SUBMISSION PREPARED BY THE SALVATION ARMY Victoria Social Programme and Policy Unit

Transcription

1 SUBMISSION PREPARED BY THE SALVATION ARMY Victoria Social Programme and Policy Unit FOR WHOLE-OF-GOVERNMENT VICTORIAN ALCOHOL AND DRUG STRATEGY COMMUNITY CONSULTATION 21 ST SEPTEMBER 2011

2 The Salvation Army, Australia Southern Territory Victorian State Council: Submission to the Whole-of-Government Victorian Alcohol and Drug Strategy For further information on this Submission please contact: Major Robyn Fernihough, Manager Victoria Social Programme and Policy Unit PO Box 288 Coburg 3058 (03) All rights reserved. No part of this publication may be reproduced in any form without prior consent of the copyright owners The Salvation Army Australia Southern Territory The Salvation Army Victoria Social Programme and Policy Unit Page 2 of 16

3 Table of Contents 1. Introduction Key Issues Evidence from the Service Level Conclusions The Salvation Army Victoria Social Programme and Policy Unit Page 3 of 16

4 1. Introduction This submission to the Victorian Department of Health s Whole-of-Government Victorian alcohol and drug strategy Community Consultation is provided on behalf of The Salvation Army Victoria Social Programme and Policy Unit. The Salvation Army is represented in Victoria by four discrete Divisions Melbourne Central, Eastern, Western and Northern Victoria. The Salvation Army has been operating in Australia for 130 years and is one of the most recognised and well respected charitable, welfare organisations. The Salvation Army provides a significant service capacity and reach into local communities, providing a diversity of services, including: Alcohol and Other Drugs (AOD) service, aged care, family support, out of home care, accommodation and homeless services, disability services, emergency disaster responses, employment services as well as financial assistance and counselling. The Salvation Army has a significant, long standing history and reputation in the provision of Alcohol and Other Drug services in Victoria, including residential and home-based withdrawal services, rehabilitation facilities, outreach services, Counselling Consultancy Continuing Care, AOD services within the Homelessness and Drug Dependency Program, AOD supported accommodation, drug diversion programs, needle and syringe programs (NSPs), treatment coordination services, primary health services, AOD linkage services, youth outreach, and AOD aftercare/post withdrawal linkages. Given that the focus of The Salvation Army s work in the alcohol and other drug area is in the treatment and rehabilitation service sector, this submission will focus on aspects of the Consultation Paper that address these areas and will provide feedback on the Department of Health s proposed treatment reform structure. The Salvation Army, however, remains concerned about the lack of detail in both documents relating to how the redevelopment per se and the changes to service structures and processes will impact on disadvantaged and marginalised people within our communities. In particular, The Salvation Army references the lack of consideration of service needs of youth, indigenous and homeless people. Our concern with the proposed model is that it is structured around single need and therefore simplified systems. It is the experience of The Salvation Army that the people presenting with AOD issues also present with complex and multiple social issues (housing, forensic) and with physical and mental health co-morbidities and compromised primary health needs. This submission is written with the acknowledgement that this cohort is front and centre in our deliberations and responses to the consultations. 2. Key Issues In making this submission, The Salvation Army Victoria Social Programme and Policy Unit (VSPPU) endorses and supports the key objectives of this whole-of-government AOD strategy and the framework under which it has been developed and through which it will be delivered (as advocated by the National Drug Strategy ) demand reduction, supply reduction and harm reduction. The Salvation Army Victoria Social Programme and Policy Unit Page 4 of 16

5 However, in light of the services provided by and the client group with whom The Salvation Army work, we would encourage a rationalisation of focus on these approaches and caution against limiting funds for treatment and post treatment services in favour of demand and supply reduction approaches. With reference to both the Consultation Paper and the proposed treatment service redevelopment as outlined by Department of Health at the VAADA CEO Sector Reform meeting (19/08/2011), The Salvation Army VSPPU supports and endorses the following key underlying service principles with some notes of caution: 2.1 Harm minimisation The Salvation Army Australia Southern Territory, of which the Victorian Divisions are majority service providers, endorse a harm minimisation approach to AOD. The Southern Territory operates from an international, national and state policy and legislative framework that provides for a broad spectrum of protective and treatment measures collectively known as harm minimisation measures. Although The Salvation Army s residential AOD facilities require program participants to be abstinent during the stay, the overriding framework under which services are provided recognises that a real reduction in misuse will result from a person s commitment to reducing substance misuse combined with constructive support. The Salvation Army supports the provision of needle and syringe programs (NSPs) as essential to a harm minimisation framework which recognises the imperative for a holistic approach to care that is multidisciplinary and integrated across the person s life and needs. Having been at the forefront of NSPs for over 20 years and operating one of the busiest NSPs in the world, The Salvation Army has developed a significant evidence base indicating the positive impacts NSPs have on the prevention of death and injury as a result of drug use, as well as opening up avenues to treatment for individuals. 2.2 Whole-of-government and partnership approach This submission recognises and supports the whole-of-government approach being proposed by the Department as a response to the clear evidence that people with alcohol and drug use issues often present with multiple and complex needs. Indeed, this evidence has resulted in a number of innovations of cross sector partnerships and initiatives such as Headspace and the Homelessness Drug Dependency Program (HDDP). With this in mind, The Salvation Army supports and strongly encourages the various government departments (both state and federal) continuing to work towards bridging across client needs rather than working from funding silos. We recognise that more integrated funding models have long been on the agenda for state and federal governments, but argue that until funding is based on client profiles (incorporating multiple issues, culture, health and social) rather than an issue based method, funding will remain siloed. The Salvation Army encourages a funding response that is as linked up and coordinated as the service response is required to be. A whole-of-government approach at the service level requires active and sustainable partnerships that are grounded in clear governance structures, business rules and accountability processes. Whilst strongly endorsing the need for partnerships within and between the AOD sector, the broader tertiary, and primary care sectors, the resources The Salvation Army Victoria Social Programme and Policy Unit Page 5 of 16

6 (human, financial and time) that are required to develop and maintain such partnerships should not be underestimated. Particularly, it takes time and finances to build functioning relationships between individuals and services. Whilst a number of effective partnerships have been built, of particular concern is the punitive and reactionary response to AOD use, particularly its focus in the criminal justice and policing system. The Salvation Army advocates for a stronger inter-departmental focus between the Department of Human Services and the Department of Justice on treatment for offenders as a pre-emptive intervention. Where this is not possible or realistic, proactive assessment and treatment linked and streamlined with the AOD and broader social welfare sector need to be emphasised. 2.3 Collaborative partnerships A number of The Salvation Army AOD services provide successful outcomes for clients due to their capacity to provide direct access to specialist and generic services within a holistic approach to care. Much of this work demonstrates how to link up funding options to provide a whole of client response. For example the Homelessness Drug Dependency Program, Access Health, Extended Withdrawal and the Intensive Case Management Services (see 3.2 and 3.3) all operate through extensive collaborative partnerships with other social welfare services, primary and tertiary health services, including area mental health services, community health and local government services. The Salvation Army s adoption of assertive outcomes as a component of our case management approach works on the basis of multidisciplinary teams developed as a direct outcome of our capacity to develop collaborative partnerships. These partnerships are governed under varying degrees of formal and informal arrangements including memorandums of understanding and funding contracts. 2.4 Whole-of-client approach across a continuum of care The Salvation Army strongly advocates a whole-of-client approach to its AOD treatment activities, inclusive of pre and post treatment care. Currently, many of The Salvation Army s broader services, such as homelessness and out of home care, are directly linked to and support AOD treatment. The Salvation Army is concerned that under the treatment reform agenda, the capacity of the model to provide for a whole-of-client approach which includes social and community connections, and in particularly where there are complex and multiple issues and presenting co morbidities, cannot be achieved within a cost neutral regime or without significant coordination across departments (i.e. mental health, housing, children and families). As discussed previously, it is the view of The Salvation Army that a whole-of-client approach can only be achieved through a whole-of-government approach to provision and funding of services providing linked up services that allow for coordinated treatment with facilitated access across systems. The Salvation Army advocates the sector moving from siloing clients to working with the needs clients present with and wrapping a treatment response around them. The Salvation Army Victoria Social Programme and Policy Unit Page 6 of 16

7 2.5 Central intake approaches to assessment and coordinated care The Salvation Army supports a move to a regional assessment and treatment coordination model. Such a model provides the capacity to develop long term treatment plans and opens up access to a wide range of treatment options individuals may not have previously been aware of. However, it is our experience that the operation of a streamlined, central intake service is not straightforward, and that caution should be exercised in relation to the realities of such a system: Our experience demonstrates that the benefits and challenges of a central intake model are quite distinct in rural and metropolitan areas due to the clustering of services in a metropolitan setting compared to the more dispersed nature of rural services. As a result, the application of a one-size-fits-all model is problematic. It is preferable for assessment to be face to face because this supports the development of therapeutic relationships and trust with clients. However, in order to maximise accessibility for clients, the capacity for offsite assessments needs to be made available where a common assessment framework has been developed. Central intake systems will generally be governed by access and process protocols that will not necessarily be flexible enough to accommodate the more complex presentations and more marginalised of individuals who will inevitably fall through the gaps and remain outside of the service system. If the proposed central intake approach is specifically for AOD assessment and coordination, the risk is that the system, even if it provides a holistic assessment, will not link with the broader sector. Although a central intake model provides the capacity to plan long term treatment strategies with clients, in many instances, the model has made the pathway to services more complex due to the amount of information required prior to admission (for example, the need for separate medical and psychiatric assessments if these needs are indicated on the assessment). There is a strong sense from staff that the complexity of paperwork and associated requirements fatigues the clients before they get to the point of being accepted. Given the above points, The Salvation Army supports a regional system of assessment and treatment coordination under the proposed system reconfiguration and the role of the Assessment Care and Recovery Worker. Three points of caution to this support are: Further consideration of how a central intake approach will operate in metropolitan and rural areas needs to be explored given the complexity of service networks and options. The role of the Assessment Care and Recovery Worker is endorsed by the sector; however, it needs to be a highly skilled clinician with appropriate remuneration. Given the importance of the initial assessment of an individual in the central intake coordinated care model, it is imperative that this position be properly trained and funded in order to appropriately refer clients to services. An initial assessment is widely regarded as necessary to refer clients to appropriate services. However, capacity for ongoing assessments must be made available in recognition that clients are not static and will need services to The Salvation Army Victoria Social Programme and Policy Unit Page 7 of 16

8 continually be tailored to meet their needs throughout their treatment and recovery process. 2.6 Relapse prevention model Further to the above, The Salvation Army strongly advocates for the inclusion of relapse prevention interventions and therapies as core and underlying components of holistic and successful treatments. Our concern is that, although the efficacy of such interventions is high, they are viewed as outside of AOD treatment services and as such will not be funded under the re-development. Relapse prevention activities (for example, as demonstrated through the Community Re-integration Program, see 3.3) are essential for highly disadvantaged individuals with long term addiction issues and multiple and complex needs, whose capacity to re-integrate into the community post treatment services is highly compromised and will not be dealt with in a linear single service episode of care. 2.7 Cost neutrality Given the focus of reform is on providing a more coordinated system of treatment and care, with the development of specialised Assessment, Care and Recovery Coordinators who will provide services within a coordinated and holistic service system, The Salvation Army has significant concerns about how this model can operate at current funding levels. A number of Salvation Army services operate with a mixed funding base from state and federal government departments. Network and service managers have indicated that without the addition of commonwealth funding, they would be unable to provide enhanced services to clients, particularly post treatment rehabilitation and the social and community aspects of care. Based on the financial year, 69% of funding of The Salvation Army s AOD services was provided by the Victorian Department of Health and 11% through Commonwealth resources. Within the same financial year, The Salvation Army provided approximately $1.8 million of its own funding to underwrite provision of AOD Services representing 13% of total AOD funding. (The final seven per cent of AOD funding came from other sources including client fees and bank interest.) This reflects a significant gap between departmental expectations and what is actually required to deliver services on the ground. Current departmental funding to The Salvation Army for AOD is for treatment and rehabilitation, with the organization subsidising the vast majority of social and community connections aspects of treatment support. With this in mind, and in light of the release of the Fair Work Australia tribunal outcome upholding the pay equity claim for community services workers in May 2011, the capacity of The Salvation Army to continue to top up departmental funding needs to be rationalised. The Salvation Army urges the Department to consider funding services at a level appropriate to maintain the required skilled workforce. 2.8 Access to pharmacotherapy and GP services The Salvation Army has significant concerns about the paucity of registered providers of pharmacotherapy within the sector. This is further compromised by the low numbers of GPs interested in working with AOD services. Although a large emphasis has been placed The Salvation Army Victoria Social Programme and Policy Unit Page 8 of 16

9 on a medical based model of intervention, lack of access to primary health care is of major concern. Even with the roll out of AOD specific training to GPs 1 through regional Divisions of General Practice, the low uptake suggests the need for culture change about working with AOD issues in general practice that should be addressed through engagement of medical students. The Salvation Army does, however, acknowledge the support and expertise of a number of general practitioners who work within our services. 2.9 Workforce skills There is general agreement from within the sector that the minimum mandated qualification of a Certificate IV in AOD is too low, and that in reality many staff have higher level qualifications. The issue with mandating a higher level qualification is the capacity of funding to cover the remuneration of staff at this level. The Productivity Commission has already identified that services within the broader social services sector are underfunded and often function on lower wages, requiring the use of additional organisational funds to supplement wages. The sector is cautious about mandating specific qualifications for employment within the sector as it may exclude individuals with specific natural skill sets. Rather, a series of pathways for entry to the sector would be viewed more positively. However, this should be viewed with reference to the need for skilled and experienced staff to work with clients presenting higher and more complex needs. Ongoing professional development options can only be realised if appropriate funding is available. Consideration should be given to funding, or at the very least subsidising, mandated cross-sector training within organisations. I.e. area mental health services should be mandated to provide targeted training to AOD/homelessness services on clinical governance issues. Whilst this approach would enable a more holistic approach to service provision, it should be recognised that such training opportunities also build relationships between services and provide opportunities to understand how other services operate Research and Innovation The Salvation Army recognises the importance of, and supports, research and innovation throughout the sector and has a significant track record of engaging in such activities on 1 The Victorian Government, as part of "Restoring the Balance" - Victoria's Alcohol Action Plan , has sought assistance from the Victorian Divisions Network to achieve an increase in general practice provision of brief interventions, treatment and appropriate referral to address risky and harmful alcohol use. The Mental Health and Drugs Division of the Department of Health have provided funding to GPV for the delivery of education and resources through local divisions of general practitioners and practice nurses across Victoria. Sourced from General Practice Victoria website on 15.09/ The Salvation Army Victoria Social Programme and Policy Unit Page 9 of 16

10 an organisational level. 2 However, there is a very strong feeling within the sector that the capacity for research and innovation to occur at the service level has been minimised following a redistribution of resources (both human and financial) to support growing quality assurance and compliance obligations. There is considerable concern from service managers that what was once seen as a core activity, particularly service and practice reviews and innovation, is now the first activity to be rationalised in an ever increasing compliance focused service model. 3. Evidence from the Service Level In response to the identified questions outlined as the key focus for this Submission, the following provides evidence of learnings about treatment models, pathways, and approaches to collaborative care that ensure a responsive and targeted service. 3.1 Improved access and build stronger recovery pathways for people with serious AOD issues In 2009/2010 the Bridge Network was funded by the Department of Health to pilot a state wide Streamline Treatment Coordination Service approach for all Salvation Army AOD residential treatment services (excluding Geelong Withdrawal Unit). The rationale underlying this pilot was that potential clients would have a single and straightforward pathway to navigate and that within this pathway they would have access to multiple avenues for residential and non-residential support options. In practice, this has not always been the case, particularly for the homeless. While the program has provided the capacity for services to work with clients to plan a long term treatment pathway, the down side of the program has been that the most marginalised individuals (such as the homeless) who do not fit into the box of the central intake system fall through the gaps and remain excluded from accessing treatment. This is, of course, a major concern to The Salvation Army given the organisation s concern for the most marginalised. (Please see section 2.5 for further learnings regarding the Streamline Treatment Coordination Service and its effect on developing treatment pathways) 3.2 Different agencies work more closely in partnership to help people overcome their AOD problems. The Salvation Army Victorian AOD services have a strong reputation for working in partnership and with innovation to meet the needs of disadvantaged clients. The experiences and learnings from two specific programs - the Homelessness and Drug Dependency Program (HDDP) and the Access Health Program - will be detailed. There are a number of key components to these services that contribute to their effectiveness: 2 Roy Morgan Research on behalf of The Salvation Army. Alcohol Awareness Study. Melbourne VIC. 2010, 2005, 2004, 2003, 2003, 2001; The Salvation Army Crisis Service. Who s Using? St Kilda VIC. June 2003; The Salvation Army Crisis Service. A Raw Deal? St Kilda Vic The Salvation Army Victoria Social Programme and Policy Unit Page 10 of 16

11 Partnerships between services Multidisciplinary teams Co-location of multidisciplinary staff Holistic approach to care across the service continuum (from intake and including post withdrawal and aftercare support). Homelessness and Drug Dependency Program 3 The Homelessness and Drug Dependency Program is a collaborative approach between The Salvation Army, Hanover Welfare Services and VincentCare to addressing the significant increase in the number of people referred to Crisis Supported Accommodation Services (CSAS) who have problematic drug and alcohol problems and who are homeless. It received recurrent funding following a three year trial period that commenced in This program intersects the accommodation, homelessness, AOD, and mental health service sectors and is evidence of the significant level of complexity and vulnerability of the target population. Referrals into Flagstaff Crisis Accommodation and other Crisis Supported Accommodations are via an Opening Doors access point. Prioritisation is given to those clients in housing crisis presenting with the highest level of multiple and complex needs. The CSAS setting provides the opportunity to engage with individuals and provide an ongoing level of assessment and referral into the services below. HDDP provides intensive case management that is out reaching within the context of a multidisciplinary site. A number of specialist and specific services are co-located or provide in-reaching sessional services i.e. Consultant Psychiatrist, RDNS, PDRSS counsellors, mental health clinicians, and Personal Helpers and Mentors (PHaMs) workers. HDDP also provides a needle and syringe programme (NSP) specifically for residents of the Flagstaff CAC. HDDP has formal links with accommodation services, having a number of targeted transitional housing management (THM) properties and priority access to three Salvation Army Bridge Network residential withdrawal beds. Learnings from HDDP AOD problems do not occur in isolation, and clients often present with physical and mental health co-morbidities and social issues such as forensic issues, lack of housing and accommodation, long term disengagement from education and/or employment. As such AOD services cannot operate in isolation. Indeed, assistance provided in areas of housing security, relationship building/restoration, and community integration are not always considered as outcomes of treatment by funders, but may be precursors to individuals being able to address problematic AOD issues. o A long term case management and service coordination approach is essential. 3 Hanover Welfare Services, on behalf of The Salvation Army and VincentCare, will be making a formal submission to the Community Consultation based on the learnings from the HDDP. The Salvation Army Victoria Social Programme and Policy Unit Page 11 of 16

12 o Comprehensive linked access is needed from treatment to post-treatment rehabilitation and social re-integration. o Whilst dedicated access to specific AOD and/or homelessness beds is useful within a coordinated system of care, it is not essential. However, it is essential that staff from generalist services have the skills, knowledge and capacity to engage and work with high need clients. o A social model of health, actively combined with a medical model through co-location and in-reaching activities, is essential to address more complex and multi-factorial presentations. The funding of AOD needs to consider the broad scope of services provided and should include post treatment and after care as essential components of the care continuum. Partnerships, particularly those that provide co-located and/or in-reaching services, should be mandated under funding agreements with clear clinical governance and business rules governing activities and responsibilities. o There must be an acknowledgement that development and maintenance of partnerships is a lengthy and resource intensive activity and should be adequately resourced to ensure efficacy and sustainability. The interface between clinical mental health services and AOD/homelessness services is disconnected and reflects the disparity of models the two systems work under and a discordance between governance mandates. Access Health Access Health is a concrete example of how The Salvation Army has developed innovative service networks to meet the needs of its client group, particularly those clients whose life situations and complex health and social needs mean that access and engagement is severely compromised. The Access Health Service is located alongside the St Kilda based Crisis Centre and provides multidisciplinary specialist on-site, in-reaching and referral support, as well as a state-wide 24 hour Health Information Exchange (NSP) within the Crisis Services Network. The service collaborates with a range of relevant health and support services in order to provide quality health care that facilitates client linkage into mainstream services. Primary health care is offered from a social health framework, with a focus on multidisciplinary teamwork and includes a research and client involvement focus. The service includes general practitioners (registered pharmacotherapy prescribers) through St Vincent s Hospital, Royal District Nursing Service (RDNS) homeless persons program nurses, AOD counsellors, generalist counsellors, mental health/ psychiatry and an aboriginal access worker. Provision of such a range of services is evidence of The Salvation Army s capacity and willingness to partner with disparate organisations to meet the needs of its client group. Learnings from Access Health The success of the model lies in providing an easy point of entry that can address a range of issues without requiring a client to negotiate multiple systems. The Salvation Army Victoria Social Programme and Policy Unit Page 12 of 16

13 In addition, the service provides assertive case management support that allows workers to outreach beyond The Salvation Army services to negotiate services access and response as indicated. 3.3 Current treatment services meeting the needs of people seeking treatment The Salvation Army provides a range of different types of AOD treatment services modelled around the partnerships between services, provision of co-located multidisciplinary teams and a holistic approach to care across the service continuum. Kardinia Extended Withdrawal Service (Geelong) The Kardinia Extended Withdrawal Service provides a three stage withdrawal service: stage one of the program is a six to seven day stay for adults seeking to withdraw from alcohol and or other drugs in a safe and supportive environment; stage two consists of a further three-week stay to enable people to stabilise following withdrawal; and stage three offers a further 12-week stay in a house located close to the Unit offering clients the opportunity to progress with recovery and discharge planning, with access to group programs and a case worker. On entry, clients engage in health and risk assessments with a general practitioner completing a GP Management Plan and risk assessment. GP services are provided one and a half days per week. Stage two engages clients in holistic assessment and response and the development of a recovery and relapse prevention plan. Stage three sees a move to recovery through post treatment support and care which aims to meet the needs of individual clients though services such as, family support groups, group work processes, individual counselling, housing support etc. An after care worker maintains contact with clients. Bendigo Bridge Program The Bendigo Bridge Program is an intensive community based rehabilitation program designed to provide individuals with continuing holistic care following their residential withdrawal program. The program operates on a six week model during which clients have access to individual counselling, group activities, practical skill development, and community support services such as financial counselling and access to a general practitioner. Clients are given the option of cycling through a second six week treatment processes if needed or they are exited into independent living and/or community based support programs. Anecdotal evidence from within the sector has shown that outcomes are more comprehensive for clients during the second round of treatment. The program is built around the individual needs of clients, who most often present with multiple and complex needs, and works on both a motivational and self directed model. The program allows for a rolling re-entry post weekend release and operates across three sites 24 hours a day, seven days a week. Clients are engaged in a range of group and individual interventions with underlying assertive case planning outlining holistic assessment and goal development. Learnings from extended withdrawal and community based rehabilitation models Movement through stages of treatment is based on a client s commitment to proceed. This allows the clients to have control of their treatment process and The Salvation Army Victoria Social Programme and Policy Unit Page 13 of 16

14 assists them to judge their capacity and commitment to the next stage of treatment. Giving clients the option of negotiating re-access to an earlier stage of treatment if required (safety net) is important to ensure clients achieve comprehensive rehabilitation. A holistic response to addressing needs, through a supportive case managed approach, limits clients exiting back into homelessness or back into dysfunctional systems. It is important for formal after-care to be linked to the treatment system in order to provide a safety net for clients whilst allowing for independence. The formalised medical model focus of treatment is the shortest phase of what is a longer term integrated model (withdrawal process) with considerable focus on social and personal recovery. Partnerships with multidisciplinary service providers enhance holistic care options. These services are more successful with clients where they are provided on-site or in-reaching to the service. Community Re-integration Program The Community Reintegration Program provides essential formal and informal activities for clients of the HDDP, ranging from basic communication and living skills, to computer literacy and pre-vocational training. Given the level of complexity of issues and range of co-morbidities that clients of HDDP present with, their capacity to engage with and negotiate the broader community is significantly compromised and such programs are essential to bridge these gaps. As part of the aftercare process, this treatment component is of implicit importance to the long term outcomes of clients. Without providing clients with social, occupational and/or employment rehabilitation AOD treatment has only been partly achieved. This is particularly true for clients of The Salvation Army who are typically highly disadvantaged and marginalised from mainstream community. Assertive outreach The Salvation Army has a significant reputation for providing an outreach service response, as it provides direct access to people without requiring them to access a service site. The Salvation Army strongly supports an assertive outreach response, particularly in response to those who are homeless and with complex multiple needs. An assertive outreach response differs from a standard outreach model in that it is (from a homelessness point of view): conceptualised as part of a broader, integrated and intentional policy response that requires both a multidisciplinary team...a model of service delivery that is described as persistent and aiming to work with people over the medium to longterm as a means to assist people to access housing and sustain their tenancies post-homelessness. 4 4 A, Phillips, R., Parsell, C., Seage, N, and Memmott, P. January 2011, Assertive outreach. AHURI Positioning Paper No AHURI, Queensland Research Centre. The Salvation Army Victoria Social Programme and Policy Unit Page 14 of 16

15 The service models adopted through the HDDP, the Community Re-integration Program in the Hume region, Kardinia, and Adult Services AOD residential programs all adopt an assertive outreach approach to their case management support and provide successful linkages and client focused partnerships between and within services. A key component of the model is the multi-disciplinary team and the capacity of the teams to expand into disparate core services such as mental health, housing and AOD. 4. Conclusions The Salvation Army welcomes the opportunity to provide input into the reform agenda of the AOD sector and endorses and supports the key objectives of this whole-ofgovernment AOD strategy, and the framework under which it has been developed focusing on demand, supply reduction, and harm reduction. In light of The Salvation Army s support of the reform framework, several points of caution have been expressed in relation to the provision and funding of services. Namely: Due to the client group with whom The Salvation Army work, we would caution against limiting funds for treatment and post treatment services in favour of demand and supply reduction approaches. AOD problems do not occur in isolation; and as such, AOD services cannot operate in isolation. The most successful models of AOD treatment combine aspects of medical, social and community connectedness models of care. Without appropriate funding models that focus on client profiles and the complex nature of clients needs, there is concern that funding and services will remain siloed and disconnected. A successful reform of the AOD sector cannot remain cost-neutral. The significant resources required to provide a whole-of-client approach to AOD treatment needs to be recognized, particularly in relation to: o The resources required to develop and maintain partnerships amongst services. o The need to invest in the cross-training of staff within organisations and the recognition that positions within the broader service sector often function on lower wages and need to be topped up by organisational funds. o In light of the Fair Work Australia tribunal outcome upholding the pay equity claim for community services workers, the capacity of The Salvation Army to continue to top up departmental funding in an effort to bridge the gap between departmental expectations and what is required to deliver successful social and community orientated services on the ground is unsustainable and will need to be rationalised. Pharmacotherapy services are a vital component of successful and holistic AOD treatment; however, there remain a limited number of GPs and pharmacies interested or willing to provide pharmacotherapy services. The shortage of these services is cause for significant concern within the sector as it compromises the ability of services to provide individually tailored treatment to clients. Although there has been an effort to roll out AOD specific training to GPs, the low uptake The Salvation Army Victoria Social Programme and Policy Unit Page 15 of 16

16 suggests the need for a cultural change about working with AOD issues in general practice. Experience has demonstrated that the benefits and challenges of a central intake model are quite distinct in rural and metropolitan areas; and that as a result, the application of a one-size-fits-all model is problematic. There is concern that, while it provides capacity to plan long term treatment strategies, a central intake approach will not be flexible enough to accommodate the more complex presentations and the more marginalised clients will continue to fall through the gaps. It is therefore, The Salvation Army s view that while such a model provides some benefits; further consideration of how a central intake approach will operate in metropolitan and rural areas needs to be made. The Salvation Army would welcome the opportunity to discuss the content of this submission should any further information be of assistance. The Salvation Army Victoria Social Programme and Policy Unit Page 16 of 16