By integrating these techniques, services could improve treatment engagement and outcomes, and reduce the potentially disempowering aspects of institutional care.

Residential rehabilitation is a vital treatment option for people with complex issues associated with their alcohol and other drug use, yet little is known about the characteristics and mechanisms of good care in these settings.

“Tailoring care to individuals’ needs and preferences is widely recognised as a fundamental principle in drug treatment and residential rehabilitation, but this can be a challenge in residential and institutional environments that seek to attend to the needs of multiple people and groups,” says PhD Candidate and Research Officer Ramez Bathish.

“Care often involves imbalances in power, and there have been longstanding concerns from a variety of experts about the way residential institutions can control and regulate the lives of those receiving care, possibly causing unintended harm," he explains.

Drawing on long-term ethnographic fieldwork examining care practices at a residential rehabilitation service in Eastern Australia, the researchers set out to better understand how good-quality care is organised and delivered within these settings.

“We found that three interconnected mechanisms and techniques of good care were central to instances of caring working well,” Mr Bathish says.

Published in the latest edition of the International Journal of Drug Policy, the analysis found that good care involves:

1. Tailoring care to individual needs and preferences,
2. Choreographing care to attend to the diverse needs of others involved in care, which is mediated through
3. Dialoguing care to facilitate an empathetic understanding of people’s needs.

“In other words, care is tailored to individuals’ needs and preferences while also creating conditions that attend to the diverse needs of others involved in care, with both of these mechanisms mediated through open dialogue to facilitate an empathetic understanding of people’s needs,” explains Mr Bathish, the lead author of the paper.

1. Tailoring to individual clients

“Our analysis found that successfully tailoring care to individuals tends to emphasise people’s uniqueness and autonomy while also avoiding the disempowering effects of institutional routines,” Mr Bathish says.

According to the study, when tailoring works well, staff and residents collaboratively identify meaningful needs and preferences and adapt plans accordingly, rather than rigidly applying institutional routines.

“This approach reduces the risk that institutional imperatives will override individual recovery goals and ensures people’s uniqueness and autonomy are valued in care,” Mr Bathish says.

2. Attending to the needs of others involved in care

Care practices in residential settings typically encompass the needs of multiple people and groups, including residents, treatment peer groups, residents’ friends and families and the broader rehabilitation community.

Successfully attending to these diverse needs involves arranging living conditions, routines and communal processes to support individual recovery within a safe and functional collective environment.

“This will likely involve managing tensions between competing imperatives,” Mr Bathish explains.

Examples of these tensions include an individual’s need for privacy versus group safety, or short-term crisis response versus longer-term therapeutic goals.

"Ensuring people from diverse backgrounds – including ethnicity, religion, sexuality, gender and substance use – can meaningfully contribute to shaping living conditions was therefore a key element of successfully implementing ‘good care’ at the service,” Mr Bathish explains.

“This creates inclusive conditions where people with a range of different care needs can collaborate to care as well as possible for and with each other,” he says.

3. Enabling fair and open dialogue about individual and collective needs

According to the paper, caring as well as possible requires fostering skills and opportunities for open communication about people’s needs and preferences

“Our findings highlight the importance of providing opportunities to practice collective care and self-care and help residents develop the skills to discuss and understand their needs and negotiate and participate in care meaningfully,” Mr Bathish explains.

“By fostering peer-driven practices and opportunities for open dialogue and shared decision-making, residents’ capacity to contribute to care decisions could also increase,” he says.

Adequate resourcing is vital

“At the heart of our findings is the need for adequate resourcing and programmatic flexibility in residential rehabilitation services,” Mr Bathish says.

“Our findings reveal the significant labours and resources involved in caring well in these settings. This hinges on programmatic flexibility to attend to a diversity of needs, which is a resource-intensive endeavour,” he says.

Funding shortfalls in AOD residential settings urgently need to be addressed so that adequate time, money and training are available to ensure that staff and residents also have the skills, capacity and agency to effectively engage in developing the flexible and collaborative environment that fosters good quality care.

“With increased funding, services could instill the participatory, inclusive and collaborative mechanisms that are necessary to ensure that residential services can provide the highest possible level of care,” he says.

Read the paper in the International Journal of Drug Policy: Choreographing, tailoring and dialoguing care in residential rehabilitation

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