriginal and Torres Strait Islander Complementary Action Plan:19 (1) brief intervention; (2) integrated screening and assessment; and (3) shared care, integrated care and case management. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.