This 18 month project will introduce screening and brief interventions for high risk drinkers admitted to hospital with facial trauma and evaluate the implementation of a best practice pathway. Findings from this project will inform future hospital based injury prevention strategies.  This project will allow direct transfer of those findings to clinical practice. The project will be conducted by the Menzies School of Health Project Indigenous research and training team in partnership with the Northern Territory (NT) Department of Health (DoH), Darwin.

Need for the project
The Northern Territory has the highest estimated rate of alcohol caused assault hospitalisations and per capita alcohol consumption (Matthews et al., 2002). The incidence of mandibular (jawbone) fractures in the Northern Territory in Australia is second only to Greenland and there is a strong involvement of alcohol in the aetiology of facial trauma (Thomas ME and C. Jameson, 2007). Alcohol related harm is common amongst the patients cared for by the maxillofacial surgery unit of the RDH, Darwin, Northern Territory. Therefore, there is an urgent need to develop effective strategies to address binge drinking and alcohol related harm among at risk youth and adults. This project will develop effective strategies for early identification and treatment of high risk drinkers in hospital settings. This will diminish the ongoing impact and severity of alcohol misuse, and ultimately lead to improvements in social and emotional wellbeing of young people and their families.

This project aims to answer the following question:
Will introduction of screening and brief interventions change health service provider practice and improve access to care for high risk drinkers and those with wellbeing concerns admitted to the maxillofacial unit?
Does this change in practice improve outcomes for high risk drinkers and those with wellbeing concerns admitted to the maxillofacial unit?’

Research plan

Development of best practice pathway: We will collaborate with staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway will provide clear guidelines for screening, assessment, intervention (including distribution of plain English and pictorial information about alcohol- related risks) and referral.

Implementation of best practice pathway: The best practice pathway will be introduced to the unit following development of the pathway, adaption of tools in response to staff feedback and training of staff in the pathway.

Brief Intervention: The chosen brief intervention is based on findings of a project conducted by the Australian Integrated Mental health initiative (AIMhi) in the NT (Nagel et al., 2009). The ‘motivational care planning’ (MCP) intervention showed good engagement and acceptability (Nagel et al., 2008) and significant improvements in well being, substance dependence and self management (Nagel et al., 2008; Nagel et al., 2007). It was developed in collaboration with Aboriginal Mental Health Workers, and differs from established approaches by inclusion of pictorial tools and a holistic, family focus. A non Indigenous version of this intervention will be used for the non Indigenous patients.

We will be auditing files over the next 18 months to monitor the progress of the best practice pathway in your setting.

Research team:
Mr Mahiban Thomas
Professor David Kavanagh
Caroline Griffin – Senior indigenous Research Officer
Valerie Thompson - Indigenous Research Officer
Luke Mayo -Indigenous Research Officer
Megan Whitty – Research Student

Resources
Yarning About Services (this pamphlet was developed by the Menzies PACT project to assist in referral to appropriate services for people admitted to hospital with injuries secondary to high risk drinking)
Yarning about Alcohol (this pamphlet was developed by Department of Health in collaboration with Menzies to assist in delivery of information and brief interventions for people with high risk drinking) 
Brief Yarning about Wellbeing (this pamphlet was developed to support service providers to provide brief interventions to hospitalised patients with high risk drinking and wellbeing concerns. It provides a simple 4 step pathway to care.)