Consultation Draft - dhhs.tas.gov.au · Future Service Directions Plan – Analysis of Performance...
Transcript of Consultation Draft - dhhs.tas.gov.au · Future Service Directions Plan – Analysis of Performance...
Consultation Draft
December 2012
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 3
Contents Introduction ............................................................................................................................................................................. 5
1 Executive Summary ............................................................................................................................................................. 7
1.1 Our Achievements .......................................................................................................................................................................................... 7
1.2 Financial Summary ........................................................................................................................................................................................... 8
1.3 General Findings .............................................................................................................................................................................................. 9
1.3.1 Recruitment Issues ................................................................................................................................................................................. 9
1.3.2 Internal Administrative Processes .................................................................................................................................................... 10
1.3.3 Budgetary Pressures ........................................................................................................................................................................... 10
1.3.4 Governance of the Future Service Directions Plan ...................................................................................................................... 10
1.4 Priority Action Areas for the Future ........................................................................................................................................................ 13
1.4.1 Financial Investment ............................................................................................................................................................................ 13
1.4.2 Service Development ......................................................................................................................................................................... 13
1.4.3 Workforce Development .................................................................................................................................................................. 14
1.4.4 Promotion, Prevention and Early Intervention .............................................................................................................................. 14
1.4.5 Consumer Engagement ...................................................................................................................................................................... 14
1.4.6 Tasmanian Opioid Pharmacotherapy ............................................................................................................................................... 14
1.4.7 Review of Psychosocial Services and Interventions ...................................................................................................................... 15
1.4.8 Information Technology ..................................................................................................................................................................... 15
1.4.9 Performance Monitoring and Reporting ......................................................................................................................................... 15
1.4.10 Quality Improvement ....................................................................................................................................................................... 15
2 Background to the Future Service Directions Plan ....................................................................................................... 16
3 Strategic Focus of the Future Service Directions Plan ................................................................................................. 16
3.1 Tasmanian Governance Structure ............................................................................................................................................................ 16
3.2 Vision, Aim and Principles .......................................................................................................................................................................... 17
3.3 Tiered Service Delivery Model .................................................................................................................................................................. 18
3.3.1 Recognition that a large range of services manage/support clients who present with alcohol and drug issues ................ 18
3.3.2 Describe the differences between government and community based specialist ATOD services ...................................... 18
3.3.3 Specialist support for mainstream services .................................................................................................................................... 18
4 Major Service Developments ........................................................................................................................................... 19
4.1 Withdrawal Management............................................................................................................................................................................ 19
4.2 Opioid Pharmacotherapy............................................................................................................................................................................ 21
4.3 Consultation Liaison Services .................................................................................................................................................................... 24
4.4 Residential Rehabilitation Services ............................................................................................................................................................ 25
4.5 Youth Intervention Services....................................................................................................................................................................... 26
4.6 Outreach ....................................................................................................................................................................................................... 28
4.7 Relapse Prevention ...................................................................................................................................................................................... 29
4.8 Management of Complex Needs ............................................................................................................................................................... 30
4.9 Brief and Early Intervention ....................................................................................................................................................................... 31
4.10 Places of Safety ........................................................................................................................................................................................... 32
4.11 Support for Families .................................................................................................................................................................................. 33
4.12 Smoking Cessation .................................................................................................................................................................................... 34
4.13 Supporting the Aboriginal Community .................................................................................................................................................. 36
4.14 Workforce Development ......................................................................................................................................................................... 37
4.15 Continuous Quality Improvement .......................................................................................................................................................... 39
4.16 Advocacy Support ...................................................................................................................................................................................... 41
4.17 Governance, Planning and Policy Development ................................................................................................................................... 42
4.18 Information Management ......................................................................................................................................................................... 44
4.19 Legislative Reform ..................................................................................................................................................................................... 46
5 Financial Overview of Expenditure .................................................................................................................................. 47
6 Statistical Summary of Activity ....................................................................................................................................... 50
6.1 Withdrawal Management............................................................................................................................................................................ 50
6.2 Pharmacotherapy ......................................................................................................................................................................................... 51
6.3 Psychosocial Interventions (Community Team) – Alcohol and Drug Service .................................................................................. 54
6.4 National Minimum Data Set ....................................................................................................................................................................... 55
7 Summary of Consultation Questions .............................................................................................................................. 57
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 4
Index of Tables
Table 1 Future Service Directions Plan, Funding Allocation, 2008/09 to 2011/12
Table 2 Future Service Directions Plan, Funding Allocation by Priority Focus Area, 2008/09 to 2011/12
Table 3 ATOD Service Development Funding Allocation, 2008/09 to 2011/12
Figure 1 Inter-Agency Working Group on Drugs – Governance Framework (April 2012)
Table 4 Additional Financial Investment for Withdrawal Management, 2008/09 to 2011/12
Table 5 Withdrawal Management - Achievements against Outcomes
Table 6 Additional Financial Investment for Opioid Pharmacotherapy, 2008/09 to 2011/12
Table 7 Opioid Pharmacotherapy - Achievements against Outcomes
Table 8 Additional Financial Investment for Consultation Liaison, 2008/09 to 2011/12
Table 9 Consultation Liaison - Achievements against Outcomes
Table 10 Additional Financial Investment for Residential Rehabilitation, 2008/09 to 2011/12
Table 11 Residential Rehabilitation - Achievements against Outcomes
Table 12 Additional Financial Investment for Youth Intervention Services, 2008/09 to 2011/12
Table 13 Youth Intervention - Achievements against Outcomes
Table 14 Additional Financial Investment for Outreach, 2008/09 to 2011/12
Table 15 Outreach - Achievements against Outcomes
Table 16 Relapse Prevention - Achievements against Outcomes
Table 17 Additional Financial Investment for the Management of Complex Needs, 2008/09 to 2011/12
Table 18 Complex Needs - Achievements against Outcomes
Table 19 Additional Financial Investment for Brief and Early Intervention, 2008/09 to 2011/12
Table 20 Brief and Early Interventions - Achievements against Outcomes
Table 21 Additional Financial Investment for Places of Safety, 2008/09 to 2011/12
Table 22 Places of Safety - Achievements against Outcomes
Table 23 Additional Financial Investment for Support for Families, 2008/09 to 2011/12
Table 24 Support for Families - Achievements against Outcomes
Table 25 Additional Financial Investment for Smoking Cessation, 2008/09 to 2011/12
Table 26 Smoking Cessation - Achievements against Outcomes
Table 27 Supporting the Aboriginal Community - Achievements against Outcomes
Table 28 Additional Financial Investment for Workforce Development, 2008/09 to 2011/12
Table 29 Workforce Development - Achievements against Outcomes
Table 30 Continuous Quality Improvement - Achievements against Outcomes
Table 31 Additional Financial Investment for Advocacy Support, 2008/09 to 2011/12
Table 32 Advocacy Support - Achievements against Outcomes
Table 34 Governance, Planning and Policy Development - Achievements against Outcomes
Table 35 Additional Financial Investment for Information Management, 2008/09 to 2011/12
Table 36 Information Management - Achievements against Outcomes
Table 37 Additional Financial Investment for Information Management, 2008/09 to 2011/12
Table 38 Legislative Reform - Achievements against Outcomes
Table 39 ATOD Service Development Funding Allocation, 2008/09 to 2011/12
Table 40 ATOD Service Development Recurrent Expenditure and Future Allocation, 2008/09 to 2011/12
Table 41 Tasmanian Opioid Pharmacotherapy Program, Total Individual Clients, 2009/10 to 2011/12
Table 42 Tasmanian Opioid Pharmacotherapy Program, Active Clients, 2007/08 to 2011/12
Table 43 Closed Treatment Episodes by Client Type, Sex and Age, Tasmania and Australia, 2007-08 to 2009-10 (per cent)
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 5
Alcohol, Tobacco and Other Drug Services, Tasmania
Future Service Directions Plan – Analysis of Performance
Introduction
In 2007/08 the State Government commissioned an independent review of the alcohol, tobacco and
other drug sector in Tasmania. The review made 47 recommendations and highlighted a number of
concerning issues across the sector, most importantly the need for an immediate injection of funds
to increase the capacity of the sector to meet the most urgent needs (particularly in the area of
pharmacotherapy).
In responding to the recommendations and in consultation with the sector and other stakeholders,
the Department of Health and Human Services released a five year Plan for the sector – the Future
Service Directions Plan. This Plan outlines a range of significant service development strategies
across both the government and community sector. Although the Plan highlights the important role
of the broader, mainstream health and human services system, it’s development strategies were
purely focused on specialist alcohol, tobacco and other drug treatment services (particularly those
provided or funded by the Tasmanian State Government). In addition to this, a decision was taken to
exclude the criminal justice system from the scope of the Plan. This decision was made because of
the enormity of the task and the significant reforms that were being undertaken within the
Tasmanian Prison system at that time.
The underlying objective of the Plan was to attempt to establish a basic foundation of specialist
services across the State which could then be grown and further developed in the future. This was a
significant aspect in the development of the Plan and highlighted the importance of continuing the
reforms and developments beyond the life of the Plan. In consultation with the sector and other
stakeholders (by way of an interim discussion paper) it was agreed that there was a desperate need
to have an initial focus of energy on developing a highly specialist government service system which
could then support the rest of the sector. This enabled the Alcohol and Drug Service to focus on
the urgent and critical issues that were identified within the review.
In preparing for the 2009/09 budget process, the Alcohol and Drug Service considered the Plan and
pulled together a detailed costing proposal to implement the Plan. As part of the 2008/09 State
Budget, the Tasmanian Government (at that time) committed just over $17 million to implement the
strategies contained in the Plan and a further $2.7 million to help Tasmanians to quit smoking. It is
important to note that the funding was initially provided for four years to fit in with State
Government forward estimate cycles (a four year cycle). The funding provided aligned with what
had been included in the costing proposal for the first four years of the Plan. At that stage no
financial commitment had been made by the Government for strategies due to commence in the
final year of the Plan (ie 2012/13).
Given that we are now in the final year of the Plan, the Alcohol, Tobacco and Other Drug Steering
Committee agreed to undertake an analysis of the implementation of the Future Service Directions
Plan.
To ensure the analysis is thorough and complete, it is important that key stakeholders have the
opportunity to provide input on the initiatives included in the Plan that have been undertaken over
the past four years. This consultation document has been drafted to assist stakeholders in that
process.
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This Consultation Draft follows the format of the Future Service Directions Plan and focusses on:
the major achievements of the Sector arising from the Plan;
barriers and issues faced during the implementation of the Plan; and
any strategies/initiatives that are yet to be finalised or have not yet been progressed.
The Consultation Draft also provides some future development options for consideration. A series
of questions have been asked throughout the document to help with the feedback process.
Feedback on the Consultation Draft should be provided by 1 March 2013 and can be provided by
email to [email protected] or by regular mail at the following address:
Mark Frohmader
Alcohol and Drug Service
GPO Box 125
Hobart, Tas 7001
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 7
1 Executive Summary
As part of the 2008-2009 State Budget, an additional $17.2 million over four years was provided for
the alcohol, tobacco and other drugs sector. The Future Service Directions Plan was released in late
2008 to guide the investment of the new funding.
1.1 Our Achievements
Since the release of the Plan, the Alcohol Tobacco and Other Drug sector has made some
considerable achievements in the development of specialist alcohol, tobacco and other drug services
in Tasmania.
Some of the more notable achievements include:
significant investment and growth in the public pharmacotherapy program;
improved services within the specialist withdrawal management unit;
established a dedicated Workforce Development Unit for the sector;
increased support for policy development;
increased support for young people with alcohol and drug issues;
significant investment into the three community based residential rehabilitation services in this
State;
established new services of care coordination, advocacy and consumer participation within the
community sector;
established a family support service for the North and North West regions of the State;
established a new community based support service located on the East Coast (Break O Day
local government area);
finalised the Tasmanian Opioid Pharmacotherapy Policy and Clinical Practice Standards;
implementation of a new client information management system and improved reporting;
commenced a new Statewide Smoking Cessation Service;
increased tobacco control strategies;
release of the Guide to Consumer Engagement for Tasmanian Alcohol, Tobacco and Other
Drug Services;
released an Alcohol Action Plan that complements national strategies to reduce binge drinking
and to promote responsible consumption of alcohol; and
infrastructure redevelopment to accommodate expanded services and staffing.
In addition to these developments, there are a range of further initiatives that will be finalised in
2011/12, including:
implementation of the Tasmanian Opioid Pharmacotherapy Policy and Clinical Practice
Standards;
a Promotion, Prevention and Early Intervention Strategy.
In managing these significant developments, the Alcohol and Drug Service is on track to deliver on all
outcomes that were identified in the Future Service Directions Plan. A summary of our progress in
implementing the initiatives and meeting the outcomes in the Plan is provided later in this document.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 8
1.2 Financial Summary
In 2008/09 a considerable unspent allocation was realised. This was predominantly caused by the
following factors:
Allocation of funding did not occur until just prior to the 2008/09 financial year which made it
impossible for the Alcohol and Drug Service to pull together a Project Team to manage the
considerable service developments that were included in the first year of the Plan.
In January of 2009 there were considerable concerns about the state of the health budget and
as a result there was requirement for the Sate Manager to undertake a detailed budget analysis
on Future Service Direction Plan commitments and plan in anticipation of a reduced budget for
2009/10. There was a resultant hold on expenditure approval for the remaining half of that
financial year.
Recruitment to specialist positions proved extremely difficult. For example, specialist addiction
medicine positions and specialist nursing positions needed to support the pharmacotherapy
program were not filled in the first year despite having allocated funding for those positions (the
initial allocation for specialist nursing and medical positions for pharmacotherapy was just over
$600,000 in 2008/09 – these positions could not be filled despite intensive recruitment
processes).
Any funding earmarked for the community sector could not be allocated until a formal request
for proposal process had been undertaken. As a result, in 2008/09 only 65% of the funds
allocated to residential rehabilitation were actually paid and only 22% of funding earmarked for
youth services was allocated to community sector organisations (this amounted to
approximately $350,000 unspent funding in 2008/09).
Similarly in 2009/10, difficulties in recruitment and delays in processing funds to the community
sector resulted in an underspend of just under $400,000 for that year.
The Alcohol and Drug Service was required to deliver savings of $200, 000 in 2009/10 and 2010/11
and a further $805,000 in 2011/12. These were taken from funding for the Future Service
Directions Plan.
Table 1 below highlights the expenditure across the four years of the Plan and the investment into
government and community sector services (more detailed financial information is provided later).
Table 1 Future Service Directions Plan, Funding Allocation, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12 Total
Allocation
Funding Allocated (2008/09 State Budget) $1,788,000 $3,810,000 $5,450,000 $6,160,000 $17,208,000
Expenditure -
Service Delivery $564,684 $2,504,670 $4,165,163 $5,355,000 $12,589,517
Project Team $168,202 $320,210 $320,210 $221,210 $1,029,832
Other One Off Expenditure (including
capital works) $387,779 $697,247 $57,247 $1,142,273
Savings Target $200,000 $200,000 $805,000 $1,205,000
Total Allocation $732,886 $3,412,659 $5,282,620 $6,438,457 $15,966,622
Unspent Allocation $1,055,114 $397,341 $167,380 -$278,457 $1,241,378
Investment in Service Delivery
Community Sector $349,719 $1,308,509 $1,534,358 $2,274,358 $5,466,944
Government $214,965 $1,196,161 $2,630,805 $3,080,642 $7,122,573
Total Allocation $564,684 $2,504,670 $4,165,163 $5,355,000 $12,589,517
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 9
Consultation Question 1 – Financial Investment
Has the investment of funding through the Future Service Directions Plan helped to improve the
capacity of the sector? Has it helped to lift the profile of the sector?
Table 2 below provides an overview of funding allocation by priority area as identified in the Future
Service Directions Plan. It is important to note that, until ongoing funding is secured, the allocation
to outreach services in 2011/12 has yet to be committed.
Table 2 Future Service Directions Plan, Funding Allocation by Priority Focus Area, 2008/09
to 2011/12
Priority Focus Area 2008/09 2009/10 2010/11 2011/12
Withdrawal Management $14,153 $157,977 $157,977 $150,000
Opioid Pharmacotherapy Program $87,021 $530,927 $1,151,878 $1,597,642
Consultation Liaison Services
$25,000 $220,000 $220,000
Residential Rehabilitation Services $277,839 $424,358 $424,358 $424,358
Youth Intervention Services $119,628 $428,151 $439,950 $461,000
Outreach Services
$710,000
Management of Complex Needs
$255,000 $390,000 $390,000
Brief and Early Intervention Services
$345,000 $200,000
Places of Safety Services $11,880 $81,320 $115,000 $95,000
Support for Families
$200,000
Population Based Strategies $20,000 $20,000 $20,000 $20,000
Workforce Development $10,386 $280,000 $310,000 $280,000
Planning and Policy Development $23,777 $301,937 $591,000 $607,000
Total Allocation $564,684 $2,504,670 $4,165,163 $5,355,000
Consultation Question 2 – Financial Investment Across Priority Areas
Was the allocation of funding across the priority areas appropriate and did it provide positive
outcomes for clients and services? Has the funding gone some way to addressing service issues?
What issues still remain? What areas would require further investment? Are there
opportunities for improvement that don’t require an increased financial investment?
1.3 General Findings
There are a number of general issues that have arisen through the implementation of the Future
Service Directions Plan that impacted on the ability to implement strategies within the identified
timeframes. The issues fall into three categories: recruitment issues, internal administrative
processes and budgetary pressures. Performance against individual strategies (for the Priority Focus
Areas) is addressed later in this report.
1.3.1 Recruitment Issues
The biggest barrier to implementing strategies contained in the plan was the ability to recruit suitably
qualified/experienced personnel to positions. This single issue caused significant delays through the
entire life of the Plan and was an issue for both the government and community sectors.
In implementing the Plan it was recognised that there would be some difficulties in recruiting to
newly created positions. In fact, this anticipated “slippage” money (arising from delays in
implementing strategies) was to be used to fund the small Project Team that was established to
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 10
support and drive the implementation of the Plan. However, the difficulties in recruitment were
significantly more challenging that what was ever anticipated. These difficulties were not just limited
to clinical positions but were a significant issue in the establishment of the Project Team.
For example, the recruitment of an Addiction Specialist takes a minimum of 18 months and in some
cases some of the positions have remained vacant well beyond 18 months. The two Workforce
Development Consultants were filled approximately 18 months after they were first advertised only
to have both occupants accepting positions on the mainland some 6-12 months later.
Discussions with successful and potential applicants have revealed that Tasmania offers competitive
packages across the range of clinical positions. The difficulty in recruitment and retention is a result
of a national shortage of skilled workers across the country (and internationally). The small
numbers of experienced workers are sought by all jurisdictions, across both government and the
community sectors.
The difficulty in recruiting suitable workers had a significant impact on implementing all the strategies
contained in the Plan.
1.3.2 Internal Administrative Processes
The internal administrative processes surrounding expenditure of funds presented as a major barrier
in meeting the ambitious timeframes, for both the government and community sectors.
The creation and establishment of new services within the Alcohol and Drug Services required the
recruitment of additional staffing. To enable this to occur a range of administrative processes
needed to be undertaken including, developing statements of duties, creation of new position on the
establishment, advertising position and interview and recruitment processes. As with most
organisations, especially those expending public money, there is requirement for approval at pre-
established levels of delegation which collectively lead to delays. However, it is recognised that to
ensure a fair and equitable process these administrative functions are unavoidable. Throughout the
course of the Future Service Directions Plan, the Department has endeavoured to streamline the
administrative processes and make recruitment of new staff quicker and easier.
Similarly the process of procuring new services from community organisations proved to consume
considerable more time than anticipated and combined with delays in the distribution of annual
Future Service Directions Plan funds minimised what could be achieved in any financial year.
While recognising the value and importance of government policies and procedures that ensure
value for money, accountability and transparency the process from the initial business case and
associated plans through to seeking request for proposals, selection and funding of an external
organisation had a greater impact on project time frames than was initially anticipated.
Once an organisation had received funding there was often a further delay in the actual
commencement of the service because of the need to develop/establish infrastructure as well as
managing recruitment issues.
1.3.3 Budgetary Pressures
The financial difficulties of the Tasmanian State Government over the past two years (2010/11 –
2011/12) have been well documented along with the inevitable need for the Government to make
significant savings and reductions in expenditure. With more than a quarter of Government
expenditure directed towards health, the Department of Health and Human Services was required
to make significant savings over the past two years.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 11
In order to minimise the impact of the savings strategies on current services, a decision was made to
delay implementation of any new services (to deliver one-off savings) and in some cases to not
proceed with anticipated new service development and investment. This essentially meant that the
sector avoided the need to reduce the current services (across government and community sector
organisations).
Implementation of the Future Service Directions Plan in a difficult budget environment meant that
the Alcohol and Drug Service was attempting to expend additional new funds in tension with a range
of fiscal strategies that had been applied across the Health Department with the intent of enforcing
budgetary restraint. These strategies especially in relation to recruitment had a significant impact on
the projects timetable and delayed the procurement and implementation of new service initiatives.
In addition to these issues, the Government initially provided funding for the Future Service
Directions Plan for a four year period (2008/09 to 2011/12) which has been continued for a further
12 month period (2012/13). However, the Department has (at this stage) been unable to secure
ongoing funding for initiatives commenced under the Future Service Directions Plan (ie beyond
2012/13).
The uncertainty around ongoing funding has resulted in the delay of any further service development
activities until a resolution can be found. Those service development activities identified in the
fourth year of the Plan have not been progressed at this stage. The major area that has been
affected is the area of outreach expansion. Investment to increase outreach capacity to rural and
remote areas of the State was due to occur in 2011/12. This initiative has not been progressed at
this stage.
1.3.4 Governance of the Future Service Directions Plan
Following the release of the Future Service Directions Plan and the Government’s announcement to
provide funding over four years, the Department established the Alcohol, Tobacco and Other Drug
Services, Future Service Directions Steering Committee. The terms of reference outline that the
Committee is responsible for overseeing the implementation of the Future Service Directions Plan
and the provision of direction and leadership in the development and reform of the ATOD sector
and the investment in both government and community sector organisations.
Membership of the ATOD Steering Committee consists of the following positions:
Chair: CEO Statewide and Mental Health Services
Membership: Clinical Director Alcohol and Drug Service
Director Population Health
Deputy Director Population Health
State Manager, Alcohol and Drug Service
Manager Coordination and Innovation, Statewide and Mental Health
Services
Chief Executive Officer, Alcohol, Tobacco and Other Drug Council of
Tasmania (ATDC)
Manager Service Development Unit (Ex-Officio)
Senior Advisor Tobacco Policy and Programs (Ex-Officio)
Statewide Smoking Cessation Coordinator (Ex-Officio)
Project Officer: Project Officer, Alcohol and Drug Service (Exec Support)
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 12
Representatives from other groups could also attend meetings to provide information and updates
pertinent to the activities of the Future Service Directions Plan.
Initially this structure provided good governance to the implementation of the Plan and expenditure
of funding. It also provided representation from Senior Management (particularly the CEO of
Statewide and Mental Health Services and the Director of Population Health) which ensured any
significant issues could be raised and managed at a whole of Agency level if needed.
The life of the Future Service Directions Plan is now coming to an end and most of the initial
allocated funding has been committed. Therefore, the focus will shift from one of monitoring
investment to a focus on the continuation of building services capacity, strategic development and
quality improvement. The current steering committee has an imbalance of representation from the
Government sector compared to representation from the community sector. The CEO of the
ATDC is currently the only community sector representative. To progress sector wide issues it will
be important to establish a more equitable representation from across the sector. This will ensure
that there is more direct input from experts from the community sector in the decision making
process and will also encourage better ‘ownership’ of development initiatives by the wider sector.
The current wider reforms occurring across the Health system will also require a different
governance process with different representation if alcohol and drug issues are to be progressed
effectively.
To ensure a more collaborative approach to progressing issues in the future, it is suggested that a
new governance structure be adopted. Such a structure should try to maintain involvement of
senior positions within the Department but also allow for the ongoing oversight of
projects/initiatives to be managed by experts from across the sector.
Until the Departmental restructure is complete, it will be difficult to articulate what positions would
form a senior steering committee that would oversee development initiatives. Therefore it is
suggested that, at this stage, a new structure that involves managers/CEO’s of government and
community sector organisations is established to provide expert leadership and advice to service
development projects and initiatives. This model would also allow for other key stakeholders to be
represented if required (for example other areas of the Department, representation from the
Commonwealth Government and from other State Government Agencies).
The following figure provides an overview of a proposed new governance structure.
Steering Committee
Structure to be determined.
AOD Treatment Expert Working Group State Manager ADS, CEO ATDC, Policy Manager SMHS, CEOs Community
Sector Organisations (X4), Clinical Director ADS, Commonwealth
Government and Other Representatives as required (eg Medicare Locals)
Major Service Development Projects
Projects and Initiatives Projects and Initiatives Projects and Initiatives
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 13
The AOD Treatment Expert Working Group would oversee the major service development
projects that have sector wide implications (the projects would include the continuation of current
initiatives, such as workforce development, PPEI and consumer engagement as well as specific
projects that come out of the review of the Future Service Directions Plan). The role of the Expert
Treatment Working Group would also involve providing direction, leadership and support for major
service development projects for the Tasmanian Alcohol and Other Drug Treatment Sector.
Operationally the majority of the ongoing work would be overseen by the Expert Treatment
Working Group who would meet on a regular basis (for example every month or every second
month) to progress the development agenda. Updates could be provided to the Steering
Committee electronically which could reduce the need for that Committee to meet (it is suggested
that the Steering Committee would meet every 6 months with the option of convening at other
times when needed).
Consultation Question 3 – Sector Development Governance
Will the establishment of an Alcohol and Other Drug Treatment Expert Working Group (with
more representation from the community sector) be beneficial in progressing the range of issues
for the sector? Are there alternative models that may achieve better representation and
engagement from across the sector?
1.4 Priority Action Areas for the Future
In considering the findings and recommendations contained in this review, it is clear that there has
been significant success in implementing the Future Service Directions Plan. However, it is also clear
that initial expectations were very high and, in hindsight, probably too optimistic in terms of what
could be achieved in the given timeframes.
There is still some considerable work to be undertaken to fully implement the plan (some of this
work was not explicitly identified within the plan and has been identified through the course of
implementing the plan). The level of work still to be undertaken is documented throughout this
report.
To assist with the ongoing workload it is suggested that effort/resources are directed towards the
following issues/areas. To progress these important areas it is anticipated that a similar level of
service development positions (to that required to implement the Future Service Directions Plan)
would be required. More detailed information on these issues/areas is provided within the relevant
areas of this report.
1.4.1 Financial Investment
An urgent priority for the alcohol and drug sector will be to secure ongoing funding to ensure the
ongoing delivery of services that have been established under the Future Service Directions Plan. In
addition to this it will be important to seek opportunities for continued investment into the sector
to build on the foundation of services which the Plan has established (this would also include seeking
funding for the final year of the Plan and ongoing growth funding).
1.4.2 Service Development
Given the uncertainty with ongoing funding, development identified in the fourth year of the Plan has
not progressed. The major area of growth for the fourth year was to increase services to the more
rural and remote areas of the State. Should ongoing funding be secured, the development of these
new services will become an immediate priority.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 14
1.4.3 Workforce Development
Workforce development is identified as a critical issue within the Plan. Workforce Development
positions have been created within the Alcohol and Drug Service and the community sector. As a
result, significant workforce development activity has occurred within the community sector.
However, given recruitment issues and competing priorities, the Alcohol and Drug Service has not
progressed workforce development to the extent identified in the Plan. This will be a significant
area of focus for the Alcohol and Drug Service in the near future.
1.4.4 Promotion, Prevention and Early Intervention
Over the past 18 months significant work has been undertaken in developing the Alcohol and Other
Drugs Promotion, Prevention and Early Intervention Strategic Framework. The development of the
Strategic Framework document is designed to align with, and complement, a broad range of actions,
activities and initiatives planned or underway at the National, State and local level to enable better
outcomes for individuals, families and communities who are impacted by the use and misuse of
alcohol, tobacco and other drugs.
The Strategic Framework has been developed, on behalf of Government, by the Inter Agency
Working Group on Drugs the principal policy advisory body to the Tasmanian Government
concerning the use of alcohol, tobacco and other drugs in Tasmania.
The Strategic Framework will provide direction for the Tasmanian ATOD sector in the delivery of
promotion, prevention and early intervention activities. It is anticipated that a sector workplan will
be established that helps to define and identify the roles of individual services across the sector.
1.4.5 Consumer Engagement
The engagement of consumers in the delivery of services continues to be a high priority for the
ATOD sector. In late 2009, the Department funded Advocacy Tasmania Inc. (ATI) to support the
development of strategies aimed at improving the engagement of consumers in alcohol and drug
treatment services across the State. In mid 2011, ATI released a Guide to Consumer Engagement to
support services in their desire to better engage clients. This was followed by a sector wide forum
in early 2012 that identified and agreed upon a range of strategies and priorities to progress the
consumer engagement agenda. It is anticipated that a sector wide work plan will be established to
progress consumer engagement across the sector.
1.4.6 Tasmanian Opioid Pharmacotherapy
Over the course of the Plan, significant resources have been invested into the pharmacotherapy
program. These resources have focused on increasing the capacity of the program (by recruiting
specialist clinical staff) and improving the quality of treatment (and therefore reducing the risk to
clients) by establishing a new statewide policy and clinical practice standards.
The new policy and clinical practice standards were released in August 2012. The implementation of
the new policy and clinical practice standards will be a very high priority for the Alcohol and Drug
Service but will also require significant resources to support that process. In line with the
implementation of the new policy, there will continue to be a need to build the capacity of the
program with a particular emphasis on increasing access to prescribers across the State (by
recruiting additional addiction medical specialist and supporting new general practitioners to join the
program) and to boost dosing sites for clients (by engaging more community pharmacists into the
program).
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 15
1.4.7 Review of Psychosocial Services and Interventions
The need to undertake a review of psychosocial services and interventions is an extremely high
priority for the sector. Both government and community sector organisations provide psychosocial
interventions as a significant component of their treatment services. The need to review how and
what types of interventions are most effective for Tasmanian clients is paramount to ensuring a
sector that is contemporary, high quality and sustainable. It is envisaged that a major outcome of the
review will be the development of a framework for the provision of psychosocial services associated
clinical guidelines that will guide the delivery of evidence based psychosocial services and
interventions.
1.4.8 Information Technology
The Alcohol and Drug Service has made significant progress in the area of information management
with the implementation of iPatient Manager (iPM) in July 2012. It is anticipated that iPM will
improve the management of information for clinicians. However, iPM will not fully meet the needs
of the Alcohol and Drug Service to electronically manage all clinical information for clients. The
Alcohol and Drug Service will continue to investigate technology solutions for the management of
clinical information. Further work should also be undertaken to identify the needs of community
sector organisations in the area of information technology with the view to supporting services to
manage clinical information electronically.
In addition to this, there are a number of other information technology issues which need to be
progressed including real time reporting, development of the National Minimum Data Set,
Pharmcare, iPharmacy and an electronic health record system.
1.4.9 Performance Monitoring and Reporting
The need to improve the monitoring and reporting of activity and performance continues to be a
significant issue for the Alcohol and Drug Service. A lack of reliable data has a significant impact on
the ability to plan, develop and manage services. Information provided to the National Minimum
Data Set has always been subject to quality issues which has made it difficult to compare Tasmanian
data with other States. Reporting by community sector organisations also remains problematic for
both the individual organisation and the Department as the funding body. There have been some
attempts in recent times to develop key performance indicators across government and community
sector organisations. It is important that further work is undertaken in this area to establish a
meaningful data collection, reporting and monitoring system for the sector.
1.4.10 Quality Improvement
The other significant body of work to be undertaken by the Alcohol and Drug Service is in the area
of quality improvement, particularly to progress the accreditation of the service. A large body of
work has already been undertaken to progress accreditation so it will be important for the Alcohol
and Drug Service to maintain the momentum to ensure the service reaches accreditation.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 16
2 Background to the Future Service Directions Plan
The Tasmanian State Government, as part of the 2008/09 Budget, committed $17.2 million over four
years (2008/09 to 2011/12) to the development of alcohol, tobacco and other drug (ATOD) services
in Tasmania. In addition to this, the Government also invested an additional $2.7 million over four
years to initiatives to support Tasmanians to quit smoking.
The development of the Future Service Directions provides a clear direction for the Tasmanian
ATOD sector and has guided the investment of the additional funding over the next four years (the
final year of the plan is yet to be funded).
Table 3 below provides details of the allocation of funding provided in the 2008/09 State Budget over
the four year period: 2008/09 to 2011/12.
Table 3 ATOD Service Development Funding Allocation, 2008/09 to 2011/12
2008/09
($’000)
2009/10
($’000)
2010/11
($’000)
2011/12
($’000)
Total
($’000)
Allocation (2008/09 State Budget) $1,788 $3,810 $5,450 $6,160 $17,208
3 Strategic Focus of the Future Service Directions Plan
One of the key objectives in establishing the Future Service Directions Plan was to provide direction
and cohesion for the Tasmanian ATOD sector and establish a broader service framework to provide
clarity on the roles and responsibilities of the individual services within that sector (across both the
government and the community sectors). In addition to this the Plan also attempted to establish a
more appropriate and effective governance structure that provided opportunities for discussion of
alcohol and drug issues at a whole of government level with input from specialist groups and
individuals from the field.
3.1 Tasmanian Governance Structure
The Plan details a governance structure from a whole of government perspective to ensure that
issues relating to alcohol and drug use are considered and debated so that a well-informed position
can be presented to government for consideration and/or decision. The governance structure goes
beyond the ATOD treatment sector but was included in the Plan to provide clarity on the reporting
and decision making processes at a whole of government level. The key objectives of the proposed
structure was to ensure that issues were well informed and debated across government and the
community sector and that an avenue existed to receive advice/information from specialist groups
and individuals.
In Tasmania, the Inter Agency Working Group on Drugs as a whole of government committee
performs the role as described in the Future Service Directions Plan. Additional financial investment
to support a dedicated position to provide the secretariat functions and some project work of the
Inter Agency Working Group on Drugs are provided by Statewide and Mental Health Services from
Future Service Directions funding. However, with proposed structural changes within the
Department of Health and Human Services and the advent of both the Tasmanian Health
Organisations and Tasmanian Medicare Local, the governance structure for responding to alcohol
and drug issues will need to be revisited. It will be vital to ensure that a whole of government
structure to discuss and lead issues relating to alcohol, tobacco and other drug use continues to
exist in Tasmania.
Since the release of the plan, the Governance structure for dealing with alcohol, tobacco and other
drug issues in Tasmania has been altered slightly to better reflect the processes and the relationship
with bodies at a National level.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 17
Figure 1 below provides an overview of the current governance structure in Tasmania.
Figure 1 Inter-Agency Working Group on Drugs – Governance Framework (April 2012)
Consultation Question 4 – Inter Agency Working Group on Drugs
Does the current structure of the Inter Agency Working Group on Drugs adequately support
the coordination of drug related initiatives across Tasmania?
3.2 Vision, Aim and Principles
The vision, aim and principles contained in the Future Service Directions Plan were widely agreed
during consultation with the sector and other stakeholders prior to the finalisation of the Plan. They
are similar to those adopted by other jurisdictions. Services within the Tasmanian ATOD sector
were already operating in accordance with the Vision, Aim and Principles.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 18
Throughout the course of the Plan the only suggestion provided in relation to the Principles was the
inclusion of a principle around access to services. If another Plan for the treatment sector is
developed (post 2012/13), the Vision, Aim and Principles could be revisited at that stage.
3.3 Tiered Service Delivery Model
The inclusion of the tiered service delivery model was an attempt to describe thee important
elements for the Tasmanian service system and how it responds to alcohol and drug issues.
3.3.1 Recognition that a large range of services manage/support clients who present with alcohol
and drug issues
The tiered service delivery model highlights the important role that all services (not just specialist
alcohol and drug treatment services) play in supporting Tasmanians who present with alcohol and/or
other drug issues. The model recognises that the majority of Tasmanian’s with alcohol and/or drug
issues will be seen by other health services (eg acute care, general practitioners, primary health
services etc) and may never be seen by specialist treatment services. The model attempts to outline
the responsibility for different service responses across the full spectrum of services in Tasmania.
Generally there is acceptance by the ATOD sector and other stakeholders that the tiered model
explains the role played by a broader range of health and human services in dealing with alcohol and
drug issues in Tasmania. However, there is a need to continue to strengthen this message so that
the management of alcohol and drug issues become everybody’s business.
3.3.2 Describe the differences between government and community based specialist ATOD services
Another important objective of the tiered model was an attempt to describe the differences
between government and community based services in the ATOD sector. Achieving this objective
was always going to be a challenging task because of the variety of service provision provided across
the government and community sectors.
Theoretically, the tiered model has generally been accepted as a good description of how the
specialist treatment service system (both government and community sectors) should respond to
alcohol and drug issues in Tasmanian. However, in reality, the adoption of such a service system has
been problematic. There is still some confusion in relation to the role of government and the
community based treatment services as there are a large variety of interventions provided by both
sectors. There is still an “us and them” mentality (this is not as pronounced as it was prior to the
implementation of the Plan) within the ATOD sector and more effort needs to focus on the
importance of the sector as a whole and recognition that all services in that sector are providing
specialist ATOD treatment services. In this aspect, the ATOD sector is quite unique in Tasmania as
there exists several different relationships between the government and community sector services.
These include: a contractual relationship; a development relationship; and most importantly a clinical
relationship.
To assist with the clarification of the roles and responsibilities of the ATOD treatment sector it will
be important for the sector to develop some of the overarching frameworks to guide specialist
service delivery. Of particular importance will be a framework (or guidelines) for the provision of
psychosocial interventions.
3.3.3 Specialist support for mainstream services
The tiered model of service provision clarifies that services beyond the ATOD sector (identified as
mainstream health and human services in the Plan) have an important role to play in supporting
Tasmanians who present with alcohol and/or drug issues. To ensure this aspect of the model is
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 19
effective the Plan clearly identifies the need to support those services with education, training and
development from the specialist ATOD services.
Throughout the course of the Plan, the Alcohol and Drug Service has increased its support to the
mainstream services with the introduction of a dedicated consultation liaison service in the Royal
Hobart Hospital and the establishment of a statewide Smoking Cessation Service. Both these
services have provided some significant benefits for mainstream services and for Tasmanians affected
by alcohol and drug use. In addition to these specific initiatives, the Alcohol and Drug Service has
provided a greater level of support and advice to other areas, particularly general practitioners and
community pharmacists involved in the pharmacotherapy program. The community sector
continues to work closely with their partner services and the introduction of a new service, Care
Coordination, is an excellent example of the networks that already exist within the community
sector. There are many other examples of our efforts in this area which will be discussed under the
major service developments below.
This is an extremely important aspect of work for the ATOD sector and it will be important to
continue to expand the efforts in this area. Providing more specialist support and advice to
mainstream services will result in better outcomes for Tasmanians who are affected by alcohol and
drug use.
Consultation Question 5 – Tiered Service Delivery Model
Does the tiered model of service delivery adequately describe the role of specialist treatment
services and the responsibilities of mainstream services in managing alcohol and other drug
issues? If not, is there a better model that defines broader roles and responsibilities?
4 Major Service Developments
The following is a summary of the major developments (by program/service type) that has occurred
over the past two years (2008/09 to 2009/10) and developments which are proposed for future
years.
4.1 Withdrawal Management
The Alcohol and Drug Service has undertaken a range of policy and service development work
within the Withdrawal Management Unit which has resulted in improved accessibility for clients
(across the State), more appropriate admissions, improved support and programs for clients and
improved discharge processes. This has resulted in improved utilisation of the unit and reduced
readmission rates for clients. Considerable effort has also focussed on collaboration with other
services (across government and community sectors) to improve linkages and referral processes and
ultimately improve outcomes for clients.
Recruitment to specialist medical positions which support the Withdrawal Management Unit has
always been problematic. The recruitment of Addiction Medicine Specialists in the South has now
provided good medical coverage for the Unit (with medical specialists working across all aspects of
the Alcohol and Drug Service).
A number of new treatment/support strategies have been implemented within the Unit over the past
two years. These are designed to expand (and improve) the options available to both clients and
services who access the Unit and include: Opioid rotations, an increased involvement of the ADS
South Community Team during a client’s admission and the ability to extend clients stay for a short
period following the acute withdrawal period. This will assist transition to the planned follow up
treatment option. This has resulted in improved utilisation of the unit and reduced readmission rates
for clients.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 20
From 1 January 2011, the Inpatient Withdrawal Management Unit introduced a smoke free policy.
The introduction of the Policy saw a minor, short term impact on client numbers. To support
clients, the Unit now offers Nicotine Replacement Therapy (NRT) during admission to the unit.
Clients are also offered a supply of NRT on discharge if required.
In addition to these initiatives, the Alcohol and Drug Service has developed a more appropriate
staffing structure within the Unit.
Future Development Options
1. The Alcohol and Drug Service will work on the development of statewide guidelines for the
provision of withdrawal management and will involve the major hospitals to improve hospital
based withdrawal management across the State.
2. Continue to investigate opportunities to better integrate the Withdrawal Management Unit with
the Royal Hobart Hospital (RHH), including the option to relocate the Unit to be incorporated
into the redeveloped RHH (or within close proximity of the RHH).
3. There continues to be a need to develop diversity in where and how withdrawal management
services are provided. Tasmania will focus on developing and resourcing a range of best practice
models, including ambulatory withdrawal, acute care (hospital based) and the further
development of the dedicated withdrawal management unit. Consideration of how youth are
managed within this service type will also need to be addressed in any future service framework.
In developing these models, it will be important to ensure that withdrawal management is better
integrated with acute care services and have close links to residential rehabilitation and
supported accommodation services.
Table 4 Additional Financial Investment for Withdrawal Management, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Staffing Restructure (ADS South) $14,153 $157,977 $157,977 $150,000
Total Withdrawal Management $14,153 $157,977 $157,977 $150,000
Achievements against the Future Service Directions Plan
The Alcohol and Drug Service has made some significant progress in meeting the outcomes for
Withdrawal Management that are outlined in the Future Service Directions Plan. The table below
indicates that nearly all outcomes have been achieved within the first three years of the Plan.
The Alcohol and Drug Service has invested significant resources into the development and
implementation of a range of clinical tools which are utilised in all aspects of the service. These
include a common assessment tool, referral processes, admission practices, treatment plans and
goals and discharge planning processes. The development of these tools, practices and processes
has seen a significant improvement in the type and quality of care provided to people admitted to
the Withdrawal Management Unit.
There are two outcomes which have yet to be fully achieved:
the development of withdrawal management guidelines; and
providing access to withdrawal management services for up to six clients from the North
and/or North West at any one time.
The development of withdrawal management guidelines is still a priority for the Alcohol and Drug
Service but has been put on hold until resources can be identified to undertake this significant body
of work. Until such time as specific Tasmanian guidelines are developed, the Alcohol and Drug
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 21
Service will utilise guidelines from interstate which have recently been updated and reflect
contemporary best practice.
The inpatient withdrawal management unit in the South continues to be the States only dedicated
specialist facility. A number of strategies have been implemented to improve access for clients from
other regions (North and North West). These strategies have proven to be successful with an
increase in admissions from different regions of the State. However, future development work will
see the Alcohol and Drug Service work closely with the regional health services (particularly the
major hospitals) to develop a stronger hospital based support for clients requiring withdrawal
management.
Table 5 Withdrawal Management - Achievements against Outcomes
Priority Area Outcomes Progress
Withdrawal
Management Statewide guidelines in place which are based on
contemporary best practice
Future development
Common approaches to assessment, referral,
admission, treatment and discharge planning across
the State
Achieved
Improved quality of service (and access to) the
dedicated ten bed withdrawal management service
in the South
Achieved
Access to withdrawal management services for up
to six clients from the North and/or North West
at any one time
Partially Achieved
Access to aftercare support for clients following
withdrawal when required
Achieved
Access to specialist medical support (through the
Alcohol and Drug Service) in all three regions
Achieved
Access to specialist psychiatric support for
withdrawal management clients when needed
Achieved
Reduced reliance on inappropriate services for
withdrawal management in the North and North
West and therefore significantly reduced risk for
clients
Achieved
Consultation Question 6 – Withdrawal Management
What opportunities exist to improve access and utilisation of the specialist Inpatient Withdrawal
Management Unit? Does Tasmania need to invest in alternative models of withdrawal
management (including a model to support young people)?
4.2 Opioid Pharmacotherapy
The Alcohol and Drug Service has made a major investment into the Opioid Pharmacotherapy
Program within Tasmania. This investment has been in both policy and service development. The
public pharmacotherapy program has been bolstered across the State with the recruitment of
additional Addiction Medicine Specialists and specialist pharmacotherapy nurses. This has provided a
significantly safer service response with reduced risks for clients. In recent times there has been a
movement of clients from the private (general practitioners) to the public services. This has resulted
in an increase in the management and dosing of clients within the public program over the past two
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 22
years. Overall there has been a continual increase in the numbers of clients accessing the program
across the State (see Section 6 for statistical information).
Since 2008/09, the key focus for Tasmania has been to effectively resource and support the shared
care model of opioid pharmacotherapy treatment. To achieve this, it has been vital 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 has also been
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.
When fully operational, the shared care model will provide improved accessibility for clients and will
utilise resources in the most effective and efficient manner.
Under the shared care model, the management of clients entering the program or those who are
unstable will be undertaken by the public program through the specialist Alcohol and Drug Service.
Clients, who are stable on the program, where possible, will be generally managed and maintained
on the program by approved general practitioners.
Although services are managed under the same shared care framework, there are some regional
differences in the operational model for pharmacotherapy service provision across the State. At this
point in time, a larger proportion of clients on the program are based in the Southern region which
has resulted in the need to develop a dedicated pharmacotherapy unit (at St Johns Park) where
clients are medically managed, monitored and dosed. Significant capital investment has been
provided for the development of the specialist Pharmacotherapy Unit in the South. The clinical,
consultation and waiting areas have been significantly improved and expanded which has resulted in a
more effective and safe service for both clients and staff.
In the Northern region a more multi-disciplinary model of service provision has been adopted with
the addiction specialist managing a caseload of clients with input from a team of professionals when
required. The majority of dosing in the Northern region is delivered through community
pharmacists. In the North West, the Alcohol and Drug Service supports very few clients on the
pharmacotherapy program (due to the lack of medical support in that region) with all dosing
occurring through community pharmacists. In all three regions, a large number of clients on the
program are managed by general practitioners (however, it is important to note that there has been
a reduction in the number of clients being managed by general practitioners in recent years –
essentially there has been a shift towards the public program as the Alcohol and Drug Service
continues to develop its capacity to treat more complex and high risk clients).
A major recent development has been the release of the Tasmanian Opioid Pharmacotherapy Policy
and Clinical Practice Standards. The document reflects cotemporary evidence based practice and
will assist to guide the delivery of a high quality and safe Opioid Pharmacotherapy Program in
Tasmania. There will be a need to support prescribers and pharmacists in moving towards the
requirements of the policy and associated standards.
Future Development Options
1. There continues to be a need to grow expertise in this area and to continue to expand the
program across both the Government and community sectors. The ADS continues its
recruitment activities to secure Addiction Medical Specialists across the State (it is important to
note that the Addiction Medicine Specialists will have a much broader role across the ATOD
sector and have not been engaged purely to support the opioid pharmacotherapy program).
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 23
2. Management of pharmacotherapy clients will occur as part of the Clarence Integrated Care
Centre. ADS are working to develop a model for this service in conjunction with general
practitioners and local pharmacists.
3. Supporting the implementation of the new Tasmanian Opioid Pharmacotherapy Policy and
Clinical Practice Standards will be a key priority for the Alcohol and Drug Service.
Table 6 Additional Financial Investment for Opioid Pharmacotherapy, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
South $45,021 $230,927 $660,927 $982,509
North $42,000 $300,000 $60,000 $515,000
North West $430,951 $100,000
Total Opioid Pharmacotherapy $87,021 $530,927 $1,151,878 $1,597,642
Achievements against the Future Service Directions Plan
The Alcohol and Drug Service has made some significant progress in meeting the outcomes for
pharmacotherapy that are outlined in the Future Service Directions Plan. The development and
growth of the pharmacotherapy program relies heavily on the ability to attract addiction medicine
specialists to the Alcohol and Drug Service. There has been some level of success in attracting
addiction specialists but in some cases it has proven difficult to sustain a good balance between
home and work for specialists that have moved to Tasmania from interstate or from other
countries.
Table 7 Opioid Pharmacotherapy - Achievements against Outcomes
Priority Area Outcomes Progress
Opioid
Pharmacotherapy A shared care model of opioid
pharmacotherapy treatment which is evidence
based and reflects contemporary best practice
Partially achieved
Implemented Opioid Pharmacotherapy Policy
and Clinical Practice Standards
Near finalised
Additional four hundred clients receiving
treatment through the Opioid
Pharmacotherapy Program
Partially achieved
An additional one hundred and seventy clients
dosed by government provided services
Partially achieved
Reduced deaths and safe opioid prescribing
practices
Achieved
Access to 24 hour, seven days per week
specialist medical support, advice and
information for Acute Care Services, general
practitioners and pharmacists
Partially achieved
Consultation Question 7 – Opioid Pharmacotherapy
What should the ADS do to better support current external providers (general practitioners
and community pharmacists) and to encourage the involvement of new general practitioners and
pharmacists in Tasmanian Opioid Pharmacotherapy Program? Will supporting the “shared care”
model build the capacity and improve access to the Pharmacotherapy program? If not, what
other options could be explored?
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 24
4.3 Consultation Liaison Services
A specialist consultation liaison role has now been established in the South with a specialist nurse
permanently located within the Royal Hobart Hospital. Access to addiction medicine specialists is
provided as required. The service aims to support and develop clinical staff of the Royal Hobart
Hospital by providing expert assessment, information, brief intervention, advice and often shared
care in the clinical management of patients admitted to the Royal Hobart Hospital with significant
and complex alcohol and other drug related problems.
The Clinical Director and other medical specialists continue to support and visit General
Practitioners and private prescribers across the State.
A Pharmacotherapy Liaison Service (PLS) service model has been established and is in the early
stages of operation in the N/NW.
Future Development Options
1. There is a need to continue to grow the consultation liaison service in the South and to establish
similar services in the North and North West Regions whereby specialist Alcohol and Drug
Consultation service is provided within the major hospitals on a regular (weekly) basis. The
current barrier to expansion has been the difficulties in recruiting specialist staffing to the area. It
is anticipated that additional resources may also be required to grow this service model.
2. The Consultation Liaison Model in the South has been operational for some time. There is a
need to review the model to ensure that the service is effective and utilised to its maximum
potential.
Table 8 Additional Financial Investment for Consultation Liaison, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Additional Staff (ADS) $25,000 $200,000 $200,000
Total Consultation Liaison Services $25,000 $220,000 $220,000
Achievements against the Future Service Directions Plan
The Alcohol and Drug Service has made some significant progress in meeting the outcomes for
Consultation Liaison that are outlined in the Future Service Directions Plan. There are two
outcomes in the Plan which are yet to be achieved. These focus on providing dedicated sessions
within the North and North West. However, support is provided to the Launceston General
Hospital on a visiting and as required basis. The main barrier to progressing these initiatives is the
difficulties associated with establishing and maintaining a specialist workforce within the ADS.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 25
Table 9 Consultation Liaison - Achievements against Outcomes
Priority Area Outcomes Progress
Consultation
Liaison A specialist alcohol and drug consultation
liaison service
Achieved
A minimum of:
five sessions (20hrs) per week within the
Acute Care Service in the South (Royal
Hobart Hospital)
two sessions (8 hrs) per week in the
Acute Care Service in the North
(Launceston General Hospital)
two sessions (8 hrs) per week in the
Acute Care Service in the North West
(North West Regional Hospital)
Achieved
Future
development
Future
development
Consultation Question 8 – Consultation Liaison
How valuable is a specialist consultation liaison service in Tasmania? With limited resources is
this an area of service provision that should be expanded? Should a specialist consultation liaison
service be limited to supporting hospitals? Are there more effective mechanisms to support
mainstream health services?
4.4 Residential Rehabilitation Services
The Government has provided significant investment into the three established community based
residential rehabilitation services across the State: The Bridge Program, Missiondale and Live Free
Tassie.
The Alcohol, Tobacco and Other Drug Council (ATDC), continue to work closely with the three
organisations to assist with the development of their workforce (additional funding has been
provided to the ATDC to employ a Workforce Development Consultant to undertake this role as
well as progressing broader workforce development initiatives for the community sector).
In addition to the recurrent investment into services provision, the Alcohol and Drug Service is
supporting the organisations through the provision of clinical support, advice and expertise and will
continue to work closely with the organisations to assist with the ongoing development of their
services.
A protocol has been established between the Bridge Program and the Withdrawal Management Unit
to improve outcomes for clients. A Memorandum of Understanding has been developed to outline
the level and type of specialist medical support provided by the ADS (North) to Missiondale.
Future Development Options
1. It is recognised that considerable work is still required to further support the current residential
rehabilitation services to develop their programs in line with contemporary best practice. To
this end it will be important to develop and establish a framework for the delivery of residential
rehabilitation services in Tasmania. The framework will differentiate and define rehabilitation
services into a number of program types based on the types of clients they support. The
programs to be offered by residential rehabilitation services will be principally either
rehabilitative or accommodation support, long stay or short stay (or combinations of these).
2. Significant work has been undertaken in developing the relationship between the Withdrawal
Management Unit and the three residential rehabilitation services (particularly the Bridge
Program). This has improved referral and discharge planning processes. However there is still a
need to continue to strengthen the relationship between the residential rehabilitation services
and the Withdrawal Management Unit.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 26
3. The relationship between the ADS and the three residential rehabilitation services has been
strengthened dramatically with all services working collaboratively together for the benefit of
clients. This work has seen significant benefits for all parties. It will be important to continue to
build on these relationships to ensure a strong partnership approach is maintained.
Table 10 Additional Financial Investment for Residential Rehabilitation, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
South (The Bridge and Live Free Tassie) $160,839 $289,618 $249,618 $249,618
North (Missiondale) $117,000 $174,740 $174,740 $174,740
Total Residential Rehabilitation $277,839 $464,358 $424,358 $424,358
Achievements against the Future Service Directions Plan
Significant financial investment was provided to the three community based residential rehabilitation
services in the first year of the Plan (2008/09). Since that time the three organisations have
undertaken a range of service developments to improve access and quality and to establish specialist
targeted programs for clients of their service. The Alcohol, Tobacco and Other Drug Council of
Tasmania and the Alcohol and Drug Service will continue to work closely with the three residential
rehabilitation services to support the continued development of their programs and services.
A key initiative included in the Plan was the establishment of a new “specialist residential
rehabilitation service that can provide access to intensive medical and therapeutic interventions for
clients with complex needs”. The development of this new service has been highlighted for the final
year of the Plan (2012/13), however at this stage funding has only been provided to implement
initiatives for the first four years of the Plan. The Alcohol and Drug Service will not progress this
initiative in the absence of available funding.
Table 11 Residential Rehabilitation - Achievements against Outcomes
Priority Area Outcomes Progress
Residential
Rehabilitation Improved access to residential rehabilitation
services
Achieved
Improved quality of service, programs and
support for clients who access residential
rehabilitation services
Partially achieved
Specialist, targeted programs for clients within
residential rehabilitation services across the
State
Achieved
A specialist residential rehabilitation service
that can provide access to intensive medical
and therapeutic interventions for clients with
complex needs
On hold pending
future funding
allocation
Consultation Question 9 – Residential Rehabilitation
Are the current residential rehabilitation services meeting the need in Tasmania? What
additional support or initiatives would benefit the current residential rehabilitation services?
4.5 Youth Intervention Services
Investment into specialist alcohol and other drug services for youth was identified as a high priority
for the Government in the Future Service Directions Plan. As such, the capacity of both
government and community sector organisations has been improved with additional recurrent
investment. Funding has enabled the establishment of additional youth consultants within the
Alcohol and Drug Service and within the three specialist youth community sector organisations.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 27
Future Development Options
1. In expanding services to young people, it will be important for the Alcohol and Drug Service to
establish clear guidelines for the provision of those services which will assist in ensuring that
services are provided in line with contemporary best practice. Initial work has already been
undertaken with the development of a Youth Services Framework. However, the sector
continues to struggle with a number of complex issues associated with the role of individual
services in the broader provision of alcohol, tobacco and other drug services. To address this
issue, work has commenced on developing a broad overarching service statement for the
Tasmanian alcohol, tobacco and other drug sector. This task has now been incorporated into a
broader project looking at psychosocial interventions with a view to establishing a
comprehensive framework and guidelines for the provision of psychosocial services in Tasmania
(across both government and the community sector).
2. As part of the review of psychosocial interventions and subsequent development of a
framework, services to young people will also be described and better defined across the
government and community services.
Table 12 Additional Financial Investment for Youth Intervention Services, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
South
Government (ADS) $39,101 $78,202 $90,000 $100,000
Community Sector (The Link) $20,000 $87,000 $87,000 $87,000
North
Government (ADS) $20,527 $88,949 $88,950 $100,000
North West
Community Sector (BYADS and YAFF) $40,000 $174,000 $174,000 $174,000
Total Youth Intervention Services $119,628 $428,151 $439,950 $461,000
Achievements against the Future Service Directions Plan
Services to young people have been bolstered considerably since the introduction of the Future
Service Directions Plan. Additional Youth Workers have been employed by the three specialist
community sector organisations and the Alcohol and Drug Service (South and North).
Table 13 Youth Intervention - Achievements against Outcomes
Priority Area Outcomes Progress
Youth Intervention Specialist youth alcohol and drug services
supporting an additional eighty clients
statewide
Achieved
Increased consultation support and services
for the range of children and family services
Partially achieved
Consultation Question 10 – Youth Intervention Services
Has the investment in additional youth specialists enabled services to increase their capacity?
Are there significant areas of AoD treatment service gaps for young people affected by alcohol
and drugs in Tasmania? If so, how might they be addressed?
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 28
4.6 Outreach
The Future Service Directions Plan identifies outreach as a key focus area with the need to increase
the capacity of services to support clients who live outside the major city centres. The development
of outreach services is due to occur in 2011/12 to 2012/13. Although not exactly an outreach
model, a new service has been established to support clients on the East Coast (focus on the Break
O Day area). This service has been established under a new model of service delivery which
involves a close partnership between the community sector organisation, the local council and the
Alcohol and Drug Service. Essentially this service is a new services as opposed to an outreach from
an existing service. This initiative has been included under “outreach” as it meets the intent of the
Future Service Directions Plan by servicing more rural and remote areas of Tasmania. Initial
planning has been undertaken to service more rural/remote areas of Tasmania with the West Coast
identified as a priority area. However, with the current budgetary difficulties there has been a
requirement for all areas to identify significant savings. In discussion with senior management it has
been agreed to delay the development of any further services as one savings strategy. This option is
a better alternative to establishing new services only to have to reduce services across the board to
meet targeted savings.
Table 14 Additional Financial Investment for Outreach, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government $150,000
Community Sector Organisation $560,000
Total Outreach Services $710,000
Achievements against the Future Service Directions Plan
In establishing a new service on the East Coast a model of service provision which is based on a
partnership approach has been developed. It is anticipated that this model will prove to be a very
effective model for rural and remote areas where there has been little (if any) provision of specialist
alcohol and drug intervention in the past. The model aims to work closely with already established
services in the area to ensure a better uptake of service by local clients.
Future Development Options
Any future development of outreach type services is entirely dependent on available funding. Should
funding be made available in future years the following developments could proceed:
1. A key area for development will be to expand services in rural and remote areas. The initial
focus will be on establishing a service for the West Coast. A consultation process will be
undertaken with existing service providers on the West Coast to determine what services are
needed which in turn will assist in the development of a service model.
2. Other areas of need may also be considered (dependant on available funding). This will require
a level of consultation/discussion services and other stakeholders. Other areas for consideration
may include the North East, Tasmanian Peninsula, East Coast, Derwent Valley and the Midlands.
Table 15 Outreach - Achievements against Outcomes
Priority Area Outcomes Progress
Outreach Increased support for clients outside the
major city centres by year 4
Future
development
Increased access to specialist alcohol and drug
support, information, education and training
for staff within mainstream health and human
services
Partially achieved
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 29
Consultation Question 11 - Outreach
Is an outreach type model of service provision the most effective way to support clients in more
rural and remote areas of Tasmania? What would be an appropriate service model to support
an area such as the West Coast?
4.7 Relapse Prevention
The Future Service Directions Plan highlights the need to focus on the incorporation of relapse
prevention strategies across all service types within the Tasmanian alcohol, tobacco and other drug
sector. The Plan highlights the need to develop clinical guidelines which include interventions
designed to prevent relapse and to better integrate treatment services with aftercare support.
Achievements against the Future Service Directions Plan
Individual services have progressed some of this work over the past 2-3 years. The improvements in
referral processes and better integration of the Alcohol and Drug Service with community sector
organisations is expected to assist clients with relapse prevention. As relapse prevention is a key
element to any service/intervention it was envisaged that the focus would be a policy and workforce
development response to addressing the issues identified. Unfortunately the establishment of the
Workforce Development Unit was delayed due to recruitment difficulties and the development of
psychosocial guidelines is the next major priority (following the finalisation of the Opioid
Pharmacotherapy Guidelines).
Future Development Options
1. Guidelines for relapse prevention strategies will be incorporated into broader psychosocial
guidelines. Work on the development of these guidelines is not expected to occur until
2012/13.
2. Early discussions with the sector (and the ATOD Steering Committee) has resulted in rethinking
the strategy of establishing specific relapse prevention group programs. Relapse prevention
should be a component of any treatment/intervention provided by services. As the capacity of
services has been expanded so has the ability to incorporate relapse prevention strategies into
service delivery. The focus will shift towards developing existing services with the establishment
of guidelines and the development of the workforce to ensure that relapse prevention is
incorporated into all interventions.
Table 16 Relapse Prevention - Achievements against Outcomes
Priority Area Outcomes Progress
Relapse
Prevention Evidence based relapse prevention guidelines Future
development
Establishment of evidence based relapse
prevention group programs on a statewide
basis
Future
development
Consultation Question 12– Relapse Prevention
Most services include, as part of their treatment interventions, aspects of relapse prevention. Is
there a specific need to focus on a more consistent approach to relapse prevention? If so, could
this be achieved through guidelines, broad policy position and/or workforce development? Are
there other options to consider?
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 30
4.8 Management of Complex Needs
Improving support for clients with complex needs is an important priority and is highlighted in the
Future Service Directions Plan. Considerable investment has been directed towards a new service
type for Tasmania, Care Coordination. Care co-ordination services are provided by a community
sector organisation and aims to support clients with multiple and complex issues by working closely
with other service providers to ensure that the needs of the client are met in a holistic manner.
In November 2011, a comprehensive review was undertaken of the care coordination services
provided by Anglicare after their first two years of operation. A common theme from the review
was that the care coordination service has been successful in obtaining the consumer outcomes as
specified in the funding agreement. This is reflected in the consistency of the feedback received
from within Anglicare, ADS referring clinicians, and the clients themselves. In fact, the client
interviews, conducted by Advocacy Tasmania, which represent almost 30% of the total client cohort,
indicated that clients found the service extremely beneficial.
Considerable work is being undertaken by both the Alcohol and Drug Service and Mental Health
Service to better support clients who have a co-existing mental health issue. It will be important for
the Alcohol and Drug Service and Mental Health Service to continue to work closely together to
effectively support clients who present with co-occurring alcohol and drug and mental health issues.
With the new Departmental structure being introduced it will be important to identify robust
structures and systems are in place to ensure collaboration and cooperation between the two
service areas (both at a service level and a systemic policy and planning level).
Table 17 Additional Financial Investment for the Management of Complex Needs, 2008/09 to
2011/12
2008/09 2009/10 2010/11 2011/12
South
Community Sector Organisation $135,000 $180,000 $180,000
North
Government $50,000 $50,000
Community Sector Organisation $60,000 $80,000 $80,000
North West
Community Sector Organisation $60,000 $80,000 $80,000
Total Complex Needs $255,000 $390,000 $390,000
Achievements against the Future Service Directions Plan
Services are now established in each region to assist clients in the coordination and engagement of
services and supports to meet their multiple and complex needs. In establishing this new service
type the Alcohol and Drug Service together with Anglicare developed a clearly defined model and
guidelines for its operation. A review of the service has indicated that some very positive outcomes
have been achieved for some clients.
Work continues with Mental Health Services to better manage clients who present with co-existing
mental health issues.
Future Development Options
1. Work with Anglicare and others to implement the accepted recommendations from the review
of Care Coordination services.
2. The Alcohol and Drug Service will continue to work closely with other services to continue to
improve the service response to clients with complex and multiple needs.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 31
3. Establish clinical guidelines to assist in the management of clients with complex needs (beyond
comorbid AoD and mental health issues).
Table 18 Complex Needs - Achievements against Outcomes
Priority Area Outcomes Progress
Management of
Complex Needs Models of intervention and clinical guidelines
established
Partially achieved
Clinical expertise in the management and
support of clients who present with complex
needs and difficult behaviours
Partially achieved
Consultation Question 13 – Management of Complex Needs
What resources/supports would help services better manage people with complex needs? Is
there a need for clinical guidelines and associated training for supporting clients with complex
needs (beyond mental health issues)?
4.9 Brief and Early Intervention
The further development of brief and early intervention strategies is identified as a key area for
development by the Alcohol and Drug Service. Significant effort has been invested in developing and
implementing a smoking cessation brief intervention model for use by the broader health workforce.
The Alcohol and Drug Service has provided significant brief intervention training for health
professionals (at all levels) in both hospital and community settings. The success of this approach
has seen the Alcohol and Drug Service develop a similar brief intervention model to tackle the high
levels of alcohol consumption in this State. The model has yet to be trialled as a submission for
Commonwealth funding was unsuccessful. However, a future trial of the model will be considered
should resources become available.
Table 19 Additional Financial Investment for Brief and Early Intervention, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government $290,000 $145,000
Community Sector Organisation $55,000 $55,000
Total Brief and Early Intervention $345,000 $200,000
Achievements against the Future Service Directions Plan
A clear brief intervention model of service has been developed and implemented for smoking
cessation.
The Alcohol and Drug Service is also an integral component to the Tasmanian Early Intervention
Pilot Project. The Project is Commonwealth Funded (under the National Binge Drinking Strategy)
which has utilised expertise from the Alcohol and Drug Service to develop a model of brief and early
intervention for young people and their parents or guardians. The Alcohol and Drug Service is
expanding the service so that it is available on a statewide basis.
Future Development Options
1. Should funding be available, research and trial (subject to obtaining research grant funding) the
new brief intervention model for alcohol.
2. Expand the Tasmanian Early Intervention Pilot Project to operate statewide.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 32
Table 20 Brief and Early Interventions - Achievements against Outcomes
Priority Area Outcomes Progress
Brief and Early
Intervention Access to brief and early intervention for
clients with alcohol and drug issues from a
range of health and community care settings
Partially achieved
Established alcohol and drug training and
education program and improved support for
general practitioners, staff within primary
health, acute care and other services who
could provide brief and/or early intervention
Partially achieved
Consultation Question 14 – Brief and Early Interventions
What resources would assist AoD workers to deliver brief interventions (eg guidelines,
training)? Would investment in a brief intervention approach that mirrors the ABC approach to
smoking cessation be effective in reducing alcohol consumption and its associated harms?
4.10 Places of Safety
The need to support and develop the Places of Safety services across the State is a key strategy of
the Future Service Directions Plan. The Alcohol and Drug Service engaged an independent
consultant (Turning Point) to undertake a review of the Places of Safety services in Tasmania with
the view to providing recommendations to address access issues and to improve outcomes for
clients.
Table 21 Additional Financial Investment for Places of Safety, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Review of Places of Safety (Turning Point) $11,880 $20,780 $30,000
Funding to Community Sector Organisation $60,540 $85,000 $95,000
Total Places of Safety Services $11,880 $81,320 $115,000 $95,000
Achievements against the Future Service Directions Plan
An independent review of Places of Safety services has been completed and, where appropriate, the
recommendations are being progressively implemented. Additional funding has been provided to
some organisations to bolster their capacity to effectively meet the current demand.
Future Development Options
1. Continue to support and monitor progress of organisations implementation of the
recommendations from the review.
2. Future opportunities to further improve the Places of Safety service model may become available
when broader health reforms are progressed (for example the redevelopment of the Royal
Hobart Hospital may provide greater opportunities to incorporate places of safety services with
acute care services in the South).
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 33
Table 22 Places of Safety - Achievements against Outcomes
Priority Area Outcomes Progress
Places of Safety Effective places of safety services in all three
regions of Tasmania
Achieved
Integration of places of safety services with
other specialist alcohol and drug services and
Acute Care Services.
Partially achieved
Consultation Question 15 – Places of Safety
Are there further opportunities to develop and refine the model of places of safety services?
4.11 Support for Families
The Future Service Direction Plan recognises the importance of supporting families of people who
are affected by alcohol and drug use. The Plan particularly focusses on the need to establish this
type of support for clients in the North and North West regions of the State. In mid 2011, the
Alcohol and Drug Service sought interest from experienced community sector organisations to
deliver specialist support services to the families and significant others of people experiencing
alcohol and drug issues in the North and North West of Tasmania. Anglicare have been approved
as the successful organisation to provide the service. Negotiations in relation to the Funding and
Service Agreement have now been finalised and the organisation is currently finalising a recruitment
process and it is anticipated that the service will be operational by late 2012.
Table 23 Additional Financial Investment for Support for Families, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
North and North West
Community Sector Organisation $ $200,000
Total Support for Families $ $200,000
Achievements against the Future Service Directions Plan
In addition to the establishment of a new community based service for the North and North West,
the Alcohol and Drug Service continues to work closely with Child and Family Services to ensure
families are appropriately supported and maintained (where possible) when there are substance
abuse issues present. A Memorandum of Understanding has been developed and implemented with
Youth Justice to ensure that both service areas work together for the best interest of clients.
Future Development Options
1. Anglicare have been approved to deliver a new family support service in the North and North
West and it is anticipated that services will be operational towards the end of 2012. Once
operational it is anticipated that the new service will meet the outcomes as stipulated in the
Future Service Directions Plan.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 34
Table 24 Support for Families - Achievements against Outcomes
Priority Area Outcomes Progress
Support for
Families
Increased support for families in the North
and North West of the State, including the
provision of information sessions for between
200 and 250 clients per year
Commenced
Provision of fifteen family support programs
per year across the North and North West
to support between 100 and 125 clients
Commenced
4.12 Smoking Cessation
Following an independent review commissioned by the State Government in 2007, $2.7 million over
four years was allocated to progress smoking cessation initiatives in Tasmania. Key
recommendations from the review included increasing funding for social marketing strategies;
increasing healthcare workers capacity to deliver a brief intervention with people who smoke; and
the development of a Statewide Smoking Cessation Program. In line with the review
recommendations, the Future Service Directions Plan outlines a range of strategies designed to assist
Tasmanian smokers to quit.
The allocation of funding for smoking cessation initiatives was provided separately to Population
Health to complement their existing range of tobacco control measures. Population Health then
contracted the Alcohol and Drug Service to develop and implement a Statewide Smoking Cessation
Program. Since that time, the Smoking Cessation Program has aimed to bring about a cultural
change within the sector so that the provision of smoking cessation intervention becomes a routine
component of healthcare, by the delivery of standardised education to all health care professionals
on using a brief intervention with clients who smoke.
In addition to the establishment of the Smoking Cessation Program, funding was also provided to
increase the Social Marketing Program in Tasmania. This funding is overseen by a committee with
representation from Government and specialist community sector organisations. The Social
Marketing Program is managed by the Cancer Council who also received additional funding for
increased telephone counselling and support (for Quit Tasmania).
Table 25 Additional Financial Investment for Smoking Cessation, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government $400,000 $400,000 $400,000 $400,000
Community Sector Organisation (Media
Campaigns) $200,000 $200,000 $200,000 $200,000
Community Sector Organisation $60,000 $60,000 $60,000 $60,000
Total Smoking Cessation $660,000 $660,000 $660,000 $660,000
Achievements against the Future Service Directions Plan
Over the past three years, the Alcohol and Drug Service has implemented a new smoking cessation
program across the State.
The Program comprises a statewide coordinator and three regional Clinical Nurse Specialists based
at the major hospitals, who deliver face to face education to health professionals and provide one on
one smoking cessation specialist support to clients within the acute sector. The program has also
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 35
developed and launched an interactive e-learning tool in August 2010 to support and improve access
of health professionals to education and increase the reach of the Program.
A group smoking cessation program (No More Butts) was implemented statewide in 2011. This
new program will enable clients outside the acute sector to have access to face to face smoking
cessation support. Under this program, the three Clinical Nurse Specialists provide facilitator
training to individuals wishing to run programs within their own service and can assist in co-
facilitating groups in addition to facilitating groups of their own. This approach will ensure that a
wider range of services will provide more intensive smoking cessation interventions to their clients.
In addition to improved access to specialist support, the Smoking Cessation Program has initiated
important structural changes to ensure sustainable long term cultural change. Some of these
initiatives include the endorsement of clinical guidelines for nicotine dependent patients at all of the
major hospitals; development of supportive materials such as flowcharts and brochures; the Health
Executive endorsement of brief intervention education being a mandatory component of orientation
programs and an annual mandatory competence for all clinical staff within DHHS; the inclusion of
smoking cessation interventions as a component of some undergraduate health degrees; and the
endorsement of the e-learning tool by many professional health bodies.
Recently published statistics are also indicating a reduction in smoking rates in Tasmania. In 2011
the Program embarked on an outcome evaluation to ascertain if the program was bringing about a
cultural change in which all clients presenting to the DHHS receive a brief intervention. A random
case note audit lacked documented evidence of the application of brief intervention, but a staff
survey indicated that most staff are actually incorporating it into their practice, believe it makes a
difference and provided relevant and constructive feedback on the training and resources provided
by the Program.
Major Barriers/Issues Encountered
Recruitment and Retention of Staff
The repetitive nature of the role; a minimal client focus; and a huge workload for one individual in
each Area Health Service, has led to issues with recruitment and retention. As the Program has
evolved, the diversity of the role has increased along with the workload. Providing more face to face
support to the team members and providing more flexible working arrangements has assisted in
alleviating some of these issues.
Difficulty Accessing Health Professionals for Education
The ever changing environment within the acute sector, professional ambivalence, budget cuts and
competing priorities have been a challenge in accessing health professionals for the purpose of
education. The Health Executive endorsement of the training as mandatory (except in the North)
and the introduction of the e-learning tool has overcome some of these issues.
Future Development Options
1. The current approach to smoking cessation is proving to be extremely successful. The Alcohol
and Drug Service will continue to focus on the acute care sector but will look for opportunities
to extend the service to cover a larger component of the community sector.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 36
Table 26 Smoking Cessation - Achievements against Outcomes
Priority Area Outcomes Progress
Smoking Cessation Reduced rates of smoking Partially Achieved
(early indications
are that rates
have dropped)
Increased support for smokers who would
like to quit
Achieved
Specialist smoking cessation intervention
provided within the three major acute care
hospitals
Achieved
Consultation Question 16 – Smoking Cessation
Has the development of the e-learning tool been a success? Are there particular groups of
smokers that should be identified as a priority for smoking cessation support?
4.13 Supporting the Aboriginal Community
An Aboriginal Policy and Liaison Officer, funded under an Agreement with the Commonwealth
Department of Health and Ageing Office of Aboriginal and Torres Strait Islander Health has been
established. The function of the position is to:
- support and coordinate the ADS liaison with Tasmanian Aboriginal communities on issues
relating to alcohol, tobacco and other drugs use;
- assist to coordinate, support, monitor and evaluate policy and projects under National and State
Strategic Plans and initiatives, particularly the provision of advice for project and policy
development in response to Aboriginal and Torres Strait Islander alcohol, tobacco and other
drugs use issues;
- work with ADS to facilitate linkages to improve:
o access to alcohol, tobacco and other drugs interventions and treatment services
opportunities for Aboriginal communities and organisations;
o accessibility of alcohol, tobacco and other drugs information to, and coordination of
services for Aboriginal communities and organisations; and
o the coordination and enhancement of Aboriginal workforce development initiatives and
capacity building in the alcohol, tobacco and other drugs sector.
Achievements against the Future Service Directions Plan
A significant level of workforce development and Aboriginal cultural sensitivity awareness training
has been provided for the sector through liaison and consultation with the Alcohol, Tobacco and
Other Drugs Council and the Area Health Service (Tasmanian Aboriginal Centre).
An audit was undertaken against the 2008 Review of the Needs of the Aboriginal Community in
response to the use of alcohol, tobacco and other drugs with a view to develop both a statewide
and individual organisations implementation plans. Under development or already in train are
individualised plans; draft referral tools and protocols; assessment tool(s); reciprocal open days/staff
visitation programs between ADS services and Aboriginal organisations; consultation liaison; and
development of a model for outreach support.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 37
Major Barriers/Issues Encountered
The incorporation of a specific section for Aboriginal workforce and cultural sensitivity awareness
training under the ADS Workforce Development Strategy has been delayed due to delays and
difficulties in recruiting and retaining staffing within the ADS Workforce Development Unit to
progress the ADS Workforce Development Strategy.
Most of the progress has been achieved in the South of the State, eg South Eastern Aboriginal
Organisation, Karadi and the Tasmanian Aboriginal Corporation. This has been mainly due to the
position being located in the South.
Future Development Options
1. Work is still required to ensure that ADS services and staff statewide are providing culturally
sensitive and appropriate services to ensure Aboriginal organisations and staff feel comfortable
both referring clients and working collaboratively with ‘shared’ clients.
2. The current approach to working with the Aboriginal organisations in the South whilst slow has
been successful. Greater engagement with the North and North West Aboriginal organisations
and closer liaison between ADS and those organisations is still required.
3. The position, whilst originally seen to be strategic policy oriented, has become more focussed
on direct client liaison and support. Consideration should be given to locating this position
within service delivery.
Table 27 Supporting the Aboriginal Community - Achievements against Outcomes
Priority Area Outcomes Progress
Tasmanian
Aboriginal
Community
ATOD services more accessible for the
Tasmanian Aboriginal community.
Achieved in part
Aboriginal community organisations better
equipped to address alcohol, tobacco and
other drug issues.
Achieved in part
Identification of early intervention strategies
that are targeted towards young Aboriginal
people in Tasmania.
Work in progress
- linked to Youth
Interventions
Consultation Question 17 – Supporting the Aboriginal Community
Has the establishment of an Aboriginal Policy and Liaison Officer assisted to reduce the barriers
to AoD treatment for the Tasmanian Aboriginal Community? What other opportunities exist to
improve treatment for the Aboriginal community?
4.14 Workforce Development
Workforce development was identified as a major issue throughout the review of ATOD services in
Tasmania. In responding to this, the Government has invested considerable resources into creating
dedicated workforce development positions for the ATOD sector.
The Alcohol and Drug Service (ADS), has established a Workforce Development Unit for the
ATOD sector which consists of two specialist Workforce Development positions within the Alcohol
and Drug Service (one being a nursing focussed and the other allied health focussed) and a third
position based with the Alcohol, Tobacco and Other Drug Council (ATDC) of Tasmania.
Unfortunately, the two positions within the ADS have been vacant for a considerable period (mainly
due to difficulties associated with recruitment of suitably qualified personnel). This has resulted in
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 38
some of the more specific workforce development strategies being delayed. However, considerable
work has been undertaken in the identification of core and mandatory training requirements for the
ADS workforce.
The two ADS Workforce Development Consultants have progressed two important workforce
development initiatives:
identification and development of resources and training to support the release and
implementation of the Tasmanian Opioid Pharmacotherapy Policy and Clinical Guidelines; and
finalisation of Guidelines for the Clinical Assessment Tool and the development of specialist
training in the delivery of that tool.
These two initiatives will continue to be a priority for the Alcohol and Drug Service.
The ATDC have implemented a large range of extremely valuable workforce development initiatives,
which have included the coordination and delivery of specialist training for the sector, management
of significant conferences, undertaken a training needs analysis for the community sector (including
the release of a major report to highlight the findings from that survey) and more recently the
development of a discussion paper on a minimum qualifications strategy for the community sector.
Table 28 Additional Financial Investment for Workforce Development, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government $10,386 $200,000 $200,000 $200,000
Community Sector Organisation $80,000 $80,000 $80,000
Total Workforce Development $10,386 $280,000 $280,000 $280,000
Achievements against the Future Service Directions Plan
A Workforce Development Unit has been established; however the occupants of both positions
within the Alcohol and Drug Service vacated the positions. Recruitment to these positions has
proven to be problematic and they are now subject to the Agency’s vacancy control measures.
Progress on workforce development has been delayed considerably because of these vacancies.
Considerable work has been undertaken by the ATDC in surveying the community sector
workforce and providing a detailed analysis of the results. Statewide and Mental Health Service has
developed an overarching Workforce Development Framework.
Future Development Options
1. The Alcohol and Drug Service will finalise guidelines and develop and deliver training for the
Clinical Assessment Tool.
2. The development of training and resources to support the release and implementation of the
new Tasmanian Opioid Policy and Clinical Practice Guidelines will be a high priority.
3. Continue to progress the work to identify core and mandatory training requirements across the
ATOD sector.
4. Investigate the possibility of providing a comprehensive AoD training program for all AoD
workers.
5. A Workforce Development Strategy will be established for the sector.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 39
Table 29 Workforce Development - Achievements against Outcomes
Priority Area Outcomes Progress
Workforce
Development
A dedicated workforce development unit for
the sector
Achieved
An established professional development
program which is accessible to all workers in
the alcohol, tobacco and other drug sector
Partially achieved
Overall increase in the skill set of workers
within the sector and of general health
workers
Partially achieved
Establishment of entry level qualifications and
competencies for the sector
Future
development
An established medical registrar and graduate
nursing programs
Partially achieved
Consultation Question 18 – Workforce Development
What are the biggest workforce development issues facing the sector at this stage? What
strategies should be in place to address those issues? Would the delivery of a comprehensive
training program for all AoD workers be beneficial?
4.15 Continuous Quality Improvement
Many of the initiatives contained in the Plan are all focussed on improving quality of service provision
for clients across the State. New and expanded government and community based services have
resulted in an increased number of clients supported as well as enabling a more appropriate mix of
service types in each region. The focus on developing services in line with best practice and the
development of statewide policies and clinical guidelines are also designed to improve the quality of
services in Tasmania. The investment in developing the workforce is also a major quality
improvement initiative. All these initiatives are discussed in more detail in other areas of this report.
Achievements against the Future Service Directions Plan
There have been some specific Quality Improvement initiatives progressed in line with the strategies
contained in the Future Service Directions Plan. For services within the community sector, the
Department has established a quality and safety framework for funded organisations. The Quality
Futures has established a set of 6 standards by which organisational performance is monitored and
evaluated. The need for compliance against the Standards has been captured within funding and
service agreements with each funded community sector organisation that provides specialist alcohol,
tobacco and other drug treatment. The Alcohol and Drug Service is currently working closely with
the Community Sector Relations Unit to support and encourage funded organisations to be involved
in the Standard Performance Pathway project (managed through TasCOSS) which will assist
organisations in their monitoring and reporting against a range of quality standards.
In recent times, the Alcohol and Drug Service has worked closely with funded organisations to
refine the client outcome measures and key performance indicators that are now included in service
agreements. However, there is more work to be undertaken in this area to ensure that there is a
consistent approach to the measurement of performance across all service types (including
government services). The Alcohol and Drug Service has had initial discussions with the community
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 40
sector in relation to performance measurement and reporting requirements with the view to
establishing this as a key project for the sector.
Since the introduction of the Future Service Direction Plan, the Alcohol and Drug Service has been
keen to work towards accreditation against an appropriate set of nationally recognised standards.
Significant work was initially undertaken by the Alcohol and Drug Service to meet the Quality
Improvement Council’s Health and Community Services standards. However, in more recent years
Statewide and Mental Health Services (SMHS) have signed an agreement with the Australian Council
on Healthcare Standards (ACHS) for accreditation purposes for the different service areas.
The Alcohol and Drug Service has undertaken significant work and has made considerable progress
towards meeting the ACHS standards. In their initial assessment report (June 2011), ACHS
identified that considerable work had been undertaken in recent times by ADS to improve the
quality of service provision and move towards meeting the ACHS standards. In their report, ACHS
agreed with almost all of the self-assessed ratings made by the Alcohol and Drug Service against the
mandatory criteria. The report also provided some guidance to the organisation on where future
improvements would need to be made. Since that time, the Alcohol and Drug Service has worked
hard to progress initiatives designed to improve service quality and hence to better meet the
required standards. The Organisation is due for a formal assessment against the Standards in early
2013.
A key initiative identified in the Future Service Directions Plan was the need to establish a quality
improvement framework for the sector. To support the implementation of the Future Service
Directions Plan, the Alcohol and Drug Service established a Clinical Speciality Group Quality
Improvement Committee which would serve as a central forum where issues, developments and
opportunities could be discussed and debated with input from a range of levels and from across
government and the community sector. This structure has worked extremely well and has enabled
the strategies within the Plan to be progressed and implemented in a timely and supportive manner.
In recent times, a more formalised Quality Improvement Framework has been adopted (building
upon current processes) which includes the development of a formalised Quality Improvement Plan
for the sector.
Future Development Options
1. Improve performance/outcome measures and reporting processes across all government and
community sector service providers.
2. Continue to work towards accreditation for the Alcohol and Drug Service against the Australian
Council of Healthcare Standards.
3. Finalise the Quality Improvement Plan and promote the Quality Improvement Framework
throughout the sector and to other interested stakeholders.
4. The Alcohol and Drug Service and funded community sector organisations will continue to work
closely with the Community Sector Relations Unit to ensure funded services are supported to
meet, monitor and report their performance against standards.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 41
Table 30 Continuous Quality Improvement - Achievements against Outcomes
Priority Area Outcomes Progress
Continuous
Quality
Improvement
A clear model of service provision for all
service types within the alcohol, tobacco and
other drug sector.
Partially Achieved
Established set of service standards for
services within the alcohol, tobacco and other
drug sector.
Future
Development
Consultation Question 19 – Continuous Quality Improvement
What strategies can the sector implement to encourage and support continuous quality
improvement? How can we measure and monitor the quality and performance of the sector?
4.16 Advocacy Support
As part of the Future Service Directions Plan, the Government has invested in the development of
advocacy support services for clients of alcohol, tobacco and other drug services. To further
support client rights and to engage clients in the development and planning of services, the Alcohol
and Drug Service provided funding to a community sector organisation to develop a range of
consumer engagement strategies.
Table 31 Additional Financial Investment for Advocacy Support, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Community Sector Organisation $206,831 $259,000 $259,000
Total Support for Advocacy Support $206,831 $259,000 $259,000
Achievements against the Future Service Directions Plan
In 2009/10 the Alcohol and Drug Service established a statewide consumer advocacy service in the
community sector. At the same time, additional funding was also provided to the community sector
organisation to establish and support a range of consumer engagement strategies. A Consumer
Engagement Guide was released in late 2011. The Guide provides direction and support for
organisations to effectively engage consumers in their own treatment pathways as well as the
development of alcohol and drug services which impact their lives. Engaging consumers in key
decision making processes is essential for improving the provision of ATOD services delivered in
Tasmania.
Following the development of the Guide, a Statewide forum was conducted in April 2012 to seek
input from the sector on the consumer engagement strategies to be progressed by the sector. In
establishing the future strategies for the sector, the forum also considered and agreed on the role of
Advocacy Tasmanian in supporting the implementation of those strategies. Advocacy Tasmania will
continue to work with the sector to develop an action plan to progress consumer engagement in
Tasmania.
Future Development Options
1. Establish a sector wide action plan to progress consumer engagement initiatives in Tasmania.
2. Continue to support individual service organisations to develop and implement appropriate
consumer engagement policies and strategies.
3. Investigate and progress opportunities for consumer engagement through social networking
platforms.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 42
4. Continue to investigate and progress options to establish and support a Statewide ATOD
consumer organisation.
Table 32 Advocacy Support - Achievements against Outcomes
Priority Area Outcomes Progress
Advocacy Support Access to statewide advocacy support for
clients and their carers
Achieved
Consultation Question 20 – Advocacy Support and Consumer Engagement
Has the establishment of advocacy support for clients assisted with resolving issues for clients or
seen positive changes in service delivery across the sector? Advocacy Tasmania will progress a
range of key initiatives to support consumer engagement in the delivery of AoD treatment
services. Are there other opportunities for consumer engagement?
4.17 Governance, Planning and Policy Development
The Government recognises the important role which policy and planning plays in the delivery of an
effective service system in Tasmania. Investment in this area has occurred across both the
government and the community sectors with the engagement of a specific policy and research
position which supports the secretariat functions of the Inter Agency Working Group on Drugs and
the development, monitoring and reporting of Tasmania’s drugs policies.
Table 33 Additional Financial Investment for Governance, Planning and Policy Development,
2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government (Policy Unit) $95,106 $95,106 $95,106 $95,106
Total Governance, Planning and Policy $95,106 $95,106 $95,106 $95,106
Achievements against the Future Service Directions Plan
The effectiveness of the Inter Agency Working Group on Drugs has been enhanced through
increased support under Future Service Directions. The Inter Agency Working Group on Drugs has
representation from a wide range of government agencies and the Alcohol, Tobacco and Other
Drugs Council of Tasmania and receives input from a range of expert bodies.
The Tasmanian Alcohol Action Framework 2010-2015 Rising Above the Influence was developed
and provides a range of strategies to address alcohol issues in a planned and coherent manner for
the State. An Alcohol Advisory Group has been established to coordinate the implementation of
the Tasmanian Alcohol Action Framework, and has developed and reported against a 2011 Annual
Implementation Plan; and developed a 2012 Annual Implementation Plan. The 2011 Report and 2012
Plan are currently with the Minister for Health for presentation to Cabinet.
The Tasmanian Drug Strategy (TDS) expired at the end of 2009. In 2010, the Policy Development
Unit coordinated the TDS review process on behalf of the Inter Agency Working Group on Drugs
(IAWGD) during which, Agencies were asked to report on activities and achievements in relation to
the TDS and to provide feedback on the TDS objectives and strategies. The review report was
provided to Government in November 2010, and in June 2011, the Minister agreed to extend the
TDS to the end of 2012. The Inter Agency Working Group is currently planning the next phase of
the TDS, and is seeking Ministerial approval to use the National Drug Strategy 2010-2015 as the
overarching strategic policy document with localised Tasmania specific actions and activities. A two
stage review of the Tasmanian Psychostimulants Action Plan was also undertaken, and a review
Report provided to Government. As a result of the review, the Plan was extended to the end of
2013 when it is envisaged a broader Tasmanian Illicits Drug Strategy will be developed.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 43
The Alcohol and Drug Service, through the Policy Development Unit, have released a Draft
Promotion, Prevention and Early Intervention Strategy for the sector. A consultation process has
been undertaken and it is anticipated that the final strategy will be released in 2012.
Major Barriers/Issues Encountered
Tasmania’s strategic drugs policies, including the Tasmanian Drug Strategy, Tasmanian Alcohol
Action Framework and Tasmanian Psychostimulants Action Plan do not receive any Government
funding which severely curtails the ability of the Inter Agency Working Group on Drugs or the
Alcohol and Drug Service to implement strategies requiring specific financial resourcing.
Whilst the Plan has enabled the creation of a specific governance, planning and policy position,
with recent budget cuts, there are no longer any other policy positions within the Alcohol and
Drug Services or Statewide and Mental Health Services to support drugs policy development or
specific project work. This has limited the capacity to progress certain initiatives, for example,
ability to undertake research is on hold.
Other Tasmanian strategic initiatives have and will continue to impact on the Tasmanian alcohol,
tobacco and other drugs agenda, including the Agenda for Children and Young People Our
Children Our Young People Our Future; and A Healthy Tasmania.
Significant National reform in the alcohol, tobacco and other drugs strategic policy agenda has
posed its own unique set of challenges. The Ministerial Council on Drug Strategy, as a result of
the COAG review of Ministerial Council, ceased to exist from 1 July 2011. The uncertainty
around the ongoing governance of national drugs policy remains, with the Inter-Governmental
Committee on Drugs (IGCD) now likely to be reporting to the new Mental Health, Drug and
Alcohol Principal Committee of the Standing Council on Health. The IGCD has written to
Ministers for Health and Police and Emergency Management expressing concerns about the lack
of a viable ongoing governance structure to support the long established health and law
enforcement nexus that has driven drugs policy since 1985.
The amalgamation of alcohol and drug and mental health policy into one policy unit early in 2010
sitting within Statewide and Mental Health Services state office posed challenges especially in
ensuring that Alcohol and Drug Services service development and clinical input was maintained
into strategic policy.
Future Development Options
1. Development and establishment of local research capacity within the alcohol and drug field is still
required, due to a lack of Tasmanian specific data and research.
2. Finalisation of the Promotion, Prevention and Early Intervention Strategic Framework in 2012.
3. Consumer input into policy and planning
4. Development of an agreed set of whole of population performance indicators to monitor the
effectiveness of drugs policy.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 44
Table 34 Governance, Planning and Policy Development - Achievements against Outcomes
Priority Area Outcomes Progress
Governance,
Planning and Policy
Development
A clear and accountable process by which
whole of government decisions in relation to
alcohol and drug issues can be appropriately
informed, discussed and debated
Achieved
Better collaboration between government
agencies, local government, community sector
organisations and clinicians in relation to
alcohol and drug issues
Achieved
A formal mechanism to allow clients and
carers involvement in the policy development,
planning and service delivery within the
ATOD sector in Tasmania
Near finalised
Development and establishment of local
research capacity within the alcohol and drug
field to ensure that decisions and service
delivery is evidence based and underpinned by
local research data.
Future
development
Consultation Question 21 – Governance, Planning and Policy Development
Should Tasmania progress the establishment of a local research capacity? Are there key
strategic policy issues and/or developments that should be progressed for the Tasmanian AoD
treatment sector? What strategies should be implemented to ensure that consumers are
engaged in broader policy and planning activities?
4.18 Information Management
The need to address information management issues is an important focus of the Future Service
Directions Plan. A key priority over the past 18 months has been the development of an effective
clinical and data management tool. Significant resources has been invested by both Statewide and
Mental Health Services and the Alcohol and Drug Service to ensure policies, procedures and
practices are agreed upon and finalised so that the design of an information management tool could
be progressed.
Table 35 Additional Financial Investment for Information Management, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government (SMHS Team) $37,247 $37,247
Total Information Management $37,247 $37,247
Achievements against the Future Service Directions Plan
Significant resources have been invested in the initial planning for the development of a client
information management tool. The Alcohol and Drug Service has spent the past 18 months finalising
the large range of forms, procedures and policies associated with service delivery and client care. In
more recent times, training has been provided to clinicians across the state in preparation for the
introduction of the new client information management system, Inpatient Manager (IPM). IPM was
operational on 1 July 2012 and is now being utilised across the Alcohol and Drug Service. It is
anticipated that IPM will greatly improve the quality of activity data collected.
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 45
At this stage, the implementation of a standard client information tool has been limited to the
Alcohol and Drug Service. However, it is recognised that some funded community sector
organisations continue to struggle with their client information management systems and in some
cases organisations continue to rely upon the Alcohol and Drug Information Management System
(ADIMS) – a system with significant limitations. It will be important for community sector
organisations to be able to provide consistent and comparable data on a regular basis to support the
National Minimum Data Set and to assist in local monitoring and planning processes.
Resources have also been allocated to identify and develop a range of key performance indicators
for the Alcohol and Drug Service. These indicators will be collected (and reported) when a client
information management system is implemented.
Initial work has commenced on the introduction of real time reporting across departmental services,
private general practitioners and community pharmacies. At this stage there is still some significant
work to be progressed before the system can be implemented more publically.
The Alcohol and Drug Service is currently investigating information technology solutions for use
within the public pharmacotherapy program and for community pharmacies (including Pharmcare
and iPharmacy).
Future Development Options
1. Continue work on the implementation of a client information management system.
2. Establish an appropriate reporting framework across government and community sector
organisations and consider information technology options to support that framework.
3. Continue to support the implementation of real time reporting within the Alcohol and Drug
Service and across other Departmental and private service providers (general practitioners and
pharmacies).
4. Continue to support the implementation of Pharmcare and iPharmacy for the Alcohol and Drug
Service.
Table 36 Information Management - Achievements against Outcomes
Priority Area Outcomes Progress
Information
Management
A consistent clinical and information
management system for all alcohol and drug
services
Commenced
Improved quality of information reported
nationally
Partially achieved
Consultation Question 22 – Information Management
Should the sector look to establish a common client information management and reporting
system (across both the government and community sectors)? What information technology
solutions are currently available that could be modified to meet the needs of the Tasmanian
AoD sector?
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 46
4.19 Legislative Reform
The Future Service Directions Plan highlights the need to undertake a review of the Alcohol and
Drug Dependency Act, 1968.
Table 37 Additional Financial Investment for Information Management, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12
Government (ADS) $52,000
Total Support for Families $52,000
Achievements against the Future Service Directions Plan
The review of the Alcohol and Drug Dependency Act, 1968 commenced in February 2010 and is
planned for completion in 2012. A draft Discussion Paper has been finalised and released for
consultation. A reference Group has been established to support the review and to provide
feedback as required. It is anticipated that the discussion paper will be released for consultation in
late 2012. Feedback received from the consultation process will help to inform recommendations
on the future legislation.
Future Development Options
1. Further consultation will be undertaken and will involve a series of small to medium size focus
groups with the general community and external/internal stakeholders.
2. Feedback received from consultations will be consolidated into a directions paper comprising of
recommendations and options for legislative reform. Consideration of these recommendations
and, if relevant, the progression of legislative options will then be actioned.
Table 38 Legislative Reform - Achievements against Outcomes
Priority Area Outcomes Progress
Legislative Reform A legislative framework which supports the
models of service delivery and protects the
rights of clients
Commenced
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 47
5 Financial Overview of Expenditure
The following table provides details of the allocation of funding provided in the 2008/09 State Budget
over the four year period: 2008/09 to 2011/12.
Table 39 ATOD Service Development Funding Allocation, 2008/09 to 2011/12
2008/09 2009/10 2010/11 2011/12 Total
Allocation (2008/09 State Budget) $1,788,000 $3,810,000 $5,450,000 $6,160,000 $17.208
It should be noted that ADS has been required to deliver savings in the 2009-10 ($200,000) and
2011-12 ($805,000) financial years which were taken from the Future Services Direction budget
reducing the annual recurrent budget to $5,355,000.
Details of recurrent expenditure to date and anticipated future allocation (2011/12) for ATOD
treatment services in Tasmania is outlined in the table below. The table provides expenditure details
by service type, by region and by service sector.
Table 40 ATOD Service Development Recurrent Expenditure and Future Allocation, 2008/09
to 2011/12
Withdrawal Management 2008/09 2009/10 2010/11 2011/12
South
Staffing Restructure - Government Inpatient
Withdrawal Management Unit $14,153 $157,977 $157,977 $150,000
Total Withdrawal Management $14,153 $157,977 $157,977 $150,000
Opioid Pharmacotherapy Program
South
Additional Staff - Government
Pharmacotherapy Program $45,021 $230,927 $660,927 $982,513
North
Additional Staff - Government
Pharmacotherapy Program $42,000 $300,000 $60,000 $515,129
North West
Additional Staff - Government
Pharmacotherapy Program $430,951 $100,000
Total Opioid Pharmacotherapy $87,021 $530,927 $1,151,878 $1,597,642
Consultation Liaison Services
Statewide
Additional Staff - Government $25,000 $220,000 $220,000
Total Consultation Liaison Services $25,000 $220,000 $220,000
Residential Rehabilitation Services
South
Funding Provided to two Community Sector
Organisations $160,839 $249,618 $249,618 $249,618
North
Funding Provided to one Community Sector
Organisation $117,000 $174,740 $174,740 $174,740
Total Residential Rehabilitation $277,839 $424,358 $424,358 $424,358
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 48
Youth Intervention Services 2008/09 2009/10 2010/11 2011/12
South
Additional Staff - Government $39,101 $78,202 $90,000 $100,000
Funding to Community Sector Organisation $20,000 $87,000 $87,000 $87,000
North
Additional Staff - Government $20,527 $88,949 $88,950 $100,000
North West
Funding Provided to two Community Sector
Organisations $40,000 $174,000 $174,000 $174,000
Total Youth Intervention Services $119,628 $428,151 $439,950 $461,000
Outreach Services
South
Additional Staff - Government $50,000
Funding to Community Sector Organisation $180,000
North
Additional Staff - Government $50,000
Funding to Community Sector Organisation $200,000
North West
Additional Staff - Government $50,000
Funding to Community Sector Organisation $180,000
Total Outreach Services $710,000
Management of Complex Needs
South
Funding to Community Sector Organisation $135,000 $180,000 $180,000
North
Additional Staff - Government $50,000 $50,000
Funding to Community Sector Organisation $60,000 $80,000 $80,000
Statewide
Funding to Community Sector Organisation $60,000 $80,000 $80,000
Total Care Coordination $255,000 $390,000 $390,000
Brief and Early Intervention Services
Statewide
Additional Staff - Government $290,000 $145,000
Funding to Community Sector Organisation $55,000 $55,000
Total Brief and Early Intervention Services $345,000 $200,000
Places of Safety Services
Statewide
Review of Places of Safety (Turning Point) $11,880 $20,780 $30,000
Funding to Community Sector Organisation $60,540 $85,000 $95,000
Total Places of Safety Services $11,880 $81,320 $115,000 $95,000
Support for Families
North
Funding to Community Sector Organisation $ $200,000
Total Support for Families $ $200,000
Population Based Strategies 2008/09 2009/10 2010/11 2011/12
Statewide
Additional Staff - Government $20,000 $20,000 $20,000 $20,000
Total Population Based Strategies $20,000 $20,000 $20,000 $20,000
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 49
Workforce Development
Statewide
Additional Staff – Government $10,386 $200,000 $230,000 $200,000
Community Sectors $80,000 $80,000 $80,000
Total Workforce Development $10,386 $280,000 $310,000 $280,000
Planning and Policy Development
Statewide
Funding to Community Sector Organisation
to provide Consumer and Carer Advocacy
Service $206,831 $259,000 $259,000
Policy and Service Development Govt $23,777 $95,106 $332,000 $348,000
Total Planning and Policy Development $23,777 $301,937 $591,000 $607,000
Total Expenditure and Future Allocation for
ATOD Treatment Service Delivery in Tasmania $564,684 $2,504,670 $4,165,163 $5,355,000
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 50
6 Statistical Summary of Activity
The following section provides a statistical summary of activity from across the sector. It is
important to note that there are some limitations with some of the data provided in the following
section. The following data has been collated from internal data bases (in the case of activity related
to the Alcohol and Drug Service) and from the National Minimum Data Set (information which has
been collated from the out dated Alcohol and Drug Information Management System). There
continues to be a range of issues related to the quality of the data and the utilisation of data
collection systems.
6.1 Withdrawal Management
Over the past three years monthly admissions to the Inpatient Withdrawal Management Unit have
averaged 18.6 admissions per month with the lowest number of admissions occurring in December
2009 with only 9 admissions for that particular month. However, in recent months there has been a
small growth in the numbers of monthly admissions to the Unit, with the highest number of
admissions occurring in May 2012 where there were a total of 33 admissions for the month.
The graph below shows the average length of stay for clients in the Inpatient Withdrawal
Management Unit over the past three years. Typically clients stay and are treated within the Unit
from between five to seven days. The average length of stay for the past three years is 6.16 days (as
demonstrated by the red line in the graph below). It is interesting to note that in January 2010 and
again in 2011, there was a significant reduction in the average length of stay from the previous
months (in December 2009 the average length of stay was 7.60 days which reduced to 5.00 days in
January 2010 and in December 2010 the average length of stay was 5.21 days which reduced to 4.31
days in January 2011). Although this pattern was not as significant in January 2012, the average
length of stay had reduced in December 2011 and remained low in January 2012. A similar pattern
(although not as dramatic) can also be observed towards the middle of each year (May, June and
July). Of further interest, is to consider the monthly admission for January which has increased each
year on the previous month (see earlier graph). This indicates that in January of each year there is a
pattern of increased client admissions that have a much shorter length of stay. Further research
would be needed to determine if this is a seasonal pattern or has resulted for some other reason.
0
5
10
15
20
25
30
35
Jul-0
9
Aug
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12
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Mar
-12
Apr
-12
May
-12
Jun-
12
Withdrawal Management Unit Monthly Admissions, July 2009 to June 2012
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 51
The graph bellows shows the average bed occupancy rate for the inpatient Withdrawal Management
Unit for the past three years. The rate has remained reasonably constant at around the 45% (or 4.5
beds occupied on average) with some small fluctuations up and down over the three year period.
September 2009 saw the highest average occupancy rate of 68.2% with the lowest occurring in July
2011 with a rate of 31.8%.
6.2 Pharmacotherapy
As discussed in earlier sections, there has been significant effort and investment into the Opioid
Pharmacotherapy Program in Tasmania over the past four years. The priority for Tasmania has been
to improve the quality (and reduce the risks) of treatment for clients within the program. The effort
has been focussed on recruiting and retaining specialist clinical positions (medical and nursing) and to
establish comprehensive guidelines and clinical practice standards.
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00Ju
l-09
Aug
-09
Sep
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Nov
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Jan-
10
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Jul-1
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Jan-
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Feb
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Mar
-12
Apr
-12
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-12
Jun-
12
Withdrawal Management Unit Average Length of Stay, July 2009 to June 2012
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Jul-0
9
Aug
-09
Sep
-09
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb
-10
Mar
-10
Apr
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May
-10
Jun-
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Jul-1
0
Aug
-10
Sep
-10
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-10
Nov
-10
Dec
-10
Jan-
11
Feb
-11
Mar
-11
Apr
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-11
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Jul-1
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-11
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-11
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Nov
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Dec
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Jan-
12
Feb
-12
Mar
-12
Apr
-12
May
-12
Jun-
12
Withdrawal Management Unit Average Bed Occupancy Rate, July 2009 to June 2012
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 52
Table 41 below provides details of total numbers of clients treated on the pharmacotherapy
program for the past three financial years (2009-10 to 2011-12). Effectively, the table provides the
total number of individuals that have been on the program for some period within the relevant year
(remembering that clients leave the program and new clients commence). The total number of
clients supported on the program has remained fairly constant at just under eight hundred
individuals each year for the past three years. However the table demonstrates that there has been
a shift of clients from the private sector to the Alcohol and Drug Service.
Table 41 Tasmanian Opioid Pharmacotherapy Program, Total Individual Clients, 2009/10 to
2011/12
Year ADS Private Total
2009-2010 419 366 785
2010-2011 402 382 784
2011-2012 468 323 791
The graph below further demonstrates the changes in total clients being treated by the Alcohol and
Drug Service and by private prescribers.
Table 42 below shows that, over the past five years, the total number of clients on the Opioid
Pharmacotherapy Program has fluctuated from a low of 569 in March 2008 and again in February
2010 to a high of 659 in March 2011. In the years following increased investment (2008-09 to 2011-
12) the total number of clients on the program averaged 624 which is just over a six per cent
increase on the average number of clients of 587 on the program prior to the increased investment
(in 2007-08).
0
100
200
300
400
500
600
700
800
900
2009-2010 2010-2011 2011-2012
Tasmanian Pharmacotherapy Program Total Annual Clients by Prescriber, 2009/10 to June 2011/12
Total
ADS
Private
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 53
Table 42 Tasmanian Opioid Pharmacotherapy Program, Active Clients, 2007/08 to 2011/12
Year Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2007-2008 603 595 591 603 597 590 582 576 569 575 577 588
2008-2009 574 573 579 598 614 610 607 608 615 614 622 634
2009-2010 631 633 628 628 633 579 602 569 602 618 606 621
2010-2011 626 629 648 648 642 653 643 653 659 643 653 645
2011-2012 657 648 639 640 642 636 633 623 628 630 630 608
The following graph provides total number of clients treated on the program from July 2009 to June
2012. Although client numbers have remained relatively constant, there was a decline in numbers
towards the end of 2009 and in early 2010. This decline resulted from difficulties in maintaining
prescribers within program.
The graph below shows total number of clients treated on the program from July 2009 to June 2012
by prescriber (prescriber employed by the Alcohol and Drug Service or employed privately). In July
2009 the Alcohol and Drug Service was managing 309 clients on the program which rose to 327 in
June 2012. The decline in numbers in late 2009 and early 2010 occurred in both the Alcohol and
Drug Service and the private sector. As mentioned earlier this occurred due to difficulties in
maintaining medical specialists (within ADS) and the movement of clients from a retiring general
practitioner to another general practitioner. The changes in client numbers remained similar for
ADS and private prescribers until early 2012. At that point there was a significant divergence caused
by a number of clients transferring from a private prescriber to being managed by the ADS.
520
540
560
580
600
620
640
660
680
Jul-0
9
Aug
-09
Sep
-09
Oct
-09
Nov
-09
Dec
-09
Jan-
10
Feb
-10
Mar
-10
Apr
-10
May
-10
Jun-
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Jul-1
0
Aug
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Sep
-10
Oct
-10
Nov
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Dec
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Jan-
11
Feb
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Mar
-11
Apr
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May
-11
Jun-
11
Jul-1
1
Aug
-11
Sep
-11
Oct
-11
Nov
-11
Dec
-11
Jan-
12
Feb
-12
Mar
-12
Apr
-12
May
-12
Jun-
12
Tasmanian Pharmacotherapy Program Total Clients, July 2009 to June 2012
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 54
The following graph further highlights the difficulties Tasmania faces with retaining prescribers in the
Pharmacotherapy Program. In 2007-08 there were 52 prescribers participating in the program
which declined to a low of 31 in 2009-10 (representing a decline of 40%) before slightly increasing to
a current figure of 38. Fortunately there has been a slight increase in the number of dosing locations
across the State, rising from 50 in 2007-08 to 60 in 2011-12.
6.3 Psychosocial Interventions (Community Team) – Alcohol and Drug Service
The graph below shows both closed and open episodes of treatment for the Alcohol and Drug
Service’s psychosocial program (or Community Team). It has long been recognised that the
measurement of treatment episodes is not a good indicator of activity or performance as it only
measures episodes of treatment and does not provide an indication of the level of complexity
involved in episodes of treatment. However, the information is presented here to show changes
over the past three years.
250
260
270
280
290
300
310
320
330
340
350Ju
l-09
Aug
-09
Sep
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-09
Nov
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Jan-
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Feb
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-10
Apr
-10
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Jul-1
0
Aug
-10
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-10
Oct
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Nov
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Dec
-10
Jan-
11
Feb
-11
Mar
-11
Apr
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May
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Jul-1
1
Aug
-11
Sep
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Oct
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Nov
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Dec
-11
Jan-
12
Feb
-12
Mar
-12
Apr
-12
May
-12
Jun-
12
Tasmanian Pharmacotherapy Program Total Clients by Prescriber, July 2009 to June 2012
ADS Private
0
10
20
30
40
50
60
70
2007-08 2008-09 2009-10 2010-11 2011-12
Tasmanian Pharmacotherapy program Prescribers and Dosing Locations, 2007/08 to 2011/12
Prescribers Dosing Locations
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 55
Over the past three years there has been a slight overall decline in both closed and open treatment
episodes, with open episodes dropping from a high of 118 in August 2009 (and again in October
2009 and again in March 2010) to a low of 49 in December 2011. The numbers of open episodes
have increased in recent times with 112 episodes reported in May 2012. The trend for closed
episodes is similar with a high of 124 reported in July 2012 which has to a low of 51 in June 2012. It
is difficult to pinpoint a reason for the decline without further detailed research. The Alcohol and
Drug Service has implemented a new client information management system (in July 2012) which
should provide more clarity in the level of activity for the psychosocial program.
6.4 National Minimum Data Set
The Alcohol and Other Drugs Treatment Services – National Minimum Data Set (AODTS-NMDS) is
a nationally agreed set of common data items collected by government-funded service providers for
clients registered for alcohol and other drug treatment.
The collection aims to provide:
demographic information of clients who use government-funded treatment services;
the treatments they receive, and;
administrative information about the agencies that provide alcohol and other drug treatment.
For the purposes of this review basic summary information from the AODTS-NMDS has been
utilised. Further statistical data from the AODTS-NMDS can be accessed via the Australian
Institute of Health and Welfare’s website at: www.aihw.gov.au
Table 43 below provides summary information from the three most recent AODTS-NMDS, 2007-08
to 2009-10. Over the three year period, Tasmanian treatment services are seeing an increased
proportion of male clients, having risen from 68.5 per cent of total clients in 2007-08 to 71.2 per
cent in 2009-10. Interestingly this is an opposite trend with that at a national level, where the
proportion of males dropped from 68.3 % of all clients in 2007-08 to 66.4% in 2009-10.
0
20
40
60
80
100
120
140
Jul-
09
Au
g-0
9
Sep
-09
Oct
-09
No
v-0
9
Dec
-09
Jan
-10
Feb
-10
Mar
-10
Ap
r-1
0
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-10
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-10
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10
Au
g-1
0
Sep
-10
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No
v-1
0
Dec
-10
Jan
-11
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Mar
-11
Ap
r-1
1
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-11
Jun
-11
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11
Au
g-1
1
Sep
-11
Oct
-11
No
v-1
1
Dec
-11
Jan
-12
Feb
-12
Mar
-12
Ap
r-1
2
May
-12
Jun
-12
Psychosocial Program (Community Team), ADS Treatment Episodes, July 2007 to June 2012
Closed Episodes Open Episodes
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 56
Table 43 Closed Treatment Episodes by Client Type, Sex and Age, Tasmania and Australia,
2007-08 to 2009-10 (per cent)
2007-08 2008-09 2009-10
Tas Aus Tas Aus Tas Aus
Client type
Own drug use 92.3 95.9
95.3 96.1 94.0 95.9
Others’ drug use 7.7 4.1
4.7 3.9 6.0 4.1
Sex
Male 68.5 68.3
69.7 66.7 71.2 66.4
Female 31.5 33.6
30.3 33.2 28.8 33.5
Not stated
0.1
— 0.1 0.1 0.1
Age group (years)
10–19 16.7 11.4
18.1 12.1 23.6 12.5
20–29 35.2 31.1
32.5 30.5 28.4 29.1
30–39 25.2 28.6
24.0 28.0 22.5 27.9
40–49 14.5 18
14.4 18.2 15.4 18.9
50–59 5.8 7.7
7.2 7.9 7.2 8.2
60+ 2.5 2.9
3.0 3.0 2.9 3.3
Not stated 0.1 0.3 0.9 0.2 — 0.1
Source: AIHW 2011. Alcohol and other drug treatment services in Australia 2007-08, 2008-9 and 2009-10: report on
the National Minimum Data Set.
Table 43 also shows that in Tasmania the proportion of closed treatment episodes have increased
for younger clients over the three year period. In 2007-08, clients aged 10-19 years made up 16.7
per cent of all treatment episodes which rose to 23.6 per cent in 2009-10 (which is almost twice the
rate of 12.5 per cent recorded nationally in 2009-10). The graph below clearly shows that the
proportion of treatment episodes provided to 10-19 year olds has steadily increased in Tasmania.
Conversely the proportion of treatment episodes provided to 20-29 year olds has decreased in
Tasmania. Other age groups have remained relatively stable. This trend is reflective of the
increased emphasis (and investment as part of the Future Service Directions Plan) on supporting
younger people in Tasmania.
Source: AIHW 2011. Alcohol and other drug treatment services in Australia 2007-08, 2008-9 and 2009-10: report on
the National Minimum Data Set.
0
5
10
15
20
25
30
35
40
10–19 20–29 30–39 40–49 50–59 60+ Not stated
%
Age
Closed Treatment Episodes by Age, Tasmania, 2007–08 to 2009-10
2007-08 2008-09 2009-10
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 57
7 Summary of Consultation Questions
Consultation Question 1 – Financial Investment
Has the investment of funding through the Future Service Directions Plan helped to improve the
capacity of the sector? Has it helped to lift the profile of the sector?
Consultation Question 2 – Financial Investment Across Priority Areas
Was the allocation of funding across the priority areas appropriate and did it provide positive
outcomes for clients and services? Has the funding gone some way to addressing service issues?
What issues still remain? What areas would require further investment? Are there opportunities
for improvement that don’t require an increased financial investment?
Consultation Question 3 – Sector Development Governance
Will the establishment of an Alcohol and Other Drug Treatment Expert Working Group (with
more representation from the community sector) be beneficial in progressing the range of issues
for the sector? Are there alternative models that may achieve better representation and
engagement from across the sector?
Consultation Question 4 – Inter Agency Working Group on Drugs
Does the current structure of the Inter Agency Working Group on Drugs adequately support the
coordination of drug related initiatives across Tasmania?
Consultation Question 5 – Tiered Service Delivery Model
Does the tiered model of service delivery adequately describe the role of specialist treatment
services and the responsibilities of mainstream services in managing alcohol and other drug issues?
If not, is there a better model that defines broader roles and responsibilities?
Consultation Question 6 – Withdrawal Management
What opportunites exist to improve access and utilisation of the specialist Inpatient Withdrawal
Management Unit? Does Tasmania need to invest in alternative models of withdrawal
management (including a model to support young people)?
Consultation Question 7 – Opioid Pharmacotherapy
What should the ADS do to better support current external providers (general practitioners and
community pharmacists) and to encourage the involvement of new general practitioners and
pharmacists in Tasmanian Opioid Pharmacotherapy Program? Will supporting the “shared care”
model build the capacity and improve access to the Pharmacotherapy program? If not, what other
options could be explored?
Consultation Question 8 – Consultation Liaison
How valuable is a specialist consultation liaison service in Tasmania? With limited resources is
this an area of service provision that should be expanded? Should a specialist consultation liaison
service be limited to supporting hospitals? Are there more effective mechanisms to support
mainstream health services?
Consultation Question 9 – Residential Rehabilitation
Are the current residential rehabilitation services meeting the need in Tasmania? What additional
support or initiatives would benefit the current residential rehabilitation services?
Consultation Question 10 – Youth Intervention Services
Has the investment in additional youth specialists enabled services to increase their capacity? Are
there significant areas of AoD treatment service gaps for young people affected by alcohol and
drugs in Tasmania? If so, how might they be addressed?
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 58
Consultation Question 11 - Outreach
Is an outreach type model of service provision the most effective way to support clients in more
rural and remote areas of Tasmania? What would be an appropriate service model to support an
area such as the West Coast?
Consultation Question 12– Relapse Prevention
Most services include, as part of their treatment interventions, aspects of relapse prevention. Is
there a specific need to focus on a more consistent approach to relapse prevention? If so, could
this be achieved through guidelines, broad policy position and/or workforce development? Are
there other options to consider?
Consultation Question 13 – Management of Complex Needs
What resources/supports would help services better manage people with complex needs? Is
there a need for clinical guidelines and associated training for supporting clients with complex
needs (beyond mental health issues)?
Consultation Question 14 – Brief and Early Interventions
What resources would assist AoD workers to deliver brief interventions (eg guidelines, training)?
Would investment in a brief intervention approach that mirrors the ABC approach to smoking
cessation be effective in reducing alcohol consumption and its associated harms?
Consultation Question 15 – Places of Safety
Are there further opportunities to develop and refine the model of places of safety services?
Consultation Question 16 – Smoking Cessation
Has the development of the e-learning tool been a success? Are there particular groups of
smokers that should be identified as a priority for smoking cessation support?
Consultation Question 17 – Supporting the Aboriginal Community
Has the establishment of an Aboriginal Policy and Liaison Officer assisted to reduce the barriers
to AoD treatment for the Tasmanian Aboriginal Community? What other opportunities exist to
improve treatment for the Aboriginal community?
Consultation Question 18 – Workforce Development
What are the biggest workforce development issues facing the sector at this stage? What
strategies should be in place to address those issues?
Consultation Question 19 – Continuous Quality Improvement
What strategies can the sector implement to encourage and support continuous quality
improvement? How can we measure and monitor the quality and performance of the sector?
Consultation Question 20 – Advocacy Support and Consumer Engagement
Has the establishment of advocacy support for clients assisted with resolving issues for clients or
seen positive changes in service delivery across the sector? Advocacy Tasmania will progress a
range of key initiatives to support consumer engagement in the delivery of AoD treatment
services. Are there other opportunities for consumer engagement?
Consultation Question 21 – Governance, Planning and Policy Development
Should Tasmania progress the establishment of a local research capacity? Are there key strategic
policy issues and/or developments that should be progressed for the Tasmanian AoD treatment
sector? What strategies should be implemented to ensure that consumers are engaged in broader
policy and planning activities?
Future Service Directions Plan – Analysis of Performance Consultation Draft Page 59
Consultation Question 22 – Information Management
Should the sector look to establish a common client information management and reporting
system (across both the government and community sectors)? What information technology
solutions are currently available that could be modified to meet the needs of the Tasmanian AoD
sector?
Alcohol and Drug Service
Department of Health and Human Services
GPO Box 125, Hobart 7001
Ph: 1300 139 641