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: ceo@atdc.org.au 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.