Future Service Directions

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1 Alcohol, Tobacco and Other Drug Services Tasmania Future Service Directions A five year plan 2008/ /13 Department of Health and Human Services

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3 Contents Foreword... 5 Introduction... 6 Australian Policy Context... 6 National Drug Strategy Australia s Integrated Framework ( )...6 National Governance Structure...7 Tasmanian Policy Context... 7 Tasmania s Health Plan...7 Tasmanian Drug Strategy Tasmanian Governance Structure... 9 Future Directions for the Alcohol, Tobacco and Other Drug Service System in Tasmania Vision...10 Aim...10 Principles for an Effective Alcohol, Tobacco and Other Drug Service System...10 A Tiered Service Delivery Model...11 Role of Mainstream Health and Human Services...13 Role of Government and Community Sector Organisations in ATOD Specialist Services...14 Priority Focus Areas Treatment and Ongoing Care Services Withdrawal Management Opioid Pharmacotherapy Consultation Liaison Residential Rehabilitation Psychosocial Interventions and Support Services Youth Intervention Outreach Relapse Prevention Management of Complex Needs Brief and Early Intervention Places of Safety Support for Families Health Promotion, Demand Management and Harm Reduction Smoking Cessation Population Based Strategies Supporting the Aboriginal Community Supporting Partnerships to Reduce Harm Strengthening Organisational Structures Workforce Development Continuous Quality Improvement Advocacy Support Supporting Collaborative Partnerships Governance, Planning and Policy Development Information Management Legislative Reform...36 Outcomes... 37

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5 Foreword The Tasmanian Government recognises that alcohol and drug programs deliver positive results for clients and the wider community. We have made some important progress in addressing issues related to alcohol and drug use in Tasmania in recent times, including the recruitment of additional medical specialists and other clinical staff to the Alcohol and Drug Service. This has resulted in safer clinical practice and an expansion of treatment services in Tasmania over the past eighteen months. The review of alcohol, tobacco and other drug services undertaken in 2007/08 reaffirmed the Government s view of the importance of effective programs for Tasmania, and the need for further development and investment across all areas of the service sector. The Government, as part of the Budget, has committed $17.1 million over four years to the development of alcohol, tobacco and other drug services in Tasmania. Around half this investment will be in the community sector. This is the single biggest investment ever made in the sector in this State and highlights the Government s strong commitment to improving services for people with an alcohol and drug issue. The Government has also committed $2.7 million over four years to Tasmanians to quit smoking. This investment also involves working in partnership with the community sector. The Future Service Directions Plan provides guidance for the investment of this funding and for the development of alcohol, tobacco and other drug services in Tasmania over the next five years. The Plan has been developed in conjunction with key stakeholders and draws from three important reviews: the review of Alcohol, Tobacco and Other Drug Services in Tasmania; the review of Smoking Cessation Interventions in Tasmania; and the review of the Needs of the Aboriginal Community in Response to Alcohol, Tobacco and Other Drug Use Issues. The Plan also reflects the Government s emphasis on preventative health and sustainable service delivery through Tasmania s Health Plan. Progress in implementing the Future Service Directions Plan will be closely monitored and evaluated at the end of each twelve month period. As part of that evaluation, there will be opportunity to amend and refine aspects of the Plan as required. Key stakeholders will continue to be involved in the ongoing refinement of the Plan. I commend the Future Service Directions Plan to you. Lara Giddings Minister for Health Alcohol, Tobacco and Other Drug Services, Tasmania Page 5

6 Introduction The Future Service Directions A five year plan provides a strategic focus for the alcohol, tobacco and other drugs service sector in Tasmania for the next five years. This plan identifies the areas where the Tasmanian Government will make significant investment in service delivery to ensure a quality and sustainable system designed to support people who have a substance abuse issue in the safest and most effective manner. The plan outlines a service framework and establishes the building blocks from which a contemporary service system can be constructed. This plan represents the beginning of that construction. This plan provides: A framework for the provision of services and a stronger client-centred focus in the delivery of services; A shared vision, aim and principles which strive for excellence within the Tasmanian alcohol, tobacco and other drug service system; Strategic priority focus areas and future directions to guide service planning, delivery and evaluation; Clarity on the roles and responsibilities of the different services in the sector; and Opportunities for increased collaboration, partnerships, linkages and support between alcohol, tobacco and other drug services and mainstream health and community services. This plan builds upon a review of the Alcohol, Tobacco and Other Drug services which was conducted in The plan also draws from the reports of the review of Smoking Cessation Interventions in Tasmania and the review of the Needs of the Aboriginal Community in Response to Alcohol, Tobacco and Other Drug Use Issues. A number of stakeholders contributed their views on the existing service system and provided ideas for improvement and service development. The key goal of this plan is to enhance the capacity of the service system and to deliver better outcomes for clients. The Future Service Directions A five year plan makes significant steps towards meeting that goal. Australian Policy Context National Drug Strategy Australia s Integrated Framework ( ) The National Drug Strategy Australia s Integrated Framework is a national policy framework, which is supported by a range of national, state, territory, government and non government strategies. The mission of the National Drug Strategy is to improve health, social and economic outcomes by preventing the uptake of harmful drug use and reducing the effects of licit and illicit drugs in Australian society. The basis of the National Drug Strategy is that of harm minimisation, focussing on both licit and illicit drugs. Specifically, harm minimisation seeks to prevent anticipated harm and reduce actual harm, using a balance between demand reduction, supply reduction and harm reduction strategies. supply reduction seeks to disrupt production and supply of illicit drugs and control and regulate licit drugs; demand reduction seeks to prevent uptake of harmful drug use and to provide treatment to reduce drug use; and harm reduction seeks to reduce drug-related harm to individuals and communities. Alcohol, Tobacco and Other Drug Services, Tasmania Page 6

7 The National Drug Strategy has twelve stated objectives that support the mission statement. In addition, the National Drug Strategy has identified eight priority areas, which are: prevention; reduction of supply; reduction of drug use and related harms; improved access to quality treatment; development of the workforce, organisations and systems; strengthened partnerships; implementation of the National Drug Strategy Aboriginal and Torres Strait Islander Peoples Complementary Action Plan ; and identification and response to emerging trends. A key feature of the National Drug Strategy is that it has a national coordinated and integrated approach. National Governance Structure Ministerial Council on Drug Strategy: Australian policy for alcohol and other drugs is overseen by the Ministerial Council on Drug Strategy, as the peak body with policy and decision making responsibility. The membership of the Ministerial Council on Drug Strategy includes Australian and State and Territory Ministers of Health and Law Enforcement, including the Minister responsible for Education. Intergovernmental Committee of Drugs: The Ministerial Council on Drug Strategy is supported by the Intergovernmental Committee on Drugs, which provides policy advice to Ministers on the full range of drug-related matters and is responsible for implementing the National Drug Strategic Framework. The membership of the Intergovernmental Committee on Drugs includes representatives from each state and territory, as well as New Zealand. There are two members from Tasmania. Australian National Council on Drugs: The Australian National Council on Drugs also provides support to the Ministerial Council on Drug Strategy. Membership includes independent experts, which facilitates integration with the non government sector. Other: Other supporting bodies or initiatives include the National Expert Advisory Panel, National Drug Research Centres and Annual Strategic Issues Workshop. Tasmanian Policy Context Tasmania s Health Plan The Tasmania Health Plan was released in May 2007, which is supported by the Clinical Services Plan and the Primary Health Services Plan. The Tasmania Health Plan seeks to position the Tasmanian health system to meet the current and future challenges, which include: workforce shortages; keeping pace with rapidly changing technology; high proportion of population aged 65 years or over (above the national average), that is increasing; high demand for health services driven by the needs of those aged 65 years or over, and an epidemic of chronic disease; escalating costs; and addressing the mismatch between current services and community needs. Alcohol, Tobacco and Other Drug Services, Tasmania Page 7

8 The plan indicates a need to focus on preventative and early intervention services, ensure proper system design to support quality care and opportunities to introduce new models of care, and benefit from new technologies. Tasmania s Health Plan identifies five key principles in striving for a sustainable service system for the future. Tasmania s health services will be: accessible as close as possible to where people live, providing services can be delivered safely, effectively and at an acceptable cost; appropriate to community needs; client and family focused; integrated through effective service coordination and partnerships between providers; and designed for sustainability. Where services cannot be delivered safely, effectively and at an acceptable cost locally, access will be facilitated through service coordination, transport assistance and other appropriate support. Tasmanian Drug Strategy The Tasmanian Government s response to alcohol and drug misuse is contained within the Tasmanian Drug Strategy The Tasmanian Drug Strategy states that it compliments the Tasmania Together 2020 and is consistent with the National Drug Strategy The Tasmanian Drug Strategy is based on six principles, which are: partnership and collaborative effort; building capacity in community and alcohol and other drug sector; harm minimisation; prevention and early intervention; equity of access; and research, data collection and evaluation. There are three priorities identified in the Tasmanian Drug Strategy, under which each has a range of specific objectives. The objectives have been clearly linked to the aims of the Tasmanian Drug Strategy, as well as its compliance to the Tasmania Together 2020 and the National Drug Strategy. The priorities are: Community safety; Prevention and reduction; and Improved access to quality treatment. Alcohol, Tobacco and Other Drug Services, Tasmania Page 8

9 Tasmanian Governance Structure It is important for any government to have clear and accountable processes to discuss, negotiate and debate issues to ensure policy decisions are fully and properly informed. An effective and coordinated response can only be achieved if supported by a whole-of-government governance structure which allows input from a wide range of stakeholders. To support the government in its decision making, it will be informed by and receive recommendations and proposals from the Inter-Agency Working Group on Drugs. The Inter-Agency Working Group on Drugs works strategically across government and community sector organisations to achieve a collaborative approach to dealing with the issues associated with alcohol, tobacco and other drug abuse in Tasmania. Figure 1 Governance Structure to Address Alcohol, Tobacco and Other Drug issues in Tasmania Alcohol, Tobacco and Other Drug Services, Tasmania Page 9

10 Future Directions for the Alcohol, Tobacco and Other Drug Service System in Tasmania Vision To reduce the harms of alcohol, tobacco and other drugs on individuals, families and communities. Aim To ensure that Tasmanians affected by alcohol, tobacco and other drug use have access to appropriate, timely, effective and quality alcohol, tobacco and other drug services, supports and interventions which are based on contemporary best practice. Principles for an Effective Alcohol, Tobacco and Other Drug Service System The Tasmanian alcohol, tobacco and other drug service system will: be client focussed; be committed to continuous quality improvement; operate in a harm minimisation framework; be evidence based and in line with contemporary best practice; be integrated and delivered in partnership with other sections of the health and human services system; be underpinned by common approaches to assessment, referral, counselling and case management; be supported by a skilled and flexible workforce; and be designed for sustainability and provided at an acceptable cost. Client Focussed The alcohol, tobacco and other drug service system needs to ensure that clients are effectively and meaningfully engaged in the planning, development, delivery and evaluation of interventions and services. It is important that all services and interventions are based on an identified need and are designed to provide the best possible outcomes for clients. Continuous Quality Improvement The alcohol, tobacco and other drug service system will have a commitment to continuous quality improvement to ensure that all services have the capacity to improve outcomes for clients. The key elements of a continuous quality improvement framework include measurement, comparison, action and evaluation. It will be important for Tasmania to establish clear models of service provision that incorporate service standards and practice guidelines upon which services can be measured and evaluated. Operate in a Harm Minimisation Framework Harm minimisation refers to policies and programs aimed at reducing drug-related harm. A harm minimisation framework aims to improve health, social and economic outcomes for both the community and the individual, and encompasses a wide range of approaches, including abstinence-oriented strategies. Harm minimisation includes preventing anticipated harm and reducing actual harm. Alcohol, Tobacco and Other Drug Services, Tasmania Page 10

11 Evidence Based and in Line with Contemporary Best Practice Evidence based and contemporary best practice is an approach to health care whereby health professionals, clinicians and support workers use the best evidence available, in consultation with the patient, to decide upon the option which best suits the patient. All services, supports and interventions will be based on evidence and delivered in line with contemporary best practice so that the harms of alcohol, tobacco and other drugs on individuals, families and communities are reduced. Integrated and Delivered in Partnership with Other Services In ensuring an effective and sustainable service system it is imperative that services, interventions and supports are developed and delivered in partnership with other health and human specialties, local, state and federal agencies and the community sector. While specialist alcohol, tobacco and other drug services play a key leadership role, they cannot be solely responsible for meeting all the needs of people who have an alcohol or drug problem. Common Approaches to Assessment, Referral, Counselling and Case Management The delivery of specialist alcohol, tobacco and other drug services in Tasmanian will be underpinned by common approaches to assessment, referral, counselling and case management. These approaches will form the basis from which service interventions can be delivered in the most effective and efficient manner. A key priority for Tasmania will be to develop guiding principles and practices in the delivery of case management and counselling interventions and to implement a common assessment and referral tool across all specialist alcohol, tobacco and other drug services. Supported by a skilled and flexible workforce In order to achieve a high quality alcohol, tobacco and other drug service system it is essential that it is supported by a skilled and flexible workforce. Investment in supporting staff to update and improve their knowledge and skills will be a critical component in ensuring the success of the future service and sector development initiatives. Designed for Sustainability and Provided at an Acceptable Cost 1 Specialist alcohol, tobacco and other drug services will be provided safely, effectively and at an acceptable cost. To ensure sustainability it is necessary that there is sufficient client volume to allow for the ongoing provision of high quality services. Specialist services should be appropriately funded to meet reasonable costs that are sustainable over time. A Tiered Service Delivery Model A tiered service delivery model has been adopted to provide clear direction on responsibility for service response across the full continuum of alcohol, tobacco and other drug support and interventions. The model recognises the importance of integration and collaboration between the specialist alcohol, tobacco and other drug services, other health and human service providers, private and community sector organisations. The model is also based on a commitment to the leadership role of specialist alcohol, tobacco and other drug services as a key resource to support and assist our partner services to provide quality outcomes for people with alcohol, tobacco and other drug issues (see figure 2). 1 The principles contained within Tasmania s Health Plan (Summary 2007) will be applied when determining acceptable cost and service sustainability Alcohol, Tobacco and Other Drug Services, Tasmania Page 11

12 Figure 2: A Tiered Model of Service Delivery Primary Services Generic Health and Community Services Secondary Services ATOD Services Tertiary Services Specialist Treatment ATOD Services The model provides a framework and recognition of the importance for primary and specialist providers to work together to develop systems that are integrated across the health and human services sector and are client focussed. The tiered model explains the level of involvement of primary and specialist providers (across both government services and community sector organisations) in the care of clients with alcohol, tobacco and/or other drug issues (see figure 3). The specialist service intent is to work with the range of other service providers to treat, support and best meet the needs of clients, families and communities. Tier one services are usually the first point of contact for those in the community seeking generic health and community based services. These services would also include the broader population based health promotions and harm reduction strategies. Tier one services would include: general practitioners, generic primary health services, community based services, population health promotion and information strategies Tier two services are generally for people seeking support, assistance and information. Clients falling under this category will have access to the provision of community based services that target people with alcohol and drug issues as well to generic alcohol and drug information to both clients and other service providers. Tier two services would include: needle and syringe programs, supported accommodation services, peer support, community-based self help groups, alcohol, tobacco and other drug information services. Tier three services provide support and interventions which are targeted at people with alcohol, tobacco and other drug problems. The range of services in tier three is designed to assist clients requiring specialist ATOD interventions and support. These services provide specialist alcohol, tobacco and other drug support, advice and information; specialist non-medical interventions; and assist in the shared care of clients with other service providers. Tier three services would include: consultation liaison services, specialist assessment and referral, case management, relapse prevention, community pharmacotherapy, pharmacotherapy assisted smoking cessation youth specific interventions, counselling, places of safety, outreach, family support, group work. Tier four service provision is expected to address the needs of clients with complex and high risk issues. Services provided include highly specialised medical and clinical interventions that are aimed at improving the function and reducing the risks for clients with complex alcohol and drug issues. Alcohol, Tobacco and Other Drug Services, Tasmania Page 12

13 Tier four services would include: specialist withdrawal management services (youth and adult); specialist pharmacotherapy (including opioid pharmacotherapy programs); residential rehabilitation; specialist psychosocial interventions; intensive assessment, counselling and case management; specialist consultation liaison services; clinical advisory service; and withdrawal management services provided through Acute Care Services. Figure 3: Supports and Interventions under the Tiered Model Role of Mainstream Health and Human Services The need for alcohol and drug interventions in Tasmania will always exceed the capacity of specialist alcohol, tobacco and other drug services. The sheer number of Tasmanians who could benefit from an alcohol and drug intervention, their geographical distribution and the services which they are most likely to access will require the involvement of mainstream health and human services. Mainstream health services (including general practitioners, primary health services, community nursing, youth services, mental health services, acute care services, correctional primary health services, children and family services and other community sector organisations) have an important role to play in assessing clients for alcohol, tobacco and other drug use, carrying out brief interventions and referring as appropriate. The involvement of these services will help make a significant positive impact in addressing alcohol, tobacco and other drug issues in Tasmania. The focus for Tasmania over the next five years will be to establish the delivery of brief alcohol, tobacco and other drug interventions within the domain of mainstream health and human services. To achieve this goal, this plan outlines a number of strategies that will: Establish whole of government support to reducing and preventing the harms associated with alcohol, tobacco and other drug use; Ensure the provision of specialist information, advice, support and intervention to mainstream health and human services when required; and Better equip mainstream health services (and their staff) to provide brief interventions and information in relation to alcohol, tobacco and other drug use. Alcohol, Tobacco and Other Drug Services, Tasmania Page 13

14 Role of Government and Community Sector Organisations in ATOD Specialist Services The provision of specialist alcohol, tobacco and other drug services in Tasmania is delivered by a range of public, community and private services. The provision of these services is extremely complex and involves a wide range of treatment, support and interventions. It will be important for the specialist alcohol, tobacco and other drug services across both the government and community sectors to adopt a collaborative and integrated approach with each other and with other mainstream health and human services. The service framework allows for the development of identified broad roles to guide the delivery of services through the government and community sectors. However, it is important to note that the provision of specialist alcohol, tobacco and other drug services cannot always be clearly defined and there will always be areas of support which are shared between government services and community sector organisations. In establishing a sustainable service system it is important to recognise that specialist alcohol, tobacco and other drug services perform a dual role. They provide: 1. A service provision/intervention role whereby services and interventions are provided directly to the primary client; and 2. An educative and support role whereby specialist services inform, educate and support other mainstream health and community services to better manage people who present with an alcohol and drug issue. The following figure identifies the roles of community sector organisations and government in the provision of alcohol, tobacco and other drug services in Tasmania. Figure 4: Role of Community Sector Organisations and Government Providers in Alcohol, Tobacco and Other Drug Services under the Tiered Model Alcohol, Tobacco and Other Drug Services, Tasmania Page 14

15 Figure 4 above describes the role of government services and community sector organisations and details those areas of client support that can (and is) shared across both sectors. Most clients who present to specialist ATOD services will, in the main, have complex needs. For the life of this plan, it is envisaged that clients with the most complex and multiple needs will, in most cases, be supported by government services where specialist clinical assessment, support and interventions are more accessible. At this point in time, it is the government services that employ a range of clinicians (including addiction medicine specialists, specialist nurses and other health professionals) that can offer clients a multidisciplinary approach to treatment and support. Therefore clients who are at a high risk or require medical treatment or require a range of clinical interventions (or a combination of any or all of those characteristics) will, in most cases be supported by government services. Clients who are less risky and do not require intensive specialist clinical input will, in the main, be supported by community sector organisations that can offer a range of psychosocial interventions and supports. The figure above also identifies that there will be a section of clients who can (and will) be supported by both government and community sector organisations. In describing the characteristics of the client group, it is important to note that the characteristics of individual clients change over time. In practice this will mean that the needs of some individual clients will require support from both components of the sector. To become more responsive to the changing needs of clients, it will be important for the Tasmanian ATOD service sector to develop effective client pathways, networks, referral and coordination processes to ensure that transition between the government and community sectors is as smooth as possible for clients. Priority Focus Areas The following section provides an overview of the priority focus areas for the next five years for the alcohol, tobacco and other drug service sector in Tasmania. The priority focus areas represent those areas of the sector which require development and change over the next five years. The four priority focus areas are: 1. Treatment and Ongoing Care Services 2. Psychosocial Interventions and Support Services 3. Health Promotion, Demand Management and Harm Reduction; and 4. Strengthening Organisational Structures. 1. Treatment and Ongoing Care Services It is important to note that approaches to treatment are often very complex and may involve a range of other issues which may need to be addressed concurrently (for example pain management, mental health issues etc.). To ensure that appropriate and comprehensive treatment services are provided to these clients, it is essential that treatment services and addiction medicine specialists work closely with other sections of the health and human services sector. To achieve this it will be important for the ATOD sector to attract and retain additional addiction medicine specialists to the state. The different types of treatment and ongoing care services in an effective alcohol, tobacco and other drug sector would include withdrawal management, opioid pharmacotherapy, relapse prevention, consultation and liaison and residential rehabilitation. In providing the best possible outcomes for clients it will be vital to ensure that these types of treatment services can be delivered in different settings, including residential, outpatient clinics, outreach provision, correctional settings and hospital and acute care services. This will be the developmental focus for Tasmania over the next five years Withdrawal Management The Alcohol and Drug Service manages a specialist residential based withdrawal management service in the south of the State at St Johns Park. The service is a 10 bed inpatient-based unit providing statewide withdrawal management services. Alcohol, Tobacco and Other Drug Services, Tasmania Page 15

16 The current model within the state is focused around inpatient or residential withdrawal management. Within Tasmania, there is a need to develop diversity in where and how withdrawal management services are provided. A key focus for Tasmania will be to develop and resource a range of best practice models, including ambulatory withdrawal, acute care (hospital based) and the further development of the dedicated withdrawal management unit. It will be a priority to develop services for the North and North West of the State given that the dedicated residential withdrawal management facility is based in the South of the State. The current dedicated facility is not integrated with the acute hospital services and is dependent on a single medical officer. There are further limitations such as the lack of diversion programs, difficulties obtaining psychiatric support, and problems managing specific client groups and patients under involuntary orders. The long term future for dedicated withdrawal management units will see them more integrated with acute hospital services. The redevelopment of the Royal Hobart Hospital, in Southern Tasmania, will present an opportunity to plan for more integrated service delivery in this area. Key Points: Withdrawal Management Treatment is often considered a necessary step to moving clients towards a life without being dependent on drugs. Treatment significantly reduces risks for clients through the medical monitored stabilisation of substance abuse and the use of safer longer acting medication. Treatment works and is cost effective. Research indicates that the benefits of treatment can outweigh the costs of treatment by up to four to one. Research into the effects on individuals 12 months after treatment found that treatment: cut drug use in half; reduced criminal activity by up to 77%; increased employment; decreased homelessness and improved physical and mental health (Centre for Substance Abuse Treatment 1996). Every dollar spent on alcohol and drug treatment can save the community up to seven dollars, mostly through reductions in crime and the need for medical care. There is no dedicated withdrawal management service in the North or North West and it is difficult for clients in those areas to access the dedicated withdrawal management facility in the South of the State. Initiative Outcomes Timeframe I. Develop and implement Guidelines for Withdrawal Management in Tasmania. Statewide guidelines based on best practice and developed in conjunction with Acute Care Services. Establishment of minimum standards for withdrawal services. Improved clinical practice across all service settings. Common approaches to assessment, referral, admission, treatment and discharge planning processes across the State. Provision for future service development in the area of withdrawal management. 2008/09 Alcohol, Tobacco and Other Drug Services, Tasmania Page 16

17 II. Develop and invest in an effective consultation and liaison service to ensure the availability of on-call specialist alcohol and drug advice and support Improved specialist support and advice to the acute care sector. Improved access to treatment and improved outcomes for clients. Increased medical specialists to support withdrawal management services in Tasmania. 2008/ /13 III. Investigate models of withdrawal management for young people who are under the age of 18. IV. Ensure access to specialist psychiatric support/care for clients who are withdrawing and who have a mental health issue. V. Access to support to assist in the coordination and engagement of services and supports for clients following treatment. VI. Integrate approaches for aftercare and relapse prevention after withdrawal through collaboration and strong linkages to other support services. New models of withdrawal management for youth are identified and trialled. Improved management and support for clients who have a co-existing mental health issue. Improved outcomes for clients. Relapse rates reduced. Improved transition for clients to aftercare support and access to case coordination services when required. Improved longer term outcomes for clients. Relapse rates reduced. 2009/ / / / / / / / Opioid Pharmacotherapy Opioid substitution pharmacotherapy is the prescribing of regular doses of legal drugs to enable opioid users to reduce or stop illegal, harmful and dangerous drug use. In Tasmania, Pharmacotherapy programs are managed by doctors in the Alcohol and Drug Service and by general practitioners. Dosing mainly occurs in community pharmacies, although a small number of clients are managed through the southern pharmacotherapy unit of the Alcohol and Drug Service. The key focus for Tasmania is to effectively resource and support the shared care model of opioid pharmacotherapy treatment. To achieve this, it will be essential to develop the public program, within the Alcohol and Drug Service, to ensure it has the capacity to treat patients who have multiple and complex medical and psycho-social issues. In addition to this, it will also be necessary to build an appropriate support structure for general practitioners and community pharmacists to ensure that they have access to specialist clinical advice and support when required. Key Points: Opioid pharmacotherapy treatment works and is cost effective. For example The economic benefits of treatment exceed the costs of treatment (for every dollar spent on care it can result in up to seven dollars in benefits). Treatment benefits can include increases in employment income and a decrease in the costs of criminal activities, incarceration, and hospitalisation. Alcohol, Tobacco and Other Drug Services, Tasmania Page 17

18 Treatment in correctional settings plus aftercare in the community when offenders are released can lead to substantial reductions in the rates of re-incarceration and the associated costs of arrest, prosecution and incarceration. Treatment for alcohol and drug disorders can lead to reductions in the utilisation and cost of medical care. In 2005, Tasmania had the highest rate of accidental deaths due to opioids per million persons among those aged years of any State in Australia. The rate of accidental deaths due to opioids in Tasmania has steadily increased since There are over five hundred patients across Tasmania who are currently prescribed opioid medications and who would be more safely and effectively managed and treated on the Opioid Pharmacotherapy Program. Initiative Outcomes Timeframe I. Develop and implement the Tasmanian Opioid Pharmacotherapy Policy and Clinical Practice Standards. Statewide Policy and Clinical Practice Satndards that are informed by evidence and based on contemporary best practice. Shared care model of opioid pharmacotherapy treatment is evidence based and reflects contemporary best practice. Statewide consistency in the treatment of pharmacotherapy clients. 2008/09 II. Increase the capacity of the opioid pharmacotherapy program by recruiting additional addiction medicine specialists and other professionals (nursing) to support the program. Improved access for clients. Increased numbers of clients on the program. Improved health outcomes for clients. 2008/ /13 III. Develop and invest in an effective consultation and liaison service to ensure the availability of on-call specialist alcohol and drug advice and support for the Acute Care Service, general practitioners and pharmacists. IV. Access to support to assist in the coordination and engagement of services and supports for clients. V. Integrate approaches for relapse prevention for pharmacotherapy clients through collaboration and strong linkages to other support services. VI. Develop and invest in appropriate mechanisms to better support and train staff, general practitioners and pharmacists who work within the pharmacotherapy program. Improved specialist support and advice to general practitioners, pharmacists and the acute care sector. Improved access to treatment and improved outcomes for clients. Improved outcomes for clients. Relapse rates reduced. Improved longer term outcomes for clients. Relapse rates reduced. Training and education program is developed and implemented for general practitioners and pharmacists. 2008/ / / / / / / /10 Alcohol, Tobacco and Other Drug Services, Tasmania Page 18

19 1.3. Consultation Liaison A core element of any alcohol, tobacco and other drug service system is an effective consultation liaison service. A consultation liaison service should provide specialist advice, assistance, and guidance to clinical staff on the effective diagnosis and management of patients with alcohol and drug problems within the major hospitals and community based services (including general practitioners) across the State. Alcohol and drug services should be regarded as a core service for all acute care hospitals as there is a high prevalence of alcohol and drug problems in presenting and admitted patients. This presents a unique opportunity to reach people with alcohol and drug problems that present to a major hospital who may not otherwise be seen by other health or human services. Therefore a key focus for Tasmania is to ensure that all acute care facilities have staff available on all shifts that have, at a minimum, a basic level of drug and alcohol training, as well as access to on-call specialist alcohol and drug advice and support. The immediate priority for the Tasmanian alcohol and drug consultation liaison service will be to support Acute Care (Hospital) Services. It is further recognised that there is a high demand for access to specialist alcohol and drug support and advice by other health and human services, including general practitioners, primary health services, mental health services, child and family services, population health services, youth justice, correctional health, Aboriginal organisations etc. Future investment in an effective consultation liaison role within the Alcohol and Drug Service will enable this demand to be met. Key Points: Treatment for alcohol and drug abuse can often be complex and may have to address a range of other issues (such as pain management, pregnancy, mental health issues, child protection issues etc). Therefore, it is essential to build capacity to enable specialist alcohol and drug services to work closely with other sections of the health and human service sector. There are a significant number of people who present to acute care services (hospitals) with alcohol and drug related issues who do not access specialist alcohol and drug services. Specialist alcohol and drug interventions may reduce the likelihood of re-injury or readmission to emergency departments of hospitals for clients who present with related alcohol and drug issues. In , there were a total of 1765 separations in Tasmanian public hospitals that had a primary diagnosis relating to an alcohol and drug issue. Based on current trends, it is estimated that this figure will steadily increase over the next 15 years (2,400 in , 2,744 in and 3,039 in ). Initiative Outcomes Timeframe I. Establish a consultation liaison service across Tasmania to deliver specialist clinical alcohol and drug interventions, advice, information and support. Improved health outcomes for clients. Improved access to specialist alcohol and drug interventions. 2008/09 II. Provide improved support to Acute Care Services (hospitals) and general practitioners to strengthen alcohol and drug interventions. Improved delivery of general medical treatment. Established alcohol and drug training and education for acute care staff. 2008/09 Alcohol, Tobacco and Other Drug Services, Tasmania Page 19

20 III. Provide improved support to other health and human services to strengthen alcohol and drug interventions. Improved delivery of health and community based services for clients with alcohol and drug issues. Established alcohol and drug training opportunities for staff. 2009/ / Residential Rehabilitation Residential rehabilitation is a critical element in a comprehensive alcohol, tobacco and other drug service system. When used appropriately it can be an effective treatment suitable for a range of clients at different stages in their treatment. Residential rehabilitation is especially important in providing a pathway out of dependency or through which clients might ultimately exit treatment. A range of residential rehabilitation services needs to be available to clients seeking treatment. The programs offered by residential rehabilitation services are principally either rehabilitative or accommodation support, long stay or short stay (or combinations of these). Rehabilitative treatment services provide accommodation and a structured and planned program of therapeutic and other activities. They are suitable for clients with a medium or high dependence on drugs and/or alcohol and who have medium to high care needs. Rehabilitative programs consist of: 1. Long stay programs these can run for up to six months or more and are better suited to clients whose drug and alcohol use is long-term and entrenched, and who are likely to be socially excluded, unemployed, in severe housing need, lacking in life skills, and persistent, prolific offenders 2. Short stay programs usually last less than 12 weeks. Short stay programs can include o Intensive programs that provide intensive medical and therapeutic interventions for clients with complex medical needs and likely to need long stay residential treatment or structured community treatment; and o Medium care programs for clients with shorter drug and alcohol misuse histories and who are more likely to be able to return to employment and housing with community or family support. Accommodation support services provide accommodation, often following treatment in a rehabilitative program, with specialist alcohol and drug and non-alcohol and drug related support. They are suitable for clients with low dependence on drugs and alcohol or who are now abstinent and have low care needs and require time-out, accommodation and/or additional support. A key focus for Tasmania will be to investigate the need and cost effectiveness of establishing a service (or developing current services) that offer residential rehabilitative support services as outlined above. Key Points: Residential rehabilitation is: A highly effective form of treatment for alcohol and drug users who wish to achieve a drug free lifestyle; Appropriate for a range of alcohol and drug users at different stages of their treatment; An essential element in treatment systems; and Most effective when aftercare is planned before the end of the treatment. Residential rehabilitation for drug users has demonstrated improved outcomes for clients; Alcohol, Tobacco and Other Drug Services, Tasmania Page 20

21 Clients with more severe problems will often experience better outcomes from treatment stays of 90 days or longer; Tasmania has no specialist residential rehabilitation service that can offer 24 hour specialist support and access to intensive medical and therapeutic interventions for clients with complex needs. Initiative Outcomes Timeframe I. Investigate models of residential rehabilitation treatment that offers both long and short term programs and which meets the needs of Tasmanian clients. Model of residential rehabilitation established for Tasmania. 2008/ /11 II. Invest in the development of current services to ensure clients have access to specialist alcohol and drug support. Establishment of specialist alcohol and drug support for clients within current services. 2008/ /13 Improved outcomes for clients. III. Access to support to assist in the coordination and engagement of services and supports for clients. IV. Establish a specialist residential rehabilitation service that can provide access to intensive medical and therapeutic interventions for clients with complex needs. Improved outcomes for clients. Relapse rates reduced. Access to both long term and short term specialist residential rehabilitation programs. 2009/ / / /13 2. Psychosocial Interventions and Support Services Psychosocial interventions and support services describe a wide variety of services, supports and strategies that aim to change behaviour and support people with drug and alcohol problems. They are services which are provided within community settings. These types of services provide a range of psychosocial (non-medical) interventions for people with alcohol and drug issues including assessment, counselling, case management, coordination of care, group work, information, community education and professional consultation to other service providers. The focus for Tasmania over the next five years will be to improve the capacity of specialist psychosocial interventions and support services through increased investment in both government and community sector alcohol and drug services and the development of stronger partnerships with other areas of the health and human service system Youth Intervention There are a range of generic youth services provided across Tasmania by both government (including local government) and community sector organisations. A very small number receive funding to provide specific alcohol and drug interventions for youth. Currently, these services are limited in their capacity to meet the current demand for dedicated alcohol and drug services for youth. It will be important for Tasmania to develop a range of flexible intervention and support services for youth that are integrated into the broader health and community services across the State. Key Points: Alcohol and drugs are often linked to youth justice clients (up to as much as 50% of these clients use alcohol and/or drugs). Alcohol, Tobacco and Other Drug Services, Tasmania Page 21

22 Mental health and substance abuse disorders can account for 60-70% of the burden of disease among year olds. Parents of children in out-of-home care have high rates of harmful substance use. A report on Child Protection Services in Tasmanian in October 2006 found: an increase in the use of illicit drugs and alcohol by parents has added to the level of risk of many children being notified to child protection services; most notifications included a range of welfare issues including alcohol and drug use; and increased numbers of mothers affected by drugs and alcohol are being identified at antenatal clinics. Initiative Outcomes Timeframe I. Develop and establish a service framework for specialist alcohol and drug interventions which is integrated with other community and health services for youth. Increased support for youth Improved access to service 2008/09 II. Increase the numbers of specialist alcohol and drug youth workers to provide information, support, advice and referral for young people. Increased support for youth Improved access to service 2008/ /10 III. Strengthen the capacity of the Alcohol and Drug Service to better support Children and Family Services when they encounter alcohol and drug issues which are impacting on families and children. IV. Access to support to assist in the coordination and engagement of services and supports for youth V. Strengthen specialist alcohol and drug interventions for young people who are at risk and engaged with mental health and accommodation services. VI. In collaboration with other youth services, explore opportunities for early intervention services and programs for vulnerable young people. Improved consultation support and services for the range of child and family services. Improved service outcomes for clients Improved outcomes for clients. Relapse rates reduced. Improved access to specialist alcohol and drug interventions, support and advice for clients with mental health and/or accommodation issues. Improved access to specialist support, advice and information for young people. 2008/ / / / / / / Outreach One component of community-based alcohol and drug services is the provision of services on an outreach basis. This can include the range of psychosocial interventions. Outreach services are useful in providing services to clients who would otherwise be unable to access specialist alcohol, tobacco and other drug services in a timely and equitable manner. Services are designed to provide: counselling; assistance with accessing other services; access to skilled and professional help; assistance with the development of strategies to reduce harm; and access to specialist advice and information. Services can be provided to individuals or in group settings. Alcohol, Tobacco and Other Drug Services, Tasmania Page 22

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