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Teaching kids to P.A.R.T.Y.

In April the ACT government announced funding for the P.A.R.T.Y. program to be trialled in Canberra Hospital. ACT Minister for Health Simon Corbell said the program “takes students into Canberra Hospital to see first-hand the risks and consequences of alcohol.”

Featured in a DrugInfo newsletter in 2012, the P.A.R.T.Y. program attempts to curb the incidence of young people who experience bodily trauma through bad decisions involving alcohol. As we know, young people’s inexperience with alcohol, often coupled with a mistaken belief of their own invincibility, can result in tragic consequences that didn’t need to occur in the first place.

While we’re highly dubious of any program that uses scare tactics to attempt to affect behaviour — evidence shows it doesn’t work —P.A.R.T.Y. aims at something different: by informing and persuading rather than scaring, the hope is young people will be receptive to its message.

GrogWatch’s Matt recently got a behind-the-scenes look at P.A.R.T.Y. in operation at Melbourne’s The Alfred hospital, and reports back on how the program operates in practice.  

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In a classroom deep within Melbourne’s Alfred Hospital, thirty Year 11 and 12 St Cuthbert’s schoolgirls nervously take their seats. They’re all here because they volunteered to take part in the Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y.) program.

Janet McLeod, program coordinator and a trained nurse, is dressed in scrubs with the program logo sewn on. She told me she wears the scrubs to emphasise the fact she’s not a teacher – “And it means I feel comfortable.” It’s the first of many cues students receive that help determine what sticks with them long after they’ve walked out the hospital’s front doors.

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Established in Canada in 1986, the P.A.R.T.Y. program operates at more than 100 sites around the world, including twelve in Australia. The premise is simple. Students spend a day in a trauma hospital, visiting different wards, speaking to staff and patients, and hearing presentations from specialists. After they leave, they share their experiences with classmates, and they become less likely to end up in hospital again — involuntarily.

Watching Janet welcome the St Cuth’s girls, joking around with them to put them at ease, I quickly realised that these students weren’t in for anything like the US-based ‘scared straight’ initiatives the program initially reminded me of. “If they leave shocked or scared,” Janet told me afterwards, “we’ve made a mistake.” Indeed, although many of the images that students are confronted with are graphic, they fall short of horrific — the aim isn’t to harm or traumatise students, it’s to ram home a single, overriding message: choice.

Trauma – an injury caused by physical force, like a car crash, assault or a fall – is overwhelmingly the reason that young people wind up as hospital patients, whereas chronic disease is the leading cause for older cohorts. The thing about trauma is that it never needs to happen. Traumatic injuries are almost always the result of bad choices, all too often as a result of impaired judgement caused by – you guessed it – alcohol. Rather than patching up young people when they come in with burns, broken bones or missing limbs, P.A.R.T.Y. aims to help them make better decisions in the first place.

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As Janet begins, a projector plays a clip of fashionable women tottering in high heels. The class cringes audibly as the women fall, their ankles straining and buckling. Janet admits she tailors the imagery slightly depending on the gender of the audience; a class of boys might get a clip showing cricket accidents instead. “It’s about the most effective vehicle for the information,” Janet says. Everything — from roll call to climbing the stairs between wards — becomes what she terms a ‘teachable moment’. “We’ve just passed people who can’t climb the stairs,” she tells the kids puffing behind her.

After a presentation on traumatic brain injury and a quick reminder of the recovery position, we’re split into groups and rotated through the wards. First stop is the Intensive Care Unit. Nurses usher us into a curtained-off room where a life-sized medical dummy lies on a bed, plugged into a ventilator and a catheter. The girls are guided into position and move the dummy, changing the bed sheets around its prone body as the ventilator hisses and beeps.

We’re told we would have seen Michael, a man in his early twenties brought in the previous day after surviving a car crash. He was driving with his girlfriend in remote Victoria, after leaving a party where he’d had too much to drink. He wasn’t found for four hours after his car left the road. His girlfriend was fine, but he was knocked unconscious and suffered a broken pelvis and broken legs. We would have seen him, but a scan that morning discovered he was brain dead. Machines could keep his body alive, but his mind was gone. His parents had flown in from New Zealand to hear the devastating news.

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A 2012 published study from Perth followed 225 juvenile offenders who’d been referred to the program, and compared their health outcomes over three years to offenders who hadn’t been referred (young people from around the country, including Victoria, have taken part in separate targeted trials). Of those who hadn’t attended the program, 27% went on to commit traffic or violence-related offences; less than 4% of those who went through P.A.R.T.Y. re-offended.

A 2010 Canadian study also followed students who had participated in the program. It discovered that after a decade, they were 4% less likely to have suffered trauma injuries. That doesn’t sound like much, until the cost of a hospital stay is taken into account. “Preventing even one of these kids from ending up back here can save hundreds of thousands of dollars,” Janet says, “so of course it’s worth it.”

When Janet calls schools for a follow-up chat a few months later, she says teachers often tell her that the ‘risk-takers’ have toned it down. Perhaps that’s why there’s so much competition to get into The Alfred’s program that schools have to enter a ballot. There are about 16 schools currently involved, with an equal split between public and private, but The Alfred can only accommodate 60 students a month. Nationally that’s fewer than 7,000 students a year. Janet says they try to target students who will hopefully relay the message back to their peers.

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In the burns ward, students have formed a circle around Dennis’ bed as he tells them why his body is swaddled in gauze bandages.  “I always told my kids not to play with fire,” he says. But the fire in his living room just wouldn’t get going. “I decided to take a shortcut” – a capful of petrol.

Dennis, in his late thirties, especially regrets the impact of his accident on his kids, who saw him jump into the family pool still burning. It could have been worse, though. He’s been in hospital for two weeks and has endured painful skin grafts, but he’ll be allowed home soon.  “I definitely regret it,” Dennis says.

The program has been designed to stimulate all five senses. Students hear from a doctor about brain trauma. They can’t help but notice the young bodies strapped to wheelchairs and beds that we pass in the corridors. They use scissors to cut the clothes off a medical dummy, and try to grip things with the manipulators they’re given in the rehabilitation ward. The heavy, inevitable waft of hospital disinfectant is even supplemented by an incongruous food smell, as they sample the mush that’s fed to patients who can’t chew solids. The students are blindfolded and asked to move around a room, not speaking, trying to communicate by gesture alone.

The sensations demonstrate what a loss of independence feels like, while the message – choice, risk, consequence – is repeated all day by doctors, nurses, ambulance staff and patients. It’s designed to be a memorable experience, not an overwhelmingly awful one.

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As I’m leaving, I ask Janet what she’d change about the program, given the opportunity. She said she’d like to do more regional work (only a quarter of schools involved in The Alfred’s program are from further than 100km from the hospital). She’ll get her wish: shortly after my day at The Alfred, word came through that the government would fund engagement with regional centres, so students outside Melbourne will soon have the opportunity to go through the program.

Pulling medical staff from their regular duties costs hospitals money, though the Victorian state government has supported the in-hospital version of the program since 2009. It’s also currently sponsored in part by AAMI Insurance, who have an understandable interest in keeping people healthy; they also give all participants skilled driving course vouchers.

At the end of their backstage pass to The Alfred, the St Cuthbert’s girls head back to school the same students they were when they arrived in the morning – just hopefully a little less likely to return to the Emergency Department as a patient in the future.