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