Health care providers
Health care providers were generally of the view that CRA and CRAFT could successfully be delivered to Aboriginal Australians if tailored to their needs, preferences and literacy levels. In particular, modifying language and terminology commonly used in the delivery of CRA and CRAFT procedures to make it more appropriate for Aboriginal people was identified by participants in interviews and working group meetings as important. History, low literacy levels and Aboriginal-specific use of the English language were commonly identified as reasons for changing the language to make it more appropriate to Aboriginal people.
We’re going to have to modify (CRA and CRAFT) a bit for…Australia, for the clients…just the wording and that sort of stuff…maybe use some pictures (health care provider 107).
…you’re working with people who live in these worlds of chaos, you’ve really got to look at the language so that everyday people in that country can relate to it. So I think it really needs to be - an Australian version of it really needs to be looked at. The concepts are still the same but again, you need to look at it in a different way (health care provider 102).
…(with Aboriginal people) you really need to look at what’s happened to them in the past, how would you present this…I think it’s all doable with the Aboriginal community, it’s just that the language might just need to be adapted a little bit to suit them a bit better (health care provider 101).
Language was changed in all CRA and CRAFT resources to be more appropriate for Aboriginal Australians. In particular, technical language was changed to words more regularly used by Aboriginal Australians. CRA and CRAFT resources were modified to include more appropriate language, and clearer formatting in large font. For example, “Who is your loved one usually with when drinking/using?” was changed to “Who is your relative usually with when drinking/using?”
Working group meetings and interviews were used to assess health care providers’ perceptions of the usefulness of resources used to deliver core CRA and CRAFT procedures to clients. Overall, health care providers perceived these resources to be useful, in particular, the Happiness Scale, that asks clients to rate health, social, emotional and economic aspects of their life on a ten-point scale (1 = completely unhappy, 10 = completely happy).
To maximise the likelihood of Aboriginal clients attending and completing CRA and CRAFT, it was suggested at working group meetings that the Aboriginal-specific CRA and CRAFT interventions comprise less than eight sessions (the original United States based CRA and CRAFT interventions are twelve sessions each), and be delivered to clients in groups, as well as to individuals, consistent with the standard model of care used by the health care services. Group programs for CRA and for CRAFT were developed by certified CRAFT health care providers that included the same content as the individual programs; however, the individual programs are designed to use the core procedures in an order that is appropriate for each client and the group programs presents the core procedures in a standardised order using a PowerPoint presentation. Client workbook exercises are also included in the group programs to guide participants through intervention procedures. Clients attend six group sessions and are given the opportunity to attend additional individual sessions if required.
Working group meetings with Aboriginal and non-Aboriginal health care providers were used to gain feedback on early drafts of the CRA and CRAFT manuals. Health care providers said that they wanted “…something to take and something to refer to…not too detailed…more of a guideline” (working group meeting C). Modified examples of how to deliver the interventions were included in the manuals and presented CRA and CRAFT in the Australian context which helped health care providers to translate the United States CRA and CRAFT interventions into an Aboriginal Australian based model of care. When the final versions of the manuals were made available to health care providers for comment and review their feedback was generally positive.
…(the manual) made it a lot easier to understand what each component was (health care provider 106).
When the CRA and CRAFT programs are implemented the certified health care providers delivering the programs will gain feedback from participants and make appropriate modifications to the programs, under the guidance of the research team.