Until 2003, alcohol policy in New South Wales was determined by the NSW Youth Alcohol Action Plan 2001-2005 and the NSW Adult Alcohol Action Plan. The strategic approach set by these two policy frameworks has been subsumed by the recommendations made at the NSW Summit on Alcohol Abuse and this report in response to those recommendations.
A number of documents will also be developed to set the strategic approach to health and treatment services, over the next four years. These include:
§ NSW Drug and Alcohol Treatment Services Development Plan 2006-2015
§ Alcohol Disease Prevention Action Plan 2005-2009
§ NSW Health Drug and Alcohol Workforce Development Strategic Plan
§ Quality Framework for Managing Drug Treatment Services.
A. DISEASE PREVENTION
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Development of new alcohol disease prevention approaches
3.1 A range of disease prevention initiatives be further developed to address alcohol related disease (eg. thiamine fortification of alcoholic beverages). |
Government Response
Alcohol disease prevention
The Deputy Chief Health Officer, NSW Health, will convene a Committee on Alcohol Disease Prevention including medical and population health experts, non-government organisations and the liquor industry to examine options for disease prevention. The Committee will report in 2005 through the development of the Alcohol Disease Prevention Action Plan 2005-2009. Other chronic and complex disorders attributable to alcohol that will be addressed through the action plan include:
§ Alcoholic Cardiomyopathy
§ Alcoholic Ketoacidosis
§ Alcoholic Liver Disease and Cirrhosis
§ Alcoholism
§ Alcohol Withdrawal Syndrome
§ Ethanol Abuse
§ Foetal Alcohol Syndrome (FAS)
§ Glycol Abuse
§ Isopropyl Alcohol Abuse
§ Methanol Abuse.
Thiamine fortification of alcoholic beverages
Thiamine fortification is an evidence based public health strategy for reducing brain damage.
In Australia, since 1991, it has been a mandatory addition to bread as a prevention strategy for brain disorders such as Wernicke-Korsakoff Syndrome (WKS), a severe neurological disorder caused by vitamin B1 (thiamine) deficiency. Studies have indicated some 10-20 percent of Australians are thiamine-deficient and that Australians have one the highest prevalence of WKS in the world. Heavy drinkers are considered most at risk of developing the disease due to alcohol being the main calorie intake for this group. The syndrome responds well to thiamine supplementation, with marked clinical improvement evident in most cases after treatment.
In 1987, the National Health and Medical Research Council (NHMRC) recommended addition of thiamine to beer and flagon/cask wine to reduce the incidence of WKS. However this did not proceed.
Currently, the Food Regulation Ministerial Council is looking at the issue of fortification and is preparing a position paper on mandatory fortification. NSW Health will seek further advice from the Intergovernmental Committee on Drugs (IGCD), the Australian Health Minister’s Council (AHMC), Foods Standards Australia and New Zealand, and the NHMRC on whether it is advisable and feasible to mandate a minimum level of thiamine in beer under the Food Standards Code.
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Education and information to promote awareness about risks of drinking levels
3.2 Given that a major barrier to treatment is a lack of knowledge about and acceptance of the dangers of alcohol, a range of education and information campaigns, including mass media campaigns, be developed to promote awareness of the risks associated with different levels of drinking.
The major purpose of these campaigns be to reduce the cultural acceptance of high levels of drinking and to encourage people to seek interventions. General campaigns be also framed to target specific groups, i.e. youth. |
Government Response
The NSW and Commonwealth Governments currently run campaigns to raise awareness about the dangers of high levels of alcohol consumption, challenge the drinking culture, and to educate people about drinking guidelines.
Further education and information issues are to be addressed through new initiatives such as the new Alcohol Education and Information Taskforce, a new NSW Alcohol Communication Plan, enhanced partnerships with the liquor industry, community action groups, non-government organisations and liquor accords, and the promotion of safe drinking guidelines and responsible industry advertising. (These initiatives are outlined in the response to recommendations concerning The Community – Section 1.)
The taskforce will identify the key information issues raised during the Summit such as the current lack of education regarding the health and disease risks associated with alcohol abuse. The taskforce will be responsible for promoting the coordination, consistency and quantum of information and education programs.
Specific communication and information initiatives elsewhere in this report will also be referred to the taskforce for consideration, such as the information and education requirements of specific populations groups, including young people and Aboriginal communities.
The NSW Alcohol Communication Plan will be developed by NSW Health to build on current State and Commonwealth Government education and information initiatives relating to alcohol abuse. It will include all the initiatives being undertaken by Government agencies represented on the taskforce.
In addition, NSW Health will:
§ Further reinforce key alcohol messages through a number of population based strategies, including the Chronic Disease Prevention Strategy 2003-2007, a strategy which aims to tackle the major determinants of the burden of disease in New South Wales through primary prevention initiatives.
§ Undertake a chronic disease prevention campaign, addressing alcohol issues. It will include the development of television and radio advertisements, along with GP training and will be trialled in two regions.
§ Develop a series of Fact Sheets on drug and alcohol use for distribution to Area Health Services, as well as on the Department’s website.
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B. WORKFORCE DEVELOPMENT
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Education and training for health workers and General Practitioners
3.3 NSW Health in consultation with the Australian Professional Society on Alcohol and Drugs, the Chapter of Addiction Medicine (RACP), the College of Nursing, other professional bodies and relevant tertiary institutions should investigate an appropriate means to facilitate professional education and training about alcohol (and other drugs) for generalist health workers and non-government organisations and to provide more advanced training for specialist drug and alcohol workers.
Training for health workers on early identification and brief intervention
3.4 Ongoing training should be provided to generalist health workers and community workers in early identification of alcohol related problems and provision of brief interventions.
3.5 Support and training should be provided to General Practitioners with the aim of enhancing both their identification of alcohol related problems and the interventions provided by them. This program would be provided by multiple disciplines and would involve both Government and non-government agencies.
3.17 Provide training to frontline health workers in brief intervention. This should be a mandatory component of training for all primary health care workers and should be aimed at both Aboriginal and non-Aboriginal workers. |
Government Response
Professional education and training including early identification and brief intervention of alcohol problems for health workers
NSW Health is developing the NSW Health Drug and Alcohol Workforce Development Strategic Plan, to be considered by the new NSW Drug and Alcohol Workforce Development Council for submission to the Government.
Current activities will be maintained and strengthened including:
§ Provision of drug and alcohol education curriculum content in the Master of Social Health, Post Graduate Diploma and Postgraduate Certificate in Social Health offered by the Department of Psychology at Macquarie University, and the University of Sydney Medical School drug and alcohol curriculum. Both are funded by the NSW Government.
§ The NSW Health Alcohol and Other Drug Nursing Project (Clinical Guidelines and Framework for Progress 2000-2003 – Alcohol and Other Drug Policy for Nursing Practice in NSW). The project provides nursing staff with the expertise required to effectively manage patients with alcohol and drug related illness, injury or concerns. The framework and Clinical Guidelines are currently being reviewed and updated for release as the Framework for Progress 2004-2007.
§ The Drug and Alcohol Allied Health Worker Advisory Committee established in 2003 by the Centre for Drug and Alcohol at NSW Health. Key issues being examined by the Committee include training and education, standards and emerging clinical issues.
§ Establishment of a Vocational Training Order (VTO) to enable an apprenticeship in the drug and alcohol field. The NSW Community Services Industry Training Accreditation Board has established a new apprenticeship in Certificate IV Alcohol and Other Drugs. NSW Health has provided funding to the Community Services ITAB to develop and pilot resources for the Certificate IV in Alcohol and Other Drugs. These resources will support the processes of Recognition of Prior Learning (recognition of current competence), the pending traineeship for this qualification and workplace based assessment for workers in the drug and alcohol sector in New South Wales. The resources are scheduled for completion in 2005.
§ Certified alcohol and drug prevention and intervention courses provided by TAFE for community health professionals that comply with the Community Services Training Package. In addition new assessment resources are being developed by the NSW Department of Community Services and the Health Industry Training and Advisory Body to support training by TAFE in the drug and alcohol field. This is an effective way to fast-track frontline workers toward a vocational qualification, as well as develop skills in drug and alcohol.
§ Training and development programs for non-government organisations that provide Supported Accommodation Assistance Program (SAAP) services including courses for relapse prevention, motivation, and assisting parents who are substance abusers.
Key new initiatives over the next four years will include:
§ A Drug and Alcohol Workforce Development Toolkit for managers of non-government organisations, including a guide to identifying workforce needs, professional development strategies, human resource planning, strategic planning and partnerships.
§ Better training for health workers tackling complex presentations of drug, alcohol and mental health. The Department of Community Services and the Mental Health Coordinating Council has commenced a project to assist frontline workers and staff in non-government organisations work with families affected by dual diagnosis. This will be completed in 2005.
§ A directory of drug and alcohol training due for completion in 2004.
See Recommendations 7.4-7.8.
Support and training for General Practitioners
A Drug and Alcohol General Practitioner Liaison Officer (GPLO) has been funded in each of the 17 Area Health Services (AHS) since the Drug Summit of 1999 and provides assessments of the needs of General Practitioners (GPs) in this area, and develops links between AHS, Divisions of General Practitioners and GPs to meet these needs. The NSW GP Drug and Alcohol Support Project:
§ facilitates training, development and resources for local GPs
§ builds the capacity of Area Health Services, Divisions of General Practice and GPs to collaborate in the management of clients with drug and alcohol problems
§ increases GP participation in drug and alcohol treatment and intervention
§ increases the choice and access to comprehensive treatment for clients.
Key future action:
§ An evaluation report on the GP project is due later in 2004 and will be used to assess and determine the future direction of the project.
§ NSW Health will include training and support in alcohol assessment and intervention on the General Practitioners Project Business Plan. This will provide a broader skill base for General Practitioners and greater options for Continuing Professional Development (CPD) training.
§ NSW Health will work with professional medical organisations to encourage a greater range of professional training options for GPs including:
§ extension of GP Liaison roles to assess the training needs of GPs in relation to alcohol assessment and intervention
§ training through the Royal Australian College of General Practitioners or drug and alcohol training providers with the provision of Continuing Medical Education (CME) points
§ business planning process to incorporate an outline of how Area Health Services plan to approach the role of primary care in alcohol interventions
§ Area Health Services being required to develop networks that ensure GPs have the support and training required specifically to provide alcohol assessment intervention.
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Training for health workers providing services to Aboriginal communities
3.15 Establish and provide funding for an Aboriginal community controlled and culturally appropriate training program for awareness, treatment and addiction, aimed at communities and frontline workers, with involvement from Elders and other community experts. Training to be provided by the Aboriginal Health and Medical Research Council of NSW Health College.
3.16 Provide cultural trainers in Aboriginal communities who are able to provide cultural training to enhance the clinical skills of frontline workers involved in alcohol and other drugs.
3.17 Provide training to frontline health workers in brief intervention. This should be a mandatory component of training for all primary health care workers and should be aimed at both Aboriginal and non-Aboriginal workers. |
Government Response
Training by Aboriginal organisations
Over the next four years, NSW Health will work with the Aboriginal Health and Medical Research Council of NSW to achieve the following outcomes:
§ Development of a new Aboriginal Drug and Alcohol Traineeship, which will involve Aboriginal workers in the community controlled sector being placed in Area Health Services, related agencies, and vice versa.
§ New Training Agreements between Government agencies and community controlled services, to obtain greater access to training for all Aboriginal workers, and mechanisms to allow for the exchange of agency staff.
§ Development of an accredited drug and alcohol course for Aboriginal health workers at the new Aboriginal Health College (Prince Henry Hospital) by the Aboriginal Health and Medical Research Council of NSW.
§ A culturally sensitive education booklet titled What Works? for Area Health Services, Aboriginal Community Controlled Health Services, and non-government service providers, looking at what works in alcohol treatment and prevention approaches for Aboriginal communities.
§ A resource on Working with Drug and Alcohol Carers in Aboriginal Communities for organisations using volunteers as a human resource in service delivery.
§ The development of the Aboriginal Family and Carers Training Project includes community consultation and focus testing to determine the nature and content of the resources being developed to assist Aboriginal families and communities. This is being undertaken by Streetwize Communications.
These initiatives will be backed up by:
§ The new Aboriginal Drug and Alcohol Network (ADAN) established in 2003 by NSW Health, the Commonwealth Department of Health and Ageing and the Aboriginal Health and Medical Research Council of NSW (AH&MRC) to support Aboriginal health workers with information and training.
§ The expansion of the Network of Alcohol and Drug Agencies (NADA) Drug Summit IT Project, which will involve support for Aboriginal Community Controlled Health Services, as well as build their information technology and reporting capacity. This will be done through collaborative work undertaken by both NADA and the Aboriginal Health and Medical Research Council of NSW to build an Aboriginal drug and alcohol website.
§ The NSW Health Aboriginal Workforce Development Strategic Plan 2003-2007 which guides the work of Area Health Services and other services in building a workforce that has the capacity to address Aboriginal drug and alcohol issues.
§ An additional 50 Aboriginal nursing cadetships (20 registered nurses and 30 enrolled nurses) to encourage increased numbers of Aboriginal people becoming nurses.
§ The Department of Community Services annual Aboriginal Officer’s Conference for all Indigenous staff, which addresses the effective management of drug and alcohol issues for clients.
§ TAFE NSW three accredited courses that train Aboriginal drug and alcohol workers. The courses include an Advanced Diploma and Certificate II in Aboriginal Health and a Certificate III in Aboriginal Studies. Each of these courses trains workers in delivering flexible, and culturally and community appropriate approaches to workforce development.
Local initiatives will continue to reinforce state-wide developments. For example, the Hunter Centre for Health Advancement, in partnership with Awabakal Aboriginal Medical Service, has developed the Walkabout Learning Program. The program includes drug and alcohol training, community education and Aboriginal cultural competency training for mainstream health workers. The Walk-a-bout our Kulcha, online learning program is complemented with a one and half day face-to-face training session. A one day training session has also been developed titled Bout Us, as well as a commonly asked questions and answers booklet to assist in communication with Aboriginal people titled Didja Know?
Cultural training
The NSW Government recognises the importance of addressing the skill and competency level of the mainstream workforce, to ensure the effective management and provision of care for Aboriginal people in all services. By increasing the cultural competency of the mainstream workforce, some of the access issues facing Aboriginal people entering mainstream services will be reduced.
NSW Health is currently refining a framework of principles and protocols for the Aboriginal Cultural Respect and Communication training program which is designed to improve health outcomes, achieve a culturally competent workforce and ensure the workplace is culturally safe for Aboriginal staff. Similarly, the Department of Community Services runs a Bridging Cultures Program which is delivered to all staff to improve awareness of the needs of Aboriginal families and communities. NSW Health will pilot a training program in 2004 in the Department itself, and an Area Health Service. The state-wide training roll-out will commence in 2004.
Mandatory training on brief interventions for primary health care workers in Aboriginal communities
Over the next four years, NSW Health will work with the Aboriginal Health and Medical Research Council of NSW and the NSW Divisions of General Practice to educate and train GPs through the NSW GP Drug and Alcohol Support project.
As an initial step this will be done through the distribution of the Talking About Alcohol with Aboriginal and Torres Strait Islander Patients – A Brief Intervention Tool for Health Professionals flip-chart. This resource was developed by the Centre for Aboriginal Economic Policy Research with funding from the Office of Aboriginal and Torres Strait Islander Health (OATSIH).
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C. DRUG AND ALCOHOL TREATMENT SERVICES
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Planning for alcohol treatment services
3.6 An appropriate range of services for people with drug and alcohol related problems should be available in Area Health Service regions. This range of services should include enhanced capacity in consultation-liaison, case management, counselling, support of generalist clinicians, including General Practitioners, treatment of people with combined drug and alcohol and mental health problems, treatment of alcohol-using pregnant women, pharmacotherapies, specialist medical services, where appropriate, residential rehabilitation, and recognising and responding appropriately to the impact of the client’s alcohol misuse on other family members.
The range of services should be detailed in an Alcohol Clinical Services Plan linked to the existing NSW Drug Treatment Services Plan 2000-2005. |
Government Response
The types of services referred to in the recommendation are run by both Government and non-government service providers and are in a range of locations throughout New South Wales. The 1999 NSW Drug Summit led to a significant increase in resources for services focused on illicit drug abuse and many of these new services also provided specific services for clients with alcohol abuse issues, for example detoxification and rehabilitation services.
Following the Drug Summit, NSW Health developed the first NSW Drug Treatment Services Plan 2000-2005. A second plan, for 2006-2015, will be developed and will incorporate alcohol related services.
The second plan will incorporate a plan for clinical services for alcohol. NSW Health will work with Area Health Service Drug and Alcohol Services, medical experts, and the non-government sector in the development of this plan which will cover all areas of disease prevention, dependence and treatment.
It is recognised that not every locality can have every treatment service type. The continued loosening of stringent entry criteria to alcohol treatment and improved collaborative partnerships between services and sectors across geographical boundaries will assist facilitate access to specialist drug treatment services.
NSW Health is currently undertaking a number of evaluations of programs that will inform the development of the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 including:
§ an evaluation of the rural counsellor and Clinical Nurse Consultant program
§ an evaluation of the non-government organisation residential rehabilitation beds program, along with an independent costing study
§ an evaluation of the General Practitioner project
§ an evaluation of the drug and alcohol information and data base services program
§ an audit of the pharmacotherapy program
§ a review of the range of outreach services provided by Government and non-government agencies.
In addition, NSW Health has engaged a health economist to undertake a costing study of each of the treatment streams provided by NSW Health to drug and alcohol clients. This will enable the establishment of costing benchmarks for drug and alcohol programs.
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Provision of detoxification services
3.7 Area Health Services should develop improved infrastructure for a full range of detoxification services, including outpatient and home detoxification, having regard to existing or potential government and non-government services. |
Government Response
Since the NSW Drug Summit, the Government has substantially increased detoxification services throughout the State and provided an additional 42 detoxification beds. The NSW Drug Treatment Services Plan 2000-2005 outlined a new approach to the management of detoxification services and this approach has been adopted including the development and implementation of Detoxification Clinical Practice Guidelines 1999.
Detoxification services provide health care and support to manage the symptoms of alcohol withdrawal, and occur in an inpatient and outpatient setting. It is important that detoxification treatment is available in a range of settings such as general hospitals, mental health hospitals, in outpatient or community health services, in people’s homes and from the surgeries of private medical practitioners, from designated detoxifications units, in prisons and in police cells.
A range of models are currently used for providing detoxification services. These include:
Inpatient services:
§ fully medicated specialist detoxification facilities with the capacity to manage acute conditions such as the Wyong and Nepean detoxification units
§ partially medicated specialist facilities that can manage alcohol withdrawals such as the Herbert St Clinic at Royal North Shore Hospital
§ non-medicated government and non-government facilities that handle uncomplicated withdrawals such as Gorman House at St Vincent’s or the William Booth Institute run by the Salvation Army and funded by NSW Health
§ general hospital beds, particularly in rural areas where no alternatives exist. All general hospitals are able to manage alcohol withdrawal
§ mental health facilities where an acute mental health condition coexists.
Outpatient services and home detoxification:
§ local GPs run outpatient detoxification from outpatient counselling units or their own surgeries in most local Area Health Services
§ supported home detoxification services run by a number of Area Health Services, including Southern, Central Sydney and South Western Sydney Area Health Services.
Over the next four years, NSW Health will:
§ examine the current capacity, distribution and mix of detoxification services in developing the new NSW Drug and Alcohol Treatment Services Development Plan 2006-2015. Workforce development strategies will also be considered in this context
§ review the current NSW Health Detoxification Protocols to ensure they remain up to date and address any gaps identified since they were first introduced in 1999
§ review and update existing clinical practice guidelines on detoxification
§ undertake research to determine benchmarks for detoxification services in New South Wales
§ promote agreements across Area Health Services for assessing and transferring patients to specialist detoxification services where appropriate.
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Effective case management of people with an alcohol dependence
3.10 A holistic 'case management' approach should be adopted to address the range of issues facing those with alcohol dependence. Fundamental to this is a chain of care which links services to guarantee individuals smooth passage through the different levels of the service system. |
Government Response
NSW Health is presently developing state-wide Case Management Guidelines for drug and alcohol treatment and a policy framework for such case management. The chain of care model represents an effective system for establishing cooperation between all agencies and services and ensures that when a person makes contact with one link in the chain, they are engaged with all other relevant links, and their transition to another service is managed effectively.
This is being developed under the auspice of the NSW Health Drug Program Council. A special Case Management Sub-Committee of the Council has been established and will have guidelines and a framework completed during 2005. The Committee includes non-government representatives and the Centre for Mental Health.
At this stage a preliminary discussion paper on a state-wide approach is being developed, in the light of a survey of the range of case management approaches, policies and practices already operated by Area Health Services. Some of these case management approaches are limited to case management of pharmacotherapy program clients, but many are broader and encompass other drug and alcohol clients.
The Sub-Committee is currently examining the issue of case management and enhanced care. The work of the committee is not due for completion until later in the year. Guidelines for the provision of enhanced care has been included as part of the work plan for this group.
In addition to case management within health services, broader collaborative case management approaches linking health services for people with multiple needs, to housing services, mental health services, employment and other services are increasingly promoted by Area Drug and Alcohol Services.
The Far West Area Health Service and South Western Sydney Area Health Services have been funded to develop local Case Management Guidelines for working with local Aboriginal communities and to develop and facilitate links to services.
Area Health Services will develop formal Memorandums of Understanding with social support agencies to ensure clients can easily be referred to appropriate services. Wentworth Area Health Service has a service agreement in place with Centrelink, which provides for fortnightly attendance by a representative of Centrelink to facilitate the processing of key welfare issues for patients.
This approach will be supported by the finalisation of Interagency Guidelines for the Early Intervention, Response and Management of Drug and Alcohol Misuse which have been developed following the Drug Summit, and aim to ensure a multi-agency approach to drug and alcohol issues and treatment pathways for non-drug and alcohol services. The guidelines are expected to be released to health services, other agencies, and the non-government sector later this year.
Other agencies also run case management programs which include components to tackle drug and alcohol abuse and dependence. These include:
§ The Department of Juvenile Justice administered Community Funding Program (CFP), to reduce the likelihood of re-offending by young people by helping them with their alcohol and drug problems, living situation, employment and training prospects and engagement with the community.
§ General and Bail Accommodation Support Programs, managed by the Department of Juvenile Justice to assist young offenders through housing, alcohol and drug programs, living skills programs and case management services.
§ Programs run by the Department of Community Services such as the family support for parents with drug and/or alcohol using adolescent children or the Getting it Together scheme, which funds projects to develop specialised services that help vulnerable young people who are unwilling or unable to access conventional youth services. Support is provided to help these at-risk young people with employment, education, training, linking them to their communities and, where appropriate, reconnecting them with their families.
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A quality framework for managing drug and alcohol treatment services
3.11 A process should be put in place to improve the quality of treatment provided to people with alcohol related problems. A Quality Framework for Managing Drug and Alcohol Treatment Services in New South Wales should be developed and implemented, and the effectiveness of treatments should be monitored over time. |
Government Response
A Quality Framework for Managing Drug Treatment Services is being developed by the Centre for Drug and Alcohol in NSW Health, which has established a Health Care Quality Unit. It will be extended to incorporate alcohol treatment. The framework will be finalised in 2005.
The framework is being developed by a Quality in Treatment (QIT) committee of the NSW Health Drug and Alcohol Council. This group comprises senior Government and non-government drug and alcohol clinicians.
The framework will be included in the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 and will build on the commitments and action concerning the management of the quality of drug treatment services outlined in the 2000-2005 plan, including clinical governance, quality control, quality care indicators, accreditation for all service providers (Government, non-government and private) and outcomes.
In October 2003, infrastructure grants were allocated to non-government organisations to improve their capacity to meet accreditation standards.
NSW Health has established a Health Care Quality Unit to monitor the quality of programs run throughout the state, including alcohol treatment.
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Interagency services agreements
3.12 Interagency service agreements be developed outlining agreed protocols for referral pathways, service delivery criteria and joint working arrangements in each Area Health Service region.
One model that could be adopted is that currently being undertaken in the Hunter as part of the Intoxicated Persons Protocol (this program has successfully case managed homeless people with alcohol problems into a range of services, including public housing). |
Government Response
It is anticipated that over the next four years cooperative interagency approaches combined with better case management and links with the non-government and private sector providers will be further enhanced. This approach will focus on:
§ continuing to develop and implement protocols involving intoxicated persons
§ management of early intervention in drug and alcohol presentations
§ management of homeless people with multiple needs and problems
§ management of people with multiple disorders such as drug and alcohol and mental health problems.
Some of the key initiatives and areas of action and priority are outlined below.
Intoxicated persons
Future action in this area is outlined in Part J of Section 8.
Drug and alcohol presentations at health and or community services
An important initiative providing interagency cooperation and better client case management and referrals will shortly be completed by the finalisation of new Interagency Guidelines for the Early Intervention, Response and Management of Drug and Alcohol Misuse. These guidelines were a recommendation of the 1999 Drug Summit.
The new guidelines were trialled in Goulburn and Nowra and provide a framework to assist agencies across sectors who work with drug dependent individuals to provide improved and coordinated service delivery. The guidelines aim to ensure a multi-agency approach to drug and alcohol issues and treatment pathways for non-drug and alcohol services. The guidelines are expected to be released to justice and human services later this year.
The Drug and Alcohol Case Management Guidelines and Policy Framework currently being developed will also include guidelines on interagency referrals, coordinated management and follow-up support for people presenting with drug and alcohol addictions (Rec. 3.10).
Homeless people with multiple needs and multiple problems
Other key interagency protocols which will complement these guidelines include the NSW Government’s Partnerships Against Homelessness initiative which recognises that the causes of homelessness are complex and that service responses need to be multi-faceted.
Key initiatives under this umbrella are:
§ The Inner City Homelessness Action Plan of Government agencies, local government and community organisations to provide better services and solutions for homeless people.
§ The Signpost two year pilot program delivered by Mission Australia to develop new service delivery models to address homelessness in the Hunter region. The project supports local agencies in ways to increase housing and other services for homeless men and women in the area.
§ The proposed development of the Western Sydney Homelessness Action Plan is being lead by the Department of Community Services, in conjunction with a range of other Government agencies.
Mentally ill people with a drug and alcohol problem
Improved referrals and case management of mentally ill people with drug and alcohol problems is a key area for priority action over the next four years (Rec. 3.13). The development of management protocols between government agencies, and the non-government sector will be a key component of future action.
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Strengthening dual diagnosis services
3.13 In dealing with alcohol related problems more attention needs to be paid to people with dual diagnosis, especially in regard to interagency cooperation, and building and further strengthening joint services.
In order to promote understanding of the relationship between alcohol dependency and other mental illnesses, better coordination of alcohol drug and mental health services is required. |
Government Response
Steps to achieve this have been put in place:
Health services
In 2000, following the Drug Summit, NSW Health issued The Management of People with Co-existing Mental Health and Substance Use Disorders: Service Delivery Guidelines. The Guidelines provide a framework for health service providers to cooperate on meeting the needs of this specific target group, including homeless people.
A review of the guidelines found that most Area Health Services have made significant progress towards implementation, and a recent report by the Commonwealth Department of Health and Ageing which undertook an audit of activity relating to comorbid presentations of mental health and drug and alcohol problems across all Area Health Services in New South Wales also found significant activity at local levels for this client group.
Area Health Services have undertaken specific initiatives, including:
§ The Northern Rivers Area Health Service eight week program on substance abuse and mental illness (the INTRA Dual Disorder Program).
§ A service model for young people experiencing dual disorders and other severe mental health problems (YIPPI-IA) being developed by the Central Coast Mental Health Service.
§ Provision by the Hunter Dual Diagnosis Service of consultation, liaison, and a variety of treatment and ongoing maintenance and support programs for clients, families and health professionals working with comorbid clients.
§ A Northern Sydney Health specialised ten bed inpatient unit at Macquarie Hospital providing intensive psychiatric rehabilitation for patients with a psychotic illness in the 18 – 35 year age group. The patients are generally referred to the unit because of their high rates of relapse and re-hospitalisation due to non-compliance with community treatments and recurrent substance abuse.
§ Practices for joint assessment and case management of dual diagnosis patients developed during 2000-2001 in all Area Health Services. These practices will be assessed through a formal independent analysis of current barriers to service provision that will be commissioned by the Centre for Drug and Alcohol. The outcomes of this analysis will be incorporated into the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 to ensure effective systems and structures address the health concerns of dual diagnosis patients.
Key directions by NSW Health for addressing this issue in the future are:
§ Coordinated state-wide delivery of services to people with dual diagnosis disorders. The Centre for Drug and Alcohol will commission a formal independent analysis of current barriers to service provision and presenting patient characteristics and incorporate the outcomes from this into the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015.
§ Implementation of joint service delivery mechanisms for those populations that have a high incidence of dual disorder cases. Subsequent to the Centre for Drug and Alcohol analysis of dual diagnosis services, service planning will occur in each Area Health Service to determine whether local patient characteristics demonstrate a need for specialist dual diagnosis services.
§ Establishment of eight new dual diagnosis projects in eight Area Health Services over a period of three years which will facilitate strengthened dual diagnosis management for these patients by promoting models of care and links to drug services, mental health services, NGO services and other services. These projects will aim to achieve better identification, referral and treatment of these complex patients.
In addition, the Australian Government has provided funding under the National Illicit Drug Strategy Strengthening and Supporting Families Coping with Illicit Drugs for a dual diagnosis project for families. The funds will be used to develop information resources for children, families and carers; improve the capacity of NSW Department of Community Services’ caseworkers and other family support services to work with families affected by dual diagnosis; and to employ a project officer (Dual Diagnosis), who will work with the Mental Health Coordinating Council in consultation on complex cases, developing networks, assisting in the recruitment and training of specialist carers and coordinating training needs.
Service delivery for people with mental health and substance use disorders
In December 2001, the Government established an Advisory Committee on Best Practice Service Delivery for People with Mental Health and Substance Use Disorders, comprising 13 clinical and non-clinical experts. The Committee met during 2002 and 2003 and the report will be submitted to the Government shortly.
The report makes recommendations, primarily focussing on improving service delivery to key at-risk groups (young people, homeless people and Indigenous people) and proposes that three models of coordinated housing support and clinical care are trialled. As a result of the report, the Government will consider running three key trials addressing dual diagnosis and comorbidity:
§ Homeless People: A trial of strategies targeted at homeless people with comorbid mental health and substance use disorders. The Department of Housing, in conjunction with NSW Health and the Department of Community Services is developing three supported housing projects to be trialled in 2004/2005 to 2005/2006 for people with coexisting mental health and substance abuse disorders who are homeless or at risk of homelessness. A service model is being developed.
§ Young People: A trial of early intervention and prevention strategies specifically targeted at young people with coexisting mental health and substance abuse disorders. This trial could be undertaken in cooperation with the School Link program, and related initiatives within the Department of Community Services, NSW Health and relevant non-government Organisations. The possibility of another trial targeting 16-25 year olds in the Greater Murray Area Health Service will also be investigated.
Education Department officers liaise with School Link coordinators from NSW Health in the promotion of mental health programs and practices in schools. Schools will continue to utilise services identified and accessed through this partnership to ensure students with alcohol and drug problems receive support. NSW Health will develop Phase 4 of the School Link training program which will specifically address issues of comorbidity of mental health problems with drug abuse including alcohol. Planning is to commence in 2005.
§ Indigenous People: The exact nature of this trial will be determined by a research project under the Better Futures Regional Strategy, as well as full consultation with Indigenous communities.
NSW Health also signed a Memorandum of Understanding (MOU) with NSW Police in 1998, which was reviewed and refined in 2000 and 2002. The MOU provides a framework for managing people who require the services of both organisations.
See also Recommendations 4.15 and 4.16.
The management of persons in a state of intoxication with a dual diagnosis presentation is also addressed in Part J of Section 8.
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Preventing relapse into alcohol addiction
3.23 Reduce the chance of relapse by following up treatment with intensive post discharge support services and activities. |
Government Response
Over the next four years the Centre for Drug and Alcohol will:
§ Ensure all Area Health Services and funded non-government organisations provide appropriate training for drug and alcohol staff in motivational interviewing and relapse prevention as part of the delivery of all drug and alcohol services.
§ Develop discharge plans that clearly provide clients with information on post treatment health support and intervention services and actively encourage further contacts. All Area Health Services will be obliged to ensure Government services provide such plans, and ensure that it is a condition of funding that non-government organisations providing alcohol treatment services comply with the NSW Health discharge planning framework. This will include an investigation of the use of referral networks, telephone contact links and drop-in groups, dependent on the local circumstances.
§ Ensure performance and funding agreements exist between drug and alcohol health services and non-government organisations and Government agencies that deal with welfare and psychosocial issues related to drug and alcohol dependency. Further, the Memorandums of Understanding between human service agencies that deal with alcohol dependent individuals will be reviewed and enhanced as appropriate.
§ Investigate the use of the internet as a way of delivering drug and alcohol information and counselling to geographically isolated individuals.
§ Investigate the feasibility of non-government organisations providing ongoing follow-up and support services to clients.
§ Introduce an Outcome Treatment Measure for alcohol, counselling and detoxification. This will involve a greater focus upon following up clients on a periodic basis. This will then allow additional support and services to be offered as required.
§ Finalise guidelines regarding the management of psychosocial issues related to alcohol dependency. These guidelines will incorporate recommendations on models for joint-action with other Government agencies. These guidelines will be incorporated into the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015.
The Corrections Health Relapse Prevention Group Work Program for offenders in custody currently operates across New South Wales. The program assists offenders identify those triggers that possibly create relapse situations and develop coping strategies that facilitate behaviour changes.
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Research on alcohol policy, treatment, and harm prevention issues
3.14 In relation to research:
§ Research should be undertaken to monitor policy changes and individual modalities to allow comparison of the cost-effectiveness of different approaches. Pharmacological intervention should face the same cost-effectiveness criteria as non-pharmacological interventions.
§ The NSW Government fund research by tendering research questions.
§ Consideration be given to the development of longitudinal research studies to understand the outcomes of alcohol treatment and that research relevant to public policy be facilitated in understanding alcohol treatment outcomes.
§ Research projects involving Aboriginal communities should comply with the Aboriginal Health and Medical Research Council Ethical Guidelines and the NSW Aboriginal Health Information Guidelines 1998, and be linked to Aboriginal community-identified needs and priorities.
§ In view of overseas developments regarding safe alcohol consumption, NSW Health, through the Intergovernmental Committee on Drugs, should request the NHMRC to review and update the Australian Alcohol Guidelines. |
Government Response
Public policy and research
Following the decision to launch the National Campaign against Drug Abuse in 1985 at the Special Premiers’ Conference on Drugs it was agreed by the Heads of Government to establish Centres of Excellence for research into the prevention and treatment of drug abuse. Three centres have been established to date and are Commonwealth funded as follows:
§ The National Drug Research Institute (NDRI) in Perth. NSW Health has funded a partnership between NDRI and the Bureau of Crime Statistics to undertake a long-term program of research on alcohol related violence and other crime.
§ The National Drug and Alcohol Research Centre (NDARC) at the University of New South Wales. It receives funding from the NSW Government for specific projects. For instance, NSW Heath funded NDARC to undertake the Brief Treatment Outcomes Measure (BTOM) which examined the effectiveness of brief treatment interventions.
§ The National Centre for Education and Training on Addiction (NCETA) in Adelaide focuses on education and training issues as they relate to drug and alcohol use.
The NSW Government will continue to use the expertise of all three national centres in the development of research including the measurement of cost effectiveness of different treatment interventions.
Longitudinal studies
Longitudinal research is the collection and analysis of data over time and is essential in measuring social and behavioural change. Because longitudinal research is a broad term, methods for the analysis of social change may vary substantially.
NSW Health has contributed to the 45 and Up longitudinal survey being conducted by the NSW Institute of Health Research. The study will recruit some 250,000 men and women aged 45 and over, about ten percent of the State's population in that age group, into one of the world's largest long-term studies to track the health issues people face as they age. The study, which will run for at least ten years, will initially focus on cancer, cardio-vascular disease, diabetes and mental health and the various factors that impact them.
The Government supports this research and will continue to support various long-term survey approaches such as the Australian School Student’s Alcohol and Drug (ASSAD) survey and the National Drug Strategy Household Survey.
Research involving Aboriginal communities
The NSW Government will continue to support the NSW Aboriginal Health Information Guidelines.
The NSW Aboriginal Health Information Guidelines were developed as part of the NSW Aboriginal Health Information Strategy (AHIS). Their primary purpose is to ensure consistency and good practice in the management of health and health related information about Aboriginal people in New South Wales. The guidelines provide a framework and principles for the collection, ownership and use of information, as well as addressing issues of confidentiality and privacy. The guidelines are particularly pertinent to health service providers for Aboriginal people and to information custodians, information managers, epidemiologists, researchers and research ethics committees.
Australian Alcohol Guidelines
The Australian Alcohol Guidelines were developed by the National Health and Medical Research Council and released in 2001. They have been reprinted in both 2002 and 2003. The guidelines were written to provide Australians who wish to drink with the necessary knowledge and understanding to do so safely. The guidelines are based on an Australian Standard Drink, which contains ten grams of alcohol. All alcoholic beverages, by law, state on the label the number of standard drinks in the container.
The Australian Alcohol Guidelines were endorsed by the Ministerial Council on Drug Strategy in October 2001. Australia’s guidelines are lower than or commensurate with most of the developed world, and are consistent with World Health Organisation (WHO) standards.
There are many complex messages contained in the Australian Alcohol Guidelines. Many of the concepts are new to Australian drinkers including standard drink information and the health risks involved in short and long term drinking.
Communication materials for the Australian Alcohol Guidelines were launched by the Commonwealth Government on 20 February 2003 and have been widely distributed through alcohol beverage and hospitality industry networks and to health care settings.
The Pharmacy Guild of Australia has received funding from the Alcohol Education and Rehabilitation Foundation (AERF) to produce the Australian Alcohol Guidelines on pharmaceutical prescription slips nationwide.
In November 2003, the Commonwealth Department of Health and Ageing held a workshop in Sydney to discuss the development of a communicator’s guide to the Australian Alcohol Guidelines as a result of concerns about the complexity of the guidelines and subsequent low levels of knowledge and understanding. A draft report of Phase 1 of the Communicators’ Guide Project has been distributed to those attending the workshop.
The Intergovernmental Committee on Drugs have agreed the Ministerial Council on Drugs Strategy should request the National Health and Medical Research Council to develop an evaluation strategy for the Australian Alcohol Guidelines.
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D. DRUG AND ALCOHOL TREATMENT SERVICES FOR ABORIGINAL PEOPLE
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Aboriginal treatment services
3.8 Development of any specific treatment programs for Aboriginal people should be undertaken collaboratively with the Aboriginal Health and Medical Research Council, Aboriginal Community-Controlled Health Services and community representatives. Such services should be culturally sensitive and respond appropriately to gender issues, and the needs of families and young people. |
Government Response
Strategic initiatives to be undertaken over the next four years include:
§ Finalisation of an Indigenous Drug and Alcohol Action Plan which has been under development following consultation with Aboriginal communities during 2002 and 2003. Development of the plan has involved extensive consultation with the Aboriginal Health and Medical Research Council of NSW, non-government organisations, Area Health Services and the Commonwealth Department of Health and Ageing.
§ The action plan will include initiatives to engage Aboriginal community leaders and Elders; promote locally based and locally determined approaches in addressing drug and alcohol abuse; provide peer support programs for Aboriginal communities; link local initiatives on intervention, prevention and treatment to employment, transport, housing, recreational activities, cultural programs, and family initiatives; and link drug and alcohol programs to established community networks and infrastructure.
§ NSW Health, the Aboriginal Health and Medical Research Council of NSW and the Office of Aboriginal and Torres Strait Island Health – NSW (OATSIH), will develop and sign a Memorandum of Understanding that determines agency responsibility and accountability.
§ Each Area Health Service, in partnership with the local Aboriginal Medical Service(s), non-government organisations, and related Government agencies, will be required to develop an area Aboriginal Drug and Alcohol Treatment Services Plan. This plan will link to the Area’s existing Drug and Alcohol Treatment Services Plan.
§ As part of a longer term approach the Centre for Drug and Alcohol will also introduce a new process of service planning for all population groups. The process will provide drug and alcohol service planning for Aboriginal and Torres Strait Islanders that will identify state-wide demographic data in relation to drug and alcohol related harm, review service configurations across the state; and provide a framework for clinical service planning. The results of the service planning process will enable more informed consultations with the Aboriginal Health and Medical Research Council of NSW and Aboriginal Community Controlled Health Services.
§ The framework for Two Ways Together, Partnerships: A new way of doing business with Aboriginal people will be considered by the NSW Government in 2004.
Key projects now underway or planned include:
§ Continued support for 19 Aboriginal Community Controlled Health Services to run drug and alcohol programs for local communities. This money is usually spent on the recruitment of a drug and alcohol counsellor.
§ An investigation into the development of an Aboriginal Alcohol Treatment Information and Education Program to inform Aboriginal Community Controlled Health Services and Aboriginal communities about treatment options, available services and aftercare.
§ Funding partnerships for Area Health Services working with local Aboriginal communities on a range of special projects. For example, the Far West Area Health Service Grog Project, which is partly funded through the National Mental Health Reform Incentive Project, is currently operating in Menindee and Brewarrina to develop the capacity of service providers and communities on alcohol related problems.
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Dedicated Aboriginal treatment places
3.18 Provide dedicated Aboriginal beds/places in a diverse range of treatment services, at all Area Health Services, from detoxification to residential rehabilitation and relapse prevention.
This should include the development of an Aboriginal and Torres Strait Islander specific detoxification service. |
Government Response
Area Health Service Aboriginal Drug and Alcohol Treatment Services Plans (2006-2015) will be required to identify the availability of services for Aboriginal people and how their access will be enhanced. This will include reference to detoxification services, outpatient and community based services, pharmacotherapy services such as naltrexone and alcamprosate, residential treatment and quality control.
Detoxification services
The Centre for Drug and Alcohol will review the current availability of inpatient and outpatient detoxification services for Aboriginal communities.
Each Area Health Service will be required to nominate the number of specific beds they will dedicate to Aboriginal patient detoxification services, where these beds will be located and the process for how they will be managed, as well as the availability of ambulatory detoxification services for Aboriginal clients.
The Centre for Drug and Alcohol and the Aboriginal Health and Medical Research Council of NSW will develop Guidelines for Drug and Alcohol Detoxification in Aboriginal Communities. These will be distributed to Aboriginal Community Controlled Health Services, General Practitioners and Area Health Services.
NSW Health will investigate establishing an Aboriginal detoxification service at an appropriate location in the Sydney metropolitan area with linkages to referral, follow-up and rehabilitation after detoxification. The service could be attached to an existing effective detoxification service and provide culturally appropriate liaison, outreach and home detoxification services.
NSW Health will develop a state-wide Aboriginal Drug and Alcohol Treatment Services Plan that will be complemented by Area Health Service level Aboriginal Drug and Alcohol Treatment Services Plans. These will be implemented though a partnership between NSW Health Centre for Drug and Alcohol, the Aboriginal Health and Medical Research Council of NSW and the Aboriginal Drug and Alcohol Network. This partnership will identify the needs of Aboriginal communities in relation to treatment services and develop services appropriate to those needs, including home detoxification services, outpatient counselling and the identification of designated beds.
South Western Sydney Area Health Service has been funded to appoint an Aboriginal Community Detoxification Liaison Officer to link with the current home detoxification service in the Area and liaise with Aboriginal Health Services to facilitate greater access to detoxification services and aftercare.
Residential services
The Centre for Drug and Alcohol and the Aboriginal Health and Medical Research Council of NSW will develop Guidelines for Managing Aboriginal Clients in Residential Rehabilitation in partnership with the non-government sector.
NSW Health will continue to support the Oolong Aboriginal Corporation, which operates Oolong House, an Aboriginal Community Controlled Health Service at Nowra, and Ngaimpe Aboriginal Corporation which administers The Glen. Oolong House provides a 16 week residential rehabilitation for Aboriginal men in relation to alcohol and other substance misuse and addresses issues such as psychological and physical health, and independent living and work related skills. While this is located in Nowra, it provides a state-wide service.
The Glen, a Central Coast Service, also offers a holistic approach to rehabilitation and the program involves group therapy, living skills, educational courses and community involvement.
Outpatient/community based services
The Aboriginal Drug and Alcohol Network (ADAN) is convened by the Aboriginal Health and Medical Research Council of NSW (AH&MRC). The ADAN links up over 30 Aboriginal Medical Services and provides them with ongoing support and information in relation to best practice in drug and alcohol interventions. The members of the ADAN will work with Area Health Drug and Alcohol Services to develop the Area Health Service Aboriginal Drug Treatment Plans 2006-2015. These plans will link community based Aboriginal Community Controlled interventions with other public health drug services such as outpatient counselling, home detoxification and other community based interventions.
The AH&MRC is represented on the NSW Health Drug and Alcohol Council and will work closely with the Centre for Drug and Alcohol and Area Directors in the development of an Aboriginal Drug and Alcohol Treatment Services Plan that will complement the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015.
Pharmacotherapies
Pharmacotherapy is a medical therapy that uses specific drugs such as methadone, buprenorphine and naltrexone to treat withdrawal, reduce alcohol or opiate craving, or to produce an unpleasant physical reaction to drinking.
Sedative pharmacological treatment is necessary in severe alcohol withdrawal to prevent seizures and the risk of mortality. Naltrexone is at times used for people with alcohol dependence.
A major Australian study, to be based at Sydney’s Royal Prince Alfred Hospital and conducted in conjunction with the National Drug and Alcohol Research Centre, is set to establish the efficacy of two major pharmacotherapies, in relation to alcohol addiction. Using naltrexone and acamprosate (a relatively new drug for alcohol addiction), the study will trial the drugs at four major Sydney hospitals over the next 18 months. The effectiveness of naltrexone and acamprosate will be compared over a twelve week period. Treatment will involve daily medications, five medical appointments and six individual therapy sessions with a six-month follow-up after completion. The medication will be randomly allocated and compared to a placebo group.
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Services for Aboriginal women in tackling the adverse health consequences of alcohol abuse
3.19 The need for services specific to Indigenous women, to take into account the unique family social structure that exists in Indigenous society, should be addressed. |
Government Response
It has been reported that in New South Wales 22.7 percent of Aboriginal women drink at high-risk compared to 11.7 percent of non-Aboriginal women.
The use of alcohol while pregnant can cause bleeding, miscarriage, stillbirth and premature birth. The risk is greatest in the early stages of pregnancy, often when the woman is unaware of the pregnancy. Initiatives need to target young men and women of childbearing age and inform them of the dangers of drinking while pregnant.
Excessive consumption of alcohol while pregnant can also lead to Foetal Alcohol Syndrome, which is described as the commonest cause of mental retardation in the western world. According to the National Drug Strategy – Alcohol in Australia: Issues and Strategies, the available evidence suggests the birth prevalence of Foetal Alcohol Syndrome is small in Australia (although diagnosis can be difficult) and ‘includes characteristic physical abnormalities, growth retardation and neurological dysfunction with developmental delay’.
Key initiatives underway include:
§ Provision of three information resources regarding alcohol for Aboriginal women: What Alcohol Can Do To Your Body, Culture is Healing and Path of Change. They will be reprinted and distributed to health and Aboriginal services throughout New South Wales.
§ The continued distribution and implementation of the Neonatal Abstinence Syndrome Guidelines to improve the outcomes for drug dependent pregnant women, mothers and their newborn infants, and their families. The guidelines are used by all health workers involved with the care of pregnant women and mothers and their newborn infants who are affected by drugs. The guidelines, however, recognise that women who are dependent on other substances may have similar health care and support needs. They also provide a framework that can be applied to women who abuse alcohol.
§ The Centre for Drug and Alcohol in partnership with the Aboriginal Health and Medical Research Council will develop new information resources for pregnant Aboriginal women outlining issues relating to drug and alcohol use in pregnancy. They will address all drug types and the associated risks and will be distributed to all Aboriginal Community Controlled Health Services, Area Health Services and through the NSW Aboriginal Maternal and Infant Health Program in 2005.
As well as the range of initiatives being undertaken by NSW Health, the Department of Juvenile Justice will, over the next four years:
§ introduce an Aboriginal Mums and Bubs program, to improve the emotional, physical and social wellbeing of young mothers and babies by addressing issues such as drug use in pregnancy, emergency first aid for children and positive parenting skills
§ develop the No More program for young Aboriginal women with the aim of reducing alcohol related violence against young women
§ implement the Koori Elders and Youth Program, to reduce the incidence and severity of abuse toward Aboriginal Elders by young Aboriginal women, including where it is drug and alcohol related.
The Intergovernmental Committee on Drugs (IGCD) has agreed the Ministerial Council on Drug Strategy should consider whether workshops are appropriate to disseminate the findings of the initiatives and consider what national approaches need to be adopted, such as the establishment of an IGCD taskforce.
The Western Australian Child Health Institute has received funding of some $5 million from the Rio Tinto Foundation, the Alcohol Education and Rehabilitation Foundation and some state based governments (WA, QLD, NT) for a range of activities to improve the health of Indigenous children, including the development of strategies to address Foetal Alcohol Syndrome. Any further work by the IGCD in this area should link into this work.
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NSW Aboriginal and Torres Strait Islander Substance Abuse Plan
3.20 Endorse the NSW Aboriginal and Torres Strait Islander Substance Abuse Plan. |
Government Response
Consultation on a plan for the prevention and management of substance misuse in Aboriginal communities across Government was undertaken during 2002 and 2003 by NSW Health with the Aboriginal Health and Medial Research Council of NSW, Aboriginal Community Controlled Health Services, Area Health Services, the Office of Aboriginal and Torres Strait Islander Health and all relevant NSW Government agencies.
It is envisaged that the plan will be released as the Indigenous Drug and Alcohol Action Plan following further work and consultations in light of the action agreed upon following the Summit on Alcohol Abuse. The plan will also link to the National Drug Strategy – Complementary Strategy for Aboriginal and Torres Strait Islander Peoples, and will address the principles concerning programs for Aboriginal communities that were endorsed at the 2003 Summit and the Talking About Grog forum.
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E. PREVENTION AND HEALTH SERVICES FOR YOUNG PEOPLE
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Involvement of young people in development of alcohol education and treatment programs
3.9 Development and implementation of any specific education and treatment programs for young people be based on the consultation and participation of young people and youth advocates. |
Government Response
Involvement of young people in developing information and education programs is promoted by the 2002-2006 NSW Youth Policy: Working Together Working for Young People, and the Taking Participation Seriously, a kit that helps organisations involve young people in decision making processes that affect them.
Consultation with young people in alcohol harm reduction programs will also be promoted through:
§ participation by young people on a range of advisory bodies to Government including the Youth Advisory Council, the TAFE NSW Board, the Children’s Court Advisory Committee and the Expert Advisory Group on Drugs and Alcohol
§ Area Health Services across New South Wales which ensure youth participation in planning and delivery of alcohol and drug treatment programs. For example, Wentworth Area Health Service established a 16 person Young People's Health Advisory Committee in October 2003
§ Department of Education and Training programs involving young people in the development of drug education programs (Rec. 2.29)
§ the Centre for Drug and Alcohol, which, in collaboration with the NSW Association for Adolescent Health, will continue to improve processes to ensure youth consultation in the planning and delivery of alcohol and drug treatment programs.
See also Recommendations 1.11 and 2.29.
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Youth health services
3.21 Have specialist youth staff who know about alcohol eg. adolescent mental health workers, not generalist counsellors.
3.22 Improve young people’s knowledge of services by taking young people on school excursions to local services so they meet the workers face to face and therefore feel more comfortable contacting them or create opportunities for youth services to visit schools and provide information, for example, a ‘Service Expo’. |
Government Response
NSW Health will address the youth issues raised at the Summit and the Youth Forum through a new NSW Health Youth Alcohol Action Plan 2005-2009.
The NSW Health Centre for Drug and Alcohol, in partnership with the NSW Association of Adolescent Health (NAAH), and the Commission for Children and Young People will establish a process that supports youth participation in the implementation of youth drug and alcohol treatment services.
Targeted youth health services
NSW Health will continue to fund a range of services that encourage, where appropriate, the employment of youth staff who can address alcohol related issues. Some of the services include Youth Solutions (Macarthur), Ted Noffs Foundation (Randwick), Fairfield Liverpool Youth Health team, Manly Drug Education and Counselling Centre, Kirketon Road Centre (Kings Cross) and the Oasis Youth Service (Kings Cross).
NSW Health, in partnership with the Commonwealth Government, funds nine specialist youth health services that provide integrated health services to young people including advice and interventions in relation to alcohol use and related health harms. Some of these services include High Street Youth Health Service (Harris Park), Cellblock Youth Health Service (Camperdown), Murlappi Youth Health Program (Chippendale), Crossroads Shoalhaven Youth Health Service (Nowra), Community Health for Adolescents in Need (CHAIN) (Wollongong) and Penrith Streetwork Project (Penrith).
One Stop Shop Service Delivery Models have been piloted in the Hunter, Greater Murray and New England Area Health Services as a result of Drug Summit Phase I to provide for the health needs of young people in rural areas.
Phase II of the One Stop Prevention Trials includes an additional pilot program in the Southern Area under the banner of the Snowfields Injury Prevention Service (SIPS). This service aims to reduce the harm associated with drug and alcohol misuse by young people during the snow season.
These pilots aim to improve the health and wellbeing of disadvantaged and at-risk young people from rural areas by encouraging them to access relevant youth, specialist health and welfare services as well as enhancing their participation in local communities.
School based alcohol education
The Department of Education and Training employs 13 drug education consultants to assist schools plan, implement and evaluate drug education, as well as provide policy advice, assist with curriculum support and provide up-to-date information on resources.
In April 1999, the Council of Australian Governments (COAG) agreed on an integrated national strategy to include resources to increase the capacity of schools and school communities to respond to drug and alcohol issues. This included support materials to build school and community awareness through local summits. Summits are designed to promote stronger partnerships between schools, their local communities and service providers, and complement school drug education programs.
Officers from the Department of Education and Training will liaise with School Link coordinators from NSW Health in the promotion of mental health programs and practices in schools. Schools will continue to utilise services identified and accessed through this partnership to ensure students with alcohol and drug problems receive support. NSW Health will develop a Phase 4 of the School Link training program which will specifically address issues of comorbidity of mental health problems with drug abuse including alcohol. Planning will commence in 2005.
NSW Health, through Area Health Services will work with the Department of Education and Training and non-government organisations to assist schools develop local strategies to improve young people’s understanding of alcohol abuse. This will include taking young people on school excursions to local services and providing opportunities for youth services to visit schools and provide information, for example, a ‘Service Expo’.
Also see Recommendations 2.12 and 4.24.
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F. FUNDING OF ALCOHOL HARM REDUCTION PROGRAMS
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Funding and resources
3.24 Additional funding and resources be allocated to implement all of the above recommendations. |
Government Response
See Recommendation 1.14.
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