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Future Service Directions Plan

Analysis of Performance

DEC 2013 | FINAL REPORT 1.0

ATOD Future Service Directions Plan – Analysis of Performance FINAL REPORT

Contents Introduction ............................................................................................................................................................................. 5

1 Executive Summary ............................................................................................................................................................. 6

1.1 Our Achievements .......................................................................................................................................................................................... 6

1.2 Financial Summary ........................................................................................................................................................................................... 7

1.3 General Findings .............................................................................................................................................................................................. 9

1.3.1 Recruitment Issues ................................................................................................................................................................................. 9

1.3.2 Internal Administrative Processes ....................................................................................................................................................... 9

1.3.3 Budgetary Pressures ........................................................................................................................................................................... 10

1.3.4 Governance of the Future Service Directions Plan ...................................................................................................................... 11

1.4 Priority Action Areas for the Future ........................................................................................................................................................ 13

1.4.1 Financial Investment ............................................................................................................................................................................ 13

1.4.2 Service Development ......................................................................................................................................................................... 13

1.4.3 Workforce Development .................................................................................................................................................................. 13

1.4.4 Promotion, Prevention and Early Intervention .............................................................................................................................. 14

1.4.5 Consumer Engagement ...................................................................................................................................................................... 14

1.4.6 Tasmanian Opioid Pharmacotherapy ............................................................................................................................................... 14

1.4.7 Review of Psychosocial Services and Interventions ...................................................................................................................... 14

1.4.8 Information Technology ..................................................................................................................................................................... 15

1.4.9 Performance Monitoring and Reporting ......................................................................................................................................... 15

1.4.10 Quality Improvement ....................................................................................................................................................................... 15

2 Background to the Future Service Directions Plan ....................................................................................................... 16

3 Strategic Focus of the Future Service Directions Plan ................................................................................................. 16

3.1 Tasmanian Governance Structure ............................................................................................................................................................ 16

3.2 Vision, Aim and Principles .......................................................................................................................................................................... 18

3.3 Tiered Service Delivery Model .................................................................................................................................................................. 18

3.3.1 Recognition that a large range of services manage/support clients who present with alcohol and drug issues ................ 18

3.3.2 Describe the differences between government and community based specialist ATOD services ...................................... 18

3.3.3 Specialist support for mainstream services .................................................................................................................................... 19

4 Major Service Developments ........................................................................................................................................... 20

4.1 Withdrawal Management............................................................................................................................................................................ 20

4.2 Opioid Pharmacotherapy............................................................................................................................................................................ 23

4.3 Consultation Liaison Services .................................................................................................................................................................... 25

4.4 Residential Rehabilitation Services ............................................................................................................................................................ 26

4.5 Youth Intervention Services....................................................................................................................................................................... 28

4.6 Outreach ....................................................................................................................................................................................................... 29

4.7 Relapse Prevention ...................................................................................................................................................................................... 30

4.8 Management of Complex Needs ............................................................................................................................................................... 31

4.9 Brief and Early Intervention ....................................................................................................................................................................... 32

4.10 Places of Safety ........................................................................................................................................................................................... 33

4.11 Support for Families .................................................................................................................................................................................. 34

4.12 Smoking Cessation .................................................................................................................................................................................... 35

4.13 Supporting the Aboriginal Community .................................................................................................................................................. 37

4.14 Workforce Development ......................................................................................................................................................................... 39

4.15 Continuous Quality Improvement .......................................................................................................................................................... 40

4.16 Advocacy Support ...................................................................................................................................................................................... 42

4.17 Governance, Planning and Policy Development ................................................................................................................................... 44

4.18 Information Management ......................................................................................................................................................................... 46

4.19 Legislative Reform ..................................................................................................................................................................................... 47

5 Financial Overview of Expenditure .................................................................................................................................. 48

6 Statistical Summary of Activity ....................................................................................................................................... 51

6.1 Withdrawal Management............................................................................................................................................................................ 51

6.2 Pharmacotherapy ......................................................................................................................................................................................... 52

6.3 Psychosocial Interventions (Community Team) – Alcohol and Drug Service .................................................................................. 56

6.4 National Minimum Data Set ....................................................................................................................................................................... 56


Index of Tables

Table 1 Future Service Directions Plan, Funding Allocation, 2008/09 to 2011/12

Table 2 Future Service Directions Plan, Funding Allocation by Priority Focus Area, 2008/09 to 2011/12

Table 3 ATOD Service Development Funding Allocation, 2008/09 to 2011/12

Figure 1 Inter-Agency Working Group on Drugs – Governance Framework (April 2012)

Table 4 Additional Financial Investment for Withdrawal Management, 2008/09 to 2011/12

Table 5 Withdrawal Management - Achievements against Outcomes

Table 6 Additional Financial Investment for Opioid Pharmacotherapy, 2008/09 to 2011/12

Table 7 Opioid Pharmacotherapy - Achievements against Outcomes

Table 8 Additional Financial Investment for Consultation Liaison, 2008/09 to 2011/12

Table 9 Consultation Liaison - Achievements against Outcomes

Table 10 Additional Financial Investment for Residential Rehabilitation, 2008/09 to 2011/12

Table 11 Residential Rehabilitation - Achievements against Outcomes

Table 12 Additional Financial Investment for Youth Intervention Services, 2008/09 to 2011/12

Table 13 Youth Intervention - Achievements against Outcomes

Table 14 Additional Financial Investment for Outreach, 2008/09 to 2011/12

Table 15 Outreach - Achievements against Outcomes

Table 16 Relapse Prevention - Achievements against Outcomes

Table 17 Additional Financial Investment for the Management of Complex Needs, 2008/09 to 2011/12

Table 18 Complex Needs - Achievements against Outcomes

Table 19 Additional Financial Investment for Brief and Early Intervention, 2008/09 to 2011/12

Table 20 Brief and Early Interventions - Achievements against Outcomes

Table 21 Additional Financial Investment for Places of Safety, 2008/09 to 2011/12

Table 22 Places of Safety - Achievements against Outcomes

Table 23 Additional Financial Investment for Support for Families, 2008/09 to 2011/12

Table 24 Support for Families - Achievements against Outcomes

Table 25 Additional Financial Investment for Smoking Cessation, 2008/09 to 2011/12

Table 26 Smoking Cessation - Achievements against Outcomes

Table 27 Supporting the Aboriginal Community - Achievements against Outcomes

Table 28 Additional Financial Investment for Workforce Development, 2008/09 to 2011/12

Table 29 Workforce Development - Achievements against Outcomes

Table 30 Continuous Quality Improvement - Achievements against Outcomes

Table 31 Additional Financial Investment for Advocacy Support, 2008/09 to 2011/12

Table 32 Advocacy Support - Achievements against Outcomes

Table 34 Governance, Planning and Policy Development - Achievements against Outcomes

Table 35 Additional Financial Investment for Information Management, 2008/09 to 2011/12

Table 36 Information Management - Achievements against Outcomes


Table 38 Legislative Reform - Achievements against Outcomes


Table 40 ATOD Service Development Recurrent Expenditure and Future Allocation, 2008/09 to 2011/12

Table 41 Tasmanian Opioid Pharmacotherapy Program, Total Individual Clients, 2009/10 to 2011/12

Table 42 Tasmanian Opioid Pharmacotherapy Program, Active Clients, 2007/08 to 2011/12

Table 43 Closed Treatment Episodes by Client Type, Sex and Age, Tasmania and Australia, 2007-08 to 2009-10 (per cent)


Alcohol, Tobacco and Other Drug Services, Tasmania

Future Service Directions Plan – Analysis of Performance

Introduction

In 2007/08 the State Government commissioned an independent review of the alcohol, tobacco and

other drug sector in Tasmania. The review made 47 recommendations and highlighted a number of

concerning issues across the sector, most importantly the need for an immediate injection of funds

to increase the capacity of the sector to meet the most urgent needs (particularly in the area of

pharmacotherapy).

In responding to the recommendations and in consultation with the sector and other stakeholders,

the Department of Health and Human Services released a five year plan for the sector – the Future

Service Directions Plan. This Plan outlined a range of significant service development strategies

across both the government and community sector. Although the Plan highlighted the important

role of the broader, mainstream health and human services system, it’s development strategies were

purely focused on specialist alcohol, tobacco and other drug treatment services (particularly those

provided or funded by the Tasmanian State Government). In addition to this, a decision was taken to

exclude the criminal justice system from the scope of the Plan. This decision was made because of

the enormity of the task and the significant reforms that were being undertaken within the

Tasmanian Prison system at that time.

The underlying objective of the Plan was to attempt to establish a basic foundation of specialist

services across the State which could then be grown and further developed in the future. This was a

significant aspect in the development of the Plan and highlighted the importance of continuing the

reforms and developments beyond the life of the Plan. In consultation with the sector and other

stakeholders (by way of an interim discussion paper) it was agreed that there was a desperate need

to have an initial focus of energy on developing a highly specialist government service system which

could then support the rest of the sector. This enabled the Alcohol and Drug Service to focus on

the urgent and critical issues that were identified within the review.

In preparing for the 2008/09 budget process, the Alcohol and Drug Service considered the Plan and

pulled together a detailed costing proposal to implement the Plan. As part of the 2008/09 State

Budget, the Tasmanian Government (at that time) committed just over $17 million to implement the

strategies contained in the Plan and a further $2.7 million to help Tasmanians to quit smoking. It is

important to note that the funding was initially provided for four years to fit in with State

Government forward estimate cycles (a four year cycle). The funding provided aligned with what

had been included in the costing proposal for the first four years of the Plan. At that stage no

financial commitment had been made by the Government for strategies due to commence in the

final year of the Plan (ie 2012/13).

Given the Plan has now reached its final year, the Alcohol, Tobacco and Other Drug Steering

Committee agreed to undertake an analysis of the implementation of the Future Service Directions

Plan. To ensure the analysis was objective and thorough, a significant consultation process with

clients and other key stakeholders was undertaken.

This report provides a comprehensive analysis of the implementation of the Future Service

Directions Plan and outlines a range of “Future Development Options” for the ongoing development

of the alcohol, tobacco and other drugs treatment sector in Tasmania.


1 Executive Summary

As part of the 2008-2009 State Budget, an additional $17.2 million over four years was provided for

the alcohol, tobacco and other drugs sector. The Future Service Directions Plan was released in late

2008 to guide the investment of the new funding.

1.1 Our Achievements

Since the release of the Plan, the Alcohol Tobacco and Other Drug sector has made some

considerable achievements in the development of specialist alcohol, tobacco and other drug services

in Tasmania.

Some of the more notable achievements include:

significant investment and growth in the public pharmacotherapy program;

improved services within the specialist withdrawal management unit;

established a dedicated Workforce Development Unit for the sector;

increased support for policy development;

increased support for young people with alcohol and drug issues;

significant investment into the three community based residential rehabilitation services in this

State;

established new services of care coordination, advocacy and consumer participation within the

community sector;

established a family support service for the North and North West regions of the State;

established a new community based support service located on the East Coast (Break O Day

local government area);

finalised and implemented the Tasmanian Opioid Pharmacotherapy Policy and Clinical Practice

Standards;

implementation of a new client information management system and improved reporting;

commenced a new Statewide Smoking Cessation Service;

increased tobacco control strategies;

release of the Guide to Consumer Engagement for Tasmanian Alcohol, Tobacco and Other

Drug Services;

released an Alcohol Action Plan that complements national strategies to reduce binge drinking

and to promote responsible consumption of alcohol;

released a Promotion, Prevention and Early Intervention Strategy; and

infrastructure redevelopment to accommodate expanded services and staffing.

In managing these significant developments, the alcohol, tobacco and other drug sector has delivered

on many of the outcomes that were identified in the Future Service Directions Plan. A summary of

our performance in implementing the initiatives and meeting the outcomes in the Plan is provided

later in this document.


1.2 Financial Summary

In 2008/09 a considerable unspent allocation was realised. This was predominantly caused by the

following factors:

Allocation of funding did not occur until just prior to the 2008/09 financial year which made it

impossible for the Alcohol and Drug Service to pull together a Project Team to manage the

considerable service developments that were included in the first year of the Plan.

In January of 2009 there were considerable concerns about the state of the health budget and

as a result there was requirement for the Sate Manager to undertake a detailed budget analysis

on Future Service Direction Plan commitments and plan in anticipation of a reduced budget for

2009/10. There was a resultant hold on expenditure approval for the remaining half of that

financial year.

Recruitment to specialist positions proved extremely difficult. For example, specialist addiction

medicine positions and specialist nursing positions needed to support the pharmacotherapy

program were not filled in the first year despite having allocated funding for those positions (the

initial allocation for specialist nursing and medical positions for pharmacotherapy was just over

$600,000 in 2008/09 – these positions could not be filled despite intensive recruitment

processes).

Any funding earmarked for the community sector could not be allocated until a formal request

for proposal process had been undertaken. As a result, in 2008/09 only 65% of the funds

allocated to residential rehabilitation were actually paid and only 22% of funding earmarked for

youth services was allocated to community sector organisations (this amounted to

approximately $350,000 unspent funding in 2008/09).

Similarly in 2009/10, difficulties in recruitment and delays in processing funds to the community

sector resulted in an underspend of just under $400,000 for that year.

The Alcohol and Drug Service was required to deliver savings of $200, 000 in 2009/10 and 2010/11

and a further $805,000 in 2011/12. These were taken from funding for the Future Service

Directions Plan.

Table 1 below highlights the expenditure across the four years of the Plan and the investment into

government and community sector services (more detailed financial information is provided later).

Table 1 Future Service Directions Plan, Funding Allocation, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12 Total

Allocation

Funding Allocated (2008/09 State Budget) $1,788,000 $3,810,000 $5,450,000 $6,160,000 $17,208,000

Expenditure -

Service Delivery $564,684 $2,504,670 $4,165,163 $5,355,000 $12,589,517

Project Team $168,202 $320,210 $320,210 $221,210 $1,029,832

Other One Off Expenditure (including

capital works) $387,779 $697,247 $57,247 $1,142,273

Savings Target $200,000 $200,000 $805,000 $1,205,000

Total Allocation $732,886 $3,412,659 $5,282,620 $6,438,457 $15,966,622

Unspent Allocation $1,055,114 $397,341 $167,380 -$278,457 $1,241,378

Investment in Service Delivery

Community Sector $349,719 $1,308,509 $1,534,358 $2,274,358 $5,466,944

Government $214,965 $1,196,161 $2,630,805 $3,080,642 $7,122,573

Total Allocation $564,684 $2,504,670 $4,165,163 $5,355,000 $12,589,517


Table 2 below provides an overview of funding allocation by priority area as identified in the Future

Service Directions Plan. It is important to note that, ongoing funding was not secured until the

release of the 2013/14 State Budget. The allocation to outreach services in 2011/12 has yet to be

committed to a service organisation(s). A request for proposal process will be undertaken to

commit those funds during 2013/14.

Table 2 Future Service Directions Plan, Funding Allocation by Priority Focus Area, 2008/09

to 2011/12

Priority Focus Area 2008/09 2009/10 2010/11 2011/12

Withdrawal Management $14,153 $157,977 $157,977 $150,000

Opioid Pharmacotherapy Program $87,021 $530,927 $1,151,878 $1,597,642

Consultation Liaison Services

$25,000 $220,000 $220,000

Residential Rehabilitation Services $277,839 $424,358 $424,358 $424,358

Youth Intervention Services $119,628 $428,151 $439,950 $461,000

Outreach Services

$710,000

Management of Complex Needs

$255,000 $390,000 $390,000

Brief and Early Intervention Services

$345,000 $200,000

Places of Safety Services $11,880 $81,320 $115,000 $95,000

Support for Families

$200,000

Population Based Strategies $20,000 $20,000 $20,000 $20,000

Workforce Development $10,386 $280,000 $310,000 $280,000

Planning and Policy Development $23,777 $301,937 $591,000 $607,000

Total Allocation $564,684 $2,504,670 $4,165,163 $5,355,000

Consultation Feedback

Stakeholders agreed that the Sector has implemented many of the initiatives contained in the

Future Service Directions Plan. The investment into service development has resulted in increased

service capacity, greater professionalism and improved quality of services and outcomes for clients.

There was general consensus that Tasmania has a good foundation of services (and service types)

from which further development can occur.

All stakeholders highlighted the importance of maintaining and increasing the funding levels

associated with the Future Service Directions Plan. There was universal agreement to secure the

current levels of expenditure (this has since been achieved) and to continue to seek funding for the

initiatives contained in the final year of the plan.

It was noted that the allocation of funding was skewed toward investment in the government

services. Whilst it was acknowledged that the investment into government services was essential,

this imbalance of investment in tertiary treatment types rather than in community based options

has impacted on client outcomes in community settings.

Stakeholders indicated that the current levels of funding fall well short of what is required to meet

the current needs of clients and agreed that further investment into the sector is required. The

most common areas identified as requiring significant investment were rehabilitation services,

services to young people and outreach services to rural and remote regions of the State.

Gaining traction will require the ongoing commitment of increased funding to the sector and

adopting a collaborative partnership approach to the development of service models to meet the

broader community needs in relation to ATOD use.


Future Development Options

1. Establish a collaborative mechanism to agree and progress the commitment of unspent

funding associated with the Future Service Directions Plan.

2. Continue to seek additional investment into the Tasmanian alcohol, tobacco and other

drug treatment sector, including funding for the fifth year initiatives of the Plan and for

the ongoing growth of treatment services.

1.3 General Findings

There are a number of general issues that have arisen through the implementation of the Future

Service Directions Plan that impacted on the ability to implement strategies within the identified

timeframes. The issues fall into three categories: recruitment issues, internal administrative

processes and budgetary pressures. Performance against individual strategies (for the Priority Focus

Areas) is addressed later in this report.

1.3.1 Recruitment Issues

The biggest barrier to implementing strategies contained in the plan was the ability to recruit suitably

qualified/experienced personnel to positions. This single issue caused significant delays through the

entire life of the Plan and was particularly an issue for the government sector.

In implementing the Plan it was recognised that there would be some difficulties in recruiting to

newly created positions. In fact, this anticipated “slippage” money (arising from delays in

implementing strategies) was to be used to fund the Project Team that was established to support

and drive the implementation of the Plan. However, the difficulties in recruitment were significantly

more challenging that what was ever anticipated. These difficulties were not just limited to clinical

positions but were a significant issue in the establishment of the Project Team.

For example, the recruitment of an Addiction Specialist takes a minimum of 18 months and in some

cases some of the positions have remained vacant well beyond 18 months. The two Workforce

Development Consultants were filled approximately 18 months after they were first advertised only

to have both occupants accepting positions on the mainland some 6-12 months later.

Discussions with successful and potential applicants have revealed that Tasmania offers competitive

packages across the range of clinical positions. The difficulty in recruitment and retention is a result

of a national shortage of skilled workers across the country (and internationally). The small

numbers of experienced workers are sought by all jurisdictions, across both government and the

community sectors.

The difficulty in recruiting suitable workers had a significant impact on implementing all the strategies

contained in the Plan.

1.3.2 Internal Administrative Processes

The internal administrative processes surrounding expenditure of funds presented as a major barrier

in meeting the ambitious timeframes, for both the government and community sectors.

The creation and establishment of new services within the Alcohol and Drug Services required the

recruitment of additional staffing. To enable this to occur a range of administrative processes

needed to be undertaken including, developing statements of duties, creation of new position on the

establishment, advertising position and interview and recruitment processes. As with most

organisations, especially those expending public money, there is requirement for approval at pre-


established levels of delegation which collectively lead to delays. However, it is recognised that to

ensure a fair and equitable process these administrative functions are unavoidable. Throughout the

course of the Future Service Directions Plan, the Department has endeavoured to streamline the

administrative processes and make recruitment of new staff quicker and easier.

Similarly the process of procuring new services from community organisations proved to consume

considerable more time than anticipated and combined with delays in the distribution of annual

Future Service Directions Plan funds minimised what could be achieved in any financial year.

While recognising the value and importance of government policies and procedures that ensure

value for money, accountability and transparency the process from the initial business case and

associated plans through to seeking request for proposals, selection and funding of an external

organisation had a greater impact on project time frames than was initially anticipated.

Once an organisation had received funding there was often a further delay in the actual

commencement of the service because of the need to develop/establish infrastructure as well as

managing recruitment issues.

1.3.3 Budgetary Pressures

The financial difficulties of the Tasmanian State Government over the past two years (2010/11 –

2011/12) have been well documented along with the inevitable need for the Government to make

significant savings and reductions in expenditure. With more than a quarter of Government

expenditure directed towards health, the Department of Health and Human Services was required

to make significant savings over the past two years.

In order to minimise the impact of the savings strategies on current services, a decision was made to

delay implementation of any new services (to deliver one-off savings) and in some cases to not

proceed with anticipated new service development and investment. This essentially meant that the

sector avoided the need to reduce the current services (across government and community sector

organisations).

Implementation of the Future Service Directions Plan in a difficult budget environment meant that

the Alcohol and Drug Service was attempting to expend additional new funds in tension with a range

of fiscal strategies that had been applied across the Health Department with the intent of enforcing

budgetary restraint. These strategies especially in relation to recruitment had a significant impact on

the projects timetable and delayed the procurement and implementation of new service initiatives.

In addition to these issues, the Government initially provided funding for the Future Service

Directions Plan for a four year period (2008/09 to 2011/12) which has been continued for a further

12 month period (2012/13). However, the Department has (at this stage) been unable to secure

ongoing funding for initiatives commenced under the Future Service Directions Plan (ie beyond

2012/13).

The uncertainty around ongoing funding has resulted in the delay of any further service development

activities until a resolution can be found. Those service development activities identified in the

fourth year of the Plan have not been progressed

at this stage. The major area that has been affected is the area of outreach expansion. Investment

to increase outreach capacity to rural and remote areas of the State was due to occur in 2011/12.

This initiative has not been progressed at this stage.


1.3.4 Governance of the Future Service Directions Plan

Following the release of the Future Service Directions Plan and the Government’s announcement to

provide funding over four years, the Department established the Alcohol, Tobacco and Other Drug

Services, Future Service Directions Steering Committee. The terms of reference outline that the

Committee is responsible for overseeing the implementation of the Future Service Directions Plan

and the provision of direction and leadership in the development and reform of the ATOD sector

and the investment in both government and community sector organisations.

Membership of the ATOD Steering Committee consists of the following positions:

Chair: CEO Statewide and Mental Health Services

Membership: Clinical Director Alcohol and Drug Service

Director Population Health

Deputy Director Population Health

State Manager, Alcohol and Drug Service

Manager Coordination and Innovation, Statewide and Mental Health

Services

Chief Executive Officer, Alcohol, Tobacco and Other Drug Council of

Tasmania (ATDC)

Manager Service Development Unit (Ex-Officio)

Senior Advisor Tobacco Policy and Programs (Ex-Officio)

Statewide Smoking Cessation Coordinator (Ex-Officio)

Project Officer: Project Officer, Alcohol and Drug Service (Exec Support)

Representatives from other groups could also attend meetings to provide information and updates

pertinent to the activities of the Future Service Directions Plan.

Initially this structure provided good governance to the implementation of the Plan and expenditure

of funding. It also provided representation from Senior Management (particularly the CEO of

Statewide and Mental Health Services and the Director of Population Health) which ensured any

significant issues could be raised and managed at a whole of Agency level if needed.

The life of the Future Service Directions Plan is now coming to an end and most of the initial

allocated funding has been committed. Therefore, the focus will shift from one of monitoring

investment to a focus on the continuation of building services capacity, strategic development and

quality improvement. The current steering committee has an imbalance of representation from the

Government sector compared to representation from the community sector. The CEO of the

ATDC is currently the only community sector representative. To progress sector wide issues it will

be important to establish a more equitable representation from across the sector. This will ensure

that there is more direct input from experts from the community sector in the decision making

process and will also promote broader based development initiatives by the whole sector.

The current wider reforms occurring across the Health system will also require a different

governance process with different representation if alcohol and drug issues are to be progressed

effectively.

To ensure a more collaborative approach to progressing issues in the future, it is suggested that a

new governance structure be adopted. Such a structure should try to maintain involvement of

senior positions within the Department but also allow for the ongoing oversight of

projects/initiatives to be managed by experts from across the sector.


Until the Departmental restructure is complete, it will be difficult to articulate what positions would

form a senior steering committee that would oversee development initiatives. Therefore it is

suggested that, at this stage, a new structure that involves managers/CEO’s of government and

community sector organisations is established to provide expert leadership and advice to service

development projects and initiatives. This model would also allow for other key stakeholders to be

represented if required (for example other areas of the Department, representation from the

Commonwealth Government and from other State Government Agencies).

The following figure provides an overview of a proposed new governance structure.

The AOD Treatment Expert Working Group would oversee the major service development

projects that have sector wide implications (the projects would include the continuation of current

initiatives, such as workforce development, PPEI and consumer engagement as well as specific

projects that come out of the review of the Future Service Directions Plan). The role of the Expert

Treatment Working Group would also involve providing direction, leadership and support for major

service development projects for the Tasmanian Alcohol and Other Drug Treatment Sector.

Operationally the majority of the ongoing work would be overseen by the Expert Treatment

Working Group who would meet on a regular basis (for example every month or every second

month) to progress the development agenda. Updates could be provided to the Steering

Committee electronically which could reduce the need for that Committee to meet (it is suggested

that the Steering Committee would meet every 6 months with the option of convening at other

times when needed).


There was universal support from all stakeholders for the proposed new governance structure.

Increasing the involvement of the community sector in in the governance structure will promote a

stronger collaborative partnership to progress the ongoing development of the sector. With the

recent structural changes to the Tasmanian government health system, as a result of national

health reforms, the inclusion of the Tasmanian Medicare Locals and the Department of Health

and Ageing could provide a far more strategic approach to sector planning and development.

Feedback from the consultation process also highlighted the importance of consumer

representation as part of the governance structure.

Steering Committee

Structure to be determined.

AOD Treatment Expert Working Group State Manager ADS, CEO ATDC, Policy Manager SMHS, CEOs Community

Sector Organisations (X4), Clinical Director ADS, Commonwealth

Government and Other Representatives as required (eg Medicare Locals)

Major Service Development Projects

Projects and Initiatives Projects and Initiatives Projects and Initiatives



1. Establish the new governance structure to progress sector development initiatives.

2. Once established, the AOD Treatment Expert Working Group will be responsible for

prioritising and managing sector development initiatives.

1.4 Priority Action Areas for the Future

In considering the findings and future development options contained in this review, it is clear that

there has been significant success in implementing the Future Service Directions Plan. However, it is

also clear that initial expectations were very high and, in hindsight, probably too optimistic in terms

of what could be achieved in the given timeframes.

There is still some considerable work to be undertaken to fully implement the plan (some of this

work was not explicitly identified within the plan and has been identified through the course of

implementing the plan). The level of work still to be undertaken is documented throughout this

report.

To assist with the ongoing workload it is suggested that effort/resources are directed towards the

following issues/areas. To progress these important areas it is anticipated that service development

positions would be required across both the government and community sectors. More detailed

information on these issues/areas is provided within the relevant areas of this report.

1.4.1 Financial Investment

As part of the 2013/14 State Budget, the Government provided ongoing funding for the delivery of

services that have been established under the Future Service Directions Plan. However, no

additional investment was provided which means that the initiatives contained in the last year of the

plan cannot be progressed at this stage. It will be important to continue to seek opportunities for

further investment into the sector to build on the foundation of services which the Plan has

established (this would also include seeking funding for the final year of the Plan and ongoing growth

funding).

1.4.2 Service Development

Given the uncertainty with ongoing funding beyond 2012/13, development identified in the fourth

year of the Plan has not progressed. Now that this funding has been secured it will be important to

progress service development priorities contained in the fourth year of the Plan. The major area of

growth for the fourth year was to increase services to the more rural and remote areas of the State.

It should be noted that, although outreach services was highlighted as a priority in the consultation

process, the areas of residential rehabilitation and services for youth were also identified as areas of

need. It will be important that the priority for investment is discussed and confirmed by any new

governance structure implemented to drive sector development.

1.4.3 W orkforce Development

Workforce development is identified as a critical issue within the Plan. Workforce Development

positions have been created within the Alcohol and Drug Service and the community sector. As a

result, significant workforce development activity has occurred within the community sector.

However, given recruitment issues and competing priorities, the Alcohol and Drug Service has not

progressed workforce development to the extent identified in the Plan. This will be a significant

area of focus for the Alcohol and Drug Service in the near future.


1.4.4 Promotion, Prevention and Early Intervention

Over the past 18 months significant work has been undertaken in developing the Alcohol and Other

Drugs Promotion, Prevention and Early Intervention Strategic Framework. The development of the

Strategic Framework document is designed to align with, and complement, a broad range of actions,

activities and initiatives planned or underway at the National, State and local level to enable better

outcomes for individuals, families and communities who are impacted by the use and misuse of

alcohol, tobacco and other drugs.

The Strategic Framework has been developed, on behalf of Government, by the Inter Agency

Working Group on Drugs the principal policy advisory body to the Tasmanian Government

concerning the use of alcohol, tobacco and other drugs in Tasmania.

The Strategic Framework will provide direction for the Tasmanian ATOD sector in the delivery of

promotion, prevention and early intervention activities. It is anticipated that a sector workplan will

be established that helps to define and identify the roles of individual services across the sector.

1.4.5 Consumer Engagement

The engagement of consumers in the delivery of services continues to be a high priority for the

ATOD sector. In late 2009, the Department funded Advocacy Tasmania Inc. (ATI) to support the

development of strategies aimed at improving the engagement of consumers in alcohol and drug

treatment services across the State. In mid 2011, ATI released a Guide to Consumer Engagement to

support services in their desire to better engage clients. This was followed by a sector wide forum

in early 2012 that identified and agreed upon a range of strategies and priorities to progress the

consumer engagement agenda. It is anticipated that a work plan will be established by Advocacy

Tasmania to progress consumer engagement across the sector.

1.4.6 Tasmanian Opioid Pharmacotherapy

Over the course of the Plan, significant resources have been invested into the pharmacotherapy

program. These resources have focused on increasing the capacity of the program (by recruiting

specialist clinical staff) and improving the quality of treatment (and therefore reducing the risk to

clients) by establishing a new statewide policy and clinical practice standards.

The new policy and clinical practice standards were released in August 2012. The implementation of

the new policy and clinical practice standards will be a very high priority for the Alcohol and Drug

Service but will also require significant resources to support that process. In line with the

implementation of the new policy, there will continue to be a need to build the capacity of the

program with a particular emphasis on increasing access to prescribers across the State (by

recruiting additional addiction medical specialist and supporting new general practitioners to join the

program) and to boost dosing sites for clients (by engaging more community pharmacists into the

program).

1.4.7 Review of Psychosocial Services and Interventions

The need to articulate the appropriate models of psychosocial services and interventions required in

the Tasmanian service system is an extremely high priority for the sector. Both government and

community sector organisations provide psychosocial interventions as a significant component of

their treatment services. The need to review how and what types of interventions are most

effective for Tasmanian clients is paramount to ensuring a sector that is contemporary, high quality

and sustainable.


1.4.8 Information Technology

The Alcohol and Drug Service has made significant progress in the area of information management

with the implementation of iPatient Manager (iPM) in July 2012. It is anticipated that iPM will

improve the management of information for clinicians. However, iPM will not fully meet the needs

of the Alcohol and Drug Service to electronically manage all clinical information for clients. The

Alcohol and Drug Service will continue to investigate technology solutions for the management of

clinical information. Further work must also be undertaken to identify the needs of community

sector organisations in the area of information technology with the view to supporting services to

manage clinical information electronically.

In addition to this, there are a number of other information technology issues which need to be

progressed including real time reporting, development of the National Minimum Data Set,

Pharmcare, iPharmacy and an electronic health record system.

1.4.9 Performance Monitoring and Reporting

The need to improve the monitoring and reporting of activity and performance continues to be a

significant issue for the Alcohol and Drug Service. A lack of reliable data has a significant impact on

the ability to plan, develop and manage services. Information provided to the National Minimum

Data Set has always been subject to quality issues which has made it difficult to compare Tasmanian

data with other States. Reporting by the community sector is also an area which will require further

work to ensure a greater ease and consistency (with other reporting) of reporting by organisations.

The development of key performance indicators across government and community sector

organisations is important and further work is to be undertaken in this area to establish a meaningful

data collection, reporting and monitoring system for the sector.

1.4.10 Quality Improvement

The other significant body of work to be undertaken by the Alcohol and Drug Service is in the area

of quality improvement, particularly to progress the accreditation of the service. A large body of

work has already been undertaken to progress accreditation so it will be important for the Alcohol

and Drug Service to maintain the momentum to ensure the service reaches accreditation.

Continuous quality improvement is a significant priority for the community sector as well. It will be

important for the Alcohol and Drug Service to work closely with community sector organisations

and the Community Sector Relations Unit to support the continued development of a quality

framework applicable to all services within the sector.


2 Background to the Future Service Directions Plan

The Tasmanian State Government, as part of the 2008/09 Budget, committed $17.2 million over four

years (2008/09 to 2011/12) to the development of alcohol, tobacco and other drug (ATOD) services

in Tasmania. In addition to this, the Government also invested an additional $2.7 million over four

years to initiatives to support Tasmanians to quit smoking.

The development of the Future Service Directions provides a clear direction for the Tasmanian

ATOD sector and has guided the investment of the additional funding over the next four years (the

final year of the plan is yet to be funded).

Table 3 below provides details of the allocation of funding provided in the 2008/09 State Budget over

the four year period: 2008/09 to 2011/12.


2008/09

($’000)

2009/10

($’000)

2010/11

($’000)

2011/12

($’000)

Total

($’000)

Allocation (2008/09 State Budget) $1,788 $3,810 $5,450 $6,160 $17,208

3 Strategic Focus of the Future Service Directions

Plan

One of the key objectives in establishing the Future Service Directions Plan was to provide direction

and cohesion for the Tasmanian ATOD sector and establish a broader service framework to provide

clarity on the roles and responsibilities of the individual services within that sector (across both the

government and the community sectors). In addition to this the Plan also attempted to establish a

more appropriate and effective governance structure that provided opportunities for discussion of

alcohol and drug issues at a whole of government level with input from specialist groups and

individuals from the field.

3.1 Tasmanian Governance Structure

The Plan details a governance structure from a whole of government perspective to ensure that

issues relating to alcohol and drug use are considered and debated so that a well-informed position

can be presented to government for consideration and/or decision. The governance structure goes

beyond the ATOD treatment sector but was included in the Plan to provide clarity on the reporting

and decision making processes at a whole of government level. The key objectives of the proposed

structure was to ensure that issues were well informed and debated across government and the

community sector and that an avenue existed to receive advice/information from specialist groups

and individuals.

In Tasmania, the Inter Agency Working Group on Drugs as a whole of government committee

performs the role as described in the Future Service Directions Plan. Additional financial investment

to support a dedicated position to provide the secretariat functions and some project work of the

Inter Agency Working Group on Drugs are provided by Statewide and Mental Health Services from

Future Service Directions funding. However, with proposed structural changes within the

Department of Health and Human Services and the advent of both the Tasmanian Health

Organisations and Tasmanian Medicare Local, the governance structure for responding to alcohol

and drug issues will need to be revisited. It will be vital to ensure that a whole of government

structure to discuss and lead issues relating to alcohol, tobacco and other drug use continues to

exist in Tasmania.


Since the release of the plan, the Governance structure for dealing with alcohol, tobacco and other

drug issues in Tasmania has been altered slightly to better reflect the processes and the relationship

with bodies at a National level.

Figure 1 below provides an overview of the current governance structure in Tasmania.

Figure 1 Inter-Agency Working Group on Drugs – Governance Framework (April 2012)


Feedback from the consultation focused on the difficulties the Inter Agency Working Group on

Drugs has in progressing issues because it does not have a dedicated secretariat. Much of the

work for this group has been managed by alcohol and drug policy area within the Department of

Health and Human Service, which is in itself under-resourced. To better support the Inter Agency

Working Group on Drugs, it was suggested that a properly resourced Alcohol and Drug Policy Unit

is necessary. The policy analysis and associated research required for the Inter Agency Working


Group on Drugs is not able to be met, thus limiting the depth and breadth of input provided to

State and National strategies and policy directions.


1. Provide additional secretariat and research support to the Inter Agency Working

Group on Drugs.

3.2 Vision, Aim and Principles

The vision, aim and principles contained in the Future Service Directions Plan were widely agreed

during consultation with the sector and other stakeholders prior to the finalisation of the Plan. They

are similar to those adopted by other jurisdictions. Services within the Tasmanian ATOD sector

were already operating in accordance with the Vision, Aim and Principles.

Throughout the course of the Plan the only suggestion provided in relation to the Principles was the

inclusion of a principle around access to services. If another Plan for the treatment sector is

developed (post 2012/13), the Vision, Aim and Principles could be revisited at that stage.

3.3 Tiered Service Delivery Model

The inclusion of the tiered service delivery model was an attempt to describe thee important

elements for the Tasmanian service system and how it responds to alcohol and drug issues.

3.3.1 Recognition that a large range of services manage/support clients who

present with alcohol and drug issues

The tiered service delivery model highlights the important role that all services (not just specialist

alcohol and drug treatment services) play in supporting Tasmanians who present with alcohol and/or

other drug issues. The model recognises that the majority of Tasmanian’s with alcohol and/or drug

issues will be seen by other health services (eg acute care, general practitioners, primary health

services etc) and may never be seen by specialist treatment services. The model attempts to outline

the responsibility for different service responses across the full spectrum of services in Tasmania.

Generally there is acceptance by the ATOD sector and other stakeholders that the tiered model

explains the role played by a broader range of health and human services in dealing with alcohol and

drug issues in Tasmania. However, there is a need to continue to strengthen this message so that

the management of alcohol and drug issues become everybody’s business.

3.3.2 Describe the differences between government and community based

specialist ATOD services

Another important objective of the tiered model was an attempt to describe the differences

between government and community based services in the ATOD sector. Achieving this objective

was always going to be a challenging task because of the variety of service provision provided across

the government and community sectors.

Theoretically, the tiered model has generally been accepted as a good description of how the

specialist treatment service system (both government and community sectors) should respond to

alcohol and drug issues in Tasmanian. However, in reality, the adoption of such a service system has

been problematic. There is still some confusion in relation to the role of government and the

community based treatment services as there are a large variety of interventions provided by both

sectors. Focussing more attention on the relationship between government and the community

sector and on the importance of the sector as a whole, will support recognition that all services in


that sector are providing specialist ATOD treatment services. In this aspect, the ATOD sector is

quite unique in Tasmania as there exists several different relationships between the government and

community sector services. These include: a contractual relationship; a development relationship;

and most importantly a clinical relationship.

To assist with the clarification of the roles and responsibilities of the ATOD treatment sector it will

be important for the sector to collaboratively develop some of the overarching frameworks to guide

specialist service delivery.

3.3.3 Specialist support for mainstream services

The tiered model of service provision clarifies that services beyond the ATOD sector (identified as

mainstream health and human services in the Plan) have an important role to play in supporting

Tasmanians who present with alcohol and/or drug issues. To ensure this aspect of the model is

effective the Plan clearly identifies the need to support those services with education, training and

development from the specialist ATOD services.

Throughout the course of the Plan, the Alcohol and Drug Service has increased its support to the

mainstream services with the introduction of a dedicated consultation liaison service in the Royal

Hobart Hospital and the establishment of a statewide Smoking Cessation Service. Both these

services have provided some significant benefits for mainstream services and for Tasmanians affected

by alcohol and drug use. In addition to these specific initiatives, the Alcohol and Drug Service has

provided a greater level of support and advice to other areas, particularly general practitioners and

community pharmacists involved in the pharmacotherapy program.

Over 2000 separate education, training and development opportunities has been offered to health

and human service workers from government and the community sector by the ATDC through the

workforce development role.

Furthermore the community sector continues to work closely with their partner services to support

consumers with alcohol or drug problems and the introduction of a new service, Care

Coordination, is an excellent example of the networks that already exist within the community

sector. There are many other examples of our efforts in this area which will be discussed under the

major service developments below.

The community sector continues to work closely with their partner services and the introduction of

a new service, Care Coordination, is an excellent example of the networks that already exist within

the community sector. There are many other examples of our efforts in this area which will be

discussed under the major service developments below.

This is an extremely important aspect of work for the ATOD sector and it will be important to

continue to expand the efforts in this area. Providing more specialist support and advice to

mainstream services will result in better outcomes for Tasmanians who are affected by alcohol and

drug use.


There was general acknowledgement that the tiered model of service provision goes some way to

defining some of the main interventions necessary for a comprehensive treatment sector.

However it does have limitations when attempting to differentiate responsibility across government

and community providers. Whilst it is important to avoid duplication of service provision it has

become apparent throughout the implementation of the Plan that integration, collaboration and

partnership are important and necessary aspects of an effective treatment sector. The tiered

model does not sufficiently reflect these principles.



1. Any future sector strategy or plan should highlight the importance of integration,

collaboration and partnership between services, for both government and the

community sector.

4 Major Service Developments

The following is a summary of the major developments (by program/service type) that has occurred

over the past two years (2008/09 to 2009/10) and developments which are proposed for future

years.

4.1 W ithdrawal Management

The Alcohol and Drug Service has undertaken a range of policy and service development work

within the Inpatient Withdrawal Management Unit which has resulted in more appropriate

admissions, improved support and programs for clients and improved discharge processes. This has

provided an increased focus on managing withdrawal for clients which in turn has resulted in

reduced readmission rates for clients. Considerable effort has also focussed on collaboration with

other services (across government and community sectors) to improve linkages and referral

processes and ultimately improve outcomes for clients.

Recruitment to specialist medical positions which support the Inpatient Withdrawal Management

Unit has always been problematic. The recruitment of Addiction Medicine Specialists in the South

has now provided good medical coverage for the Unit (with medical specialists working across all

aspects of the Alcohol and Drug Service).

A number of new treatment/support strategies have been implemented within the Unit over the past

two years. These are designed to expand (and improve) the options available to both clients and

services who access the Unit and include: Opioid rotations, an increased involvement of the ADS

South Community Team during a client’s admission and the ability to extend clients stay for a short

period following the acute withdrawal period. This will assist transition to the planned follow up

treatment option.

From 1 January 2011, the Inpatient Withdrawal Management Unit introduced a smoke free policy.

The introduction of the Policy saw a minor, short term impact on client numbers. To support

clients, the Unit now offers Nicotine Replacement Therapy (NRT) during admission to the unit.

Clients are also offered a supply of NRT on discharge if required.

In addition to these initiatives, the Alcohol and Drug Service has developed a more appropriate

staffing structure within the Unit.

However, despite the developmental work within the Inpatient Withdrawal Management Unit, it is

clear that access for clients has not improved as a consequence of the Future Service Direction Plan.

This is supported by statistical data which indicates that occupancy rates have remained between

40% and 55% over the past few years. Renewed efforts in recent times have seen increases in the

numbers of clients accessing the service. In October 2013 the service reached and maintained full

occupancy for several weeks and a waitlist being was also established for additional clients needing

to access the service (this is the first time this has been occurred in many years). These recent

figures are an indication that the renewed focus on strategies has improved access for clients.


Table 4 Additional Financial Investment for Withdrawal Management, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Staffing Restructure (ADS South) $14,153 $157,977 $157,977 $150,000

Total Withdrawal Management $14,153 $157,977 $157,977 $150,000

Achievements against the Future Service Directions Plan

The Alcohol and Drug Service has made some progress in meeting the outcomes for Withdrawal

Management that are outlined in the Future Service Directions Plan. The table below indicates that

nearly all outcomes have been partially achieved or achieved within the first three years of the Plan.

The Alcohol and Drug Service has invested significant resources into the development and

implementation of a range of clinical tools which are utilised in all aspects of the service. These

include a common assessment tool, referral processes, admission practices, treatment plans and

goals and discharge planning processes. The development of these tools, practices and processes

has seen a significant improvement in the type and quality of care provided to people admitted to

the Withdrawal Management Unit.

There are six outcomes which have yet to be fully achieved:

the development of withdrawal management guidelines;

improved quality of service (and access to) the dedicated ten bed withdrawal management

service in the South;

providing access to withdrawal management services for up to six clients from the North

and/or North West at any one time;

access to aftercare support for clients following withdrawal when required;

access to specialist psychiatric support for withdrawal management clients when needed; and

reduced reliance on inappropriate services for withdrawal management in the North and

North West and therefore significantly reduced risk for clients.

The development of withdrawal management guidelines is still a priority for the Alcohol and Drug

Service but has been put on hold until resources can be identified to undertake this significant body

of work. Until such time as specific Tasmanian guidelines are developed, the Alcohol and Drug

Service will utilise guidelines from interstate which have recently been updated and reflect

contemporary best practice.

The inpatient withdrawal management unit in the South continues to be the States only dedicated

specialist facility. A number of strategies have been implemented to improve access for clients from

other regions (North and North West). These strategies have proven to be successful with an

increase in admissions from different regions of the State. However, the data indicates that

occupancy has remained around 40%-55% in recent years which is well below the benchmark of 70%

or greater. A renewed effort on increasing access has seen marked improvements in more recent

times which it is hoped will continue to improve occupancy rates for the future.

A strengthened partnership between the Alcohol and Drug Service and the regional health services

(particularly the major hospitals) should be a pathway to developing stronger hospital based support

for clients requiring withdrawal management.


Table 5 Withdrawal Management - Achievements against Outcomes

Priority Area Outcomes Progress

Withdrawal

Management Statewide guidelines in place which are based on

contemporary best practice

Future development

Common approaches to assessment, referral, admission, treatment and discharge planning across the State

Achieved

Improved quality of service (and access to) the

dedicated ten bed withdrawal management service in

the South

Partially Achieved

Access to withdrawal management services for up to six

clients from the North and/or North West at any one

time

Future development

Access to aftercare support for clients following withdrawal when required

Partially Achieved

Access to specialist medical support (through the

Alcohol and Drug Service) in all three regions

Achieved

Access to specialist psychiatric support for withdrawal

management clients when needed

Partially Achieved

Reduced reliance on inappropriate services for withdrawal management in the North and North West

and therefore significantly reduced risk for clients

Partially Achieved


The Inpatient Withdrawal Unit attracted the significant criticism throughout the consultation

process with many stakeholders experiencing continued frustration in accessing the service for

clients. This criticism was consistent across both government and community sector representatives.

Feedback from the consultation process supported the need to explore alternative models of

withdrawal management, including ambulatory and hospital based withdrawal. Some stakeholders

also suggested that a review of the operations of the Inpatient Withdrawal Management Unit

should be undertaken.

The need to provide better access to withdrawal management for young people wasn’t raised

throughout the consultation process. This is a change to feedback received prior to implementing

the Future Service Directions Plan where withdrawal management for young people was raised as

a service gap.


1. The Alcohol and Drug Service will work on the development of statewide guidelines

for the provision of withdrawal management and will involve the major hospitals to

improve hospital based withdrawal management across the State.

2. Continue to investigate opportunities to better integrate the Withdrawal Management

Unit with the Royal Hobart Hospital (RHH), including the option to relocate the Unit

to be incorporated into the redeveloped RHH (or within close proximity of the

RHH).

3. There continues to be a need to develop diversity in where and how withdrawal

management services are provided. There needs to be a focus on developing and

resourcing a range of best practice models, including ambulatory withdrawal, acute

care (hospital based) and the further development of the dedicated withdrawal

management unit. Consideration of how youth are managed within this service type


will also need to be addressed in any future service framework. In developing these

models, it will be important to ensure that withdrawal management is better

integrated with acute care services and have close links to residential rehabilitation

and supported accommodation services.

4.2 Opioid Pharmacotherapy

The Alcohol and Drug Service has made a major investment into the Opioid Pharmacotherapy

Program within Tasmania. This investment has been in both policy and service development. The

public pharmacotherapy program has been bolstered across the State with the recruitment of

additional Addiction Medicine Specialists and specialist pharmacotherapy nurses. This has provided a

significantly safer service response with reduced risks for clients. In recent times there has been a

movement of clients from the private (general practitioners) to the public services. This has resulted

in an increase in the management and dosing of clients within the public program over the past two

years. Overall there has been a gradual increase in the numbers of clients accessing the program

across the State (see Section 6 for statistical information). Just prior to the commencement of the

Future Service Directions Plan, the numbers of monthly clients on the program were 569 in March

2008, 577 in April 2008 and 588 in June 2008. At the end of the Plan, these figures have risen to 658

in July 2013 and 683 in August 2013. This represents an increase of more than 10 per cent in the

number of active clients on the program over the course of the Future Service Directions Plan.

Since 2008/09, the key focus for Tasmania has been to effectively resource and support the shared

care model of opioid pharmacotherapy treatment. To achieve this, it has been vital to develop the

public program, within the Alcohol and Drug Service, to ensure it has the capacity to treat patients

who have multiple and complex medical and psycho-social issues. In addition to this, it has also been

necessary to improve access to specialist support and information for general practitioners and

community pharmacists to ensure that they are appropriately supported when managing clients with

complex issues.

Under the shared care model, the management of clients entering the program or those who are

unstable will be undertaken by the public program through the specialist Alcohol and Drug Service.

Clients, who are stable on the program, where possible, will be generally managed and maintained

on the program by approved general practitioners.

Although considerable work has been undertaken to develop and support the shared care model,

there is still further work to be progressed, particularly focussing on the need to engage more

general practitioners and community pharmacists into the program. When fully operational, the

shared care model will provide improved accessibility for clients and will utilise resources in the

most effective and efficient manner.

Although services are managed under the same shared care framework, there are some regional

differences in the operational model for pharmacotherapy service provision across the State. At this

point in time, a larger proportion of clients on the program are based in the Southern region which

has resulted in the need to develop a dedicated pharmacotherapy unit (at St Johns Park) where

clients are medically managed, monitored and dosed. Significant capital investment has been

provided for the development of the specialist Pharmacotherapy Unit in the South. The clinical,

consultation and waiting areas have been significantly improved and expanded which has resulted in a

more effective and safe service for both clients and staff.

In the Northern region a more multi-disciplinary model of service provision has been adopted with

the addiction specialist managing a caseload of clients with input from a team of professionals when

required. The majority of dosing in the Northern region is delivered through community

pharmacists. In the North West, the Alcohol and Drug Service supports very few clients on the


pharmacotherapy program (due to the lack of medical support in that region) with all dosing

occurring through community pharmacists. In all three regions, a large number of clients on the

program are managed by general practitioners (however, it is important to note that there has been

a reduction in the number of clients being managed by general practitioners in recent years –

essentially there has been a shift towards the public program as the Alcohol and Drug Service

continues to develop its capacity to treat more complex and high risk clients).

A major recent development has been the release of the Tasmanian Opioid Pharmacotherapy Policy

and Clinical Practice Standards. The document reflects cotemporary evidence based practice and

will assist to guide the delivery of a high quality and safe Opioid Pharmacotherapy Program in

Tasmania. There will be a need to support prescribers and pharmacists in moving towards the

requirements of the policy and associated standards.

Table 6 Additional Financial Investment for Opioid Pharmacotherapy, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

South $45,021 $230,927 $660,927 $982,509

North $42,000 $300,000 $60,000 $515,000

North West $430,951 $100,000

Total Opioid Pharmacotherapy $87,021 $530,927 $1,151,878 $1,597,642


The Alcohol and Drug Service has made some significant progress in meeting the outcomes for

pharmacotherapy that are outlined in the Future Service Directions Plan. The development and

growth of the pharmacotherapy program relies heavily on the ability to attract addiction medicine

specialists to the Alcohol and Drug Service. There has been some level of success in attracting

addiction specialists but in some cases it has proven difficult to sustain a good balance between

home and work for specialists that have moved to Tasmania from interstate or from other

countries.

Table 7 Opioid Pharmacotherapy - Achievements against Outcomes


Opioid

Pharmacotherapy A shared care model of opioid pharmacotherapy

treatment which is evidence based and reflects

contemporary best practice

Partially achieved

Implemented Opioid Pharmacotherapy Policy and Clinical Practice Standards

Achieved

Additional four hundred clients receiving treatment

through the Opioid Pharmacotherapy Program

Partially achieved

An additional one hundred and seventy clients dosed by

government provided services

Partially achieved

Reduced deaths and safe opioid prescribing practices Achieved

Access to 24 hour, seven days per week specialist

medical support, advice and information for Acute Care

Services, general practitioners and pharmacists

Partially achieved


Feedback from the consultation generally accepted that it is important to have an effective

pharmacotherapy program and the need for investment into this area as part of the Plan was

warranted. It was also acknowledged that there should be a continued focus on engaging general

practitioners and community pharmacists onto the program to increase access for clients and to

build the capacity of the program.



1. There continues to be a need to grow expertise in this area and to continue to

expand the program across both the Government and community sectors. The ADS

continues its recruitment activities to secure Addiction Medical Specialists across the

State (it is important to note that the Addiction Medicine Specialists will have a much

broader role across the ATOD sector and have not been engaged purely to support

the opioid pharmacotherapy program).

2. It will be important to progress the ongoing development of the shared care model of

pharmacotherapy treatment in Tasmania, particularly focussing on the need to engage

more general practitioners and community pharmacists into the program. .

3. Supporting the implementation of the new Tasmanian Opioid Pharmacotherapy Policy

and Clinical Practice Standards will be a key priority for the Alcohol and Drug Service.

4.3 Consultation Liaison Services

A specialist consultation liaison role has now been established in the South with a specialist nurse

permanently located within the Royal Hobart Hospital. Access to addiction medicine specialists is

provided as required. The service aims to support and develop clinical staff of the Royal Hobart

Hospital by providing expert assessment, information, brief intervention, advice and often shared

care in the clinical management of patients admitted to the Royal Hobart Hospital with significant

and complex alcohol and other drug related problems.

The Clinical Director and other medical specialists continue to support and visit General

Practitioners and private prescribers across the State.

A Pharmacotherapy Liaison Service (PLS) service model has been established and is in the early

stages of operation in the N/NW.

Table 8 Additional Financial Investment for Consultation Liaison, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Additional Staff (ADS) $25,000 $200,000 $200,000

Total Consultation Liaison Services $25,000 $220,000 $220,000


The Alcohol and Drug Service has made some significant progress in meeting the outcomes for

Consultation Liaison that are outlined in the Future Service Directions Plan. There are two

outcomes in the Plan which are yet to be achieved. These focus on providing dedicated sessions

within the North and North West. However, support is provided to the Launceston General

Hospital on a visiting and as required basis. The main barrier to progressing these initiatives is the

difficulties associated with establishing and maintaining a specialist workforce within the ADS.

Table 9 Consultation Liaison - Achievements against Outcomes


Consultation Liaison A specialist alcohol and drug consultation liaison service Achieved

A minimum of:

five sessions (20hrs) per week within the Acute

Care Service in the South (Royal Hobart Hospital)

two sessions (8 hrs) per week in the Acute Care

Service in the North (Launceston General

Hospital)

Achieved

Future development


two sessions (8 hrs) per week in the Acute Care

Service in the North West (North West Regional

Hospital)

Future development


Feedback from the consultation supported the need for specialist consultation liaison service and

indicated that this is an area for further development and investment, highlighting the difficulties

with the current reliance on one clinician in the southern region. It was further highlighted that

there is a need to better support primary health care providers through a secondary consultation

model.


1. There is a need to continue to grow the consultation liaison service in the South and

to establish similar services in the North and North West Regions whereby specialist

Alcohol and Drug Consultation service is provided within the major hospitals on a

regular (weekly) basis. The current barrier to expansion has been the difficulties in

recruiting specialist staffing to the area. It is anticipated that additional resources may

also be required to grow this service model.

2. The Consultation Liaison Model in the South has been operational for some time.

There is a need to review the model to ensure that the service is effective and utilised

to its maximum potential.

4.4 Residential Rehabilitation Services

The Government has provided significant investment into the three established community based

residential rehabilitation services across the State: The Bridge Program, Missiondale and Live Free

Tassie. As a result of the Future Service Directions Plan, funding was provided for the first time to

Missiondale and Live Free Tassie. This enabled these services to employ additional staff and to

increase the number of residential places.

The Alcohol, Tobacco and Other Drug Council (ATDC), work closely with the three organisations

to assist with the development of their workforce (additional funding has been provided to the

ATDC to employ a Workforce Development Consultant to undertake this role as well as

progressing broader workforce development initiatives for the community sector).

In addition to the recurrent investment into services provision, the Alcohol and Drug Service is

supporting the organisations through the provision of clinical support, advice and expertise and will

continue to work closely with the organisations to assist with the ongoing development of their

services.

A protocol has been initiated between the Salvation Army Bridge Program and the Withdrawal

Management Unit to improve outcomes for clients. A Memorandum of Understanding has been

developed to outline the level and type of specialist medical support provided by the ADS (North)

to Missiondale.

Table 10 Additional Financial Investment for Residential Rehabilitation, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

South (The Bridge and Live Free Tassie) $160,839 $289,618 $249,618 $249,618

North (Missiondale) $117,000 $174,740 $174,740 $174,740

Total Residential Rehabilitation $277,839 $464,358 $424,358 $424,358



Significant financial investment was provided to the three community based residential rehabilitation

services in the first year of the Plan (2008/09). Since that time the three organisations have

undertaken a range of service developments to improve access and quality and to establish specialist

targeted programs for clients of their service. The Alcohol, Tobacco and Other Drug Council of

Tasmania and the Alcohol and Drug Service will continue to work closely with the three residential

rehabilitation services to support the continued development of their programs and services.

A key initiative included in the Plan was the establishment of a new “specialist residential

rehabilitation service that can provide access to intensive medical and therapeutic interventions for

clients with complex needs”. The development of this new service has been highlighted for the final

year of the Plan (2012/13), however at this stage funding has only been provided to implement

initiatives for the first four years of the Plan. The Alcohol and Drug Service will not progress this

initiative in the absence of available funding.

Table 11 Residential Rehabilitation - Achievements against Outcomes


Residential

Rehabilitation Improved access to residential rehabilitation services Achieved

Improved quality of service, programs and support for

clients who access residential rehabilitation services

Achieved

Specialist, targeted programs for clients within residential rehabilitation services across the State

Partially achieved

A specialist residential rehabilitation service that can

provide access to intensive medical and therapeutic

interventions for clients with complex needs

On hold pending

future funding

allocation


The need for increased access to residential rehabilitation services is a high priority for Tasmania.

This was constantly raised as a major issue throughout the consultation process. The need for

increased investment in this area is a high priority for Tasmania. There are insufficient beds

available to adults despite the increased investment into the current services through the Future

Service Directions Plan. Young people are poorly served; there are no options for young women,

and only one option for young men. Families or parents with children are not provided for,

although these cohorts have been identified by providers as having sought rehabilitation programs.


1. There is a need to increase access to residential rehabilitation services in Tasmania.

Considering all opportunities to increase residential rehabilitation will an important

priority for the sector.

2. It is recognised that to meet the needs of the Tasmanian community for residential

rehabilitation it will be important to differentiate and define rehabilitation services into

a number of program types based on the types of clients they support. The programs

to be offered by residential rehabilitation services will be principally either

rehabilitative or accommodation support, long stay or short stay (or combinations of

these).

3. Significant work has been undertaken in developing the relationship between the

Withdrawal Management Unit and the three residential rehabilitation services

(particularly the Bridge Program). This has established more formal referral and

discharge planning processes. However there is still a need to continue to strengthen

the relationship between the residential rehabilitation services and the Withdrawal

Management Unit.


4. The relationship between the ADS and the three residential rehabilitation services has

been strengthened dramatically with all services working collaboratively together for

the benefit of clients. This work has seen significant benefits for all parties. It will be

important to continue to build on these relationships to ensure a strong partnership

approach is maintained.

4.5 Youth Intervention Services

Investment into specialist alcohol and other drug services for youth was identified as a high priority

for the Government in the Future Service Directions Plan. As such, the capacity of both

government and community sector organisations has been improved with additional recurrent

investment. Funding has enabled the establishment of additional youth workers within the Alcohol

and Drug Service and within the three specialist youth community sector organisations.

Table 12 Additional Financial Investment for Youth Intervention Services, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

South

Government (ADS) $39,101 $78,202 $90,000 $100,000

Community Sector (The Link) $20,000 $87,000 $87,000 $87,000

North

Government (ADS) $20,527 $88,949 $88,950 $100,000

North West

Community Sector (BYADS and YAFF) $40,000 $174,000 $174,000 $174,000

Total Youth Intervention Services $119,628 $428,151 $439,950 $461,000


Services to young people have been bolstered considerably since the introduction of the Future

Service Directions Plan. Additional Youth Workers have been employed by the three specialist

community sector organisations and the Alcohol and Drug Service (South and North).

Table 13 Youth Intervention - Achievements against Outcomes


Youth Intervention Specialist youth alcohol and drug services supporting an additional eighty clients statewide

Achieved

Increased consultation support and services for the

range of children and family services

Partially achieved


Investment in specialist youth services have been very positive enabling a greater capacity to

support young Tasmanians with alcohol and other drug (AOD) issues. However there is a

requirement to further expand these services to meet the growing need of this client group.

Further development is required to provide clarification about the different roles and responsibilities

of services that support young people – e.g. primary health, specialist AOD treatment,

promotion/prevention.

Access to withdrawal services for young people was raised as a gap in service delivery, with the

need for acute and long term withdrawal options. Residential options for young men and women

are limited.


1. In expanding services to young people, it will be important for the Alcohol and Drug

Service to establish clear guidelines for the provision of those services which will assist


in ensuring that services are provided in line with contemporary best practice. Initial

work has already been undertaken with the development of a Youth Services

Framework. However, this work has stalled and it has been suggested to incorporate

the work into broader framework/guidelines covering psychosocial

services/interventions. This work will need to be progressed in collaboration with the

broader treatment sector.

4.6 Outreach

The Future Service Directions Plan identifies outreach as a key focus area with the need to increase

the capacity of services to support clients who live outside the major city centres. The development

of outreach services is due to occur in 2011/12 to 2012/13. Although not exactly an outreach

model, a new service has been established to support clients on the East Coast (focus on the Break

O Day area). This service has been established under a new model of service delivery which

involves a close partnership between the community sector organisation, the local council and the

Alcohol and Drug Service. Essentially this service is a new services as opposed to an outreach from

an existing service. This initiative has been included under “outreach” as it meets the intent of the

Future Service Directions Plan by servicing more rural and remote areas of Tasmania. Initial

planning has been undertaken to service more rural/remote areas of Tasmania with the West Coast

identified as a priority area. However, with the current budgetary difficulties there has been a

requirement for all areas to identify significant savings. In discussion with senior management it has

been agreed to delay the development of any further services as one savings strategy. This option is

a better alternative to establishing new services only to have to reduce services across the board to

meet targeted savings.

Table 14 Additional Financial Investment for Outreach, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Government $150,000

Community Sector Organisation $560,000

Total Outreach Services $710,000


In establishing a new service on the East Coast a model of service provision which is based on a

partnership approach has been developed. It is anticipated that this model will prove to be a very

effective model for rural and remote areas where there has been little (if any) provision of specialist

alcohol and drug intervention in the past. The model aims to work closely with already established

services in the area to ensure a better uptake of service by local clients.

Table 15 Outreach - Achievements against Outcomes


Outreach Increased support for clients outside the major city

centres by year 4

Future development

Increased access to specialist alcohol and drug support, information, education and training for staff within

mainstream health and human services

Partially achieved


The provision of outreach services should be a priority for the treatment sector in Tasmania. This

was supported throughout the consultation process. It will be important that any model for

outreach should be evidence based, taking into account what works well elsewhere, and be locally

responsive. The service model should also be developed in consultation with the communities to be

serviced, the community sector organisations in those communities and the existing specialist

treatment services (in both the community and government sectors).



1. A key area for development will be to expand services in rural and remote areas. The

initial focus will be on establishing the need for a service for the West Coast. A

consultation process will be undertaken with existing service providers on the West

Coast and other key stakeholders to determine what services may be needed.

2. Other areas of need may also be considered (dependent on available funding). This

will require a level of consultation/discussion services and other stakeholders. Other

areas for consideration may include the North East, Tasmanian Peninsula, East Coast,

Derwent Valley and the Midlands.

4.7 Relapse Prevention

The Future Service Directions Plan highlights the need to focus on the incorporation of relapse

prevention strategies across all service types within the Tasmanian alcohol, tobacco and other drug

sector. The Plan highlights the need to develop clinical guidelines which include interventions

designed to prevent relapse and to better integrate treatment services with aftercare support.


Individual services have progressed this work over the life of the Plan. The improvement in referral

processes and better integration and linkages between the Alcohol and Drug Service and community

sector organisations has assisted clients with managing and preventing relapse.

As relapse prevention is a key element to any service/intervention, it was important to have a focus

on policy and workforce development to support service delivery and clinical practice in relation to

relapse prevention. Unfortunately the establishment of the Workforce Development Unit was

delayed due to recruitment difficulties which have impacted on the ability to deliver a comprehensive

training program (that would include a focus on relapse prevention). It is envisaged that the

development of psychosocial guidelines/framework will include a focus on relapse prevention.

Table 16 Relapse Prevention - Achievements against Outcomes


Relapse Prevention Evidence based relapse prevention guidelines Future development

Establishment of evidence based relapse prevention

group programs on a statewide basis

Future development


Feedback from the consultation indicated that guidelines for relapse prevention already exist in

other jurisdictions which can be utilized, so it was seen as unnecessary to reproduce them for

Tasmania. There needs to be an examination of how providers can ensure relapse prevention is

included within the treatment plan – this may result in the need to provide specialist training and

support for the workforce.


1. Guidelines for relapse prevention strategies to be incorporated into broader

psychosocial guidelines/framework.

2. Early discussions with the sector (and the ATOD Steering Committee) resulted in

rethinking the strategy of establishing specific relapse prevention group programs.

Relapse prevention should be a component of any treatment/intervention provided by

services. As the capacity of services has been expanded so has the ability to

incorporate relapse prevention strategies into service delivery. The focus will shift


towards developing existing services with the establishment of guidelines and the

development of the workforce to ensure that relapse prevention is incorporated into

all interventions.

4.8 Management of Complex Needs

Improving support for clients with complex needs is an important priority and is highlighted in the

Future Service Directions Plan. Considerable investment has been directed towards a new service

type for Tasmania, Care Coordination. Care co-ordination services are provided by a community

sector organisation and aims to support clients with multiple and complex issues by working closely

with other service providers to ensure that the needs of the client are met in a holistic manner.

In November 2011, a comprehensive review was undertaken of the care coordination services

provided by Anglicare after their first two years of operation. A common theme from the review

was that the care coordination service has been successful in obtaining the consumer outcomes as

specified in the funding agreement. This is reflected in the consistency of the feedback received

from within Anglicare, ADS referring clinicians, and the clients themselves. In fact, the client

interviews, conducted by Advocacy Tasmania, which represent almost 30% of the total client cohort,

indicated that clients found the service extremely beneficial.

Considerable work is being undertaken by both the Alcohol and Drug Service and Mental Health

Service to better support clients who have a co-existing mental health issue. It will be important for

the Alcohol and Drug Service and Mental Health Service to continue to work closely together to

effectively support clients who present with co-occurring alcohol and drug and mental health issues.

With the new Departmental structure being introduced it will be important to identify robust

structures and systems are in place to ensure collaboration and cooperation between the two

service areas (both at a service level and a systemic policy and planning level).

The ATDC has supported the community sector through a range of capacity building activities

including facilitating access to qualifications and skill sets focused on alcohol and other drug and

mental health presentations, and ongoing support for collaboration through the comorbidity steering

committee.

Table 17 Additional Financial Investment for the Management of Complex Needs, 2008/09 to

2011/12

2008/09 2009/10 2010/11 2011/12

South

Community Sector Organisation $135,000 $180,000 $180,000

North

Government $50,000 $50,000


North West


Total Complex Needs $255,000 $390,000 $390,000


Services are now established in each region to assist clients in the coordination and engagement of

services and supports to meet their multiple and complex needs. In establishing this new service

type the Alcohol and Drug Service together with Anglicare developed a clearly defined model and

guidelines for its operation. A review of the service has indicated that some very positive outcomes

have been achieved for some clients.


Work continues with Mental Health Services to better manage clients who present with co-existing

mental health issues.

Table 18 Complex Needs - Achievements against Outcomes


Management of

Complex Needs Models of intervention and clinical guidelines established Partially achieved

Clinical expertise in the management and support of

clients who present with complex needs and difficult

behaviours

Partially achieved


The consultation process highlighted that the management of clients who present with complex

needs requires a systems response, as well as a clinical response. The Department’s Collaboration

Strategy was highlighted as a good system response to dealing with clients with complex needs. It

may be necessary to consider a similar strategy that spans the newly established structure within

the Tasmanian Health Organisations, the Department of Health and Human Services and the

community sector.

The consultations also highlighted the importance of determining and articulating the outcomes to

be achieved by our sector and ensure it compliments rather than duplicates anything that is

already being developed in this area.


1. The Alcohol and Drug Service will continue to work closely with other services to

continue to improve the service response to clients with complex and multiple needs.

2. Incorporate guidelines to assist in the management of clients with complex needs into

the development of psychosocial framework/guidelines.

4.9 Brief and Early Intervention

The further development of brief and early intervention strategies is identified as a key area for

development by the Alcohol and Drug Service. Significant effort has been invested in developing and

implementing a smoking cessation brief intervention model for use by the broader health workforce.

The Alcohol and Drug Service has provided significant brief intervention training for health

professionals (at all levels) in both hospital and community settings. The success of this approach

has seen the Alcohol and Drug Service develop a similar brief intervention model to tackle the high

levels of alcohol consumption in this State. The model has yet to be trialled as a submission for

Commonwealth funding was unsuccessful. However, a future trial of the model will be considered

should resources become available.

More recent work in implementing the Promotion, Prevention and Early Intervention Strategy has

supported the need for an increased focus on early intervention. The work by the sector identified

four clear strategies relating to early intervention, particularly for young people.

Table 19 Additional Financial Investment for Brief and Early Intervention, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Government $290,000 $145,000

Community Sector Organisation $55,000 $55,000

Total Brief and Early Intervention $345,000 $200,000



A clear brief intervention model of service has been developed and implemented for smoking

cessation. A similar brief intervention model has been developed for alcohol but has yet to be

trialled or implemented.

More recent work in implementing the Promotion, Prevention and Early Intervention Strategy has

supported the need for an increased focus on early intervention. The work by the sector identified

four clear strategies relating to early intervention, particularly for young people.

The Alcohol and Drug Service is also an integral component to the Tasmanian Early Intervention

Pilot Project. The Project is Commonwealth Funded (under the National Binge Drinking Strategy)

which has utilised expertise from the Alcohol and Drug Service to develop a model of brief and early

intervention for young people and their parents or guardians. The Alcohol and Drug Service is

expanding the service so that it is available on a statewide basis.

Table 20 Brief and Early Interventions - Achievements against Outcomes


Brief and Early

Intervention Access to brief and early intervention for clients with

alcohol and drug issues from a range of health and

community care settings

Not achieved

Established alcohol and drug training and education

program and improved support for general

practitioners, staff within primary health, acute care and

other services who could provide brief and/or early intervention

Partially achieved


The consultation process supported the importance of brief intervention in the alcohol and other

drug treatment sector. There is evidence to support the use of brief interventions and it should

form an element of the continuum of treatment that can be provided by the sector.

It was also suggested that supporting the primary health care system in the provision of brief

intervention would be a worthwhile initiative to be developed in the future.


1. Should funding be available, research and trial the new brief intervention model for

alcohol.

2. Implement the brief intervention strategies identified as part of the implementation of

the Promotion, Prevention and Early Intervention Strategy.

4.10 Places of Safety

The need to support and develop the Places of Safety services across the State is a key strategy of

the Future Service Directions Plan. The Alcohol and Drug Service engaged an independent

consultant (Turning Point) to undertake a review of the Places of Safety services in Tasmania with

the view to providing recommendations to address access issues and to improve outcomes for

clients.

Table 21 Additional Financial Investment for Places of Safety, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Review of Places of Safety (Turning Point) $11,880 $20,780 $30,000

Funding to Community Sector Organisation $60,540 $85,000 $95,000

Total Places of Safety Services $11,880 $81,320 $115,000 $95,000



An independent review of Places of Safety services has been completed and, where appropriate, the

recommendations are being progressively implemented. Additional funding has been provided to

some organisations to bolster their capacity to effectively meet the current demand.

Table 22 Places of Safety - Achievements against Outcomes


Places of Safety Effective places of safety services in all three regions of

Tasmania

Achieved

Integration of places of safety services with other specialist alcohol and drug services and Acute Care

Services.

Partially achieved


There was support for the model operated by Launceston City Mission where places of safety beds

are collocated with crisis and longer term supported accommodation. It was suggested that this is

a model which could be examined and evaluated for expansion to other regions. It was also noted

that the demand is greater than the supply for these services offered by Launceston City Mission.


1. Continue to support and monitor progress of organisations implementation of the

recommendations from the review.

2. Future opportunities to further improve the Places of Safety service model may

become available when broader health reforms are progressed (for example the

redevelopment of the Royal Hobart Hospital may provide greater opportunities to

incorporate places of safety services with acute care services in the South).

3. Consideration of the applicability (and possible utilisation) of co-located places of

safety services and accommodation services in the Northern and Southern regions of

Tasmania.

4.11 Support for Families

The Future Service Direction Plan recognises the importance of supporting families of people who

are affected by alcohol and drug use. The Plan particularly focusses on the need to establish this

type of support for clients in the North and North West regions of the State. In mid 2011, the

Alcohol and Drug Service sought interest from experienced community sector organisations to

deliver specialist support services to the families and significant others of people experiencing

alcohol and drug issues in the North and North West of Tasmania. Anglicare was selected as the

successful organisation to provide the service.

Table 23 Additional Financial Investment for Support for Families, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

North and North West

Community Sector Organisation $ $200,000

Total Support for Families $ $200,000



In addition to the establishment of a new community based service for the North and North West,

the Alcohol and Drug Service continues to work closely with Child and Family Services to ensure

families are appropriately supported and maintained (where possible) when there are substance

abuse issues present. A Memorandum of Understanding has been developed and implemented with

Youth Justice to ensure that both service areas work together for the best interest of clients.

Table 24 Support for Families - Achievements against Outcomes


Support for Families Increased support for families in the North and North West of the State, including the provision of information

sessions for between 200 and 250 clients per year

Commenced

Provision of fifteen family support programs per year

across the North and North West to support between

100 and 125 clients

Commenced


1. Continue to support Anglicare in the ongoing development and provision of support

to families in the North and North West Regions.

4.12 Smoking Cessation

Following an independent review commissioned by the State Government in 2007, $2.7 million over

four years was allocated to progress smoking cessation initiatives in Tasmania. Key

recommendations from the review included increasing funding for social marketing strategies;

increasing healthcare workers capacity to deliver a brief intervention with people who smoke; and

the development of a Statewide Smoking Cessation Program. In line with the review

recommendations, the Future Service Directions Plan outlines a range of strategies designed to assist

Tasmanian smokers to quit.

The allocation of funding for smoking cessation initiatives was provided separately to Population

Health to complement their existing range of tobacco control measures. Population Health then

contracted the Alcohol and Drug Service to develop and implement a Statewide Smoking Cessation

Program. Since that time, the Smoking Cessation Program has aimed to bring about a cultural

change within the sector so that the provision of smoking cessation intervention becomes a routine

component of healthcare, by the delivery of standardised education to all health care professionals

on using a brief intervention with clients who smoke.

In addition to the establishment of the Smoking Cessation Program, funding was also provided to

increase the Social Marketing Program in Tasmania. This funding is overseen by a committee with

representation from Government and specialist community sector organisations. The Social

Marketing Program is managed by the Cancer Council who also received additional funding for

increased telephone counselling and support (for Quit Tasmania).

Table 25 Additional Financial Investment for Smoking Cessation, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Government $400,000 $400,000 $400,000 $400,000

Community Sector Organisation (Media

Campaigns) $200,000 $200,000 $200,000 $200,000

Community Sector Organisation $60,000 $60,000 $60,000 $60,000

Total Smoking Cessation $660,000 $660,000 $660,000 $660,000



Over the past three years, the Alcohol and Drug Service has implemented a new smoking cessation

program across the State.

The Program comprises a statewide coordinator and three regional Clinical Nurse Specialists based

at the major hospitals, who deliver face to face education to health professionals and provide one on

one smoking cessation specialist support to clients within the acute sector. The program has also

developed and launched an interactive e-learning tool in August 2010 to support and improve access

of health professionals to education and increase the reach of the Program.

A group smoking cessation program (No More Butts) was implemented statewide in 2011. This

new program will enable clients outside the acute sector to have access to face to face smoking

cessation support. Under this program, the three Clinical Nurse Specialists provide facilitator

training to individuals wishing to run programs within their own service and can assist in co-

facilitating groups in addition to facilitating groups of their own. This approach will ensure that a

wider range of services will provide more intensive smoking cessation interventions to their clients.

In addition to improved access to specialist support, the Smoking Cessation Program has initiated

important structural changes to ensure sustainable long term cultural change. Some of these

initiatives include the endorsement of clinical guidelines for nicotine dependent patients at all of the

major hospitals; development of supportive materials such as flowcharts and brochures; the Health

Executive endorsement of brief intervention education being a mandatory component of orientation

programs and an annual mandatory competence for all clinical staff within DHHS; the inclusion of

smoking cessation interventions as a component of some undergraduate health degrees; and the

endorsement of the e-learning tool by many professional health bodies.

Recently published statistics are also indicating a reduction in smoking rates in Tasmania. In 2011

the Program embarked on an outcome evaluation to ascertain if the program was bringing about a

cultural change in which all clients presenting to the DHHS receive a brief intervention. A random

case note audit lacked documented evidence of the application of brief intervention, but a staff

survey indicated that most staff are actually incorporating it into their practice, believe it makes a

difference and provided relevant and constructive feedback on the training and resources provided

by the Program.

Quit Tasmania has undertaken some major changes in staffing and its structure over the course of

the Future Service Directions Plan. A new funding agreement has been established for Quit and is

now managed by Population Health. This saw increased funding for counselling services and for the

social marketing campaigns. A Social Marketing Committee has been established to support the

social marketing activities. These developments by Quit Tasmania have been very successful in

supporting Tasmanian smokers to quit.

Major Barriers/Issues Encountered

Recruitment and Retention of Staff

The repetitive nature of the role; a minimal client focus; and a huge workload for one individual in

each Area Health Service, has led to issues with recruitment and retention. As the Program has

evolved, the diversity of the role has increased along with the workload. Providing more face to face

support to the team members and providing more flexible working arrangements has assisted in

alleviating some of these issues.


Difficulty Accessing Health Professionals for Education

The ever changing environment within the acute sector, professional ambivalence, budget cuts and

competing priorities have been a challenge in accessing health professionals for the purpose of

education. The Health Executive endorsement of the training as mandatory (except in the North)

and the introduction of the e-learning tool has overcome some of these issues.

Table 26 Smoking Cessation - Achievements against Outcomes


Smoking Cessation Reduced rates of smoking Partially Achieved

(only a small

reduction achieved)

Increased support for smokers who would like to quit Achieved

Specialist smoking cessation intervention provided

within the three major acute care hospitals

Achieved


The consultation process supported the importance of dedicated resources to supporting

Tasmanians who smoke to quit. The priority groups for support remain the same as they were at

the start of the Plan. Although there is some significant collaboration that occurs through the

Tobacco Coalition, there is still a need for stronger partnerships and integration between the

Alcohol and Drug Service and Quit Tasmania, particularly at a clinical level. It was also identified

that there needed to be more investment into media campaigns (with an increasing focus on social

media opportunities) and strategies implemented to support increased referrals to Quit from the

acute care sector (and the Smoking Cessation Program).


1. The current approach to smoking cessation is proving to be successful in providing

brief intervention training to health professionals. The Alcohol and Drug Service will

continue to focus on the acute care sector but will look for opportunities to extend

the service to cover a larger component of the community sector.

2. Investigate opportunities to strengthen collaboration and integration with Quit

Tasmania and the wider treatment sector, with a particular focus on improving clinical

linkages to support increased referrals to Quit Tasmania.

3. Continue to support he need for increased investment into media campaigns

(including an increased focus on social media opportunities).

4.13 Supporting the Aboriginal Community

An Aboriginal Policy and Liaison Officer, funded under an Agreement with the Commonwealth

Department of Health and Ageing Office of Aboriginal and Torres Strait Islander Health has been

established. The function of the position is to:

- support and coordinate the ADS liaison with Tasmanian Aboriginal communities on issues

relating to alcohol, tobacco and other drugs use;

- assist to coordinate, support, monitor and evaluate policy and projects under National and State

Strategic Plans and initiatives, particularly the provision of advice for project and policy

development in response to Aboriginal and Torres Strait Islander alcohol, tobacco and other

drugs use issues;

- work with ADS to facilitate linkages to improve:


o access to alcohol, tobacco and other drugs interventions and treatment services

opportunities for Aboriginal communities and organisations;

o accessibility of alcohol, tobacco and other drugs information to, and coordination of

services for Aboriginal communities and organisations; and

o the coordination and enhancement of Aboriginal workforce development initiatives and

capacity building in the alcohol, tobacco and other drugs sector.


Aboriginal cultural sensitivity awareness training has been provided in all regions of the state for the

government and community sector through the Alcohol, Tobacco and Other Drugs Council and the

Area Health Service (Tasmanian Aboriginal Centre). Negotiations are ongoing to deliver cultural

competence training in the future.

An audit was undertaken against the 2008 Review of the Needs of the Aboriginal Community in

response to the use of alcohol, tobacco and other drugs with a view to develop both a statewide

and individual organisations implementation plans. Under development or already in train are

individualised plans; draft referral tools and protocols; assessment tool(s); reciprocal open days/staff

visitation programs between ADS services and Aboriginal organisations; consultation liaison; and

development of a model for outreach support.


The incorporation of a specific section for Aboriginal workforce and cultural sensitivity awareness

training under the ADS Workforce Development Strategy has been delayed due to delays and

difficulties in recruiting and retaining staffing within the ADS Workforce Development Unit to

progress the ADS Workforce Development Strategy.

Most of the progress has been achieved in the South of the State, eg South Eastern Aboriginal

Organisation, Karadi and the Tasmanian Aboriginal Corporation. This has been mainly due to the

Aboriginal Policy and Liaison position being located in the South.

Table 27 Supporting the Aboriginal Community - Achievements against Outcomes


Tasmanian Aboriginal

Community

ATOD services more accessible for the Tasmanian Aboriginal community.

Achieved in part

Aboriginal community organisations better equipped to address alcohol, tobacco and other drug issues.

Achieved in part

Identification of early intervention strategies that are

targeted towards young Aboriginal people in Tasmania.

Work in progress -

linked to Youth

Interventions


The Aboriginal Policy and Liaison Officer provided limited support to the ATDC in efforts to

increase Aboriginal Cultural Awareness across the State. However it was suggested that if any

meaningful improvement is to be achieved with provision of alcohol, tobacco and other drug

treatment services to the Tasmanian Aboriginal community, this will need to be driven by the

Tasmanian Aboriginal Centre. In will be important for the Alcohol and Drug Service (through an

Aboriginal Policy and Liaison Officer) should continue to work closely with the ATDC and the

Tasmanian Aboriginal community to improve service.



1. Work is still required to ensure that ADS services and staff statewide are providing

culturally sensitive and appropriate services to ensure Aboriginal organisations and

staff feel comfortable both referring clients and working collaboratively with ‘shared’

clients.

2. The current approach to working with the Aboriginal organisations in the South whilst

slow has been successful. Greater engagement with the North and North West

Aboriginal organisations and closer liaison between ADS and those organisations is

still required.

3. The Aboriginal Policy and Liaison position, whilst originally seen to be strategic policy

oriented, has become more focussed on direct client liaison and support.

Consideration should be given to locating such a position within service delivery.

4.14 W orkforce Development

Workforce development was identified as a major issue throughout the review of ATOD services in

Tasmania. In responding to this, the Government has invested considerable resources into creating

dedicated workforce development positions for the ATOD sector.

The Alcohol and Drug Service (ADS), has established a Workforce Development Unit for the

ATOD sector which consists of two specialist Workforce Development positions within the Alcohol

and Drug Service (one being a nursing focussed and the other allied health focussed) and a third

position based with the Alcohol, Tobacco and Other Drug Council (ATDC) of Tasmania.

Unfortunately, the two positions within the ADS have been vacant for a considerable period (mainly

due to difficulties associated with recruitment of suitably qualified personnel). This has resulted in

some of the more specific workforce development strategies being delayed. However, considerable

work has been undertaken in the identification of core and mandatory training requirements for the

ADS workforce.

The two ADS Workforce Development Consultants have progressed two important workforce

development initiatives:

identification and development of resources and training to support the release and

implementation of the Tasmanian Opioid Pharmacotherapy Policy and Clinical Guidelines; and

finalisation of Guidelines for the Clinical Assessment Tool and the development of specialist

training in the delivery of that tool.

These two initiatives will continue to be a priority for the Alcohol and Drug Service.

The ATDC have implemented a large range of extremely valuable workforce development initiatives,

which have included the coordination and delivery of specialist training for the sector, management

of significant conferences, undertaken a training needs analysis for the community sector (including

the release of a major report to highlight the findings from that survey) and more recently the

development of a discussion paper on a minimum qualifications strategy for the community sector.

The strategic workforce planning approach adopted by the ATDC has also led to a significant focus

upon increasing the availability of VET and tertiary ATOD qualifications. ATOD training needs are

now being addressed by the Polytechnic, the Skills Institute and the University of Tasmania.

Table 28 Additional Financial Investment for Workforce Development, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Government $10,386 $200,000 $200,000 $200,000


Total Workforce Development $10,386 $280,000 $280,000 $280,000



A Workforce Development Unit has been established; however the occupants of both positions

within the Alcohol and Drug Service vacated the positions. Recruitment to these positions has

proven to be problematic during the course of the Plan and at times the positions have been

subjected to the Agency’s vacancy control measures. Progress on workforce development was

delayed considerably because of the delays in filling these vacancies.

Considerable work has been undertaken by the ATDC in surveying the community sector

workforce and providing a detailed analysis of the results. Statewide and Mental Health Service has

developed an overarching Workforce Development Framework which incorporates the Alcohol and

Drug Service workforce..

Table 29 Workforce Development - Achievements against Outcomes


Workforce

Development

A dedicated workforce development unit for the sector Achieved

An established professional development program which

is accessible to all workers in the alcohol, tobacco and

other drug sector

Partially achieved

Overall increase in the skill set of workers within the sector and of general health workers

Partially achieved

Establishment of entry level qualifications and

competencies for the sector

Partially achieved

An established medical registrar and graduate nursing

programs

Partially achieved


Many workforce issues for the community sector were highlighted in the ATDC workforce surveys

of 2010 and again in 2012. It will be important to analyse the results from these surveys so they

can inform workforce planning for the community sector. The ATDC is also driving the

development of a sector workforce strategy in collaboration with the ADS which must be the basis

of any long term investment in the workforce.


1. The Alcohol and Drug Service will finalise guidelines and develop and deliver training

for the Clinical Assessment Tool.

2. The development of training and resources to support the release and implementation

of the new Tasmanian Opioid Policy and Clinical Practice Guidelines will be a high

priority.

3. Develop and implement a program of training aimed at increasing the core skill

requirements for working in the Sector.

4. Finalise the sector’s Workforce Development Strategy.

4.15 Continuous Quality Improvement

Many of the initiatives contained in the Plan are all focussed on improving quality of service provision

for clients across the State. New and expanded government and community based services have

resulted in an increased number of clients supported as well as enabling a more appropriate mix of

service types in each region. The focus on developing services in line with best practice and the


development of statewide policies and clinical guidelines are also designed to improve the quality of

services in Tasmania. The investment in developing the workforce is also a major quality

improvement initiative. All these initiatives are discussed in more detail in other areas of this report.


There have been some specific Quality Improvement initiatives progressed in line with the strategies

contained in the Future Service Directions Plan. For services within the community sector, the

Department has established a quality and safety framework for funded organisations. The Quality

Futures has established a set of 6 standards by which organisational performance is monitored and

evaluated. The need for compliance against the Standards has been captured within funding and

service agreements with each funded community sector organisation that provides specialist alcohol,

tobacco and other drug treatment. The ATDC and the Alcohol and Drug Service have both worked

closely with the Community Sector Relations Unit to support and encourage funded organisations to

be involved in the Standard Performance Pathway project (managed through TasCOSS) which will

assist organisations in their monitoring and reporting against a range of quality standards. Several

community sector organisations have, through capacity building projects support by Commonwealth

funding, achieved accreditation.

In recent times, the Alcohol and Drug Service has worked with funded organisations to refine the

client outcome measures and key performance indicators that are now included in service

agreements. However, there is more work to be undertaken in this area to ensure that there is a

consistent approach to the measurement of performance across all service types (including

government services). The Alcohol and Drug Service and the ATDC have commenced discussions in

relation to performance measurement and reporting requirements with the view to establishing this

as a key project for the sector.

Since the introduction of the Future Service Direction Plan, the Alcohol and Drug Service has been

keen to work towards accreditation against an appropriate set of nationally recognised standards.

Significant work was initially undertaken by the Alcohol and Drug Service to meet the Quality

Improvement Council’s Health and Community Services standards. However, in more recent years

Statewide and Mental Health Services (SMHS) have signed an agreement with the Australian Council

on Healthcare Standards (ACHS) for accreditation purposes for the different service areas.

The Alcohol and Drug Service has undertaken significant work and has made considerable progress

towards meeting the ACHS standards. In their initial assessment report (June 2011), ACHS

identified that considerable work had been undertaken in recent times by ADS to improve the

quality of service provision and move towards meeting the ACHS standards. In their report, ACHS

agreed with almost all of the self-assessed ratings made by the Alcohol and Drug Service against the

mandatory criteria. The report also provided some guidance to the organisation on where future

improvements would need to be made. Since that time, the Alcohol and Drug Service has worked

hard to progress initiatives designed to improve service quality and hence to better meet the

required standards. The Organisation is due for a formal assessment against the Standards in early

2013.

A key initiative identified in the Future Service Directions Plan was the need to establish a quality

improvement framework for the sector. To support the implementation of the Future Service

Directions Plan, the Alcohol and Drug Service established a Clinical Speciality Group Quality

Improvement Committee which would serve as a central forum where issues, developments and

opportunities could be communicated and discussed. This structure has worked well and has

provided an important avenue for input from clinicians on the implementation of strategies within


the Plan. In recent times, a more formalised Quality Improvement Framework has been adopted by

the Alcohol and Drug Service (building upon current processes) which will include the development

of a formalised Quality Improvement Plan.

Table 30 Continuous Quality Improvement - Achievements against Outcomes


Continuous

Quality

Improvement

A clear model of service provision for all

service types within the alcohol, tobacco and

other drug sector.

Partially Achieved

Established set of service standards for

services within the alcohol, tobacco and other

drug sector.

Future

Development


Through a Departmental subsidy, community sector organisations are able to access the Standards

and Performance Pathways (SPP) online system for completion of Quality Standards. It would be

positive to continue to support and encourage alcohol and drug community sector organisations to

utilize the SPP. The development of a National AOD Quality Framework is about to commence

(DoHA project) and it would be prudent for Tasmania to not only be actively engaged in this

project but to monitor the outcome of this project before establishing any parallel process.

The best way to monitor the quality and performance is to a) fund organisations to enable their

engagement in a quality process and b) establish a service reporting framework that ensures

reporting is not burdensome and that feedback is provided to ensure continuous service

improvement.


1. Improve performance/outcome measures and reporting processes across all

government and community sector service providers.

2. Continue to work towards accreditation for the Alcohol and Drug Service against the

Australian Council of Healthcare Standards.

3. Finalise the ADS Quality Improvement Framework and the development of a Quality

Improvement Plan.

4. Support the Commonwealth in the development of a National Quality Framework

with a view to achieving consistency with State requirements for funded community

sector organisations.

5. The Alcohol and Drug Service and funded community sector organisations will

continue to work closely with the Community Sector Relations Unit to ensure funded

services are supported to meet, monitor and report their performance against

standards.

4.16 Advocacy Support

As part of the Future Service Directions Plan, the Government has invested in the development of

advocacy support services for clients of alcohol, tobacco and other drug services. To further

support client rights and to engage clients in the development and planning of services, the Alcohol

and Drug Service provided funding to a community sector organisation to develop a range of

consumer engagement strategies.


Table 31 Additional Financial Investment for Advocacy Support, 2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12


Total Support for Advocacy Support $206,831 $259,000 $259,000


In 2009/10 the Alcohol and Drug Service established a statewide consumer advocacy service in the

community sector. At the same time, additional funding was also provided to the community sector

organisation to establish and support a range of consumer engagement strategies. A Consumer

Engagement Guide was released in late 2011. The Guide provides direction and support for

organisations to effectively engage consumers in their own treatment pathways as well as the

development of alcohol and drug services which impact their lives. Engaging consumers in key

decision making processes is essential for improving the provision of ATOD services delivered in

Tasmania.

Following the development of the Guide, a Statewide forum was conducted in April 2012 to seek

input from the sector on the consumer engagement strategies to be progressed by the sector. In

establishing the future strategies for the sector, the forum also considered and agreed on the role of

Advocacy Tasmanian in supporting the implementation of those strategies. Advocacy Tasmania will

continue to work with the sector to support consumer engagement in Tasmania.

Table 32 Advocacy Support - Achievements against Outcomes


Advocacy Support Access to statewide advocacy support for clients and their carers

Achieved


Feedback from the consultation process was very positive about the establishment of the specialist

advocacy support for consumers of alcohol and other drug services. Consumers across the State

now have an opportunity to be supported in their relationship with the service system.

One issue which was raised constantly was the need to establish a consumer representative body

and/or users group within Tasmania. It was suggested that such a body would require ongoing

funding to ensure its sustainability initiative to progress consumer engagement will be the

establishment of a consumer peak body.


1. Establish a sector wide action plan to progress consumer engagement initiatives in

Tasmania.

2. Continue to support individual service organisations to develop and implement

appropriate consumer engagement policies and strategies.

3. Investigate and progress opportunities for consumer engagement through social

networking platforms.

4. Continue to investigate and progress options to establish and support a Statewide

ATOD consumer organisation.


4.17 Governance, Planning and Policy Development

The Government recognises the important role which policy and planning plays in the delivery of an

effective service system in Tasmania. Investment in this area has occurred across both the

government and the community sectors with the engagement of a specific policy and research

position which supports the secretariat functions of the Inter Agency Working Group on Drugs and

the development, monitoring and reporting of Tasmania’s drugs policies.

Table 33 Additional Financial Investment for Governance, Planning and Policy Development,

2008/09 to 2011/12

2008/09 2009/10 2010/11 2011/12

Government (Policy Unit) $95,106 $95,106 $95,106 $95,106

Total Governance, Planning and Policy $95,106 $95,106 $95,106 $95,106


The effectiveness of the Inter Agency Working Group on Drugs has been enhanced through

increased support under Future Service Directions. The Inter Agency Working Group on Drugs has

representation from a wide range of government agencies and the Alcohol, Tobacco and Other

Drugs Council of Tasmania and receives input from a range of expert bodies.

The Tasmanian Alcohol Action Framework 2010-2015 Rising Above the Influence was developed

and provides a range of strategies to address alcohol issues in a planned and coherent manner for

the State. An Alcohol Advisory Group has been established to coordinate the implementation of

the Tasmanian Alcohol Action Framework, and has developed and reported against a 2011 Annual

Implementation Plan; and developed a 2012 Annual Implementation Plan. The 2011 Report and 2012

Plan are currently with the Minister for Health for presentation to Cabinet.

The Tasmanian Drug Strategy (TDS) expired at the end of 2009. In 2010, the Policy Development

Unit coordinated the TDS review process on behalf of the Inter Agency Working Group on Drugs

(IAWGD) during which, Agencies were asked to report on activities and achievements in relation to

the TDS and to provide feedback on the TDS objectives and strategies. The review report was

provided to Government in November 2010, and in June 2011, the Minister agreed to extend the

TDS to the end of 2012. The Inter Agency Working Group is currently planning the next phase of

the TDS, and is seeking Ministerial approval to use the National Drug Strategy 2010-2015 as the

overarching strategic policy document with localised Tasmania specific actions and activities. A two

stage review of the Tasmanian Psychostimulants Action Plan was also undertaken, and a review

Report provided to Government. As a result of the review, the Plan was extended to the end of

2013 when it is envisaged a broader Tasmanian Illicits Drug Strategy will be developed.

The Alcohol and Drug Service, through the Policy Development Unit, have released Everybody’s

Business, the Promotion, Prevention and Early Intervention Strategy for the sector. Several forums

with the sector have identified a range of activities to progress to support the implementation of the

strategy.


Tasmania’s strategic drugs policies, including the Tasmanian Drug Strategy, Tasmanian Alcohol

Action Framework and Tasmanian Psychostimulants Action Plan do not receive any targeted

Government funding which severely curtails the ability of the Inter Agency Working Group on

Drugs, the Alcohol and Drug Service or the community sector to implement strategies requiring

specific financial resourcing.


Whilst the Plan has enabled the creation of a specific governance, planning and policy position,

with recent budget cuts, there are no longer any other policy positions within the Alcohol and

Drug Services or Statewide and Mental Health Services to support drugs policy development or

specific project work. This has limited the capacity to progress certain initiatives, for example,

ability to undertake research is on hold.

Other Tasmanian strategic initiatives have and will continue to impact on the Tasmanian alcohol,

tobacco and other drugs agenda, including the Agenda for Children and Young People Our

Children Our Young People Our Future; and A Healthy Tasmania.

Significant National reform in the alcohol, tobacco and other drugs strategic policy agenda has

posed its own unique set of challenges.

The amalgamation of alcohol and drug and mental health policy into one policy unit early in 2010

sitting within Statewide and Mental Health Services state office posed challenges especially in

ensuring that Alcohol and Drug Services service development and clinical input was maintained

into strategic policy.

More recent reforms have seen the Alcohol and Drug Service transfer to the control of the

Southern Tasmanian Health Organisation. This will require a focus on implementing strategies

to ensure that policy development continues to connect with service and sector development

and clinical service delivery.

Table 34 Governance, Planning and Policy Development - Achievements against Outcomes


Governance, Planning

and Policy

Development

A clear and accountable process by which whole of

government decisions in relation to alcohol and drug

issues can be appropriately informed, discussed and

debated

Achieved

Better collaboration between government agencies,

local government, community sector organisations and

clinicians in relation to alcohol and drug issues

Achieved

A formal mechanism to allow clients and carers involvement in the policy development, planning and

service delivery within the ATOD sector in Tasmania

Near finalised

Development and establishment of local research

capacity within the alcohol and drug field to ensure that

decisions and service delivery is evidence based and

underpinned by local research data.

Future development


The consultation process supported the need to establish a local research capacity and suggested

that partnerships with organisations such as the University of Tasmania or other specialist research

facilities would be a more effective strategy than attempting to develop something separate.

Strategic policy issues that would benefit from attention are those linked with harm reduction and

in particular, overdose prevention, reduction of blood-borne viruses and reduction in alcohol related

injury.

Consumers into the areas of governance, planning and policy development is an important

initiative to progress.


1. Development and establishment of local research capacity within the alcohol and drug

field is still required, due to a lack of Tasmanian specific data and research.


2. Continue to support the implementation of the Promotion, Prevention and Early

Intervention Strategic Framework.

3. Consumer input into policy and planning

4. Development of an agreed set of whole of population performance indicators to

monitor the effectiveness of drugs policy.

4.18 Information Management

The need to address information management issues is an important focus of the Future Service

Directions Plan. A key priority over the past two years has been the development of an effective

clinical and data management tool for the Alcohol and Drug Service. Significant resources has been

invested by both Statewide and Mental Health Services and the Alcohol and Drug Service to ensure

policies, procedures and practices are agreed upon and finalised so that the design of an information

management tool could be progressed.


Significant resources have been invested in the initial planning for the development of a client

information management tool. In more recent times, the Alcohol and Drug Service has introduced

a new information management system, Inpatient Manager (IPM). IPM was operational on 1 July

2012 and is now being utilised across the Alcohol and Drug Service. The Alcohol and Drug Service,

has also recently trialled other clinical management systems, Pharmcare and iPharmacy. These will

now be adopted by the service.

At this stage, the implementation of a standard client information tool has been limited to the

Alcohol and Drug Service. However, it is recognised that some funded community sector

organisations would welcome support in establishing more effective information management

systems. It will be important for all organisations to be able to provide high quality, consistent and

comparable data on a regular basis to support the National Minimum Data Set and to assist in local

monitoring and planning processes.

The Alcohol and Drug Service has recently finalised a reporting framework that incorporates a range

of key performance indicators at both an organisational and clinical service level.

Initial work has commenced on the introduction of real time reporting across departmental services,

private general practitioners and community pharmacies. At this stage there is still some significant

work to be progressed before the system can be implemented more publically.


2008/09 2009/10 2010/11 2011/12

Government (SMHS Team) $37,247 $37,247

Total Information Management $37,247 $37,247

Table 36 Information Management - Achievements against Outcomes


Information

Management

A consistent clinical and information management system for all alcohol and drug services

Partially Achieved

Improved quality of information reported nationally Partially achieved



The consultation process supported the need for reliable treatment data for Tasmania. There is a

need to look at reporting options which are standardised across the sector and will be relatively

easy to manage and use. It will be important to investigate data collection and reporting systems

that can meet these requirements.


1. Establish an appropriate reporting framework across government and community

sector organisations and consider information technology options to support that

framework.

2. Continue to support the implementation of real time reporting within the Alcohol and

Drug Service and across other Departmental and private service providers (general

practitioners and pharmacies).

3. Continue to support the implementation of Pharmcare and iPharmacy for the Alcohol

and Drug Service.

4.19 Legislative Reform

The Future Service Directions Plan highlights the need to undertake a review of the Alcohol and

Drug Dependency Act, 1968.


The review of the Alcohol and Drug Dependency Act, 1968 commenced in February 2010 and is

planned for completion in 2013/14. A draft Discussion Paper has been finalised and released for

consultation. A reference Group has been established to support the review and to provide

feedback as required. It is anticipated that the discussion paper will be released for consultation in

late 2012. Feedback received from the consultation process will help to inform recommendations

on the future legislation.


2008/09 2009/10 2010/11 2011/12

Government (ADS) $52,000

Total Support for Families $52,000

Table 38 Legislative Reform - Achievements against Outcomes


Legislative Reform A legislative framework which supports the models of

service delivery and protects the rights of clients

Commenced


1. Further consultation will be undertaken and will involve a series of small to medium

size focus groups with the general community and external/internal stakeholders.

2. Feedback received from consultations will be consolidated into a directions paper

comprising of recommendations and options for legislative reform. Consideration of

these recommendations and, if relevant, the progression of legislative options will then

be actioned.


5 Financial Overview of Expenditure

The following table provides details of the allocation of funding provided in the 2008/09 State Budget

over the four year period: 2008/09 to 2011/12.


2008/09 2009/10 2010/11 2011/12 Total

Allocation (2008/09 State Budget) $1,788,000 $3,810,000 $5,450,000 $6,160,000 $17.208

It should be noted that ADS has been required to deliver savings in the 2009-10 ($200,000) and

2011-12 ($805,000) financial years which were taken from the Future Services Direction budget

reducing the annual recurrent budget to $5,355,000.

Details of recurrent expenditure to date and anticipated future allocation (2011/12) for ATOD

treatment services in Tasmania is outlined in the table below. The table provides expenditure details

by service type, by region and by service sector.

Table 40 ATOD Service Development Recurrent Expenditure and Future Allocation, 2008/09

to 2011/12

Withdrawal Management 2008/09 2009/10 2010/11 2011/12

South

Staffing Restructure - Government Inpatient

Withdrawal Management Unit $14,153 $157,977 $157,977 $150,000

Total Withdrawal Management $14,153 $157,977 $157,977 $150,000

Opioid Pharmacotherapy Program

South

Additional Staff - Government

Pharmacotherapy Program $45,021 $230,927 $660,927 $982,513

North


Pharmacotherapy Program $42,000 $300,000 $60,000 $515,129

North West


Pharmacotherapy Program $430,951 $100,000

Total Opioid Pharmacotherapy $87,021 $530,927 $1,151,878 $1,597,642

Consultation Liaison Services

Statewide

Additional Staff - Government $25,000 $220,000 $220,000

Total Consultation Liaison Services $25,000 $220,000 $220,000

Residential Rehabilitation Services

South

Funding Provided to two Community Sector

Organisations $160,839 $249,618 $249,618 $249,618

North

Funding Provided to one Community Sector

Organisation $117,000 $174,740 $174,740 $174,740

Total Residential Rehabilitation $277,839 $424,358 $424,358 $424,358


Youth Intervention Services 2008/09 2009/10 2010/11 2011/12

South

Additional Staff - Government $39,101 $78,202 $90,000 $100,000

Funding to Community Sector Organisation $20,000 $87,000 $87,000 $87,000

North


North West

Funding Provided to two Community Sector

Organisations $40,000 $174,000 $174,000 $174,000

Total Youth Intervention Services $119,628 $428,151 $439,950 $461,000

Outreach Services

South

Additional Staff - Government $50,000

Funding to Community Sector Organisation $180,000

North



North West



Total Outreach Services $710,000

Management of Complex Needs

South


North

Additional Staff - Government $50,000 $50,000


Statewide


Total Care Coordination $255,000 $390,000 $390,000

Brief and Early Intervention Services

Statewide

Additional Staff - Government $290,000 $145,000

Funding to Community Sector Organisation $55,000 $55,000

Total Brief and Early Intervention

Services $345,000 $200,000

Places of Safety Services

Statewide

Review of Places of Safety (Turning Point) $11,880 $20,780 $30,000


Total Places of Safety Services $11,880 $81,320 $115,000 $95,000

Support for Families

North

Funding to Community Sector Organisation $ $200,000

Total Support for Families $ $200,000

Population Based Strategies 2008/09 2009/10 2010/11 2011/12

Statewide


Total Population Based Strategies $20,000 $20,000 $20,000 $20,000


Workforce Development

Statewide

Additional Staff – Government $10,386 $200,000 $230,000 $200,000

Community Sectors $80,000 $80,000 $80,000

Total Workforce Development $10,386 $280,000 $310,000 $280,000

Planning and Policy Development

Statewide

Funding to Community Sector Organisation

to provide Consumer and Carer Advocacy

Service $206,831 $259,000 $259,000

Policy and Service Development Govt $23,777 $95,106 $332,000 $348,000

Total Planning and Policy Development $23,777 $301,937 $591,000 $607,000

Total Expenditure and Future Allocation for

ATOD Treatment Service Delivery in

Tasmania $564,684 $2,504,670 $4,165,163 $5,355,000


6 Statistical Summary of Activity

The following section provides a statistical summary of activity from across the sector. It is

important to note that there are some limitations with some of the data provided in the following

section. The following data has been collated from internal data bases (in the case of activity related

to the Alcohol and Drug Service) and from the National Minimum Data Set (information which has

been collated from the out dated Alcohol and Drug Information Management System). There

continues to be a range of issues related to the quality of the data and the utilisation of data

collection systems.

6.1 W ithdrawal Management

Over the past three years monthly admissions to the Inpatient Withdrawal Management Unit have

averaged 18.6 admissions per month with the lowest number of admissions occurring in December

2009 with only 9 admissions for that particular month. However, in recent months there has been a

small growth in the numbers of monthly admissions to the Unit, with the highest number of

admissions occurring in May 2012 where there were a total of 33 admissions for the month.

The graph below shows the average length of stay for clients in the Inpatient Withdrawal

Management Unit over the past three years. Typically clients stay and are treated within the Unit

from between five to seven days. The average length of stay for the past three years is 6.16 days (as

demonstrated by the red line in the graph below). It is interesting to note that in January 2010 and

again in 2011, there was a significant reduction in the average length of stay from the previous

months (in December 2009 the average length of stay was 7.60 days which reduced to 5.00 days in

January 2010 and in December 2010 the average length of stay was 5.21 days which reduced to 4.31

days in January 2011). Although this pattern was not as significant in January 2012, the average

length of stay had reduced in December 2011 and remained low in January 2012. A similar pattern

(although not as dramatic) can also be observed towards the middle of each year (May, June and

July). Of further interest, is to consider the monthly admission for January which has increased each

year on the previous month (see earlier graph). This indicates that in January of each year there is a

pattern of increased client admissions that have a much shorter length of stay. Further research

would be needed to determine if this is a seasonal pattern or has resulted for some other reason.

0

5

10

15

20

25

30

35

Jul-0

9

Aug

-09

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-09

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-09

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-09

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-11

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Jan-

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Feb

-12

Mar

-12

Apr

-12

May

-12

Jun-

12

Withdrawal Management Unit Monthly Admissions, July 2009 to June 2012


The graph bellows shows the average bed occupancy rate for the inpatient Withdrawal Management

Unit for the past three years. The rate has remained reasonably constant at around the 45% (or 4.5

beds occupied on average) with some small fluctuations up and down over the three year period.

September 2009 saw the highest average occupancy rate of 68.2% with the lowest occurring in July

2011 with a rate of 31.8%.

6.2 Pharmacotherapy

As discussed in earlier sections, there has been significant effort and investment into the Opioid

Pharmacotherapy Program in Tasmania over the past four years. The priority for Tasmania has been

to improve the quality (and reduce the risks) of treatment for clients within the program. The effort

has been focussed on recruiting and retaining specialist clinical positions (medical and nursing) and to

establish comprehensive guidelines and clinical practice standards.

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00Ju

l-09

Aug

-09

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-09

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-09

Nov

-09

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-09

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-12

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Jun-

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Withdrawal Management Unit Average Length of Stay, July 2009 to June 2012

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Jul-0

9

Aug

-09

Sep

-09

Oct

-09

Nov

-09

Dec

-09

Jan-

10

Feb

-10

Mar

-10

Apr

-10

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-10

Jun-

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Jul-1

0

Aug

-10

Sep

-10

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-10

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-10

Dec

-10

Jan-

11

Feb

-11

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-11

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May

-11

Jun-

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Jul-1

1

Aug

-11

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-11

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Jan-

12

Feb

-12

Mar

-12

Apr

-12

May

-12

Jun-

12

Withdrawal Management Unit Average Bed Occupancy Rate, July 2009 to June 2012


Table 41 below provides details of total numbers of clients treated on the pharmacotherapy

program for the past three financial years (2009-10 to 2011-12). Effectively, the table provides the

total number of individuals that have been on the program for some period within the relevant year

(remembering that clients leave the program and new clients commence). The total number of

clients supported on the program has remained fairly constant at just under eight hundred

individuals each year for the past three years. However the table demonstrates that there has been

a shift of clients from the private sector to the Alcohol and Drug Service.

Table 41 Tasmanian Opioid Pharmacotherapy Program, Total Individual Clients, 2009/10 to

2011/12

Year ADS Private Total

2009-2010 419 366 785

2010-2011 402 382 784

2011-2012 468 323 791

The graph below further demonstrates the changes in total clients being treated by the Alcohol and

Drug Service and by private prescribers.

Table 42 below shows that, over the past seven years, the total number of clients on the Opioid

Pharmacotherapy Program has fluctuated from a low of 569 in March 2008 and again in February

2010 to a high of 683 in August 2013. In the years following increased investment (2008-09 to 2011-

12) the total number of clients on the program averaged 624 which is just over a six per cent

increase on the average number of clients of 587 on the program prior to the increased investment

(in 2007-08). Over the period the numbers of active monthly clients has grown from 603 in July

2007 to 683 in August 2013. This represents an increase of more than 13 per cent.

0

100

200

300

400

500

600

700

800

900

2009-2010 2010-2011 2011-2012

Tasmanian Pharmacotherapy Program Total Annual Clients by Prescriber, 2009/10 to June 2011/12

Total

ADS

Private


Table 42 Tasmanian Opioid Pharmacotherapy Program, Active Clients, July 2007 to August

2013

Year Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

2007-2008 603 595 591 603 597 590 582 576 569 575 577 588

2008-2009 574 573 579 598 614 610 607 608 615 614 622 634

2009-2010 631 633 628 628 633 579 602 569 602 618 606 621

2010-2011 626 629 648 648 642 653 643 653 659 643 653 645

2011-2012 657 648 639 640 642 636 633 623 628 630 630 608

2012-2013 626 638 643 646 648 656 647 652 640 653 654 659

2013-2014 658 683

The following graph provides total number of clients treated on the program from July 2007 to

August 2013. Although client numbers have gradually increased over the period, there was a decline

in numbers in March to September 2008 and again towards the end of 2009 and in early 2010.

These declines resulted from difficulties in maintaining prescribers within program.

The graph below shows total number of clients treated on the program from July 2009 to June 2012

by prescriber (prescriber employed by the Alcohol and Drug Service or employed privately). In July

2009 the Alcohol and Drug Service was managing 309 clients on the program which rose to 327 in

June 2012. The decline in numbers in late 2009 and early 2010 occurred in both the Alcohol and

Drug Service and the private sector. As mentioned earlier this occurred due to difficulties in

maintaining medical specialists (within ADS) and the movement of clients from a retiring general

practitioner to another general practitioner. The changes in client numbers remained similar for

ADS and private prescribers until early 2012. At that point there was a significant divergence caused

by a number of clients transferring from a private prescriber to being managed by the ADS.

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3

Tasmanian Opioid Pharmacotherapy Program Total Active Clients, July 2008 to August 2013


The following graph further highlights the difficulties Tasmania faces with retaining prescribers in the

Pharmacotherapy Program. In 2007-08 there were 52 prescribers participating in the program

which declined to a low of 31 in 2009-10 (representing a decline of 40%) before slightly increasing to

a current figure of 38. Fortunately there has been a slight increase in the number of dosing locations

across the State, rising from 50 in 2007-08 to 60 in 2011-12.

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350Ju

l-09

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Tasmanian Pharmacotherapy Program Total Clients by Prescriber, July 2009 to June 2012

ADS Private

0

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2007-08 2008-09 2009-10 2010-11 2011-12

Tasmanian Pharmacotherapy program Prescribers and Dosing Locations, 2007/08 to 2011/12

Prescribers Dosing Locations


6.3 Psychosocial Interventions (Community Team) – Alcohol and Drug Service

The graph below shows both closed and open episodes of treatment for the Alcohol and Drug

Service’s psychosocial program (or Community Team). It has long been recognised that the

measurement of treatment episodes is not a good indicator of activity or performance as it only

measures episodes of treatment and does not provide an indication of the level of complexity

involved in episodes of treatment. However, the information is presented here to show changes

over the past three years.

Over the past three years there has been a slight overall decline in both closed and open treatment

episodes, with open episodes dropping from a high of 118 in August 2009 (and again in October

2009 and again in March 2010) to a low of 49 in December 2011. The numbers of open episodes

have increased in recent times with 112 episodes reported in May 2012. The trend for closed

episodes is similar with a high of 124 reported in July 2012 which has to a low of 51 in June 2012. It

is difficult to pinpoint a reason for the decline without further detailed research. The Alcohol and

Drug Service has implemented a new client information management system (in July 2012) which

should provide more clarity in the level of activity for the psychosocial program.

6.4 National Minimum Data Set

The Alcohol and Other Drugs Treatment Services – National Minimum Data Set (AODTS-NMDS) is

a nationally agreed set of common data items collected by government-funded service providers for

clients registered for alcohol and other drug treatment.

The collection aims to provide:

demographic information of clients who use government-funded treatment services;

the treatments they receive, and;

administrative information about the agencies that provide alcohol and other drug treatment.

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Psychosocial Program (Community Team), ADS Treatment Episodes, July 2007 to June 2012

Closed Episodes Open Episodes


For the purposes of this review basic summary information from the AODTS-NMDS has been

utilised. Further statistical data from the AODTS-NMDS can be accessed via the Australian

Institute of Health and Welfare’s website at: www.aihw.gov.au

Table 43 below provides summary information from the three most recent AODTS-NMDS, 2007-08

to 2009-10. Over the three year period, Tasmanian treatment services are seeing an increased

proportion of male clients, having risen from 68.5 per cent of total clients in 2007-08 to 71.2 per

cent in 2009-10. Interestingly this is an opposite trend with that at a national level, where the

proportion of males dropped from 68.3 % of all clients in 2007-08 to 66.4% in 2009-10.

Table 43 Closed Treatment Episodes by Client Type, Sex and Age, Tasmania and Australia,

2007-08 to 2009-10 (per cent)

2007-08 2008-09 2009-10

Tas Aus Tas Aus Tas Aus

Client type

Own drug use 92.3 95.9

95.3 96.1 94.0 95.9

Others’ drug use 7.7 4.1

4.7 3.9 6.0 4.1

Sex

Male 68.5 68.3

69.7 66.7 71.2 66.4

Female 31.5 33.6

30.3 33.2 28.8 33.5

Not stated

0.1

— 0.1 0.1 0.1

Age group (years)

10–19 16.7 11.4

18.1 12.1 23.6 12.5

20–29 35.2 31.1

32.5 30.5 28.4 29.1

30–39 25.2 28.6

24.0 28.0 22.5 27.9

40–49 14.5 18

14.4 18.2 15.4 18.9

50–59 5.8 7.7

7.2 7.9 7.2 8.2

60+ 2.5 2.9

3.0 3.0 2.9 3.3

Not stated 0.1 0.3 0.9 0.2 — 0.1

Source: AIHW 2011. Alcohol and other drug treatment services in Australia 2007-08, 2008-9 and 2009-10: report on

the National Minimum Data Set.

Table 43 also shows that in Tasmania the proportion of closed treatment episodes have increased

for younger clients over the three year period. In 2007-08, clients aged 10-19 years made up 16.7

per cent of all treatment episodes which rose to 23.6 per cent in 2009-10 (which is almost twice the

rate of 12.5 per cent recorded nationally in 2009-10). The graph below clearly shows that the

proportion of treatment episodes provided to 10-19 year olds has steadily increased in Tasmania.

Conversely the proportion of treatment episodes provided to 20-29 year olds has decreased in

Tasmania. Other age groups have remained relatively stable. This trend is reflective of the

increased emphasis (and investment as part of the Future Service Directions Plan) on supporting

younger people in Tasmania.

http://www.aihw.gov.au/


Source: AIHW 2011. Alcohol and other drug treatment services in Australia 2007-08, 2008-9 and 2009-10: report on

the National Minimum Data Set.

0

5

10

15

20

25

30

35

40

10–19 20–29 30–39 40–49 50–59 60+ Not stated

%

Age

Closed Treatment Episodes by Age, Tasmania, 2007–08 to 2009-10

2007-08 2008-09 2009-10

Alcohol and Drug Service

Tasmanian Health Organisation - South

GPO Box 125, Hobart 7001

Ph: 1300 139 641

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