Optimising the delivery of substance use interventions for young people in rural communities

people (YP) in rural Australia are more likely than urban YP to experience substance use harms. These harms are compounded by access limitations to effective healthcare services. Optimising substance use interventions across rural healthcare services is therefore crucial. This thesis seeks to determine best evidence interventions, and to identify how rural healthcare services can optimise the delivery of psycho-social interventions in reducing problematic substance use for YP. This thesis comprises four studies, and aims to: 1) conduct an overview of systematic reviews on efficacious and feasible psycho-social interventions addressing YP’s substance use, 2) examine the factors influencing the delivery of substance use interventions in a rural integrated youth mental health service (Headspace), 3) evaluate the implementation of a capacity building program (the Adolescent Substance Use Program or A-SUP) designed to enhance substance use treatments for YP in an Australian rural health district, and 4) collaborate with key stakeholders to revise A-SUP’s model of care, and re-align its aims, activities and measures. Chapter 2 highlights Multidimensional Family Therapy as a promising intervention for YP substance use, but the evidence on integrating rural YP substance use interventions into rural healthcare services remains lacking. Chapter 3 shows that in an existing program for YP (Headspace), the youth-centric and client-centred approaches enables rural YP’s access to substance use interventions. However, this chapter found YP’s’ help-seeking reluctance, practitioner skills, and societal attitudes were barriers to substance use interventions in Headspace. Given these factors, and A-SUP’s aims of mitigating these treatment barriers, Chapter 4 presented A-SUP’s evaluation findings. A-SUP’s clinical component showed success in reaching the rural clinical population, but the capacity building component lacked engagement from substance use services due to shifting program aims and deliverables. Therefore, in Chapter 5 the next iteration of A-SUP was clarified, with a greater focus on systemic-level program components. The key findings from this thesis were that rural health services need to ensure staff have skills and knowledge to work with YP on substance use problems including education in therapeutic approaches, that their services are youth-centric in design and accessibility, and attention is given to effective implementation

Performance Evaluation of the ISS Water Processor Multifiltration Beds

The ISS Water Processor Assembly (WPA) produces potable water from a waste stream containing humidity condensate and urine distillate. The primary treatment process is achieved in the Multifiltration Bed, which includes adsorbent media and ion exchange resin for the removal of dissolved organic and inorganic contaminants. The first Multifiltration Bed was replaced on ISS in July 2010 after initial indication of inorganic breakthrough. This bed was returned to ground in July 2011 for an engineering investigation. The water resident in the bed was analyzed for various parameters to evaluate adsorbent loading, performance of the ion exchange resin, microbial activity, and generation of leachates from the ion exchange resin. Portions of the adsorbent media and ion exchange resin were sampled and subsequently desorbed to identify the primary contaminants removed at various points in the bed. In addition, an unused Multifiltration Bed was evaluated after two years in storage to assess the generation of leachates during storage. This assessment was performed to evaluate the possibility that these leachates are impacting performance of the Catalytic Reactor located downstream of the Multifiltration Bed. The results of these investigations and implications to the operation of the WPA on ISS are documented in this paper

Increased demand for amphetamine treatment in rural Australia

BACKGROUND: A substantial increase in substance treatment episodes for methamphetamine problems suggests characteristics of the treatment population could have changed and that targeted treatment programs are required. To determine who methamphetamine treatment should be designed for this study has two aims. First, to empirically describe changes in amphetamine treatment presentations to a rural NSW drug and alcohol treatment agency over time. Second, to examine how these characteristics may affect the likelihood of being treated for amphetamines compared to other drugs. METHOD: The Australian Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) containing closed treatment episodes from a single agency from three time periods was used. Characteristics of people receiving amphetamine treatments in these three periods were compared and the effects of these characteristics on the odds of being treated for amphetamine were estimated using a logistic regression model. The characteristics utilised in the analysis include age, sex, Indigenous status, usual accommodation, living arrangement, source of referral and source of income. RESULTS: The proportion of amphetamine treatment episodes doubled from 2006/2007 to 2015/2016 and overtook alcohol as the most commonly treated principal drug of concern. The estimated proportion of amphetamine treatments showed an increment across all ages and for men and women. It was found that younger people, women, people in temporary accommodation or homeless, people who were self-referred and people whose main source of income was not through employment are more likely to be treated for amphetamine use. CONCLUSION: Significant changes over time in the age, sex and Indigenous status of people receiving treatment for amphetamine as the principal drug of concern requires service delivery to match demand from younger people, particularly women; and Indigenous people. The needs and preferences for treatment of younger women who use amphetamine will be important factors in treatment planning service providers who are more used to providing treatment for young men who use cannabis and older men who use alcohol. Further research on women\u27s experiences in treatment and outcomes would be useful for informing treatment practices

Increased demand for amphetamine treatment in rural Australia

Abstract Background A substantial increase in substance treatment episodes for methamphetamine problems suggests characteristics of the treatment population could have changed and that targeted treatment programs are required. To determine who methamphetamine treatment should be designed for this study has two aims. First, to empirically describe changes in amphetamine treatment presentations to a rural NSW drug and alcohol treatment agency over time. Second, to examine how these characteristics may affect the likelihood of being treated for amphetamines compared to other drugs. Method The Australian Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) containing closed treatment episodes from a single agency from three time periods was used. Characteristics of people receiving amphetamine treatments in these three periods were compared and the effects of these characteristics on the odds of being treated for amphetamine were estimated using a logistic regression model. The characteristics utilised in the analysis include age, sex, Indigenous status, usual accommodation, living arrangement, source of referral and source of income. Results The proportion of amphetamine treatment episodes doubled from 2006/2007 to 2015/2016 and overtook alcohol as the most commonly treated principal drug of concern. The estimated proportion of amphetamine treatments showed an increment across all ages and for men and women. It was found that younger people, women, people in temporary accommodation or homeless, people who were self-referred and people whose main source of income was not through employment are more likely to be treated for amphetamine use. Conclusion Significant changes over time in the age, sex and Indigenous status of people receiving treatment for amphetamine as the principal drug of concern requires service delivery to match demand from younger people, particularly women; and Indigenous people. The needs and preferences for treatment of younger women who use amphetamine will be important factors in treatment planning service providers who are more used to providing treatment for young men who use cannabis and older men who use alcohol. Further research on women’s experiences in treatment and outcomes would be useful for informing treatment practices

Additional file 1 of Study protocol for the family empowerment program: a randomized waitlist-controlled trial to evaluate the effectiveness of online Community Reinforcement and Family Training (CRAFT) on the wellbeing of family members with a relative experiencing substance dependence and mental illness

Additional file 1

Youth Mental Health Peer Support Work: A Qualitative Study Exploring the Impacts and Challenges of Operating in a Peer Support Role

Youth aged 16–24 years have the highest prevalence of mental illness in Australia, accounting for 26% of all mental illness. Youth mental health peer support work is a promising avenue of support for this population. However, limited research has examined impacts on those who provide youth mental health peer support work. We aimed to identify the benefits and challenges of working in a youth mental health peer support role. Semi-structured qualitative interviews with seven purposefully sampled peer workers from a national youth mental health organisation in Australia were conducted. The interviews were thematically analysed. Six key themes were identified: (1) personal growth, (2) interpersonal factors, (3) organisational factors, (4) boundaries, (5) role acknowledgement, and (6) challenging situations. Key supportive factors included financial reimbursement, training, support, and role-related flexibility. Identified challenges included lack of role acknowledgement, role-related stress, and boundaries. Operating within a youth mental health peer support role is perceived to have positive impacts on personal growth and interpersonal factors, enhanced through financial reimbursement, supervision, and role-related flexibility. Perspectives on the most effective form of role boundaries were diverse however their importance in addressing challenges was emphasised

Leveraging data and digital health technologies to assess and impact social determinants of health (SDoH)

Objective: Identify how novel datasets and digital health technology, including analytics- and artificial intelligence (AI)-based tools, can be used to assess non-clinical, social determinants of health (SDoH) for population health improvement. Methods: A targeted review with systematic methods was performed on three databases and the grey literature to identify recently published articles (2013-2018) for evidence-based qualitative synthesis. Following single review of titles and abstracts, two independent reviewers assessed eligibility of full-texts using predefined criteria and extracted data into predefined templates. Results: The search yielded 2,714 unique database records of which 65 met inclusion criteria. Most studies were conducted retrospectively in a United States community setting. Identity, behavioral, and economic factors were frequently identified social determinants, due to reliance on administrative data. Three main themes were identified: 1) improve access to data and technology with policy – advance the standardization and interoperability of data, and expand consumer access to digital health technologies; 2) leverage data aggregation – enrich SDoH insights using multiple data sources, and use analytics- and AI-based methods to aggregate data; and 3) use analytics and AI-based methods to assess and address SDoH – retrieve SDoH in unstructured and structured data, and provide contextual care management sights and community-level interventions. Conclusions: If multiple datasets and advanced analytical technologies can be effectively integrated, and consumers have access to and literacy of technology, more SDoH insights can be identified and targeted to improve public health