Supporting Drug & Alcohol Services to Work with Clients with Complex Needs Project VAADA Conference 2013 Ciara Donaghy and Heidi Becker, NADA
About NADA Peak body for NGO D&A sector in NSW Approx. 110 members Our goal: To advance and support non government drug and alcohol organisations in NSW to reduce the alcohol and drug related harm to individuals, families and the community
NGO Practice Enhancement Program Funded by Mental Health Drug and Alcohol Office NSW Ministry of Health in July 2010 Aim: To build capacity within NGO D&A services to respond to clients presenting with D&A / co existing D&A and mental health issues and complex needs, including cognitive impairment (ABI, ID, FASD) and/or criminal justice contact. Addressing staff skills, knowledge and confidence, as well as organisational capacity.
PEP Objectives Identify the service practice development needs and barriers in responding to complex needs. Implement projects and activities to build the capacity of the sector to respond to complex needs. Evaluate the outcome of capacity building projects to inform ongoing workforce, organisational development and provision of treatment. Improve the engagement of D&A NGOs with complex needs clients and improve treatment outcomes for this population.
Strategies Mapping and scoping activities Practice enhancement training and workshops Training grants Member and stakeholder forums Service practice enhancement seeding grants Resources Indepenent evaluation program
NADA Member Consultation Literature review aims To examine the national and international policy contexts in which drug and alcohol services work with clients with complex needs. To examine the literature stemming from programs working with clients with complex needs.
NADA Member Consultation Literature review cont d There is very little published research on those with dual diagnosis and the CJS [criminal justice system] in Australia. Baldry, E., Dowse, L. & Clarence, M. (2010) Background Paper: Lifecourse Pathways for People with Mental Health Disorders and Cognitive Disability & Pathways into the Criminal Justice System Australasian Juvenile Justice Administrators Conference 2010
NADA Member Consultation Service mapping and member consultation aims Map the ways in which drug and alcohol nongovernment services in NSW work with clients with complex needs. Consult with NADA members regarding their experiences of working with clients with complex needs.
NADA Member Consultation Service mapping and member consultation cont d Stretched and limited resources The need for functional assessment The importance of cross agency collaboration Challenges of working with clients with alcohol related and acquired brain injury in the residential rehabilitation setting
NADA Member Consultation Service mapping and member consultation cont d Physical health complications The significance of complex needs such as mental health issues, homelessness and DoCS involvement The importance of training around complex needs such as alcohol related brain injury and intellectual disability Policy, procedure and data recording
NADA Member Consultation Member consultation Service characteristics Range Mean Annual number of clients 28000 18 2084 % of clients with CJS contact 100 4 62 % of clients with cognitive 50 1 15 impairment (CI) % of clients with both CJS 95 0.5 28 contact and CI % of clients with other 100 10 60 complex needs* * Other complex needs identified included homelessness, mental health issues, pregnancy, pharmacotherapies, dual diagnosis, trauma, child abuse, behavioural issues, physical health, DoCS involvement, sexual abuse.
NADA Member Consultation
NADA Member Consultation
NADA Member Consultation
NADA Member Consultation Recommendations Employ a short questionnaire to estimate cognitive impairment at intake for drug and alcohol services Employ holistic service models that recognise the impact and role of family and personal history issues in drug and alcohol misuse Employ service models that are inclusive of therapies better suited to clients who have literacy challenges, for example, art therapies and spoken, rather than written homework Recognise that some modes of therapy, Dialectical Behaviour Therapy, for example, may not be suited to clients with alcohol related brain injury, acquired brain injury or intellectual disability Use a strengths based focus in all treatment planning
NADA member consultation Recommendations cont d Ensure smooth transitions between custody and drug and alcohol rehabilitation where so required using open lines of communication between CS NSW, Justice Health and the non government service providers Upgrade existing drug and alcohol rehabilitation facilities so that they offer more privacy and are less institutional Ensure smooth transitions between drug and alcohol rehabilitation and housing to avoid relapse during periods of unstable accommodation Dedicate placements for clients with cognitive impairment and monitor progress through the program Attempt as far as possible to maintain relationships with clients beyond the context of residency period to retain clients within the therapeutic community
NADA Member Consultation Recommendations cont d Ensure training in mental health, alcohol related brain injury, acquired brain injury and intellectual disability is accessible, and in regional areas, provide this training as in service
Training, Workshops, Forums and Training Grants Training/ Training Grants o Introduction to ABI o Screening and Assessment in ABI and the triple co morbidity o Introduction to FASD o No Bars: Supporting D&A services to work with Criminal Justice Clients Member and stakeholder forums
Service Practice Enhancement Seeding Grants $350,000 available in small grants of $20,000 $50,000 for 12 months 25 applications received worth $650,000 10 successful grant recipients o Policy, procedure and practice review o Training o Resource development o Infrastructure o Partnerships o Research
Karralika Programs ACT Aim: To increase access and retention in a residential therapeutic community environment for clients with complex needs specifically related to acquired brain injury, foetal alcohol syndrome and intellectual disability.
Karralika s activities Improved identification of complex needs clients Improved documentation including policy, assessments, service information, internal resources Staff training and development including ABI (intro and screening), FASD, IRIS Improved service / program delivery mechanisms for clients with the specified conditions including establishing a quiet space, using voice recorders/voice recognition software
Achievement Highlights Change in attitude and practice in terms of working with clients with complex needs from both staff and community Understanding of the need for flexibility in terms of program delivery Recognition that the mechanisms/strategies developed so far are beneficial for the client group as a whole and not only those with identified ABI conditions Increased access for complex needs clients
Recognise that complex needs is what we have been working with everyday anyway We have slowed down, changed the way we do things come from a one size fits all attitude to working more individually with residents engaging more with them about their needs That we can make small changes which help a lot small meetings before and after group as a check in, changing language, reframing questions and working with what is presented In the TC there are really only minor modifications required Quotes from Karralika Programs staff, April 2012
Resource Development Complex Needs Capable: A practice resource for drug and alcohol services Complex Needs Capable website E mail updates NADA Complex Needs Web pages
Where to now? External evaluation Continued advocacy and partnerships Publication in Mental Health Substance Use Project Air Strategy personality disorders training for drug and alcohol NGO s Networking for court support forums NADA sector development programs
Thank You Ciara Donaghy Ph: 02 8113 1306 E: ciara@nada.org.au Heidi Becker Ph: 02 8113 1317 E: heidi@nada.org.au www.nada.org.au/sectordevelopment/complexneeds