Submission to the National Drug Strategy Consultation
National Drug Strategy Consultation
MDP 27
GPO Box 9848
Canberra ACT 2601
()
February 2010
This brief paper has been prepared in response to the Consultation Paper on Australia’s National Drug Strategy, Beyond 2009.
Odyssey House Victoria
Odyssey House Victoria is a not-for-profit, alcohol and other drug treatment and support organisation that provides opportunities for change and growth by reducing drug use, improving mental health, and reconnecting people to their family and the community.
The first Odyssey House opened in New York in 1966 as a residential rehabilitation program for people with a drug or alcohol addiction. The program was founded on the ancient idea of a therapeutic community. Central to Odyssey House’s philosophy is the conviction that a new, drug-free lifestyle can be created through self-discovery, behavioural change and new relationships. This can be achieved within a supportive environment, based on mutual respect and responsibility.
Today, several Odyssey Houses exist throughout the United States, New Zealand, and Australia. Odyssey House Victoria was established in Melbourne in 1979, toprovide long-term, intensive residential treatment for individuals and families (including parents with addictions and their young children) within an 85 bed Therapeutic Community in Lower Plenty.
Odyssey House Victoria now offers a wide range of community based and residential programs and services throughout the state, including child and family support, dual diagnosis, youth, supported accommodation, short and long term residential rehabilitation, counseling, forensic, and employment programs. In addition, the Odyssey Institute provides nationally accredited training to clients and professionals in Victoria, and beyond through online learning.
Submission
Odyssey House Victoria (OHV)has much to offer as part of the NDS, but also faces a number of critical and difficult challenges, as with many other NGO’s working in the Alcohol and other Drug (AOD) sector. These relate to patterns of drug use, more complex client profiles, greater expectations to addressing multiple problems, adaptation to emerging evidence on what works, increased regulatory, quality assurance and administrative process, and workforce development issues.
To meet this demand, Odyssey House Victoria has been successful in attracting resources from a range of sources, and currently has over 25 separate contracts with different State and Federal Government Departments, Trusts and Foundations, in addition to fee-for-service clients and fundraising income. In order to provide for the holistic needs of the marginalised people and their families who seek our help, OHV is constantly searching for short-term funding to compliment longer term contracts, cobbling together of resources, and servicing multiple providers, all of which have unique reporting and accountability requirements. The efforts of COAG and the COMPACT with the NGO sector will hopefully address some of these issues, but they should be noted as part of this consultation around the NDS, as they impact on an organisations ability to play its part in the strategy.
While Odyssey supports all three pillars of the NDS, this submission will focus on the Demand Reduction aspects of the NDS, which are most relevant to Odyssey House Victoria.
Patterns of Drug Use
OHV recognises that there has been a reduction in overall illicit drug use, however, we are seeing greater number of clients with alcohol problems, and increasingly complex clients with a greater tendency for poly drug use. These clients seem to be suffering greater harmful impacts due to their substance dependencies. There has also been a greater emphasis on alcohol fuelled violence and mental health issues in the AOD sector. Unlike many other organisations, Odyssey House in Victoria stills treats a high proportion of clients with primary heroin addiction, especially in our residential services, where we treat individuals with some of the most chronic and long-term problems. Nevertheless, OHV also believes it also has a responsibility to intervene early by working with at-risk children, and with families affected by addiction, and to contribute to prevention efforts, especially associated with alcohol abuse.
The use of technologies (eg. Web based information and support) and school interventions would be well used in prevention and early intervention efforts over the coming 5 years, but should not replace face to face and more intensive work for those with chronic issues, where isolation and fractured relationships issues underlie addiction and should therefore form the core of treatment.
Increased Demand for Services
For many of our services, especially residential treatment, waiting times for admission are up to 3 months, due to our limited capacity to meet the increasing demand. Consequently, we believe treatment services require additionalinvestment and more flexible funding models in recognition of the:
- actual number of clients seeking help
- complexity of clients who present to treatment services (particularly alongside tightening of resources, eligibility and access to other broader service systems)
- the recognition of the harms and impact to the children and families of drug users and the acknowledged links between drug use and family dysfunction
- increased presentation of clients with co-occurring mental health problems, domestic violence, forensic issues, and vocational and training issues.
- need to strengthen relationships with other sectors, both at an organisational level and case management level, for better coordinated and integrated services and less duplication
Australia’s Drug Policy
Odyssey House Victoria recognises that there is an imbalance between investment to licit and illicit drugs, with insufficient investment in the prevention and treatment of tobacco and alcohol related harm. We also understand that the allocation of resources is difficult when resources are limited. However it is a misnomer to argue that one of the pillars of the NDS is more deserving than another. Given that Australia is a wealthy nation and that there have been a number of studies that validate the benefit to the community of investment into treatment, perhaps a better argument would be that the overall strategy is better resourced, so that investment in one pillar, is not at the expense of another. From our perspective, it is important that funding is targeted to policies that reduce harmful alcohol and other drug use and those interventions and strategies that are funded are grounded in evidence as having a long term impact, and are cost effective. The evidence is clear, treatment works (ANCD, 2001), including mandated treatment (ANCD, 2007) and investment in treatment leads to greater savings and improved health and welfare benefits to the broader community.
Other mechanisms to support this investment should be tax reform, especially the taxation of alcohol products, which while not popular, has been demonstrated to be incredibly effective in reducing demand.
At a policy level, greater emphasis should be placed on supporting families, parents with addictions, and children with substance dependent parents, to better link with child and family services and the child protection system. Furthermore, treatment should focus on recovery beyond simply reducing or ceasing drug use, to include a social inclusion agenda for meaningful community participation.
Workforce
Changes in patterns and increasing knowledge regarding evidence informed practice have led to fundamental shifts in the way alcohol and other drug treatment is practiced. AOD clinicians are now expected to be skilled in a variety of interventions and techniques, ranging from CBT and brief interventions, to working with families, mental health, case management, Indigenous and CALD communities, etc. The demand on the workforce has increased substantially. This requires a more highly qualified and experienced workforce which in turn demands better remuneration.
The allocation of resources has not enabled the existing treatment services to manage these and other emerging trends sufficiently. A critical issue is that as demands on staff have increased to manage complex presentations; alongside substantial workforce development investments; there has not been a fundamental change in funding to services to retain and remunerate skilled and experienced clinical staffs that are required to do the work. There is a continued bleed of this type of staff to other better remunerated service sectors. Given that the mental health sector deals with similar clients and presentation it would not be unreasonable to expect that funding and staff remuneration would be benchmarked similarly.
As a treatment provider however, the capacity to attract, retain appropriately skilled clinical staff and the mix of staff necessary to provide a reasonable treatment service requires a review of the current funding model and the reliance on the Episode of Care as a measure within Victoria, and the lack of resourcing for associated overhead and management costs including clinical supervision of staff.
New treatment interventions that have a sound evidence base such as working with families, breaking intergenerational cycles of disadvantage through programs and interventions targeted at children of addicted parents, programs that tackle drivers of addiction such as those that focus on social inclusion through employment and community participation require specialist skills. OHV provides a broad range of such programs. Clearly as demands and skills have been increasing then career paths and remuneration, particularly for skilled experienced clinicians need to be reviewed. Currently the AOD sector competes with other sectors to retain the level of skilled staff. Skilled clinicians often either move to other sectors or into management roles where they are paid more. Recognition of skilled workers at the front lineneeds to be tied to salaries as well as terms and conditions of employment.
Evaluation, Research & Performance Measures
OHV strongly supports an evidence informed approach to the NDS, including practice-based evidence. Such an approach should take into account the local context and acknowledge that much of the generic research has been conducted by excluding the very clients that we work with, and so may not apply to interventions with them. OHV supports further resourcing of evaluation and research associated with the NDS.
When looking at funding for treatment programs, however, most programs are judged by their throughputs rather than the outcomes they achieve. Furthermore, there is more evidence for Interventions which are easier to document, define, and therefore research. Greater emphasis should be placed in examining the long-term impacts of the breadth of interventions utilised in the sector to ensure the evidence base accurately reflects what works, rather than what is simply easy to evaluate.
Given the complexities of any evaluation and monitoring that accompany NDS, clarity on what to monitor, when and at what point is important. The current global nature of indicators means that an assessment cannot be made of which areas have proven critical to its success or even if some areas have actually been negative in impact.
Current research efforts are primarily statistically oriented. OHV would argue the need for a balance in order for such work to be translated into future actions or planning. OHV would want to know about the effectiveness and efficiency of what has been implemented in order to know “what is working and what isn’t”. There is insufficient high quality data to assist in decision making that is publicly available. Existing indicators are too global to give an accurate picture and data is not timely with report on trends that often have passed. At a service provider level, despite contributing to data collections we received little to no summary data back, which for OHV is important for planning for trends at a local level.
Finally there has been important work done in the area of social determinants of health and well being, with a clearer understanding of the multiple and casual interacting determinants that drive harmful alcohol and drug use. The evidence on cost effective responses however is less clear, particularly when scaled up to large population studies yet I think this is where research and evaluation should be targeted as it holds the most promise in our view of informing funding decision that are most likely to be effective.
Partnerships
OHV supports strong partnerships. Emphasis should be placed on strengthening the Federal / State relationships to ensure greater consistency, parity and coordination between funders of AOD services. Adult AOD services need to strengthen their partnerships with child protection and family services, and vice versa. This is to ensure the needs of adult client who are parents are considered, as well as the needs of their children, and intergenerational cycles of addiction are minimised.
Overall OHV would say that the following are needed:
- Review of NGO funding in recognition of the increased demands and complexities faced by the AOD treatment sector
- Independent evaluation and monitoring to advise decision making throughout the life of the NDS
- Ability to draw from a range of sources of advice including the inclusion of stakeholders external to Federal and State and Territory governments
- Continue the great work of the ANCD for NGO consultation and dissemination of information
- Ability to act in a timely and flexible manner to emerging trends and issues
- A strong communication strategy which provides a clear and consistent message to politicians, media and community
- Access to an evidence base to inform funding decisions through cost effectiveness analyses
- Simplification of the NDS Governance Framework and advisory structures (this is far too complex and makes simple, transparent, accountable decision making impossible).
References:
ANCD (2007). Compulsory treatment in Australia. Australian National Council on Drugs research paper 14.
ANCD (2001). Evidence supporting treatment. Australian National Council on Drugs research paper 3.