QNADA News

Submission to the Police Powers and Responsibilities and Other Legislation Amendment Bill 2023

QNADA welcomes the opportunity to provide feedback on the Police Powers and Responsibilities and Other Legislation Amendment Bill 2023, and recognises the proposed expansion of the Police Drug Diversion Program (PDDP) as an important step toward reducing the potential for harms associated with AOD use in Queensland. This submission focuses on:

• the significant individual, social and economic harms caused by the criminalisation of people who use drugs;
• shortcomings in the operation of the current PDDP to effectively divert people who use drugs who would otherwise not come to the attention of police away from the criminal justice system;
  the importance of practice change within the Queensland Police Service (QPS) that takes into account the experiences of people who use drugs and their interactions with police, and seeks to address the impact of stigma and discrimination embedded in policing practices;
• issues with the Bill, including with respect to the potential for inequity in the response to children and young people;
• opportunities to learn from the implementation challenges identified with the current approach to improve quality assurance processes and establish a strong, independent monitoring and evaluation framework; and
• other opportunities to further reduce the harms associated with the current policy approach to drug use, including the increasing shift towards decriminalisation across multiple jurisdictions.

Please click here to read the full submission.

Please feel free to watch our appearance at the the public hearing for the Inquiry into Police Powers and Responsibilities and Other Legislation Amendment Bill 2023 here (QNADA appeared from 5:09:45).

Refreshed Policy Position Papers

The following three policy position papers were recently reviewed and updated, please click on the image below to read the full version:

Decriminalisation (drug law reform)

Effective responses to drug use

Stigma and discrimination

Western Queensland Primary Healthcare AOD Capacity Development

From May 2021 to December 2022 QNADA embarked on a project supported by WQPHN and QNADA to facilitate AOD capacity development within primary healthcare services in Western Queensland. It goes without saying, Western Queensland is vast and sparsely populated, meaning there are unique challenges to health service access and delivery across this region. Western Queensland has a predominantly generalist health workforce and a limited availability of alcohol and other drugs (AOD) specialist services[1].

Primary healthcare services in the region have the potential to serve as an initial point of contact for people who use alcohol and other drugs and for those who have concerns with their use, by playing a critical role in facilitating appropriate care and follow up, particularly at an early stage[2]^,[3],[4]. The role of primary healthcare services can include informal conversations about a person’s relationship with substances through to formalised AOD screening and brief intervention, supporting referrals to specialist AOD services, and contributing to enhanced continuity of care[5]^,[6]. However, primary healthcare services often report a lack of confidence and skills to provide adequate AOD care, which is compounded by barriers such as stigma and discrimination and workforce shortage[7],[8].

QNADA, in partnership with external stakeholders, delivered and facilitated a range of activities throughout the project, including:

• providing individual primary healthcare practice support
• establishing regional service level network meetings
• coordinating the delivery of ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) training
• reviewing alcohol and other drugs related HealthPathways
• delivering an AOD in primary healthcare toolbox talk
• drafting an easy to use information resource for primary healthcare practitioners responding to AOD issues
• promoting existing resources (eg Adis 24/7, ADCAS, Insight).

The project had a small number of participants however key findings from the project evaluation indicated an overall positive impact. For example, an increased level of confidence was found in using alcohol and other drug specific screening and assessment tools (e.g. ASSIST), delivering brief intervention to patients, and matching referrals to patient needs. An increased level of knowledge was also found in some key alcohol and other drug concepts (eg harmful drug use, alcohol and other drug dependence), and in alcohol and other drug information services (eg HealthPathways, Alcohol and Drug Clinical Advisory Service). In addition, several enablers for primary healthcare services to deliver good practice AOD responses in Western Queensland were identified. At the service level, these included having accurate and informed knowledge around patterns of alcohol and other drug use, the range of AOD treatment types, and local referral options, and maintaining collaborative relationships between key workers among services. At the system level, having face to face engagement and networking opportunities (eg network meetings) for workers, and a stable and engaged workforce (eg consistent staffing within a practice) is also likely to contribute to better provision of alcohol and other drug care.

However, at a systems level, the lack of alcohol and other drug specific MBS item numbers, high workforce turnover, and excessive distance between services all contribute to challenges for primary healthcare services in providing AOD support. These issues will continue to inform QNADA’s advocacy into the future as part of our ongoing work with other state and territory partners and the national AOD peak, Australian Alcohol and other Drug Council (AADC).

In the short to medium term, there are opportunities to address a range of barriers identified in the evaluation including:

• further strengthening linkages between primary healthcare services and their locally available specialist alcohol and other drug treatment services
• continuing to address stigma that is associated with illicit drug use and negative connotations around seeking alcohol and other drug treatment, which created challenges for both providing and seeking support
• addressing concerns around lack of anonymity in small towns in order to increase help seeking
• responding to specific concerns around the normalisation of high quantity and frequency alcohol use.

In future QNADA hopes to continue our activities supporting primary healthcare services in the Western Queensland region by:

1. continuing to facilitate local workforce linkage across the Western Queensland region through AOD focused service level networks.
2. continuing individual practice engagement to enhance alcohol and other drug responses in primary healthcare services.
3. facilitating and supporting ongoing alcohol and other drug related professional development and upskilling opportunities for primary healthcare services, with a focus on staff most likely to provide an AOD response (eg practice nurses).

While QNADA is pleased with the progress we’ve made in this space, this represents a first step to enhancing AOD responses in primary healthcare settings.  We’d like to thank WQPHN for their support in funding this project and all the service providers and project partners who participated. Thank you!

————————————————–

[1] Western Queensland Primary Health Network, “A Five-Year Plan (2021-2026) to Improve Mental Health, Suicide Prevention and Alcohol and Other Drug Treatment Services in Western Queensland,” (2021).

[2] Queensland Mental Health Commission, “Achieving Balance 2022-2027: The Queensland Alcohol and Other Drugs Plan,” (2022).

[3] Queensland Health, “Better Care Together: A Plan for Queensland’s State-Funded Mental Health, Alcohol and Other Drug Services to 2027,” (2022).

[4] Michala Kowalski and Liz  Barrett, “Engaging General Practice and General Practitioners in Alcohol and Other Drug Treatment,” in Drug Policy Modelling Program Monograph (University of New South Wales, 2020).

[5] Ibid.

[6] Queensland Health, “Better Care Together: A Plan for Queensland’s State-Funded Mental Health, Alcohol and Other Drug Services to 2027.”

[7] Western Queensland Primary Health Network, “A Five-Year Plan (2021-2026) to Improve Mental Health, Suicide Prevention and Alcohol and Other Drug Treatment Services in Western Queensland.”

[8] Kowalski and Barrett, “Engaging General Practice and General Practitioners in Alcohol and Other Drug Treatment.”

Submission to the Queensland Women’s Health Strategy Consultation Paper

QNADA welcomes the opportunity to provide feedback on the Queensland Women’s Health Strategy Consultation Paper. We commend the intent of the development of the Queensland Women’s Health Strategy and recognise the importance of working to achieve gender equality and health equity in Queensland by advancing the rights and interests of women and girls, including those who use alcohol and other drugs (AOD).

While the majority of people who use AOD do not experience problems with their use, a proportion (11-12%) are likely to require specialist treatment. In Australia, women represent approximately 40% of the proportion of people accessing AOD treatment services. They continue to face a range of treatment access barriers due to issues such as:

• continuing treatment and harm reduction supply issues in the face of increasing demand
• fear of legal and social repercussions of service engagement
• employment and family responsibilities
• implications relating to parenting, pregnancy, and childbirth (e.g. potential for child protection involvement resulting reduced willingness to approach services for assistance).

Despite welcome increased investment into the AOD system in recent years, as well as recognition of these barriers, women remain underrepresented in treatment and strategies are required to increase accessibility.

A range of strategies and initiatives have the potential to make it easier for women to access AOD treatment when they need it. These include:

• offering free child care to women accessing AOD treatment
• expanding existing day rehabilitation program options to enable increased treatment availability during school hours
• establishing/funding dedicated programs for women
• expansion of programs that support families to stay together while a parent is undergoing residential rehabilitation (e.g. family units)
• other initiatives to reduce stigma and discrimination of woman who use AOD.

Please click here to read the full submission.

Queensland Government Commended for Drug Law Leadership

We commend the Palaszczuk Government for taking an important first step in prioritising health based responses to illicit substance use, for introducing legislation to expand the Police Drug Diversion Program for cannabis to include other drugs. Here is our joint media release with Alcohol and Drug Foundation and AMA Queensland. 

Please click on the image to view the full document.

QNADA submission to the Inquiry into Australia’s illicit drug problem: challenges and opportunities for law enforcement

Late last year QNADA developed a submission for the Commonwealth Inquiry into Australia’s illicit drug problem: challenges and opportunities for law enforcement. The submission identified 5 key areas of improvement to the existing Australian approach to illicit drug law enforcement:

1. The removal of criminal penalties for possession (decriminalisation) as a prudent strategy to reduce the investment required over time to process people through the criminal justice system and increase opportunities for people to access treatment when they need it.
2. A review of current approaches across law enforcement, treatment and harm reduction to ensure an appropriate balance across the three pillars of the National Drug Strategy in future investment.
3. Focused awareness-raising and training for police and other law enforcement entities on the impact of stigma and discrimination for people who use drugs.
4. The establishment of a new national governance framework to support effective coordination of the National Drug Strategic Framework, which includes representation from NGO AOD peak bodies.
5. A reinforced and sustained commitment by law enforcement agencies to support the implementation of evidence based harm reduction strategies such as drug checking services, safe injecting facilities, expanded diversion initiatives and improved access to naloxone.

QNADA’s submission to the Inquiry into Australia’s illicit drug problem: challenges and opportunities for law enforcement is available at https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/Law_Enforcement/IllicitDrugs/Submissions

QNADA Submission to the Women’s Safety and Justice Taskforce

Response To Discussion Paper 3: Women and girls’ experiences across the criminal justice system

In April 2022 QNADA provided a submission to the third discussion paper of the Women’s Safety and Justice Taskforce – Women and girls experiences across the criminal justice system. The submission focused on specific questions within the discussion paper, and called for:

• responses that focus on addressing the broader social, cultural, and structural determinants of health, and prioritise alternatives to imprisonment – particularly for low-harm drug offences;
• greater clarity around the main drivers of increased drug related imprisonment and recidivism among women and girls, namely increased law enforcement activity by police, rather than any marked change in community behaviour or attitudes;
• meaningful, transparent consideration to be given to decriminalising low-harm drugs in Queensland, in partnership with peaks and other relevant non-government organisations;
• increased investment in, and provision of, alcohol and other drug treatment and harm reduction services for women and children in contact with the criminal justice system across Queensland;
• the expansion of police diversion to all illicit substances, including the removal of the current requirement to admit to an offence prior to accessing diversion, the removal of limits on the number of times a person can access diversion, and reconsideration of the purpose, delivery and type of interventions provided to people diverted from the criminal justice system;
• recognition that, even in the context of increased investment by the Queensland Government, there remains gaps in the treatment system and, although most people who use alcohol and other drugs never require treatment or help, for every dollar invested in treatment and harm reduction there is a seven dollar return^[1];
• people deprived of their liberty for drug related offending to be provided voluntary and evidence-based health services, including harm reduction and drug treatment services, as well as essential medicines, including HIV and Hepatitis C services, at a standard that is equivalent to that in the community in accordance with the International Guidelines on Human Rights and Drug Policy^[2].

The submission also highlights significant and ongoing concerns with the recent introduction of section 229BC of the Criminal Code (Failure to report sexual offending against a child to police) in Queensland. Although the need to ensure adults are appropriately protecting children and young people from sexual abuse is beyond question, the amendments have significant implications for the support provided by non-government AOD services to people who have experienced child sexual abuse. These implications are inherently problematic as:

• a significant proportion of those who access AOD services have complex histories of abuse and trauma (including child sexual abuse), poor experiences with police and other statutory bodies and a general distrust in services (particularly for those who use illicit drugs);
• it is key for victim-survivors to have access to services they trust and can safely to disclose to, and section 229BC inhibits disclosure for those who do not wish to engage with police – this correspondingly impacts treatment outcomes, impedes future service engagement and increases the likelihood of future harm;
• the reality is conviction rates are low and many victim-survivors do not want to engage in often confusing, invasive, lengthy and traumatic criminal justice proceedings;
• although the amendments respond to findings of the Royal Commission into Institutional Responses to Child Sexual Abuse, they are not consistent with the Royal Commission’s findings in relation to the challenges faced by victim-survivors in disclosing such abuse.

The submission calls for urgent review of the provisions, seeking to repeal the amendments or include clear exclusions to ensure Queenslanders who have experienced child sexual abuse can safely disclose that abuse in therapeutic settings and receive effective support for the well-known physical and psychological impacts of trauma.

[1] Alison Ritter et al., “New Horizons: The Review of Alcohol and Other Drug Treatment Services in Australia,” in Final Report (Sydney: University of New South Wales, 2014).

[2] https://www.undp.org/library/international-guidelines-human-rights-and-drug-policy

Good Nutrition in AOD Recovery: Online learning + Quick ‘n Easy Cooking Guide

QNADA is pleased to share the Good Nutrition in Alcohol and Other Drug Recovery resources, which are made up of a recipe guide and an interactive online learning package, aimed at building service user capacity to have a healthier recovery. QNADA developed the resources following conversations with alcohol and other drugs services which pointed out the ways nutrition can lose importance for clients in the context of other recovery priorities. As the resources point out, good nutrition is an important component of recovery because it directly relates to mood and can influence substance cravings.

The guide and training module also provide information about the overlap between nutrition, brain, and body function during recovery, and how certain foods can help support recovery by providing the building blocks for serotonin, dopamine and norepinephrine. The guide uses a motivational approach to have clients weigh up the potential costs and benefits of their current food routine and changing it to a new one.

It provides some simple, budget friendly, and easy to follow recipe suggestions that provide a starting point for cooking some tasty meals.

We hope this guide will help to make focussing on nutrition easier for both workers and clients.

Access the online learning here, or download the resources here.

QNADA’s Submission to the draft National Tobacco Strategy 2022-2030

In March QNADA submitted a response to the call for feedback on the draft National Tobacco Strategy 2022-2030 (the Strategy). The QNADA submission wholly supports the priority areas for the Strategy and commends it for seeking to directly address tobacco industry interference in public health and tobacco control policy. QNADA argues this approach sets an example for other drug policy areas, such as alcohol, where industry influence and involvement continues to stifle good public health policy. QNADA agrees with the Strategy position that government action alone cannot reduce the prevalence of tobacco use, and that a strength of Australia’s tobacco control measures to date has been partnerships between governments, NGOs, health professionals, research groups and community groups. To this end, QNADA identified four areas we believe the strategy should further address. We’ve provided an abridged version of what we included in our submission below.

1. Future proof the strategy by clarifying how all priority areas and actions could be applied to new and emerging nicotine products.

While QNADA recognises the emphasis on preventing and reducing harms from new and emerging products (including e-cigarettes) in priority area 9 of the draft strategy, we believe these issues are relevant across the entire strategy and need to be outlined more widely. As novel nicotine products become more widely used and available, and the evidence around potential harm and therapeutic use continues to evolve, all priority areas and actions of the strategy will become increasingly relevant to novel products. QNADA supports strengthened regulations for new and emerging products, however we do not support legislative approaches that focus on individuals who are using these products as opposed to organisations selling and promoting them.

2. Closely monitor trends related to excise.

Excise increases have been resoundingly successful in reducing smoking prevalence at a population level. However, we note the relatively small gains excise measures have furnished in disadvantaged populations. We suggest that while price increases have been – and may continue to be – an effective mechanism to reduce tobacco use, we may be approaching a threshold, where prohibitive pricing begins pushing vulnerable populations to illicit tobacco in the absence of other nicotine replacements and support. While we acknowledge the ATO’s Tax Gap Analysis findings of a reduced net illicit tobacco market in spite of rising licit tobacco prices, we suggest targeted research be undertaken to quantify the extent of illicit tobacco use amongst disadvantaged groups and to better inform countermeasures to illicit tobacco use.

3. Prioritise support and resourcing for community controlled organisations and ensure meaningful partnerships.

We are pleased to see the strategy acknowledges the social and cultural determinants of health as influencing tobacco use and the broader importance of tobacco cessation efforts to closing the gap. We support the intent to bring culturally safe tobacco cessation interventions to mainstream health services, however resourcing and support for community controlled organisations should be a priority, and the upskilling of mainstream organisations should not be at the expense of community controlled organisations.

4. Appropriately resource organisations to deliver interventions and increase access to NRT

QNADA strongly agrees that evidence-based tobacco prevention and cessation programs should be part of routine care across all health (including AOD treatment and harm reduction services), social care and custodial settings. However, we do not support mandating tobacco interventions as a condition of government funding. In our view this makes little sense in the context of existing governance mechanisms that facilitate good clinical practice. We suggest instead working across systems to ensure that relevant frameworks, strategies, and guidelines address tobacco and other nicotine products where relevant, achievable, and necessary. Further, such an approach risks adding an unnecessary layer of reporting to already underfunded and overburdened services.

QNADA’s Submission to the Inquiry into the opportunities to improve mental health outcomes for Queenslanders

Tom Ogwang

In February QNADA submitted a response to the Mental Health Select Committee Inquiry into the opportunities to improve mental health outcomes for Queenslanders (the Inquiry). The submission addressed the Terms of Reference for the Inquiry in three distinct, but inter-related parts: Services (part A), Policy (part B) and Systems (part C). We’ve provided a very brief overview of highlights from our submission below. If you’d like to read it in full, you can download it here – https://documents.parliament.qld.gov.au/com/MHSC-1B43/IQ-5DEF/submissions/00000048.pdf.

Part A: Services

Developing a shared understanding of when and how the services system should respond to AOD related issues is key to improving AOD responses on the whole. Our shared understanding should recognise that only a small proportion of people who use AOD require treatment, however there are still insufficient specialist services available to meet demand. These challenges are compounded by critical specialist AOD workforce shortages.

Part A highlights that in order for the services system to become better coordinated or ‘integrated’, all systems of care should be informed by both AOD scientific evidence and lived experience in all aspects of program and policy development. In short, policy should be responsive to need and informed by the people it most directly affects. However, people who use drugs have traditionally been marginalised from policy debate and from receiving appropriate care.

Two case studies (Daisy’s Story and Jane’s Story) exemplify how QNADA member services and clients navigate system complexity, and how external system responses impact on client outcomes and opportunities.

Part B: Policy

The absence of a clear whole of government endorsed public AOD plan since 2017 has stifled leadership and prioritisation for AOD system reform outside the health system. It impacts agency understandings of their roles and responsibilities to deliver or support agreed state and national priorities and commitments. This absence means that there is no overarching mechanism drive action across systems such as criminal justice, domestic and family violence, youth justice, child protection, education, and communities.

Part B explores the reforms required to reduce costs and harms associated with criminalising illicit drug use. We note that the approach of criminalisation has proven largely ineffective at significantly reducing the consumption of illicit drugs and has not achieved a sustained reduction in supply. For example, the Queensland Productivity Commission’s makes a compelling economic argument for decriminalisation for low harm drugs within its 2020 Inquiry into Imprisonment and Recidivism and found that:

• Illicit drugs policy has failed to reduce supply or harm and was found to be a key contributor to rising imprisonment rates, with drug offences contributing to 32% of the increase since 2012
• Current illicit drugs policy results in significant unintended harms, through supporting a large criminal market and incentivising the introduction of more harmful drugs
• Evidence suggests legalising lower harm drugs and decriminalising others is unlikely to increase drug use and is likely to provide net benefits to Queensland of at least $2.8 billion by 2025
• Targeted community-level interventions and greater use of diversionary approaches are feasible alternatives to the criminal justice system which are significantly less expensive.

Part C: Systems

For the significant majority of people who use AOD, the risk of harm to both themselves and the community is increased primarily as a result of the social, policy and legislative responses to their use, rather than the substance itself.

Part C discusses opportunities for whole of system collaboration and partnerships across the criminal justice, child protection and youth justice systems. Queensland’s Mental Health, Alcohol and Other Drugs Strategic Plan 2018-23 (Shifting Minds) highlights the importance of collective leadership and responsibility across all policy, funding, program development and service delivery to achieve common outcomes and benefits. There is currently no entity in Queensland who has primary responsibility for, and a dedicated focus on, effectively influencing, driving and coordinating this change within the context of AOD policy and planning.

In early 2021 QNADA launched the self-funded Responsive Systems project to improve cross-agency collaboration and partnerships and support more effective system responses outside the health sector.

Data linkage across systems

Maria Ortiz

There is limited use of data to understand the engagement of people who use drugs (PWUD) in other systems such as the Child Safety, Criminal Justice and Youth Justice systems. Capturing and reporting of data is a critical part of informing and supporting better policy decisions by identifying the needs of PWUD and their families and friends in Queensland. We need this information to build an understanding of the effect that multiple contacts with different systems have on people with complex needs.

Data is also key to support a continuous improvement approach to Alcohol and other Drugs (AOD) treatment service delivery. Improved data collection would strengthen the development of policies to reduce harm and improve the ability to report on the prevalence of AOD treatment services across different systems in Queensland. With the support and perspective from multiple agencies, this would lead to better capturing of the frequency in which people with complex needs are involved in different systems.

The use of existing data (such as the National Drug Household Survey, AOD Treatment Services NMDS or the National Alcohol Indicators Project – the most prominent sources for drug-related data) is a cost effective way of identifying patterns of substance consumption and treatment within a community, and a reliable way to assess trends over time.[1] However, there are some limitations with the use of datasets that are not designed to answer the question of interest, and caution shall be taken when making conclusions to avoid misleading findings. Substantial amounts of data are collected throughout all systems, but it is gathered in ways that constrain the potential information we can obtain from it. Therefore, even though the system is data rich, it is also information poor.

Why is it important that we address data gaps?

Data quality is a measure based on validity, completeness, accuracy, and how current the data is. Advocates give data-based arguments to policy-makers in reports or inquiries, this is significant as the policy implementation approaches often draw upon the findings of these reports. The growing demand for transparent, accountable and responsive reporting from our governments is progressing the availability and volume of data. This is why it is important we address current data issues.

All information comes from raw data that without being organised can be challenging to understand. Drawing insights from raw data involves losing a certain amount of data to facilitate its interpretation. This is when there is greater risk to make misleading or invalid statements. Often these statements are somewhat correct but don’t give the full context.

Inaccurate data needs to be identified to ensure that decision-makers and other users are working with accurate information. Improved data collection/reporting methodologies would not only bring significant benefit to inform governments on the efficient use of funds across systems, but would also “inform clinicians and other service providers [across systems] on the effectiveness and appropriateness of intervention,”[2] and referral options across systems, and “consumers on the choice of service providers and treatment options.”[3]

Common issues with existing AOD data sources

Current data sources do not provide enough information to ensure system responses to people who use alcohol and other drugs is multi-dimensional and “distinguishes between occasional substance use, problematic substance use and dependence so that treatment intensity is matched to need.”[4]

One of the most common issues with the existing data sets is that the sample used to inform findings is usually not representative of the population of interest. This could be due to multiple reasons such as the sample size being too small compared to the actual population or the exclusion of particular subgroups of the sample. For example, there is currently minimal information collected to identify individuals who are members of diverse communities, especially those from culturally diverse communities.[5] According to the Queensland Mental Health Commission Don’t Judge and Listen Report, the NDSHS excludes homeless people, and those who are travelling or are in institutions such as hospitals and prisons,[6] additionally, its sampling methods assume linguistic and cultural understanding between interviewers and participants. This limitation may lead to misrepresentation of actual AOD consumption.[7] Similarly, the Drug Use Monitoring in Australia (DUMA) dataset which collects information from police detainees on drug use, interviews a low number of female detainees, thus, “caution should be exercised when interpreting the results or making gender-based comparisons.”[8]

Likewise, the AODTS NMDS which provides information on publicly funded alcohol and other drug treatment services and their clients, cannot provide information on the total number of clients who access AOD treatment. Since not all treatment services contribute to the AODTS NMDS, this dataset undercounts the number of services for young people engaged in the youth justice system and it is likely to underestimate the extent to which youth justice clients access AOD treatment services.[9]

As well, reporting biases lead to misrepresentation of the ‘average’ individual being studied (i.e. PWUD). Data completeness and uniformity are important to avoid overlooking confounding factors that create some sort of distortion of the true effect that AOD use has on PWUD. For example, the Queensland Family and Child Commission (QFCC) requested information from key government departments about the Queensland Government’s Youth Justice Strategy 2019–23 and they were told that adolescent alcohol and drug services and mental health services, especially when relating to “people with a mental disorder and a history of criminal offending,” only assess and treat clients when issues are significant, “when they may already be offending or re-offending to obtain more drugs or because of other issues in their life.”[10] The information collected in this process shall then not be used to draw conclusions about young people who use drugs and are in contact with the youth justice system, as it will over represent the severity of the issues and the effect of alcohol and other drugs. This is why it is important that datasets collect all significant information across systems, including social determinants of health to avoid perpetuating stigma.

Similarly, administrative data collected by public officers is problematic. Determining the contribution of alcohol to calls for service is constrained by “inconsistent and subjective assessments by frontline officers about the contribution of alcohol, and or poly-drug use to an incident.”[11] In the same way, reporting biases can lead to overrepresentation of particular groups in the criminal justice system such as Aboriginal and Torres Strait Islander peoples, since recording of Indigenous status in police datasets is often based on a “subjective judgement of physical appearance alone.”[12]

Data on the problematic use of alcohol among Aboriginal and Torres Strait Islander people needs to be understood within the historical and social context of colonisation, dispossession of land and culture, and social and economic disadvantage and exclusion. Factors contributing to alcohol use among Aboriginal and Torres Strait Islander people include the availability, price and marketing of alcohol, racism, and personal factors like stress, early life experiences, educational and employment disadvantage, and food insecurity. [13] (Gray, 2018)

Data consistency across jurisdictions is necessary to be able to standardise data across systems and provide a complete picture. This is why, the ongoing commitment to a cross-agency approaches is key to the success of consistent and accurate data collection that leads to complete and reliable datasets and, consequentially, leads to better-informed policy implementation.

—————————————

[1] Peter G. Miller, John Strang and Peter M., Addiction Research Methods. Blackwell Publishing Ltd, 2010.

[2] “Productivity Commission Inquiry Report on Mental Health.” Productivity Commission, 2020.

[3] Ibid.

[4] “Systemic Responses Position Paper.” QNADA, 2021.

[5]Christine Fleming, Robyn Bond, Samantha Holder and Chris Jeffries, “Evaluation of the Specialist Domestic and Family Violence Court Trial in Southport.” 15: Griffith University, 2017.

[6] “Don’t Judge and Listen: Experiences of Stigma and Discrimination Related to Problematic Alcohol and Other Drug Use.” Queensland Mental Health Commission, 2020.

[7] Ibid.

[8] “Drug and Specialist Court Review: Final Report.” Queensland Courts, 2016.

[9] “Overlap between Youth Justice Supervision and Alcohol and Other Drug Treatment Services.” Australian Institute of Health and Welfare, 2018.

[10] “Changing the Sentence: Overseeing Queensland’s Youth Justice Reforms.” Queensland Family & Child Commission, 2021.

[11] “Inquiry into Alcohol-Related Violence- Final Report.” Legislative Assembly of Queensland, Law, Justice and Safety Committee, 2010.

[12] Jacqueline Joudo, “Responding to Substance Abuse and Offending in Indigenous Communities: Review of Diversion Programs.” In Research and Public Policy Series: Australian Institute of Criminology, 2008.

[13] Dennis Gray, Kimberly Cartwright, Anna Stearne, Sherry Saggers, Edward Wilkes and Mandy Wilson, “Review of the Harmful Use of Alcohol among Aboriginal and Torres Strait Islander People.” Australian Indigenous Health Bulletin 18 (2018).

Increasing access to clinical/practice supervision among AOD workers

Courtney O’Donnell

With support from Brisbane North PHN, we are continuing our work to address the need for increased access to effective clinical/practice supervision among AOD workers in Queensland. QNADA’s Sector and Workforce Development Officer, Courtney O’Donnell, is undertaking this work as part of her PhD study at the University of Queensland (UQ) under the supervision of Professor Leanne Hides (UQ), Professor Nicole Lee (National Drug Research Institute) and Sean Popovich (QNADA).

The first phase of this project took the form of a qualitative study, which aimed to identify barriers and facilitators to accessing high quality clinical/practice supervision. Twenty-one qualitative interviews were conducted with frontline workers and service managers from eight government and non-government AOD treatment services across Brisbane. Thematic analysis indicated that there is a perceived need for all AOD workers to receive regular and frequent clinical/practice supervision from AOD specialists. Consistent with previous research, clinical/practice supervision was also perceived to have a variety of benefits for workers, their employing organisations and people who access services. Frontline workers and managers felt that barriers and facilitators to accessing effective clinical/practice supervision included limited time, the high cost of providers, availability of skilled clinical/practice supervisors, supervisor-supervisee matching and supervision modality (ie external, internal, group or individual).

During interviews, participants were also asked about their perceptions of a clinical/practice supervision exchange model. This model was developed by QNADA with the aim to increase access to effective clinical/practice supervision among workers using the limited sector resources available. A key feature of this model is that it operates on an exchange basis, whereby a worker from one organisation provides clinical/practice supervision to staff of another organisation, and vice versa. While the idea of a supervision exchange partnership was previously been suggested as a possible solution to the issue of under-resourcing in the sector, an AOD-specific clinical/practice supervision exchange model has not previously been implemented and evaluated.

Interviews revealed that frontline workers and service managers considered implementation of a clinical/practice supervision exchange model to be a resource-effective strategy to increase access to external, individual clinical/practice supervision while also exposing workers to a greater diversity of perspectives, increasing sector collaboration and improving the perceived value of clinical/practice supervision among the workforce. Participants considered potential barriers and facilitators to implementation to include willingness among services to participate, sustainability of the model and flexibility in clinical/practice supervision delivery. Data obtained from these interviews were used to inform the second phase of the study.

The second phase of this project was implementation and evaluation of a clinical/practice supervision exchange model with six participating AOD treatment services in Queensland. In late 2020, twenty frontline AOD workers (supervisees) were randomly allocated to the supervision exchange (n=10) or supervision-as-usual (n=10) arms of the study. Participants in the supervision exchange arm of the study were matched with a supervisor (n=5) employed by another participating treatment service. Supervisors and supervisees were pragmatically matched based on characteristics including years of experience in the sector, age, qualifications, expertise and interests. Monthly supervision for participants in the supervision exchange arm of the study commenced in December 2020. All participants were asked to complete a survey at baseline (0 months; pre-), 5 months (mid-supervision exchange), 10 months (post-supervision) and 15 months (follow-up). Participants were recently asked to complete the final survey and results from this trial will be available shortly.

The third phase of this project aims to identify opportunities at the service system level to increase access to effective clinical/practice supervision among the AOD workforce. As part of this project, a review of guidance documents that inform and facilitate the commissioning of AOD treatment services in Queensland is currently underway. The purpose of the review is to determine whether, and in what capacity, commissioners of services are guided to support workforce development activities, such as clinical/practice supervision, through service funding mechanisms. In addition to the review, a series of qualitative interviews with commissioners of Queensland AOD treatment services and other relevant stakeholders are being conducted. The purpose of these interviews is to: identify the perceived role and scope of commissioners of services to support the provision of clinical supervision among the AOD workforce; understand how commissioners currently support the provision of clinical/practice supervision; and identify opportunities for policymakers and commissioners of services to increase access to effective clinical/practice supervision among the workforce. Together, the review of guidelines and interviews will allow us to identify potential systemic barriers to supporting increased access to effective clinical/practice supervision, and potential opportunities to address them.

You can read the full phase one study in the journal, Drug and Alcohol Review, here – https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13450