Overview of current issues impacting on the Alcohol and other Drugs Sector

NADA Workforce Development Plan: NADA members’ Workshop

Monday 16 November 2015 9.30am – 12:30pm

Novotel Sydney Central, Sydney

Professor Ann Roche & Roger Nicholas

www.nceta.flinders.edu.au

Whole rvicesrimary health care,

What is workforce development (WFD) ? The evolution of WFD Profiles of the national and NSW NGO workforces Bigger picture influences on the NADA WFD Plan

Outline

Whole rvicesrimary health care,

……. a multi-faceted approach which addresses the range of factors impacting on the ability of the workforce to function with maximum effectiveness in responding to alcohol- and other drug-related problems.

Workforce development should have a systems focus. Unlike traditional approaches, this is broad and comprehensive, targeting individual, organisational and structural factors, rather than just addressing education and training of individual mainstream workers (Roche, 2002).

What is workforce development?

Whole of populatiot, community services

←Whole of population focus, prevention, social determinants, education, law enforcement, community services

← Primary health care, community services, information services, NSPs, peer support, self help groups

← Specialist assessment and referral, corrections, case management, relapse prevention, community pharmacotherapy, counselling

← Services for people with complex needs, specialist withdrawal management, residential rehab

rimary health care,

Tiers of AOD work involving different agencies

Whole rvicesrimary health care,

Phase 1: The Individual Focus

Education and training programs and resources to enhance individual workers’ knowledge and skills

Failed to take into consideration the influence of the systems in which people worked

This approach does not generally lead to sustainable work practice change

The Four Evolutionary Phases of AOD Workforce development

Whole rvicesrimary health care,

Phase 2: Internal Systems Approach A step forward Focused on the internal systems in which people

work Education and training seen as a subset of

workforce development Recruitment, retention, leadership, supervision,

career development, workforce wellbeing, role clarification

The problem of siloing remained

The Four Evolutionary Phases of AOD Workforce development

Whole rvicesrimary health care,

Education and Training as a Subset of Workforce Development

Roche & Pidd, (2010)

Whole rvicesrimary health care,

Phase 3: A Human Services Systems Approach Builds on Phase 2 Recognises that most people with substance use

problems don’t access specialised treatment services

More attention to social determinants of health (early life experiences, work, unemployment, social exclusion) as causal factors and response strategies

Adopting broad systems approaches incorporating primary care, hospitals, housing, employment and social support for families and children – multiple doorways and pathways

The Four Evolutionary Phases of AOD Workforce development

Whole rvicesrimary health care,

Phase 3: A Human Services Systems Approach Builds on Phase 2 Recognises that most people with substance use

problems don’t access specialised treatment services

More attention to social determinants of health (early life experiences, work, unemployment, social exclusion) as causal factors and response strategies

Adopting broad systems approaches incorporating primary care, hospitals, housing, employment and social support for families and children – multiple doorways and pathways

The Four Evolutionary Phases of WFD in the AOD Field

Whole rvicesrimary health care,Phase 3 (cont): A Human Services Systems

Approach Coordination across a range of systems improves

health, social and criminal justice outcomes Growing expectations for more coordinated and

holistic care Structured relationships with other sectors Up-skilling of generalist workers

The Four Evolutionary Phases of WFD in the AOD Field

Whole rvicesrimary health care,

Phase 4: Into the Future Builds on phase 3 Ensure that the AOD workforce has measures in

place to identify existing and future challenges.

The Four Evolutionary Phases of AOD Workforce development

Whole rvicesrimary health care, The majority are female The majority are aged 45 years or older Approximately one third are employed part time Median length of AOD service is five years The largest occupational groups are AOD workers

and nurses A substantial number of workers have no formal

AOD-specific qualifications.

National profile of the specialist AOD Workforce (Roche & Pidd, 2010)

Whole rvicesrimary health care,

Survey respondents: Average age 45 years Predominantly female 7.7 years AOD experience (5.1 years with their

current organisation) Almost half (48%) hold a university qualification and

57% hold a specific AOD qualification Most common position title: AOD Worker 82% of staff were from an organisation providing

residential rehabilitation <10% identify as ATSI; 13% from a CALD

background

The NSW NGO AOD sector (NADA, 2014)

Whole rvicesrimary health care,Bigger picture influences on the NADA

WFD Plan

Whole rvicesrimary health care,

1. Ageing Australian Population

* Substance use disorders in over

50s predicted to double by 2020 Greater use when younger

continues in later life Baby boomers’ liberal attitudes

towards alcohol / medicines and

illicit drugs

The baby boomers have arrived!

Whole rvicesrimary health care,

↑ Non-communicable diseases including accumulated AOD harm

↑ Proportion of population with ↑ rates of AOD use / harm

More complex drug interactions and sensitivities Ageing AOD specialist workforce + retirement of

highly skilled workers ↑ Competition for workers, especially registered

nurses (particularly in the context of globalisation of the workforce)

So What?

Whole rvicesrimary health care,

Projected Employment Change 2011/12 - 2016/17

Whole rvicesrimary health care,

2. Multiple Morbidities

* Physical / mental / social health co-morbidities very common among people experiencing AOD harm

* Multi-morbidities are the norm among people with chronic health / social problems

* Most common among the most disadvantaged

* At times current approaches focus too much on single morbidities

* Co-location, multi-D teams, inter-professional education, cross sectoral WFD, enhanced in-house generalist service provision, enhanced linkages

* Need to balance against the risks of being all things to all people and deskilling of specialists

Emerging issues (cont. )

Whole rvicesrimary health care,

3. New substances / patterns of use* Synthetics / pharmaceuticals / smart drugs

* Enhanced monitoring of Schedule 8 drugs

* Pain management

4. New prevention paradigms and treatments* Social determinants of health

* Integrated models of care in recognition of multiple morbidities

* New pharmacotherapies

5. Enhancing consumer input into care e.g., client- led care (funding implications)

6. Initiation into AOD use at earlier ages

Emerging Issues (cont.)

Whole rvicesrimary health care,

7. On-going restructuring (e.g., potential integration of AOD and MH agencies)

8. Outcomes- (rather than inputs- or outputs-) focussed funding

9. Downstream effects of current cutbacks in prevention activities

10.Demands for more family inclusive practice

11. Better understanding the effects of parental AOD and co-occurring problems on children

Emerging Issues (cont)

Whole rvicesrimary health care, Varies between jurisdictions Particularly contentious concerning workers with lived

experience “Minimum” versus “essential” qualifications Lack of minimum standards may lead to AOD field

being seen as unprofessional Only Vic and ACT have mandated minimum Certificate

IV qualifications Who pays for training costs including backfill? ↑ minimum qualifications = ↑ wages pressure

Minimum Qualifications / Accreditation to Work in Specialist AOD Roles

Whole rvicesrimary health care, Disincentive to base level entry into AOD work (??) Is Cert IV achievable? Too low? Existing staff? 86% of drug treatment managers prefer staff to have

higher education qualifications, and one third support graduate minimum qualification levels (Pidd et al., 2010)

Concerns from managers and trainers that the current VET package is too generic (Roche et al., 2012)

Tension between employers and governments (specialised versus generic training)

Matching qualification levels to tasks

Minimum Qualifications / Accreditation to Work in Specialist AOD Roles

Whole rvicesrimary health care,

Provides an opportunity for the NSW NGO AOD field to set itself up to cope with future challenges and have a sustainable workforce

Provides an opportunity to examine ways of working with other agencies / sectors to better meet the needs of clients with complex needs

Enhances our capacity to reduce AOD harm.

In summary the NADA Workforce development plan:

Whole rvicesrimary health care,

Conclusion

www.nceta.flinders.edu.au