Indigenous AOD Workers Wellbeing: An Examination of Individual, Organisational & Systems Factors

1. Indigenous AOD Workers Wellbeing: An Examination of Individual, Organisational & Systems Factors Professor Ann Roche Ms Donna Weetra Ms Amanda Tovell Dr Toby Freeman Mr Allan Trifonoff National Centre for Education and Training on Addiction (NCETA) www.nceta.flinders.edu.au Flinders Aboriginal Health Research Unit Seminar Monday: 25 August 2008

2. Acknowledgement of Country We recognise Kaurna people and their land The National Centre for Education and Training on Addiction (NCETA) acknowledges that we are meeting on the traditional country of the Kaurna people of the Adelaide Plains. We recognise and respect their cultural heritage, beliefs and relationship with the land. We acknowledge that they are of continuing importance to the Kaurna people living today.

3. Indigenous AOD Worker Wellbeing (1) • NCETA is researching the wellbeing of Indigenous and non-Indigenous alcohol and other drug (AOD) workers. • Funded by the Australian Government Department of Health and Ageing (Indigenous and Psychostimulants section). • Cooperative Research Centre for Aboriginal Health (CRCAH) in-kind project (for Flinders University).

4. Indigenous AOD Worker Wellbeing (2) • National study includes AOD specialist and generic health workers across government and non-government agencies and community controlled organisations. • Designed to identify factors that contribute to Indigenous workers wellbeing and stress and burnout. • Will facilitate the development of effective strategies to help attract, reward and retain workers in the AOD field.

5. Project Aims • To identify the key antecedents and consequences of stress, burnout and wellbeing amongst Indigenous AOD workers. • To develop an information base and a range of tools to inform strategies to improve worker wellbeing and reduce stress and burnout. • NCETA has also been requested to include non-Indigenous AOD workers whose clients are predominantly Indigenous.

6. Project Reference Group • Coralie Ober (Queensland Alcohol and Drug Research and Education Centre) • Scott Wilson & Sharon Drage (Aboriginal Drug and Alcohol Council SA Inc) • Mick Gooda (Cooperative Research Centre for Aboriginal Health) • Colin Dillon (Queensland University of Technology) • Don Hayward (Southern Adelaide Health Service) • Amy Cleland (University of South Australia) • Alwin Chong (Aboriginal Health Council of South Australia)

7. AOD Workers’ & Managers’ Satisfaction, Stress & Wellbeing www.nceta.flinders.edu.au

8. NCETA Previous Work on Worker Wellbeing & Workforce Development • Alcohol and Other Drug (AOD) work is rewarding but demanding. • Significant challenges related to: • Client population; • Community attitudes towards addiction; • Increasing complexity of client presentations; • Lack of resources and excessive workloads.

9. Excessive Job Demands • Work overload • Role conflict • Role ambiguity • Difficult clients • Poor physical work environment

10. Lack of Job Resources • Job autonomy • Social support • Remuneration • Perceived reciprocity • Knowledge of performance • Professional development

11. Special Challenges for Indigenous Workers • AOD qualifications for Indigenous workers are a relatively recent development. • The Indigenous AOD field is relatively small. • Responding to AOD issues often falls to workers such as Aboriginal Health Workers with general health qualifications.

12. Project Components • Literature review • Written / telephone submissions • Online survey • Site visits (face-to-face interviews and focus groups), and telephone interviews

13. Literature Review • Indigenous client base issues • Cultural competence for non-Indigenous health workers • AOD workforce issues • Indigenous health workforce issues • Rural and remote issues

14. Indigenous Client Base Issues • Grief and loss issues, extent of trauma, loss of land (Halloran, 2004; Ratnavale, 2007) • “The recent history of …Aboriginal and Torres Strait Islander communities, is one of loss of land (often accompanied by violence), forced removal, and detention of differing clans in missions and reserves, with consequent loss of culture, autonomy, identity and life skills. • Many patients come from such traumatised family backgrounds. • Dealing constantly with traumatised patients … can become a threat to the wellbeing of staff” • (Panaretto & Wenitong, 2006, p. 528) • Community acceptance – potential gender, age, family issues (Trugden, 2000; Bartick & Dixon, 2005)

15. Cultural Competence for Non-Indigenous Health Workers • Insufficient appropriate cross-cultural skilling for non-Indigenous health workers (Harris & Robinson, 2007) • “One of the most significant work-related stress factors described by Aboriginal Health Workers is the need to work with non-Aboriginal staff whose expectations and behaviour are grounded in a different culture and different health setting.” • (Howard, 2007)

16. Indigenous Health Workforce Issues • Under-representation in health workforce • 1% of workforce (Pink & Allbon, 2008) • 2.5% of Australian population (ABS, 2007) • Wage disparity: In a comparison of 12 selected community service occupations (Australian Services Union, 2007) … • Aboriginal health workers received the lowest average weekly pay ($547.76) • lower than children’s care workers (second lowest at $570.09) • welfare and community workers ($877.54) • counsellors ($905.95) • social workers ($909.89)

17. Indigenous Health Workforce Issues • Support from management and the organisation – esp. in ‘mainstream’ organisations (Whiteside et al. 2006) • Lack of clarity around role and tasks • “The welfare workers think the health workers could do more to assist welfare and housing issues, the doctors think they could do more to assist clinical management, and the transport workers think they could reduce the burden of demand by treating more patients at home.” (Genat, 2006:111)

18. AOD Workforce Issues • NCETA has conducted national research on wellbeing, stress, and burnout in the AOD Workforce (Duraisingam et al., 2006) • Main predictors of high work stress: • Role overload • Low job autonomy • High client-related pressure • Low workplace social support, and • Few professional development opportunities.

19. Rural & Remote Issues • Difficulties recruiting appropriate staff (VAADA 2003) • Large gap between community needs and available services (ANCD, 2001) • Isolation, lack of privacy (Gray et al. 2004) • Access to training (CIRC et al., 2001, NSW Mental Health Co-ordinating Council, 2005).

20. Ethics Approval Two separate ethics stages: 1) Online / paper-based survey 2) Site visits: interviews and focus groups #1 approved through Flinders University Social and Behavioural Research Ethics Committee and Yunggorendi First Nations Centre for Higher Education and Research. #2 sent to a range of committees across Australia with the first application and approval included in package.

21. Ethics Approval for Site Visits • Aboriginal Health Council of South Australia Ethics Committee • Aboriginal Health and Medical Research Council Ethics Committee (New South Wales) • Western Australian Aboriginal Health Information and Ethics Committee • Ethics support and advice provided by Yunggorendi First Nations Centre for Higher Education and Research • Flinders University Social and Behavioural Research Ethics Committee

22. Ethics Issues • Used the NEAF (National Ethics Application Form) for the different Human Research Ethics Committees (HRECs) (except WA). • Difficulty in identifying which HRECs we should be applying to. • Requisite letters of support from participating organisations. • Acknowledgement vs anonymity, confidentiality.

23. Written / Telephone Submissions: Process • Call for submissions commenced in April 08 and closed in June 08. • 220 emails and 200 written invitations sent to 420 organisations. • Input sought from managers and frontline workers in AOD treatment agencies, government and non-government health services, community controlled health organisations, in addition to representatives from Indigenous communities and peak bodies.

24. Submissions: Key Themes & Issues • Factors that contribute to worker wellbeing • Factors that contribute to worker stress • Balancing work / life issues • Access to training • Challenges: meeting client and community needs • Challenges: organisational “I’ve been working in this field for 18 years and this is the first time we as workers have ever been asked to tell ourstory”

25. Online Survey • Commenced in July 2008 • Survey instrument includes: • Mental health questions from the Indigenous Risk Impact Screen (IRIS) • Cultural Respect Framework – questions developed by NCETA staff members • Work / Life Balance questions – adapted from the Centre for Work + Life, based at University of SA

26. Invitation to Participate in Online Survey We would like to hear your views about what effects worker wellbeing in the alcohol and other drugs (AOD) field, from your experience as an Indigenous worker, or a non-Indigenous worker who has significant contact with Indigenous clients. Please log on to the NCETA website and follow the links to the survey www.nceta.flinders.edu.au. You will need about 20 minutes to complete this survey. Hardcopies can be provided if internet access is problematic.

27. Indigenous AOD Database • Historically began as a mailing list for internal use. • Grew into comprehensive listing of contact details, websites and Accessibility / Remoteness Index of Australia (ARIA+) categories for over 480 organisations and networks. • Includes information about Indigenous AOD, mental health and comorbidity courses. • Being produced and disseminated as a CD-ROM and will be accessible via the NCETA website.

28. Indigenous-Specific Accredited AOD, Mental Health & Comorbidity Courses

29. Site Visits / One-on-One Interviews • Interview protocols for focus groups and one-on-one interviews have been completed and trialled – partly informed by the submissions. • Pool of potential sites being identified and confirmed. • Site visits will occur nationally and will combine metropolitan / rural / remote sites.

30. Networking / Promotion • Face-to-face meetings / conferences / word-of-mouth. • Email notifications through listservers e.g. Alcohol and Other Drugs Council of Australia (ADCA), Australian Indigenous HealthInfoNet yarning places. • Newsletter articles e.g. Aboriginal Health Council of SA (AHSCA), Cooperative Research Centre for Aboriginal Health (CRCAH), Public Health Association of Australia (PHAA). • Attendance at celebrations and community consultations.

31. Summary • Two year project commenced in mid-2007. • Builds upon NCETA’s previous work on worker wellbeing, stress and burnout in the AOD field. • Written / telephone submissions process complete. • Literature review ongoing. • Resources database nearing completion. • Online survey is currently “live”. • Site visits / focus group / one-on-one / telephone interviews to be conducted in Sept–Dec 2008.

32. NCETA Resources • Practical tools: • Stress and Burnout Booklet • Clinical Supervision Resource Kit (available electronically only) • Workforce Development ‘TIPS’ Kit • Available from: www.nceta.flinders.edu.au

33. Thank You from the Project Team Dr Toby Freeman Ms Donna Weetra Professor Ann Roche Ms Amanda Tovell Mr Allan Trifonoff www.nceta.flinders.edu.au