Perspectives of Regional and National Federations: Australasian Therapeutic Communities Association

Dr Lynne Magor-BlatchExecutive Officer, ATCAWFTC ConferenceBangkok, ThailandNovember 2018

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The area we cover – US & Australia

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Australian First Nationslanguage groups

Australian Aboriginal languages consist of around 290–363 languages belonging to an estimated twenty-eight language families and isolates, spoken by Aboriginal Australians of mainland Australia and a few nearby islands.

Europe -Australia

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ATCA Achievements• The development of quality Standards for Therapeutic Communities and

Workforce Development have been the prime focus for ATCA for a number of years – and particularly since 2002, with the launch of the Towards Better Practice in Therapeutic Communities project.

• Key achievements:1. The ATCA Standard for Therapeutic Communities and Residential

Rehabilitation Services2. Interpretive Guides to accompany the Standard – for Adult, Youth and

services working with Aboriginal and Torres Strait Islander populations3. TC Training Course – comprising 7 modules, including professional

practicum. Developed in New Zealand and specifically altered for both NZ and Australian audiences, and offered in NZ and Australia (13 courses to date)

4. Release of the ATCA Strategic Plan 2017 – 2021

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Since its inception in 1986, a major concern for ATCA has been the implementation of program evaluation processes as required by both funding agencies and management committees.

In addition to individual program evaluations, ATCA recognised the need to assist member agencies to continually improve service delivery, therefore the review mechanism selected was a Quality Assurance task conducted as a Peer Review.

Peer reviews conducted regularly from 1988.

Why did ATCA develop Standards?

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Quality Assurance and Standards• As TCs have developed and changed, spreading along a continuum, there

has been a drift towards the centre, resulting in a noticeable change in the characteristics that define a therapeutic community.

• This drift in the model was in part due to individual service development, funding constraints and expectations and the lack of an agreed overarching Standard.

• This drift continues today and threatens to dilute the model unless the essential elements of a therapeutic community are preserved.

“standard practice creates a replicable pattern for learning and teaching or practicing the TC concept. It allows us to measure and compare treatment

outcomes and it lends fidelity to the practice of the TC.”Perfas, F, Dr. Therapeutic Community Past. Present.

And moving forward to get over addiction (p33).

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Towards Better Practice in Therapeutic Communities• This project was undertaken by ATCA in 2002, with the following

objectives: to develop clear guidelines relating to the future establishment of

TCs and/or the expansion of existing programs; to inform funding decisions; to provide an agreed model for effective interventions; to develop greater transparency in the operation of TC programs; to identify current practice in Australia and compare it to

international practice; and to develop strategies for TCs to implement continuous quality

improvement.

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• The project included examination of the SEEQ (developed by Melnick, De Leon, Hiller and Knight, 2000) and resulted in the identification of treatment elements more specific to Australian and New Zealand TCs, enabling a link between those elements, treatment experiences and treatment outcomes.

• This reduced the original list of 139 elements to 79 under the following headings:

Towards Better Practice

A. TC Ethos (reflecting the nature of the TC environment which provides a background context to intervention);

B. Aspects of program delivery (reflecting the components of intervention experienced by residents of TCs);

C. Quality assurance (more routine aspects that are important to ensuring that TCs operate in accordance with current health care standards).

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Development of the ATCA Standard

• Work on the ATCA Standard commenced with a grant from the Australian Department of Health and Ageing in 2009.

• First pilot conducted in 2010. • ATCA Standard was registered with the Joint Accreditation System of

Australia and New Zealand (JAS-ANZ) in 2013. • Refinement of the ATCA Standard to make it relevant to residential services. • Resulting ATCA Standard offers two levels of accreditation.

1. Residential Rehabilitation Program.2. Therapeutic Community.

• As a consequence of the expansion of the ATCA Standard, ATCA membership categories have also been expanded to allow the inclusion of a wider membership base.

• Increased opportunity for services to develop their services to embrace the TC model.

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2nd Edition Standard

AUSTRALASIAN THERAPEUTIC COMMUNITIES ASSOCIATIONSTANDARDFOR THERAPEUTIC COMMUNITIESANDRESIDENTIAL REHABILITATION SERVICES

Second Edition September 2017

• 13 Performance Expectations• 23 Performance Objectives

• 50 Essential Criteria• 11 Good Practice Criteria

Two tiers:1. Performance Expectations 1-6

Residential Rehabilitation Service focussed

2. Performance Expectations 1-13 Therapeutic Community focussed.

The ATCA Standard is supported and accompanied by Interpretive Guides for Adult, Youth and services working with Aboriginal and Torres Strait Islander populations, which lay out the evidence needed to meet each of the Performance Expectations and Criteria.

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ATCA Standard• September 2017 - Second

Edition of ATCA Standard• Second Edition of Interpretive

Guide

•

• Third Edition of Youth Interpretive Guide

• Interpretive Guide for services working with Aboriginal and Torres Strait Islander populations

INTERPRETIVE GUIDE TO THEAUSTRALASIAN THERAPEUTIC COMMUNITIES ASSOCIATION STANDARDFOR THERAPEUTIC COMMUNITIES AND RESIDENTIAL REHABILITATION SERVICES WORKING WITH ABORIGINAL AND TORRES STRAIT ISLANDER CLIENTS AND RESIDENTS

First Edition May 2018

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Achievement of Industry Accreditation + ATCA Certification

• Performance expectations 1-6 applicable to Residential Rehabilitation and Therapeutic Communities.

• Performance expectations 7-13 applicable to Therapeutic Communities only.• ATCA currently developing 14th expectation to address Governance and Financial

requirements.• This will negate the additional requirement (in place currently) for ATCA

members in both the RRS and TC categories to have in place an Industry Accreditation process and be accredited under this.

• Organisations can then choose pathway:• RR – 1 – 6 + Industry Standard = Accredited and Certified (ATCA)• RR – 1 – 6 + 14 = Accredited and Certified (ATCA)• TC – 1 -13 + Industry Standard = Accredited and Certified (ATCA)• TC – 1 -13 + 14 = Accredited and Certified (ATCA)

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ATCA Membership categoriesCategories of membership: Certified Therapeutic Community – Organisational and Group

(more than one location) Member. Therapeutic Community – Organisational and Group Member. Certified Residential Rehabilitation Service – Organisational

and Group Member -Associate Member. Residential Rehabilitation Service – Organisational and Group

Member - Associate Member.• Affiliate Member – Individual and Organisational, including Life

Membership.

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TC Training Course

• Developed by our New Zealand members through funding provided by NZ Ministry of Health and auspiced by Matua Raki.

• Course content is presented within learning activities which include:

• individual activities• group activities• presentations• role play and case scenarios• self-directed learning activities and assignments

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TC Training Course: IntroductionCourse Modules Time Self-directed

learning hours

BLOCK 1 TRAINING -

Module 1. Course orientation; Overview of the TC 1 day4

Module 2. Community-as-method 1 day 4

Module 3. TC structure, organisation and environment 1 day 2

BLOCK 2 TRAINING -

Module 4. Relationships in a TC 1 day 2

Module 5. Staff roles and responsibilities and rational authority 1 day4

Module 6. Group work; TC tools; work as therapy; continuing care 1 day4

Module 7. Supervised practicum: learning by experience 40*

Total 88 20

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Modules

• Module 1. Course orientation and Overview of the TC provides an introduction to the overall course including learning objectives, teaching and learning strategies, course components, an overview of the TC approach and an introduction to basic TC concepts and components.

• Module 2. Community-as-method focuses on developing a foundation understanding of community-as-method.

• Module 3. TC structure, organisation and environment develops understanding of how structure and environment are integral to the TC approach and how they support development of skills for healthy living.

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Modules• Module 4. Relationships in the TC focuses on understanding relationships in

the TC and the role of staff in supporting healthy relationships.

• Module 5. Staff roles and responsibilities and rational authority develops understanding of the roles and responsibilities of TC staff members.

• Module 6. Group work, community tools, work as therapy & continuing care develops understanding of TC treatment tools and processes designed to encourage positive change in residents.

• Module 7. Supervised practicum provides a key opportunity for observing the theoretical learning in the TC approach in practice. Gain experience the TC environment; demonstrate ability to apply theory to practice; further develop practice skills appropriate to the TC.

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TC Training Course• 2016 -2017, three courses in NZ (90 participants).• In 2018, 10 training courses across Australia in Sydney (2), Melbourne (3),

Perth (1), Brisbane (1), Adelaide (1), Canberra (1) and Darwin (1) with 255 people attending and becoming trained in TC method.

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Strategic Plan

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Our Approach• Priority 1 – To ensure the membership

of ATCA is committed to quality, through the adoption of the ATCA Standard

• Priority 2 – To improve the knowledge and confidence of governments in the quality of ATCA member services

• Priority 3 – To sustain and grow ATCA and its membership base

• Priority 4 – To build a strong workforce through the fostering of professionalpeer support and development amongst member organisations

• Priority 5 – To encourage and support ongoing research into the Therapeutic Community Model

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Thank you

For more information –Dr Lynne Magor-Blatch

Ph. +61 422 904 040Email: atca@atca.com.au

www.atca.com.au