Response to Law Enforcement and Public Health Issues Paper · respond, and make comment on the Law...
Transcript of Response to Law Enforcement and Public Health Issues Paper · respond, and make comment on the Law...
Response to Law Enforcement and
Public Health Issues Paper
September 2018
Alcohol, Tobacco and other Drugs Council of Tas Inc. (ATDC) www.atdc.org.au ABN: 91 912 070 942 Phone: 03 6231 5002 Facsimile: 03 6231 6099 Email: [email protected] PO Box 4702 Bathurst Street Post Office Hobart, TAS 7000 ©Alcohol, Tobacco and other Drugs Council Tas Inc. 2018, Hobart, Tasmania
The Alcohol, Tobacco and other Drugs Council of Tasmania
The Alcohol, Tobacco and other Drugs Council Tas Inc. (ATDC) is the peak body representing the interests
of community sector organisations (CSOs) that provide services to people with substance use issues in
Tasmania. The ATDC is a membership based, independent, not for profit and incorporated organisation.
The ATDC is the key body supporting the sector to secure adequate systemic support and funding for the delivery of
evidence based alcohol, tobacco and other drug (ATOD) initiatives. We support the sector through training and
sector capacity building, as well as undertaking policy and development projects with, and on behalf of, the sector.
We represent a broad range of service providers and individuals working in prevention, promotion, early
intervention, treatment, case management, research and harm reduction. The ATDC also plays a vital role in
assisting the Tasmanian Government to achieve its aims of preventing and reducing harms associated with the use
of alcohol, tobacco and other drugs in the Tasmanian community.
Thank you for providing the Alcohol, Tobacco and other Drugs Council Tas (ATDC) the opportunity to
respond, and make comment on the Law Enforcement and Public Health Issues Paper. The focus of the
Issues Paper around collaborative public service delivery and whole of government practice is very timely
for the alcohol and other drugs (AOD) sector in Tasmania given the current AOD service system review
being undertaken.
The ATDC has been a proactive contributor to the TILES workshops since 2017 on this subject matter, and
is a very strong supporter of the implementation of a collaborative impact approach. During these
discussions the ATDC has raised a number of challenges facing the AOD sector’s capacity to engage in cross-
sectoral collective impact initiatives, and our submission focuses on providing additional background and
context to this. Whilst not addressing the 17 questions in the Issues Paper, we hope that the following
information will provide valuable information to the purpose of your paper to present collective impact as
a pathway for new collaborative opportunities between law enforcement and public health in Tasmania.
By way of background, the Mental Health, Alcohol and Drug Directorate of the Department of Health is
leading the development of the Alcohol and other Drugs Service System Framework (the Framework) which
will be the new plan to guide the development, funding and delivery of AOD services in Tasmania. The
Framework will assist in the configuration and commissioning of public funded AOD services in the future.
It will also provide a framework to inform better coordinated service system responses across all the
settings that provide services to people who receive some form of AOD treatment. This includes
government and non-government specialist AOD services, primary care and general practitioners (GPs),
public and private practitioners and hospitals, community health services and other allied health services.1.
The development of the Framework is being informed by the recent work of Siggins Miller Consultants
(Siggins Miller) who were engaged during 2017 to undertake an independent analysis of the AOD service
system following on from a 2014 review of drug use and service responses in North West Tasmania.
Relevant to the current work of TILES was the finding that there is strong support across all stakeholders
in the AOD sector for system-level and service-type-specific reform and innovation. The change
management agenda to implement these reforms is significant and will require the ongoing effort and
contribution of all parts of the service system, as well as resourced appropriately to implement the
necessary change activities. Siggins Miller found that the complexity of the change process requires a
joined-up evidence-based approach and they recommended that a collective impact framework be used
to guide the change process.
1 Department of Health and Human Services, AOD Service System Framework Project Update, September 2017
The following is an excerpt from the Siggins Miller Final Report:
There is a need for reform within the treatment system that is client-focused, rather than provider or
institution focused, with services to be designed around client convenience, access and providing support
to seek help as close as possible to where they live. This would align the AOD service system with directions
and reforms in treatment and support of other equally intractable chronic diseases elsewhere in the broader
health system. We suggest that, due to needs of consumers crossing sectoral boundaries across portfolios
and across government, non-government and private sector providers, the system reforms to address the
identified problems be guided by the methodology developed within Stanford University, known as a
Collective Impact Framework2.
The Siggins Miller Report highlights that the focus of this multi-sector work, in the first instance, should
focus on the following:
Partnerships between government and non-government services: Relationships between
government and non-government services have been identified as an area of focus by both service
providers and consumers.
Consumer Representation: We suggest adopting the model of consumer representation used by
the mental health sector in Tasmania to support AOD consumers, and provide consumers with
support and training to increase their understanding of the AOD service system and confidence in
their abilities to provide meaningful input on ways to improve the AOD system.
Management of wait-times: When necessary, actively managing waiting times, through e-health
support to monitor health status and prioritise those deteriorating.
Continuity of care: Support for clients to improve continuity of care, including supporting clients’
transfer from one treatment to another, engage clients while they wait for treatment.
Integrated care pathways: Develop clearly articulated integrated care pathways, provided to
service providers and clients developed in partnership with consumers.
Support for GPs: Greater support for GPs not only in their role in OST but withdrawal and ongoing
treatment in primary health settings3.
2 Siggins Miller Consultants, A single Tasmanian alcohol and other drugs (AOD) service system framework Final Report, August
2017, p9.
3 Siggins Miller Consultants, A single Tasmanian alcohol and other drugs (AOD) service system framework Final Report, August
2017, p10
Over the last decade there have been a number of reviews of the AOD sector, all of which have identified
that while individual service elements and service providers are generally working well, the service system
is difficult to navigate, confusing for clients/consumers and providers and is disjointed.
The main challenges currently facing the AOD service system in Tasmania, as identified by both consumers
and service providers during the Siggins Miller Consultations, are:
A lack of consistent information on how to identify and access appropriate services
Perceived long wait times and sometimes restrictive criteria to access services, particularly
withdrawal management and residential rehabilitation services
Lengthy distances to travel to services, particularly for consumers from the north and northwest
regions, as well as travel required between different services
Lack of integration and communication between different services, including perceived lack of
communication between government and non-government services4
While the AOD service system overlaps with many other health and welfare services and sectors in
Tasmania, and there is recognition that we need a cross sector approach to tackling the co-occurring issues
that our AOD consumers face, the AOD sector acknowledges that we need a cohesive and collaborative
working structure within our own sector, before then trying to integrate with others. A first step is
improved integration between, and within, state and federal funded government and non-government
AOD service providers and programs, and with primary health care, clinical and non-clinical services and
private providers. In recent years, the AOD sector has reported ‘greater complexity’ in client presentations
meaning that there is an increase in multi-morbidities such as mental health, housing issues, financial
stresses which impact on the work of AOD workers. This means there is a greater need to work
collaboratively to address the holistic needs of each client.
Once the AOD sector has embedded some ‘internal’ collaborative practices it will be in a much better
position to provide effective and efficient integration with the justice system. We envisage this will be in
the context of AOD services offered in custodial settings, expansion of drug diversionary programs, legal
aid offered to clients/consumers of AOD services (typically in the context of child safety) and better AOD
services for people being released from prison.
4 Mental Health, Alcohol and Drug Directorate (Department of Health), Reform Agenda for Alcohol and Drug Services in
Tasmania, August 2018, p3
Currently, for the AOD sector, the barriers to collaboration are mainly driven by the current funding
arrangements and agreements whereby agencies engage in a competitive tendering process and are then
‘fragmented’ by being contracted to provide different services (i.e. residential rehabilitation, counselling,
withdrawal, promotion and prevention activities). There is also a real difference in language and models of
care between the medical sector and allied health/AOD workers. This creates some conflict between
service providers and often adds to the disjointed journey through the sector for consumers. There is
opportunity during this reform process for some shared language to be bedded down and agreed upon.
The government AOD sector is driven largely by the ‘medical model’ with the majority of service provision
in this sector focusing on the acute end of the spectrum and staffed by AOD specialists in the inpatient
withdrawal unit, pharmacotherapy program and hospital services. While it must be noted that there are
some psychosocial elements of government service provision, it occurs much more frequently in the
community sector organisations. Many of our larger CSOs provide a range of in house services which
address multi morbidities and provide holistic care to clients.
There is further opportunity to collaborate with funding bodies to ensure that they have surety in what
services they are buying, with the challenge of how to articulate the value of psychosocial interventions.
Funding bodies are often concerned about how outcomes and value for money is measured – sometimes
a single occasion of service can take an entire day, and feature many elements that are not articulated in
reporting schedules or picked up adequately in validated tools.
The ATDC is currently working across, and with, the sector to develop a data/client management tool. We
recognise the above noted differences in language and service models, and as such, significant work in its
development needs to be undertaken before any shared measurement tool can be established, or agreed
upon.
As with any reform/change process, there needs to be adequate resourcing and funding attached to ensure
its success. With the AOD service system reform process, no specific funding has been attached to it which
has created a level of cynicism in the sector as to how successful it will be, or how quickly it will evolve. The
sector is also suffering from a degree of ‘reform fatigue’ as it has been through numerous different reform
processes which have resulted in no, or very little change.
As we know, the first stage of any collective impact initiative is a common, or shared agenda.
At the ATDC 2018 Conference ‘Shaping Our Future’ in May 2018, the 120 delegates focused their thoughts
on a shared vision and were passionate and committed to working towards the best possible alcohol and
other drug system possible. The Conference Communique (below) has been ratified by the majority of
Members and is just awaiting some final affirmations, and provides a wonderful insight to the sector’s
commitment moving forward.
ATDC 2018 Conference ‘Shaping Our Future’ Communique
We the delegates of the 2018 ATDC Conference ‘Shaping Our Future’ gathered in Hobart on May 21 and 22,
reaffirm our commitment to working in the best possible alcohol tobacco and other drug service system
into the future.
We recognise that alcohol and other drug harm continues, with legal drugs perpetuating more harm than
illicit ones. We recognise that the complexity of issues of those presenting to our services continues to grow.
We know that we need to develop and emphasise prevention efforts within our sector and the community.
Underneath all of this is the problem of stigma and discrimination, a problem which undermines prevention
efforts, the provision of treatment and support and ultimately people getting well.
The problem is complex.
We have listened to the perspectives of service users. We have heard that sometimes drugs are not the
problem - it is peoples’ perceptions of drug use that drives stigma and creates barriers to treatment. We
have heard that, for example, fixing housing problems sometimes are as, if not more, important than
working on drug use. We have heard that it needs to be about listening and working with the person
themselves first rather than fixing the ‘problem’ of drug use. The person themselves is not a problem.
We are committed to continuing to listen to those who use our services and we want a client focused service
system.
We recognise that there is some innovative and reflective work occurring in our sector and that we need to
build on this and capture the success. At the centre of our system is a deeply committed workforce, seen by
the engagement at this conference. We need to develop this knowledge and expertise and value our
workforce to continually improve.
We will celebrate, build and learn from our successes as we work and collaborate together.
How do we convert this good will into action?
As we mature as a sector, we are taking some new steps towards organising ourselves and we have a new
commitment to use the data we already collect to inform the spread, the types and the co-design of services.
We are also keen to explore – perhaps through a collective impact approach – a service system designed to
reflect the ‘end to end’ needs of a person seeking support and treatment for their AOD issues. We believe
there is a way we can do this – using data and feedback from the people we work with, we can address the
challenges associated with competitive tendering process that can fragment the collaborative process; at
the same time recognising that we must adapt innovative and evidence-based approaches.
Moving forward we recognise that we can’t afford to be cynical, but in order to do that, we need
coordinated action paving the road to agreed and measurable outcomes. Otherwise we will become
fatigued. We recognise that we hold the solutions, but we need coordinated leadership, action and
adequate resourcing to make this happen.
So, we commit to work together, across Government and community sectors, across AOD and other allied
health services to create a state wide service system to deliver the outcomes our clients need.
We recognise the abundance of expertise and depth in our research institutions, the presence of UTAS at
this conference has been indicative of future multidisciplinary opportunities for partnership. And, this is vital
for our credibility.
Specific areas of focus include:
An integrated AOD service system - we will continue to discuss models and find a way forward. Other
sectors, states and regional areas within Tasmania have experienced success, let’s learn from them.
Embedding the service user voice - this is not only essential in terms of improving our services but
we know it is the right thing to do at all levels. We are a sector that has a social justice agenda
underlying our practice. Without this, our sector will not respond adequately to the needs of our
clients.
Sector wide data system - we know that we can use existing data better to inform our decisions in a
more timely manner and that this is an essential building block for a coherent state wide system.
We want to widen our focus to include GPs and mental health practitioners in developing our
system.
Looking outward - we want statewide training, for example AOD and mental health training for all
health practitioners.
We need to prevent underlying problems associated with AOD use and this starts early and
continues along the lifespan of individuals. We provide services in this area already and we must
continue. We can do better at whole of population level prevention initiatives.
Early intervention and health promotion was something that was missing from our conference - we
must ask ourselves why.
Stronger advocacy on the above points both at the political and community levels.
This requires time. Time to work with clients, time to network with others in the sector, time to think and
consider policy implications and time to participate in broader discussions.
We want to make our service system better and deliver services that Tasmanians need and deserve. We
sincerely acknowledge and thank everyone that presented and chaired our sessions. We thank all of our
delegates for their attention and time.
Tasmania is a small state and it should be relatively easy to implement collective impact initiatives for
specific projects (however keeping in mind that rural and remote areas have different needs to urban
centres). We have seen the success of the Burnie Works project, the Tasmanian Early Intervention Program,
Court Mandated Diversion Program, and the recently formed Safe Families Coordination Unit. All these are
great examples of cross sector collaboration. Their success has been enabled by dedicated resourcing,
staffing and commitment. The same must occur for the AOD sector and its reform process, and similarly
with a larger scale collective impact model across the justice and health sectors.
Our AOD sector already has some great work happening in this space. An example is our residential
rehabilitation providers working together with the impatient withdrawal unit to manage and minimise wait
times and ensure clients are allocated to appropriate services which fit their individual needs. This is
currently being administered through a committee and has been very successful in creating a more timely
and seamless journey for residential rehabilitation clients and providing more efficiencies for the services
themselves. We also have the Regional Alcohol and Drug Services Group on the north-west coast where
service providers from government organisations and CSOs meet to discuss sectoral issues. The ATDC is
currently facilitating the Consumer Organisation Development Project. This project has a system wide focus
and seeks to ensure that the voice of the client is supported and resourced to adequately provide the ‘lived
experience’ voice across the sector, in service delivery and system reform.
There are numerous benefits to working as a collective, including working towards the same goals and
measuring the same outcomes rather than working in isolation for individual impact. Working
collaboratively and holistically can help to address the complex or ‘wicked’ problems that arise, particularly
in the health and justice spheres, which ultimately brings about increased support and outcomes from
individuals navigating these complex and fragmented systems.
The ATDC is committed to continuing our involvement in this ‘collective impact’ space and feel optimistic
and positive about what future may hold.