Working with Aboriginal and Torres Strait Islander people: the Value of the Therapeutic Community Model NIDAC Conference June 2010 Lynne Magor-Blatch, Carol Daws & Karen Ward
Acknowledgement • We acknowledge the Aboriginal peoples and elders of this land, and the families who are struggling with issues of substance use. • We acknowledge that alcohol and other drug (AOD) use among Aboriginal people is to a large extent intertwined with broader social issues resulting from the continuing impact of colonisation and dispossession, family dispersal and hardship. • This, along with current underlying statistics that mark Aboriginal people as the most disadvantaged of all Australians, challenges and motivates us in our work. Page 2 An introduction to the TC
Introduction • Brief overview of the Therapeutic Community Model and its value in working with Aboriginal and Torres Strait Islander Peoples – Lynne • The Cyrenian House Program – Partnerships to provide better service – Carol & Karen Page 3 An introduction to the TC
What is a Therapeutic Community? A Therapeutic Community is a structured method and environment for changing human behaviour in the context of community life and responsibility Page 4 An introduction to the TC
• A Therapeutic Community is a treatment facility in which the community itself, through self-help and mutual support, is the principal means for promoting personal change • In a therapeutic community, residents and staff participate in the management and operation of the community, contributing to a psychologically and physically safe learning environment where change can occur • In a therapeutic community, there is a focus on the biopsychosocial, emotional and spiritual dimensions of substance use, with the use of the community to heal individuals and support the development of behaviours, attitudes and values of healthy living (ATCA 2006) Page 5 An introduction to the TC
“The development of small cohesive communities where the therapeutic decisions and functions are shared by the whole community, and where the status differences between staff and residents are greatly reduced though not abandoned” (Kennard 2000) “What creates membership of a community, what binds a group of individuals together and creates a sense of belonging, is a commitment to struggle together” (Sarah Tucker 2000) “The community is a network of relationships for support and being supported. All patients [sic] are expected to play a part as both supporter and supported and this is to some extent true to staff” (Hinchelwood 2002) Page 6 An introduction to the TC
Cultural Respect • The ‘recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander peoples achieved when the health system is a safe environment for Aboriginal and Torres Strait Islander peoples and where cultural differences are respected’, Australian Health Ministers Advisory Council (AHMAC). Page 7 An introduction to the TC
Cultural Respect • It incorporates the following principles: – An holistic approach to Aboriginal and Torres Strait Islander health; – Health sector responsibility; – Community control of Primary Health Care Services; – Working together; – Localised decision making; – Promoting good health; – Building the capacity of health services and communities; and – Accountability for health outcomes. Page 8 An introduction to the TC
The Therapeutic Community • Operates within a framework that is responsive to the needs of Aboriginal and Torres Strait Islander people; • Delivers quality services to Aboriginal and Torres Strait Islander communities within an integrated and strategic policy framework; • Embraces the diversity of Aboriginal and Torres Strait Islander cultures; and • Ensures that every aspect of the health service provision is culturally safe for Aboriginal and Torres Strait Islander people. Page 9 An introduction to the TC
The Therapeutic Community • The method of treatment is particularly suited to Aboriginal and Torres Strait Islander populations since it is based on family and a sense of community. It is a wholistic approach which embodies the need to pay attention to the connectivity of all aspects of life essential to improving overall wellbeing. • Some TCs like Cyrenian House are providing programs for indigenous Australians within the broader TC in an effort to provide a program that fits within the person’s culture and provides an evidence based framework that underpins effective treatment for addiction. Page 10 An introduction to the TC
How we started • Began from a shared desire of the Drug & Alcohol Office (DAO) and Aboriginal Alcohol & Drug Service (AADS) to use resources for maximum benefit of Aboriginal people; Involved a tough decision to close the under utilised sobering up centre in Midland and re-use the funds to deliver much needed services for Aboriginal people; • Required a visionary approach of AADS and their service partners, Cyrenian House, which was clearly demonstrated. Page 11 An introduction to the TC
WHAT WE DID • Committed to early action; • Closed Midland SUC but ensured a safety net; • Assured AADS that the resources were protected for Aboriginal people; • Agreed to use the resources to open 12 new beds for Aboriginal people in established therapeutic communities; and • Ensured AADS would be central to any new partnership, with a real role in the therapeutic community services and outpatient services before and after admission. Page 12 An introduction to the TC
WHAT WE DID • Primary focus to be on client with a view to offering a continuum of care; • The process would involve skills transfer; • Employed existing staff where possible; and • Built genuine new partnerships. Page 13 An introduction to the TC
HOW WE DID IT • DAO brokered the initial meetings but stayed out of the detailed discussions between the partners; • Everything was documented in agreements. • Partners developed trust through frank and open discussions; • DAO funded partners to visit other services in Australia; • A leap of faith and a real commitment to “give it a go”; • Faster than many thought possible. Page 14 An introduction to the TC
Page 15 An introduction to the TC
Road Trip to Research Indigenous Treatment Options • We visited a number of locations; • Broome – • Milliya Rumurra and the Kimberley Community Drug Service Team • Darwin - • CAAPS – Facility for 30 clients, mostly indigenous with partners and children. • FORWARD 12 Step facility for adults Alice Springs – DASA and the Central Australian Aboriginal Alcohol Program unit Page 16 An introduction to the TC
Page 17 An introduction to the TC
Referral & Assessment Process Sources of referral • Self referred to Cyrenian House • Referred by AADS • Other agencies Information Session • Cyrenian House Group • AADS – Individually • Telephone/other agencies This session provides accurate and current information about the Cyrenian House Therapeutic Community. Will include, but not limited to : cost, confidentiality, structure, assessment and exclusion criteria. Page 18 An introduction to the TC
ASSESSMENT PROCESS Decision from client: • If the client says no - the client is referred to AADS, Cyrenian House Non-residential or/or another appropriate agency. • If yes – client attends assessment interview (telephone assessments are provided for clients residing in remote areas) Factors Involved in Assessment • Information collection, follow up and clinical judgment • Joint decision through the assessment team • Book admission if appropriate for TC • Ongoing support and monitoring (via AADS, Cyrenian House N/R or other agency • Client admitted (ultimately decided by Manager of TC). Page 19 An introduction to the TC
Assesment Process ����������������������� �������� ���� Mangers of TC & Non Residential ����� & AADS staff ����� Ready for Assessment (i.e. attending Information group or Assessment: Cyrenian House, given Individual counselling AADS or other session) ������� ������� NOT NOT APPROVAL APPROVAL ���� ���� Client Referral Pool SUITABLE SUITABLE ����������� ����������� � � DETOX DETOX CYRENIAN HOUSE CYRENIAN HOUSE Page 20 An introduction to the TC
The importance of Aboriginal Staff All Cyrenian House staff have undertaken Cultural Security training and supported by three Aboriginal workers employed within the Therapeutic Community. Six Aboriginal-specific beds are allocated within the Mixed Gender Program to ensure the service is more culturally secure for Aboriginal populations engaging in treatment. Within the Cyrenian House Saranna Women’s & Children’s Program, approximately 50% of families are from Aboriginal or Torres Strait Islander populations. Page 21 An introduction to the TC
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