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Article << Previous     |     Next >>   Contents Vol 38(4)

Walan Girri: developing a culturally mediated case management model for problematic alcohol use among urban Indigenous people

Ray Lovett A B E, Phyll Dance A, Jill Guthrie A C, Roxie Brown D and Julie Tongs D

A National Centre for Epidemiology and Population Health, The Australian National University, ACT 0200, Australia. Email: phyll.dance@anu.edu.au
B Australian Institute for Aboriginal and Torres Strait Islander Studies, 51 Lawson Crescent, ACT 2601, Australia.
C National Centre for Indigenous Studies, The Australian National University, ACT 0200, Australia. Email: jill.guthrie@anu.edu.au
D Winnunga Nimmityjah Aboriginal Health Service, 63 Boolimba Crescent, Narrabundah ACT 2604, Australia. Email: Julie.Tongs@Winnunga.org.au, Roxie.Brown@Winnunga.org.au
E Corresponding author. Email: ray.lovett@aiatsis.gov.au

Australian Health Review 38(4) 440-446 http://dx.doi.org/10.1071/AH13148
Submitted: 13 August 2013  Accepted: 5 March 2014   Published: 8 July 2014

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Objective To describe the design and implementation of a culturally mediated case management model at Winnunga Nimmityjah Aboriginal Health Service (Winnunga) for Indigenous clients who consume alcohol at problematic levels.

Methods Our research took place from March 2008 to March 2010 in the Australian Capital Territory and built on previous research partnerships between Winnunga and The Australian National University’s National Centre for Epidemiology and Population Health. We conducted a review of existing models to determine elements for consideration in the community controlled setting, and conducted staff surveys to assess current levels of skill and confidence around alcohol screening, brief intervention and care planning. Using the information from the review and staff surveys, we then undertook staff capacity building to build confidence and skills in conducting alcohol screening, brief intervention and care planning. This process was driven by Winnunga’s social health team. To meet Medicare benefits schedule requirements, and frame the study within the Aboriginal and Torres Strait Islander Chronic Disease Package framework, we included team care arrangements, care planning and health checks.

Results Elements of case management were suggested by staff and incorporated into the final model. Forty staff in the health service participated in identifying training needs for the development of the case management model and undertook a range of training before the model was implemented. Staff working within the social health team decided that the focus of the case management was to build a stronger future for their clients, hence the name of the case management model ‘Walan Girri’ (Wiradjuri language for strong future). The model included a package of screening instruments and brief intervention, related polices and discussion of ‘mob’ and ‘country.’ Changes in Winnunga management and staff, the composition of the research team and the way Walan Girri evolved led to protracted development and implementation.

Conclusions This project highlights considerations for implementing a case management model in a dynamic health service environment. Capacity building for Winnunga staff and for an Indigenous PhD scholar were part of the process and were integral in maintaining momentum in the project.

What is known about the topic? Case management for chronic disease and other health conditions is currently recommended in assisting to resolve those issues. Case management aims to involve a range of healthcare practitioners (general practitioners, nurses and Aboriginal health workers) and providers in conjunction with the client to improve their health status. Currently, there is limited description of how case management models are used within the Aboriginal community controlled context.

What does this paper add? This paper adds to the knowledge base in this field by describing the results of a method of case management driven by the community controlled health sector. It also introduces a simple approach that may be useful in a range of contexts in the health setting in building trust and rapport with clients, while engaging the healthcare practitioner in the Aboriginal and Torres Strait Islander cultural contexts of relationships to country and family (mob).

What are the implications for practitioners? The implication may be that healthcare practitioners working in Aboriginal and/or Torres Strait Islander Health Services adopt Aboriginal and Torres Strait Islander cultural protocols, such as talking with clients about ‘mob’ and ‘country’, to build trust and rapport.


[1]  Horton D. The encyclopaedia of Aboriginal Australia: Aboriginal and Torres Strait Islander history, society and culture. Canberra: Aboriginal Studies Press for the Australian Institute of Aboriginal and Torres Strait Islander Studies; 1994.

[2]  Hannah M. Aboriginal workers in the Australian Agricultural Company, 1824–1857. Labour Hist 2002; 82: 17–33.
CrossRef |

[3]  Cowlishaw G. Culture and the absurd: the means and meanings of Aboriginal identity in the time of cultural revivalism. J R Anthropol Inst 2012; 18: 397–417.
CrossRef |

[4]  Taylor L. ‘Who’s your mob?’ The politics of Aboriginal identity and the implications for a treaty. In: Treaty: let’s get it right! Canberra: Aboriginal Studies Press; 2003. pp. 88–106.

[5]  Williamson M, Harrison L. Providing culturally appropriate care: a literature review. Int J Nurs Stud 2010; 47: 761–9.
CrossRef | PubMed |

[6]  Williams R. Cultural safety: what does it mean for our work practice? Aust N Z J Public Health 1999; 23: 213–14.
CrossRef | CAS | PubMed |

[7]  Brady M. Alcohol use and its effects upon Aboriginal women. In: Broom D, editor. Double bind: women affected by alcohol and other drugs. St Leonards: Allen & Unwin; 1994. pp. 53–63.

[8]  Brady M. Aborigines and alcohol. Meanjin 2002; 61: 147–53.

[9]  Gray D, Saggers S. Substance misuse. In: Thomson N, editor. The health of Indigenous Australians. Melbourne: Oxford University Press; 2003 pp. 158–85.

[10]  Hunter E. Aboriginal alcohol use: a review of quantitative studies. J Drug Issues 1992; 22: 713–31.

[11]  Couzos S, Murray E, editors. Aboriginal primary health care. Melbourne: Oxford University Press; 2003.

[12]  Australian Institute of Health and Welfare (AIHW). National Drug Strategy household survey: detailed findings. Drug statistics series no. 22. Catalogue no. PHE 107. Canberra: AIHW; 2008.

[13]  Brady M, Sibthorpe B, Bailie R, Ball S, Sumnerdodd P. The feasibility and acceptability of introducing brief intervention for alcohol misuse in an urban Aboriginal medical service. Drug Alcohol Rev 2002; 21: 375–80.
CrossRef | PubMed |

[14]  Durand M. General practice involvement in the management of alcohol misuse: dynamics and resistances. Drug Alcohol Depend 1994; 35: 181–9.
CrossRef | CAS | PubMed |

[15]  Anderson P, Kaner E, Wutzke S, Wensing M, Grol R, Heather N, Saunders J, on behalf of the World Health Organization Brief Intervention Study Group Attitudes and management of alcohol problems in general practice: descriptive analysis based on findings of a World Health Organization international collaborative survey. Alcohol Alcohol 2003; 38: 597–601.
CrossRef | PubMed |

[16]  Department of Health and Ageing (DoHA). Alcohol treatment guidelines for Indigenous Australians. Canberra: DoHA; 2004.

[17]  Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction 1993; 88: 791–804.
CrossRef | CAS | PubMed |

[18]  Guthrie J, Lovett R, Dance P, Brown R, Ritchie C. ‘Where’s your country?’ New approaches for working with problematic alcohol use among Indigenous Australians in an urban setting. Aust Aboriginal Stud 2010; 2010: 100–7.

[19]  Ministerial Council on Drug Strategy. National drug strategy: Aboriginal and Torres Strait Islander Peoples complementary action plan 2003–2009. Canberra: Department of Health and Ageing; 2006.

[20]  2 Pac, Ace of Spades, Chantal, Fifty-cents, Fiona, John (2), Li’l Kim, Master BJ, Tongs J, Dance P, Guthrie J. ‘I want to be heard’: an analysis of needs of Aboriginal and Torres Strait Islander illegal drug users in the ACT and region for treatment and other services. Community Report. Canberra: National Centre for Epidemiology and Population Health, The Australian National University and Winnunga Nimmityjah Aboriginal Health Service; 2005. Available at http://nceph.anu.edu.au/files/i_want_to_be_heard-community_report.pdf [verified 3 April 2014].

[21]  Dance P, Tongs J, Guthrie J, McDonald D, D’Souza R, Cubillo C, Bammer G. ’I want to be heard’: an analysis of needs of Aboriginal and Torres Strait Islander illegal drug users in the ACT and region for treatment and other services. Canberra: National Centre for Epidemiology and Population Health, The Australian National University and Winnunga Nimmityjah Aboriginal Health Service; 2004.

[22]  Guthrie J, Dance P, Cubillo C, McDonald D, Tongs J, Brideson T, Bammer G. Approaches to developing a culturally appropriate research team. In: Jackson Pulver L, McDermott D, editors. Djadi No 1.1. Revised monograph of the inaugural Indigenous Health Unit Research Day 2004. Muru Marri Indigenous Health Unit, Monograph Series. Sydney: University of New South Wales; 2005. pp. 35–44.

[23]  Gray D. Enhancing the management of alcohol-related problems among Indigenous Australians. Centrelines 2008; September: 2–4.

[24]  National Health and Medical Research Council (NHMRC). Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research. Canberra: NHMRC; 2003.

[25]  NSW Community Options Projects Incorporated. Community options case management best practice guidelines. Sydney: NSW Community Options Projects Incorporated; 2003.

[26]  Commonwealth of Australia. Case management resource kit for SAAP services . Canberra: Family and Community Services; 1997.

[27]  McDonald D. Case management in the substance abuse field: insights from the research literature. A report prepared for the Drug & Alcohol Policy Unit, ACT Health. Canberra: Social Research & Evaluation Pty Ltd; 2005.

[28]  Rossi P, editor. Case management in health care. Philadelphia, PA: Saunders; 2003.

[29]  Port Lincoln Aboriginal Health Service. Chronic disease self management: project evaluation . Port Lincoln: Port Lincoln Aboriginal Health Service; 2004.

[30]  Case Management Society of Australia. National standards of practice for case management . Sydney: Case Management Society of Australia; 2004.

[31]  Schlesinger C, Ober C, McCarthy M, Watson J, Seinen A. The development and validation of the Indigenous Risk Impact Screen (IRIS): a 13-item screening instrument for alcohol and drug and mental health risk. Drug Alcohol Rev 2007; 26: 109–17.
CrossRef | PubMed |

[32]  Gossop M, Best D, Mardsen J, Strang J. Test–retest reliability of the Severity of Dependence Scale. Addiction 1997; 92: 353–4. [Letter]
CrossRef | CAS | PubMed |

[33]  Lawrinson P, Copeland J, Gerber S, Gilmour S. Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence. Addict Behav 2007; 32: 1474–9.
CrossRef | PubMed |

[34]  Heatherton T, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerström test for nicotine dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 1991; 86: 1119–27.
CrossRef | CAS | PubMed |

[35]  National Health and Medical Research Council (NHMRC). Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC; 2009.

[36]  Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA, Ambulatory Care Quality Improvement Group The audit alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med 1998; 158: 1789–95.
| CAS | PubMed |

[37]  Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32: 959–76.
CrossRef | CAS | PubMed |

[38]  Department of Health and Ageing. OATSIH accreditation manual: a handbook for Aboriginal and Torres Strait Islander community controlled health organisations. Canberra: Department of Health and Ageing; 2010.

[39]  Tolar M, Balka E. Caring for individual patients and beyond: enhancing care through secondary use of data in a general practice setting. Int J Med Inform 2012; 81: 461–74.
CrossRef | PubMed |

[40]  Si D, Bailie R, Cunningham J, Robinson G, Dowden M, Stewart A, Connors C, Weeramanthri T. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia’s Northern Territory: use of the chronic care model. BMC Health Serv Res 2008; 8: 112
| PubMed |

[41]  Kaner E, Heather N, Brodie J, Lock CA, McAvoy BR. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract 2001; 51: 822–7.
| CAS | PubMed |

[42]  Kaner E, Rapley T, May C. Seeing through the glass darkly? A qualitative exploration of GPs’ drinking and their alcohol intervention practices. Fam Pract 2006; 23: 481–7.
CrossRef | PubMed |

[43]  Hulse GK. Impediments to screening for hazardous alcohol use and dependence in general hospital psychiatric inpatients. Aust N Z J Psychiatry 2001; 35: 606–12.
CrossRef | CAS | PubMed |

[44]  Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug Alcohol Rev 2004; 23: 11–18.
CrossRef | PubMed |

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