Preventative medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

MIDDLESEX HOUSE,34-42 CLEVELAND ST, LONDON, ENGLAND, W1T 4L

Preventive medical care in remote Aboriginal communities in the Northern Territory: a follow-up study of the impact of clinical guidelines, computerised recall and reminder systems, and audit and feedback

Background Interventions to improve delivery of preventive medical services have been shown to be effective in North America and the UK. However, there are few studies of the extent to which the impact of such interventions has been sustained, or of the impact of such interventions in disadvantaged populations or remote settings. This paper describes the trends in delivery of preventive medical services following a multifaceted intervention in remote community health centres in the Northern Territory of Australia. Methods The intervention comprised the development and dissemination of best practice guidelines supported by an electronic client register, recall and reminder systems and associated staff training, and audit and feedback. Clinical records in seven community health centres were audited at regular intervals against best practice guidelines over a period of three years, with feedback of audit findings to health centre staff and management. Results Levels of service delivery varied between services and between communities. There was an initial improvement in service levels for most services following the intervention, but improvements were in general not fully sustained over the three year period. Conclusions Improvements in service delivery are consistent with the international experience, although baseline and follow-up levels are in many cases higher than reported for comparable studies in North America and the UK. Sustainability of improvements may be achieved by institutionalisation of relevant work practices and enhanced health centre capacity

Art as everyday practice: A study of gongfu tea in Chaoshan, China

This study explores the place of traditional Chinese tea culture in a society undergoing changes both culturally, with the rise of consumerism, and structurally, with the growth of a market economy and globalization. It does so by examining tea drinking in the Chaoshan region of eastern Guangdong Province. Chaoshan is the home of a style of preparing and drinking tea known as 'gongfu' tea, involving preparation of strong tea in small pots, and drinking repeated brews in small cups. As well as being an important part of the regional food and drink culture, gongfu tea has been adopted outside Chaoshan as a refined form of tea culture, and even represented outside China as an authentic 'Chinese tea ceremony'. It therefore provides an appropriate case study through which to examine both local practices and the processes through which local cultural objects are appropriated and transformed for use in other contexts. The study pursues two lines of inquiry. The first examines the development of a contemporary discourse representing Chaoshan gongfu tea as a manifestation of a continuous tradition dating back more than 1,000 years to the Tang Dynasty. I argue that, while tea has long been consumed in Chaoshan, this representation is not supported by historical evidence, and is an example of an invented tradition. The second line of inquiry is a study of contemporary gongfu tea-drinking practices, both among people born in Chaoshan, and among non-Chaoshan people who have taken it up as an acquired practice. Methodologically, the study uses sociological ethnography, in which the ‘field’ of research is not a specific locality but a field of inquiry defined by pursuing linkages relevant to the research questions. Findings are based on fieldwork involving semi-structured interviews with, and observations among, a snowball sample of 32 individuals plus one family that was treated, for analytical purposes, as a single unit. Fieldwork was conducted in four visits to the region between 2010 and 2017. The study found that, among people born in Chaoshan, gongfu tea is experienced as an integral part of everyday life, rather than a form of tea art. As a practice, it entails close attention to detail in preparing, serving and drinking tea, on the one hand and, on the other, a high level of creativity, rather than slavish adherence to a prescriptive model. People who have taken up gongfu tea as an acquired practice exhibit similar skills, but for them, gongfu tea is unlikely to be woven into the fabric of everyday life. Some people choose to cultivate additional knowledge and skills in order to enhance their gongfu tea practice as tea art. The study concludes by considering the relationship between Chaoshan gongfu tea as a cultural object created through discourse, and contemporary tea-drinking practices. I argue that the relationship is not as close as literary accounts imply. While each is informed by the other, neither is a mirror of the other, and each is a product of distinctive social processes: the discourse, by the activities of academics, entrepreneurs and others, each pursuing their own interests; tea-drinking practices, by the opportunities and constraints generated through economic and social processes emanating from the wider society

Adolescent inhalant use, abuse and dependence

Aims  To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design  Cross-sectional survey with structured psychiatric interviews. Setting  Facilities ( n  = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants  Current MDYS residents ( n  = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11–20); more than one-third (38.6%, n  = 279) reported life-time inhalant use. Measurements  Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems. Findings  Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users. Conclusions  Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72164/1/j.1360-0443.2009.02557.x.pd

Barriers and enablers to the provision of alcohol treatment among Aboriginal Australians: A thematic review of five research projects

Introduction and Aims: To review the results of five research projects commissioned to enhance alcohol treatment among Aboriginal Australians, and to highlight arising from them. Design and Methods: Drafts of the papers were workshopped by project representatives, final papers reviewed and results summarised. Lessons arising were identified and described. Results: While the impact of the projects varied, they highlight the feasibility of adapting mainstream interventions in Aboriginal Australian contexts. Outcomes include greater potential to: screen for those at risk; increase community awareness; build capacity and partnerships between organisations; and co-ordinate comprehensive referral networks and service provision. Discussion: Results show a small investment can produce sustainable change and positive outcomes. However, to optimise and maintain investment, cultural difference needs to be recognised in both planning and delivery of alcohol interventions; resources and funding must be responsive to and realistic about the capacities of organisations; partnerships need to be formed voluntarily based on respect, equality and trust; and practices and procedures within organisations need to be formalised. Conclusions: There is no simple way to reduce alcohol-related harm in Aboriginal communities. However, the papers reviewed show that with Aboriginal control, modest investment and respectful collaboration, service enhancements and improved outcomes can be achieved. Mainstream interventions need to be adapted to Aboriginal settings, not simply transferred. The lessons outlined provide important reflections for future research

Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction

BACKGROUND: Drug users’ organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol. METHODS: This paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory. RESULTS: Although the workshops were targeted to people who use illicit drugs, people who primarily consume alcohol also attended. An unexpected finding was the potential for drug users’ organizations and other harm reduction programs to involve “illicit drinkers”: people who drink non-beverage alcohol (e.g. mouthwash, rubbing alcohol) and those who drink beverage alcohol in criminalized ways (e.g., homeless drinkers). Potential points of alliance between these groups are common priorities (specifically, improving treatment by health professionals and the police, expanding housing options, and implementing harm reduction services), common values (reducing surveillance and improving accountability of services), and polysubstance use. CONCLUSIONS: Despite these potential points of alliance, there has historically been limited involvement of illicit drinkers in drug users’ activism. Possible barriers to involvement of illicit drinkers in drug users’ organizations include racism (as discourses around alcohol use are highly racialized), horizontal violence, the extreme marginalization of illicit drinkers, and knowledge gaps around harm reduction for alcohol. Understanding the commonalities between people who use drugs and people who use alcohol, as well as the potential barriers to alliance between them, may facilitate the greater involvement of illicit drinkers in drug users’ organizations and harm reduction services

Alcohol, communities and researchers: theorizing the relationships in an unstable mixture

The growing importance of local communities as sites for preventive alcohol-related initiatives has generated interest in the role of research associated with community action. To date, however, this has not led to a theoretically informed account because of a failure to account reflexively for researchers' own practices and the use of conceptually inadequate models of "community." this paper proposes an analytical framework, derived from the author's association with alcohol initiatives in several northern Australian towns and drawing on Bourdieu's concept of the social field. It is argued that the initiation of local action generates a complex social field in which stakeholders pursue their interests by mobilizing forms of capital: economic, social, political, and symbolic. Research, as well as the conveyance of valued information, is imbued with symbolic and political capital. The analysis concludes with four propositions relating to how, by whom and with what consequences research is likely to be utilized in these settings

Responding to Aboriginal substance misuse : a review of programs conducted by the Council for Aboriginal Alcohol Program Services (C.A.A.P.S.), Northern Territory

A review conducted on behalf of the N.T. Drug and Alcohol Bureau, Department of Health and Community Services, and the Aboriginal and Torres Strait Islander Commission, ATSIC.This review is concerned with the effectiveness of CAAPS intervention programs. After presenting an overview of the organisational structure of CAAPS in Chapter One, I examine the theories, ideas and models governing the CAAPS approach to substance abuse. This examination takes up Chapter Two. The next few chapters examine individual components of the CAAPS service delivery system. Chapters Three and Four focus on two major residential programs - the Daly River Five Mile Family program and the Gordon Symons Centre residential programs respectively. Chapter Five looks at the non-residential programs offered at the Gordon Symons Centre between 1987 and 1989. In Chapter Six the focus is on CAAPS' community-based field workers. In the final chapter, I attempt to draw together the threads of pervious chapters into an overall assessment of the effectiveness of the CAAPS system