Workforce and training: The importance of cross sectoral knowledge and skills for better client outcomes

Rebecca Wen

The rapid review undertaken as part of QNADA’s Responsive Systems project examined fifty Queensland inquiries, reports and strategies undertaken in the past ten years and identified 444 recommendations and actions that are relevant to addressing alcohol and other drug related (AOD) issues across a range of systems. The findings from this review brings a valuable perspective in how cross sectoral collaboration and coordination can provide better systemic responses to improve the health and social wellbeing of individuals, families and communities that are affected by problematic AOD use.

In this article, I’ll focus on the recommendations that are related to workforce and training. There are 73 of them and it is the second largest area of focus following pathways and programs. The majority of them focuses on service improvements (27%). This includes capacity building activities for the workforce in systems such as child safety, primary health care, correction and emergency services to increase their knowledge and improve their skills about AOD related issues. For instance, Queensland Health’s Insight service has developed an AOD Brief Intervention Toolkit to help GPs and other health professionals to screen, assess and conduct brief interventions with their clients if there are concerns with AOD use. In addition, there have also been capacity building activities for our own AOD specialist workforce. Family Drug Support (FDS), for example, has expanded their service delivery scope to Central Queensland to provide workshops and information sessions for AOD and other health professionals on how to support family members who are affected by problematic AOD use.

A portion of the recommendations under service improvements is also about developing frameworks and educational recourses to encourage the communication of cross sectoral practice and knowledge. For examples, ATODA’s Domestic and Family Violence (DFV) Tools for AOD Settings provide some very practical guidance to the AOD sector on how to prevent and respond to DFV, and the recently released DFV Common risk and safety framework also includes some considerations on assessing and responding to problematic AOD use in DFV settings. A small number of the recommendations is also related to increase human resources to promote cross sectoral collaboration, such as employing youth AOD liaison staff to assist with child safety officers in some situations.

However, there are a number of recommendations that considered AOD use as a risk factor (15%) that need to be mitigated. Almost all of them are concerned about individuals displaying violent behaviours under the influence of alcohol and/or other drug. Subsequently, some workforce building and training activities were implemented, including an increase of police officers in night time precincts and the roll-out of self-defence and aggressive behaviour management trainings for ambulance and hospital staff. While these recommendations can be considered as reasonable based on the findings from their corresponding inquiries, we are apprehensive about some of the language that is used to provoke fear and marginalisation to perpetuate stigma and discrimination on people who use AOD. For example, the 2010 Inquiry into Alcohol Related Violence which has a number of recommendations related to mitigating people’s AOD use as a risk factor states:

 “The Committee agrees that the majority of law abiding citizens should not have to suffer for the actions of a few……The report calls for greater enforcement and increased penalties.”

Pleasingly though, the rapid review identified a number of recommendations that are also promoting stigma reduction work (8%) across workforces. Most of these recommendations come from QMHC’s Changing attitudes, changing lives report that was released in 2018, and one strategy that has already been endorsed by the Queensland Government is the incorporation of AIVL’s ‘Putting Together the Puzzle’ anti-stigma awareness training “into existing agency training programs and professional development strategies…, for all social service sector workforces, including, health, housing, child safety and justice”[1]. The report[2] also recommended that anti-stigma trainings should be delivered in partnership with people with lived experiences of problematic AOD use as it may help to promote social inclusion and address biases and stereotypes. Some recommendations also expressed support for similar anti-stigma awareness training to be delivered to frontline police officers.

After all, it is evident from the review’s findings that, there has been efforts from a number of systems and across different workforces in Queensland attempting to address AOD related issues, and improving the wellbeing of people and communities who are affected by problematic AOD use. Most of the recommendations that focus on workforce and training have acknowledged the importance of communicating cross sectoral knowledge and building workforce capacity to provide adequate health and social care for individuals, such as responding to DFV issues in AOD settings and vice versa. Besides, I think the involvement of the AOD sector (eg the peer workforce) to provide education and trainings to other agencies about stigma reduction is in itself an effective way to reduce prejudice that some may have towards people who use alcohol and other drugs.

QNADA’s position has always been seeing the ‘person’ first while their AOD use is just one element of their life. I think this is also a belief commonly held by our members, that when a client walks through the door, they may be experiencing other difficulties in life along with their AOD use. So if QNADA can lead this momentum in facilitating better collaboration and partnership between the AOD sector and the other systems such as the child protection, youth justice, and criminal justice systems, we hope to achieve effective systemic responses to support our members to provide high quality, person centred, and evidence informed care to their clients.

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1Queensland Mental Health Commission, 2018. Changing attitudes, changing lives. [online] Brisbane: Queensland Mental Health Commission. Available at: https://www.qmhc.qld.gov.au/documents/changingattitudeschanginglives

2 ibid

Queensland Alcohol and other Drug Treatment Service Delivery Framework

The Queensland Alcohol and other Drugs (AOD) Sector Network is excited to officially announce the release of the 2022 Queensland Alcohol & Other Drug Treatment Service Delivery Framework (TSDF).

Updated from 2015, this iteration outlines the contemporary approach to AOD treatment and harm reduction in Queensland and brings it in line with recently released national frameworks. It is designed to support a shared understanding of the aims and functions of Queensland’s specialist AOD treatment and harm reduction services system.

The updated TSDF was developed through comprehensive sector consultation and review. It is relevant to anyone with AOD in the scope of their work, or who simply wants to know more about Queensland’s AOD services system, including funders and commissioners of services, and other service sectors.

The Queensland AOD Sector Network thanks everyone involved in the update of the framework for sharing their time, wisdom, and expertise over the last two years. We look forward to continuing to support the ongoing growth and development of Queensland’s AOD services system.

If you have any questions or wish to discuss the latest TSDF, please contact sean.popovich@qnada.org.au.

Download a copy of the Framework here.

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The Queensland AOD Sector Network is:

2020-2021 Alcohol and other Drug Treatment Services National Minimum Data Set

The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) contains information about alcohol and other drug treatment services; the clients who use these services; the type of issues for which treatment is sought and the types of treatment provided. In 2020-2021, 106 NGO AODTS establishments across Queensland submitted data to the AODTS NMDS through QNADA, including statewide residential treatment services.

The 2020-2021 submission included 21,548 closed treatment episodes to 14,939 clients aged 10+, a small increase from 21,453 episodes in 2019-20. Service responses to COVID-19 impacted treatment delivery setting in 2020. This collection year, ‘other’ delivery setting usually referred to a phone setting.

Counselling was the most accessed treatment type (50%) followed by rehabilitation (16%), and support and case management (15%). More than half of episodes were provided to male clients (57%) and around three-fourths of clients were aged 25 and over. Amphetamines remains the most common principal drug of concern for which clients sought treatment (37%), followed by Alcohols (35%) and Cannabinoids (19%).

Please click here to read the full report.

We need a better ‘addictionary’: Language and Stigma in AOD Policy and Practice

Tom Ogwang

Stigma is a complex social phenomenon. Put simply, it could be defined as “an attribute that discredits an individual in the eyes of society and results in the person being devalued, discriminated against, and labelled as deviant” [1]. Expanding on that, for stigma to take shape several interrelated elements must come together. In the first element, people must identify some social difference, and categorise it with a label accordingly. This labelling is critical, as language plays a major role in shaping people’s thoughts and beliefs[2]. The social categories identified may include people who use drugs and people who don’t, immigrants and citizens, LGBTIQ+ and heteronormative cultures, people of colour and white people, and so on[3].

In the second element, the categorizing labels are linked to dominant beliefs about the difference – stereotypes. In the third element, the stereotypes provide enough distinct social categories that they distinguish ‘us’ and ‘them’ as oppositional social identities. The above examples are commonly stereotyped into oppositional identities such as ‘criminals’ vs ‘good citizens’ or ‘deviant’ vs ‘normal’ people. The fourth element sees the stigmatised people experience status loss and discrimination that lead to unequal outcomes across every conceivable measure[4].

Discrimination is the lived experience of stigma – the negative social and material outcomes that arise from stigma, which includes lower quality of health care. Both stigma and discrimination rely on societal structures and systems that facilitate and create the conditions for their operation (for example, unequal power relations is one such condition)[5]. For these reasons stigma is harmful, distressing, and marginalising to the individuals and groups who experience it, whether based on fear and exclusion, authoritarianism, or even benevolent intentions[6].

The massive body of evidence on implicit bias and discrimination across stigmatized populations means examples of the harm of stigma abound. Research from Stanford University that systematically analysed police body camera footage of routine traffic stops shows white residents were 57 percent more likely than black residents to hear a police officer say the most respectful utterances, such as apologies and expressions of gratitude like “thank you.” Meanwhile, black community members were 61 percent more likely to hear officers say the least respectful utterances, such as informal titles like “dude” and “bro” and commands like “hands on the wheel”[7]. The study authors argued that these pervasive racial disparities in officers’ language use at best erode police-community relations. At worst they express and validate negative attitudes society holds toward people of colour, which those communities experience as institutionalised racism and deaths in custody. Such research makes it harder to trivialise or dismiss the language debate as mere “semantics” or “political correctness”, as similarly strong research abounds across all stigmatised groups, including drug using communities.

It is imperative the AOD policy, practice and research communities continue to build their understanding of how language influences the way individuals think about themselves and their ability to change, how it frames what society thinks about substance use and recovery[8] and how it influences institutional responses to substance use[9]. At the individual level, there is ample evidence the words we use to describe alcohol and other drug dependence can engender self-stigma, which occurs when a member of a target group internalises public stereotypes or prejudices[10]. This influences both whether people will seek help, and the quality of the help they receive. For instance, one study demonstrated those with alcohol use disorder perceiving a high degree of public stigma toward their condition were about half as likely to seek help as those perceiving low stigma[11]. For treating clinicians, words strongly influence the way they seek to work with people experiencing alcohol and other drug use disorders: in one Harvard study, when the term ‘substance abuser’ was used in a case vignette, clinicians were significantly more likely to favor punishment (a jail term) than when the individual was described in the vignette as having a ‘substance use disorder’[12]. It’s a short journey from the implicit bias found in that research to overt negative attitudes or discriminatory behaviours enacted by individuals acting on behalf of health or criminal justice institutions[13].

Structural stigma includes poorly chosen language, policies and actions that limit – whether intentionally or not – the opportunities of target groups. Labelling people involved in the criminal justice system – many of whose most serious offence relates to illicit drugs – ‘offenders’ for the entirety of their engagement with the criminal justice system, regardless of whether they have ceased all unlawful activity, is an overt example. Thesaurus alternatives to ‘offenders’ are ‘criminals, crooks, lawbreakers, wrongdoers, reprobates and delinquents’, all of which is language that squarely returns the individual back to the place and time of their offence, without hope of moving from there in any figurative sense until all engagement with the justice system is complete. The evidence of stigma we see across the brief examples demonstrated here, and which is experienced by all marginalised persons, is a violation of the human rights and dignity expressed in Article 1 of the Universal Declaration of Human Rights – All human beings are born free and equal in dignity and rights[14].

The QNADA rapid review of Queensland inquiries, reports and strategies relevant to the alcohol and other drug sector found evidence of stigma that powerfully shapes how the state addresses AOD use across a range of sectors[15]. It argues what is evident in many inquiries, reports and strategies is a morally bound perceptual distinction between alcohol and other drugs that defines one as being culturally acceptable and the other as immoral, illegal and deviant[16]. This returns us to the elements described above that result in stereotyped, oppositional categories, and that have been significant in how AOD policy and practice has manifested: for example, while high profile and at times experimental change in night time entertainment precinct management has been undertaken in an attempt to reduce alcohol related harm over the last ten years, responses to illicit drug use have remained largely unchanged during the same period. Far more than just words, at the institutional level language ‘influences recommendation acceptance, shapes the approach taken to implementation, program design and workforce development, and is used to inform future policy and legislative priorities[17].

There is a lot of work to be done in the stigma and discrimination space. It isn’t overly complex though, and perhaps begins with the universal use of person-centred (or person-first) language to describe groups at the margins of society[18]. This is especially true of people who use drugs and who are also, for example, at the intersections of minority ethnicities, genders or sexualities. Given outstanding materials like this Language matters resource, not only does the AOD sector have its own waypoints, but it is well equipped to begin charting this journey outside its own boundaries and in such spaces as the media and other public discourses where the public gets most of its information about alcohol and other drug use.

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[1] Lancaster, K., Seear, K., Ritter, A. (2017) Reducing Stigma and Discrimination for People Experiencing Problematic Alcohol and Other Drug Use (Queensland Mental Health Commission).

[2] Volkow, N.D., Gordon, J.A., Koob, G.F. (2021) Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacology. July 2021

[3] Link, B. G., & Phelan, J. C. (2001). Conceptualizing Stigma. Annual Review of Sociology, 27, 363-385.

[4] Ibid

[5] Lancaster, K., Seear, K., Ritter, A. (2017) Reducing Stigma and Discrimination for People Experiencing Problematic Alcohol and Other Drug Use (Queensland Mental Health Commission).

[6] Broyles,L.M., Binswanger, I.A., et al (2014) Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response. Substance Abuse 35:217-221

[7] Voigt, R., Camp, N.P., et al (2017) Language from police body camera footage shows racial disparities in officer respect. Proceedings of the Natural Academy of Sciences of the United States of America

[8] Broyles,L.M., Binswanger, I.A., et al (2014) Confronting Inadvertent Stigma and Pejorative Language in Addiction Scholarship: A Recognition and Response. Substance Abuse 35:217-221

[9] Wogen, J. and Restrepo M.T. (2020) Human rights, stigma, and substance use. Health and Human Rights 22(1):51-60

[10] Ibid

[11] Keyes K.M., Hatzenbuehler M.L., McLaughlin K.A., Link B., Olfson M., Grant B.F., (2010) Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology; 172:1364–72. .

[12] Kelly J.F., Westerhoff C.M. (2010) Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy 21:202–7

[13] Wogen, J. and Restrepo M.T. (2020) Human rights, stigma, and substance use. Health and Human Rights 22(1):51-60

[14] United Nations (1948) Universal Declaration of Human Rights. www.un.org/en/about-us/universal-declaration-of-human-rights

[15] QNADA (2021) Responsive Systems: A rapid review of Queensland inquiries, reports and strategies relevant to the alcohol and other drug sector.

[16] QNADA (2021) Responsive Systems: A rapid review of Queensland inquiries, reports and strategies relevant to the alcohol and other drug sector.

[17] Ibid

[18] Lancaster, K., Seear, K., Ritter, A. (2017) Reducing Stigma and Discrimination for People Experiencing Problematic Alcohol and Other Drug Use (Queensland Mental Health Commission).

QNADA 2020- 2021 Annual Report

Our 2020/21 annual report is out now! Click on the image below to read the full report to see what we’ve been up to this last financial year!

 

It’s AODTS NMDS collection time!

Hi members! It’s AODTS NMDS collection time! We have some online learning modules available on our website if this process is new to you or if you want to refresh your knowledge – https://qnada.org.au/aodts-nmds/

Alternatively just give us a call if you have any questions on 07 3023 5050!

#ThrowbackThursday: Reefer Madness? Cannabis, the criminal justice system, and decriminalisation in the ACT

In September 2019, the ACT Parliament passed legislation allowing personal possession, use, and cultivation of cannabis for people over the age of 18 while it remains illegal to buy, sell, give or receive cannabis. It’s this duality that has the ACT government describing the change as ‘decriminalisation’ while most media outlets referring it to ‘legalisation’. So what’s actually going on?

Read more about this QNADAfocus article here: Reefer Madness? Cannabis, the criminal justice system, and decriminalisation in the ACT (page 6)

QNADA Strategic Plan 2021 – 2023

QNADA Strategic Plan 2021 – 2023 is here! The revised strategy recognises our organisational values of integrity, accountability and diversity and more explicitly acknowledges that our work occurs across three main streams of working with member organisations, working with policy makers and working with systems managers to support the delivery of high quality AOD treatment and harm reduction services in Queensland.

Click on the image below to view the full plan.

 

QNADAfocus Issue 2 2021 is out now!

This issue’s theme is Human rights and drug policy, and it includes articles on:

  • Introducing the International Guidelines on Human Rights and Drug Policy and their intersection with the Queensland Human Rights Act
  • Member Spotlight: Insights on self-determination in health from Galangoor Duwalami Primary Healthcare
  • The potential for decriminalisation to contribute to reducing social inequality in Queensland
  • The intersection of drug policy and development in Australia
  • On the topic of drugs and children

Click on the photo below to view the full newsletter.

#ThrowbackThursday: Hoping for the best: disaster preparedness

With the recent extreme weather conditions and the ongoing uncertainty of COVID-19, emergency preparedness has become an essential consideration to ensure service continuity for the AOD sector and for the clients.

Read more on #QNADAfocus article: Hoping for the best: disaster preparednesshttps://qnada.org.au/wp-content/uploads/2020/04/Fin_20200421_Issue-2.pdf

#ThrowbackThursday: Stigma, bias and lived experience

Everyone holds implicit biases that we aren’t actively aware of, but they do permeate and informs our everyday behaviours and attitudes. The impact of negative implicit bias and stereotype is pervasive across all important life domains (access to health care, employment etc.) and it is one of the most important barriers to overcome for people who experience problematic alcohol and other drug use.

Read more on #QNADAfocus artcle: Stigma, bias and lived experience – explanatory notes in the guise of a sightseer’s tale