NDARC Technical Report no. 326 (2014).
ABOUT THIS CRA MANUAL
The Community Reinforcement Approach (CRA) as it is described in this manual has been adapted from a comprehensive explanation as published in Meyers and Smith (1995) Clinical Guide to Alcohol Treatment: The Community Reinforcement Approach. This adapted CRA manual is designed for Indigenous Health and Family Workers1 and other Workers within Australian Indigenous community settings to support people who are at risk for alcohol related harm. It is likely that Workers using this manual will have a variety of qualifications. Consequently some will have more knowledge and experience of alcohol related issues than others, including an understanding of the information in this manual. Some may also have completed the CRAFT training workshop conducted by Dr Robert Meyers in Orange in May 2011. But it is the view of the project team that this manual should take an equitable approach to ensure all Workers are similarly equipped with the specialist skills and knowledge they need to confidently use CRAFT with Indigenous people. For this reason the manual acknowledges the range of existing skills and knowledge that Workers might bring to this field. It also recognises the useful resources that already address alcohol issues as they affect Indigenous communities and does not attempt to duplicate them. Rather the manual focuses on information specific to the CRAFT approach as it might be used and adapted by all Workers who provide health care to Indigenous people. The manual is written in plain English but uses technical and specialist terms when necessary. Detailed explanations and a glossary of terms and acronyms aim to ensure meanings are clear.
The manual has five sections as follows:
Section 1 outlines CRA’s structured approach to assist people who misuse alcohol and to help their families. It includes a brief overview of some of the research evidence showing that CRA strategies are more effective than others.
Section 2 describes the physical and social alcohol related harms that affect individuals who drink and their families and communities. It also describes how CRA fits in with Indigenous health service provision and a holistic approach to health care, primary health care (PHC) and community development. The section concludes by describing the individual and team roles of health practitioners, families and the community in CRA.
Section 3 explains the CRA strategies for one on one use with individual clients who have been identified being at risk of alcohol related harm. The information in this section is based on the understanding that clients will participate in a series of treatment sessions. The section therefore outlines the procedures and steps that Workers can take to implement CRA with clients in these sessions. The section includes descriptions and explanations about how to:
use the CRA screening tools to assess a client’s alcohol use and the effects of this use;
use motivational interviewing to conduct an extended brief intervention;
implement sobriety sampling;
implement CRA treatment
plan and implement skills training to meet each client’s needs
Section 4 is a glossary that lists and explains useful technical terms and concepts used to talk about alcohol in health service settings.
Section 5 lists helpful contacts and additional resources to support the delivery of CRA.
Miranda Rose, Bianca Calabria, Julaine Allan, Anton Clifford, Anthony Shakeshaft