youth drug and alcohol clinical support network model … · care and treatment delivered through...

Western NSW Local Health District Y

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The Youth Drug and Alcohol Clinical Support Network provides

coordinated treatment and care for young people with moderate

to severe substance dependence across the Western NSW Local

Health District

Western NSW Local Health District

YOUTH DRUG AND ALCOHOL

CLINICAL SUPPORT NETWORK

Model of Care March 2019

March 2019

Western NSW Local Health District Youth Drug and Alcohol Clinical Support Network

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CONTENTS

ACRONYMS ............................................................................................................................................. 1

ACKNOWLEDGEMENT ............................................................................................................................. 2

AUTHORS OF DOCUMENT ....................................................................................................................... 2

INTRODUCTION ....................................................................................................................................... 3

OUR KEY VISION ...................................................................................................................................... 3

SERVICE MODEL ...................................................................................................................................... 3

CHARACTERISTICS ................................................................................................................................... 6

INCLUSION CRITERIA ............................................................................................................................... 7

ELEMENTS OF QUALITY CLINICAL CARE .................................................................................................. 7

PRINCIPLES OF CARE ............................................................................................................................... 8

SAFETY AND QUALITY ........................................................................................................................... 10

STAFFING ............................................................................................................................................... 10

CONCLUSION ......................................................................................................................................... 11

APPENDIX A – SERVICE FLOW CHART ACROSS THE CONTINUUM OF CARE ......................................... 12

REFERENCES .......................................................................................................................................... 13

ACRONYMS

ADIS Alcohol and Drug Information Service

CAMHS Child and Adolescent Mental Health Service

DASAS Drug and Alcohol Specialist Advisory Service

D&A Drug and Alcohol

ED Emergency Department

FTE Full Time Equivalent

HEEADSSS Home, Education and Employment, Eating, Activities, Depression, Drugs, Spirituality,

Safety and Sexuality psychosocial screening tool

JIRT Joint Investigation Response Teams

MH Mental Health

MHDA Mental Health and Drug & Alcohol

MHEC Mental Health Emergency Care

NGO Non Government Organisation

NSQHS National Safety and Quality Health Service

WNSWLHD Western New South Wales Local Health District

YDACSN Youth Drug and Alcohol Clinical Support Network


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ACKNOWLEDGEMENT

NSW Health acknowledges the traditional owners of country throughout Australia and their

continuing connection to land and community. We pay our respects to them and their

cultures, and to their elders both past and present. We also acknowledge our Aboriginal

people with lived experience of drug and/or alcohol dependence.

In line with NSW Health PD 2005_319, the term “Aboriginal” is generally used in preference

to “Aboriginal and Torres Strait Islander” throughout this document, in recognition that

Aboriginal people are the original inhabitants of NSW.

We would also like to acknowledge the input provided by all who were involved in the

production of this model of care. This model could not have been developed without the

guidance and expertise of members of the Project Reference Group, which include Western

NSW Local Health District executive and clinical staff, consumers, representatives from

Aboriginal Community Controlled Health Services, Mission Australia, Headspace, the Family

Drug Support Service, and the Western NSW Primary Health Network.

Information gleaned from multiple site consultations and focus groups conducted between

August 2018 and March 2019 further informed the development of this model of care.

AUTHORS OF DOCUMENT

This document was developed by the Integrated Mental Health Drug and Alcohol (MHDA)

Service, Western NSW Local Health District.


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INTRODUCTION

The NSW Government has set a priority to tackle alcohol and drug misuse in the community

by supporting more young people and families into treatment. Substance misuse amongst

young people can be particularly detrimental as it can significantly disrupt a young person’s

social, psychological, and physical development, impacting on their health and transition to

adulthoodi.

Within Western NSW Local Heath District (WNSWLHD), approximately 37,000 people are

aged between 10-19, of which 18.4% are Aboriginal. High numbers of secondary school

students aged 12-17 years in WNSWLHD have reported ever drinking alcohol (74%)

compared to the average across NSW (61%), with 29% reporting drinking alcohol in the past

7 daysii. Across NSW, a substantial proportion of students aged 12-17 report ever using

marijuana or cannabis (15%), ever inhaling substances, such as glue, paint or other volatile

solvents (15%), or ever using sedatives or tranquilisers for non-medical reasons (17%)iii.

A range of drug and alcohol treatment and support services are available across the

WNSWLHD region. However, drug and alcohol services generally focus on adults, and youth

related community and mental health services generally have limited capacity to provide

evidence-based drug and alcohol interventions. The challenge of providing access to drug

and alcohol services close to an individual’s home is compounded by WNSWLHD’s dispersed

population and large distances between small communities and large centres.

The Youth Drug & Alcohol Clinical Support Network (YDACS Network) model of care has

been developed in response to the need to enhance youth drug and alcohol services across

WNSWLHD, and improve equity of access to treatment across rural and remote areas.

Funding will focus on services for young people aged up to and including 18 years of age

with moderate to severe substance dependence.

OUR KEY VISION

The YDACS Network aims to improve the health and wellbeing of young people at risk in

WNSWLHD by reducing drug and alcohol misuse amongst this cohort. Through reducing

drug and alcohol misuse, young people will be better placed to achieve their full potential,

be in good health, and have positive relationships with their families, school, peers and

community.

SERVICE MODEL

The YDACS Network consists of a number of service providers working together with young

people and their families to deliver a range of supports and interventions for drug and

alcohol dependence. The Network will consist of government and non-government service


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providers that specialise in either drug and alcohol prevention or treatment, health care,

community services, or youth engagement.

The YDACS Network will be supported by the establishment of a specialist team of clinicians

with expertise in youth drug and alcohol. The team of specialist clinicians will:

build the capacity of service providers to engage with youth and deliver a range of

developmentally appropriate, evidence-based drug and alcohol interventions;

work in partnership with service providers to deliver screening and assessment,

clinical consultation and review, and shared care coordination and treatment for

young people with moderate to severe substance dependence; and

be primarily virtually based so that services can be provided more equitably across

WNSWLHD using telehealth technology.

Care and treatment delivered through the YDACS Network will be holistic, trauma informed,

age appropriate, family centric and culturally safe for young people experiencing drug and

alcohol addiction. Strong partnerships and referral pathways between WNSWLHD and local

NGO organisations will underpin the delivery of the YDACS Network model of care.

The model of care is represented diagrammatically in Figure 1.

Figure 1: YDACS Network Model of Care


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A stepped care approach will be applied so that different levels of treatment are offered

based on the complexity and acuity of the needs of the young person presenting. Treatment

may range from general referral advice to individual or family therapy, withdrawal

management, harm minimisation, medical intervention and case management. The

specialist team of youth drug and alcohol clinicians will be available to provide advice,

support and capacity building to service providers to deliver interventions across the

spectrum of treatment options appropriate to their organisational capacity. The team will

also provide direct treatment to young people, supported by a local support person, for high

acuity clients where no appropriate local service is available – refer Figure 2.

Figure 2: Stepped Care Approach

Young people will be able to access support and treatment through various service

providers in the network, with referral pathways in place amongst local services. A number

of existing drug and alcohol helplines will complement the services delivered through the

YDACS Network and continue to provide support and referrals to local services for young

people with a drug or alcohol issue. These helplines include:


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NSW Drug and Alcohol Specialist Advisory Service (DASAS), which provides advice to

health professionals on the clinical diagnosis and management of patients with drug

and alcohol related problems 24 hour / 7 days a week (Ph: 1800 023 687);

Alcohol and Other Drugs Information Service (ADIS), which provides 24 hour, 7 day a

week telephone counselling, support, referrals and information for those affected

by alcohol or other drugs (Ph: 1800 250 015);

WNSWLHD Drug and Alcohol Helpline, which provides an intake service for referral

to drug and alcohol services during business hours, including triage for follow up by

the respective referral service (Ph: 1300 887 000); and

Family Drug Support 24/7 Support Line, which provides 24 hour, 7 days a week

telephone counselling, support, referrals and information to families impacted by

someone’s drug use (Ph: 1300 368 186).

A flow chart outlining the role of the specialist team and other service providers in providing

support and treatment to patients is at Appendix A.

The model of care will be implemented through a phased approach, with initial

implementation in three pilot sites across regional and remote communities. Learnings from

the pilot sites will inform broader implementation of the YDACS Network across the District.

CHARACTERISTICS

Telehealth facilities will be available across the network to support communication between

service providers, patients, and the YDACS Network specialist team, reducing the need for

young people to travel to receive treatment. Telehealth will be used by the YDACS Network

specialist team to deliver training and development activities to service providers, and to

assist with the assessment, review, treatment, and coordination of care for young people.

Capacity building of service providers is a key focus of the YDACS Network and will leverage

off the existing skill sets of staff already engaging with communities. A range of tools,

resources and training and education opportunities will be coordinated and delivered by the

YDACS Network specialist team, guided by a Capacity Building Framework. Activities will

focus on building skills and confidence of staff in:

engaging with young people;

working with families;

screening and assessment processes;

providing trauma informed, culturally safe care;

delivering evidence-based drug and alcohol interventions;

harm minimisation;

referral pathways; and

using telehealth.


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A comprehensive holistic assessment is the critical first step in the treatment of adolescent

substance use. The best available evidence for conducting a holistic assessment for a young

person is outlined in the NSW Health Youth Health and Wellbeing Assessment Guidelinesiv.

Specifically, the guidelines recommend the application of the Home, Education and

Employment, Eating, Activities, Depression, Drugs, Spirituality, Safety and Sexuality

(HEEADDSSS) psychosocial screening tool. HEEADDSSS will be the primary assessment tool

for assessing young people who come into contact with a YDACS Network service provider.

INCLUSION CRITERIA

The YDACS Network will focus on providing services to people who:

are aged between 10 and 18 (inclusive);

present with moderate to severe dependence on one or more substances; and

present with dependence on a substance that is not solely tobacco.

All service provider staff have a duty of care to any young person that comes into contact

with their service. People who come into contact with a service provider that do not meet

the above criteria will be referred to appropriate services for support via clear referral

pathways.

ELEMENTS OF QUALITY CLINICAL CARE

The Director, MHDA Services will have overall corporate responsibility for the YDACS

Network and the Clinical Team Leader of the WNSWLHD specialist team will be responsible

for ensuring quality clinical and corporate governance systems and processes are in place.

Clinical governance practices undertaken by the Clinical Team Leader will include:

• Ensuring open and clear communication pathways between partnership

organisations, consumers and their networks;

• Development and review of partnership agreements, protocols and work practices;

• Maintaining appropriate records in line with policy and legal frameworks;

• Monitoring data collection, key performance indicators and reporting;

• Continuous development, review and evaluation of the network and its services and

implementation of quality improvement projects as required;

• Clinical audits and clinical supervision;

• Maintaining staff training and education;

• Critical incident reporting and management; and

• Risk assessment and management.

YDATN will support the delivery of quality clinical care by:

• Improving equity of access to care for those in rural and remote regions;


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• Implementing a range of clinical treatment options supported by evidence and

expert opinion;

• Ensuring a collaborative and holistic recovery/care planning approach that involves

the individual and their network and assists them to work towards identified goals;

• Promoting integration between professionals to provide team-based multi-

disciplinary treatment, and between clinical and non-clinical services over a range of

settings to address the identified needs of the individual;

• Monitoring treatment outcomes;

• Developing and maintaining effective and accurate clinical documentation processes,

including multi-disciplinary assessments, summaries and clinical/case notes; and

• Striving towards excellent communication between all partners involved in care.

The YDACS Network will operate within NSW Health and WNSWLHD policies and clinical

governance frameworks.

PRINCIPLES OF CARE

The following principles underpin the YDACS Network model of care.

Partnership and Collaboration

Young people often present with complex and comorbid needs that require a linked-up,

shared and collaborative care plan involving a multiple agency response. Drug and alcohol

support and treatment services can be provided in a range of settings via a range of

agencies and professionals, and combining the specialised capacity and capability of

professionals and organisations leads to improved outcomes for young people experiencing

substance use issues.

Family Centred Care

Family/carer engagement is central to positively influencing a young person’s management

of, and response to, their substance use and other challenges in life. A young person does

best within a supportive family and community context and can be affected by the stress

experienced by their parents or carers. Family centred care can help alleviate stress by

addressing broader stressors impacting on the family and by keeping the family informed of

the young person’s condition and treatment and involving them in the patient’s care.

Holistic Care Coordination

A broad range of risk factors contribute to substance use and as such, treatment options

should consider all aspects of a young person’s life. Holistic care coordination includes

working with multidisciplinary teams and psychosocial support providers in addition to

clinical treatment. It involves a degree of systemic cooperation and local cooperation

between different groups of clinicians as well as non-health sector professionals. A


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collaborative approach to care coordination is especially helpful for consumers who have

complex needs.

Cultural Safety

Cultural safety ensures that the social, spiritual and cultural beliefs, values, and practices of

Aboriginal people and those from culturally and linguistically diverse backgrounds are

acknowledged and respected. Perceiving a service to be culturally unsafe or inappropriate

can be a barrier to a person engaging with a service, which can potentially lead to poorer

health outcomes for the individual. It is important that young people coming into contact

with a service are given the opportunity to identify as Aboriginal so that services and

support can be tailored appropriately. Service providers will ensure a culturally sensitive and

tailored service that promotes access and engages with people from Aboriginal and

culturally diverse backgrounds and their families/carers in a respectful, meaningful and

sensitive way.

Evidence-based Interventions

An evidence based approach ensures that approaches to treating young people with

moderate to severe drug and alcohol dependence are effective and minimises the risk of

causing further harm or trauma to the patient. The NSW Health Substance Use and Young

People Framework and the Western NSW LHD Psychosocial Interventions in Drug and

Alcohol Services Policy WN_PD2014_022 (currently being revised) provide benchmarks for

the delivery of quality psychosocial interventions to drug and alcohol treatment services and

will guide the implementation of interventions under the YDACS Network. Approaches will

be regularly reviewed in accordance with updates to the evidence about changing or

emerging needs of target populations and the effectiveness of interventions.

Developmentally Appropriate Interventions

Decisions about a young person need to be made in conjunction with them and based upon

an understanding of their history and neuro-developmental stage. A developmentally

appropriate approach includes: sensitivity to developmental challenges faced by

adolescents; attention to duty of care and confidentiality; applying appropriate modes of

interaction; awareness of differing developmental trajectories; and managing tensions for

vulnerable youth.

Trauma Informed Care

Trauma-informed services aim to do no further harm through re-traumatising individuals by

acknowledging that usual operations may be an inadvertent trigger for exacerbating trauma

symptoms. A client’s presentation and service needs can be understood in the context of

their trauma history. It is recognised that Aboriginal Australians may have a higher exposure

to violence and trauma, given the history of discrimination, dispossession, loss and


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disempowerment experienced by Aboriginal people in Australia. Services provided to young

Aboriginal people will be informed of this context.

Trust and Respect

Establishing trust and respect is essential to ensuring that services are delivered in a way

that is sensitive to the needs of each individual, especially their values, beliefs and culture.

Clear and honest communication is foundational to this and involves: communicating with

patients and families about the procedures relating to the planned care; making sure

patients know who the health practitioner is; communicating with families in a language

that they are confident in and using interpreters as required; asking questions and listening

to the patient and family's opinion; respecting the patient and family's privacy and

confidentiality; and asking patients if their needs are being met.

SAFETY AND QUALITY

Services provided through the YDACS Network will be provided in environments that are

safe for patients, staff and visitors. NGOs meet accreditation requirements in line with their

funding and organisational frameworks and WNSWLHD is regularly assessed against the

National Safety and Quality Health Service (NSQHS) Standards. All services providers in the

YDACS Network have their own complaint management processes in place.

Ongoing quality improvement activities will be undertaken to ensure that services continue

to develop and improve. Governance operations will include regularly examining the quality,

relevance and results of services provided through the network and identifying

opportunities to increase the capacity of services and contribute to professional

development. An evaluation process will incorporate the feedback and views of consumers

and service providers and identify opportunities to improve the YDACS Network and for

learnings to be transferred to other models of care.

The WNSWLHD Drug and Alcohol Program Clinical Leadership Meeting oversees the clinical

governance processes for drug and alcohol programs for WNSWLHD and provides strategic

review and recommendations for improvements to quality and best practice in clinical

service delivery. The WNSWLHD Drug and Alcohol Program Clinical Leadership Meeting will

provide ongoing governance for the YDACS Network following implementation.

STAFFING

A specialised team of clinicians will be recruited to support the functions of the YDACS

Network. The team will operate 5 days a week (Monday to Friday), 8 hours per day. The

team of clinicians will comprise of the following:

Clinical Team Leader (1 FTE)

Nurse Practitioner (.5 FTE)


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Clinical Nurse Specialist (.5 FTE)

Mental Health or Drug and Alcohol Clinician with experience in psychosocial

interventions, such as a Psychologist, Social Worker Level IV, Occupational Therapist

or Counsellor (1 FTE)

Family based worker delivering services face to face (1FTE)

Clinicians will be appropriately qualified and experienced health professionals with current

registration or professional affiliation in their discipline. Each clinician will have knowledge

of and experience with drug and alcohol, working with youth, coordinating care across

service providers, and developing the capacity of other staff.

CONCLUSION

Supporting young people experiencing substance dependence with appropriate treatment is

vital to ensure a healthy transition into adulthood. The YDACS Network will enhance access

to treatment for young people experiencing moderate to severe drug and/or alcohol

dependence across the WNSWLHD region. It will establish a team of specialist drug and

alcohol clinicians to build the capacity of existing community and government services and

work collaboratively with services to deliver coordinated, holistic and effective

interventions.

This model of care is unique in its approach to deliver youth-specific drug and alcohol

treatment in regional and remote areas within NSW. A process and impact evaluation will

be conducted to ensure that the needs of consumers and service providers are being met,

identify opportunities for ongoing improvement and refinement, and to distinguish enablers

and barriers to the successful implementation of such a model. Learnings will be

transferrable to the development and implementation of similar models across NSW.

Western NSW Local Health District Youth Drug & Alcohol Clinical Support Network

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APPENDIX A – SERVICE FLOW CHART ACROSS THE CONTINUUM OF CARE

Western NSW Local Health District Youth Drug & Alcohol Clinical Support Network

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REFERENCES i Substance Use and Young People Framework, NSW Ministry of Health, 2014

ii NSW School Students Health Behaviours Survey (SAPHaRI). Centre for Epidemiology and Evidence, NSW Ministry of Health. Health Stats NSW: http://www.healthstats.nsw.gov.au/Indicator/beh_alcstud_cat/beh_alcstud_cat_lhn_snap?&topic=Alcohol&topic1=topic_alcohol&code=beh_alc

iii School Students Health Behaviours Survey: 2014 Report. Sydney: NSW Ministry of Health, 2016.

iv NSW Health Youth Health and Wellbeing Assessment Guidelines, NSW Ministry of Health,

2018

http://www.healthstats.nsw.gov.au/Indicator/beh_alcstud_cat/beh_alcstud_cat_lhn_snap?&topic=Alcohol&topic1=topic_alcohol&code=beh_alc

http://www.healthstats.nsw.gov.au/Indicator/beh_alcstud_cat/beh_alcstud_cat_lhn_snap?&topic=Alcohol&topic1=topic_alcohol&code=beh_alc

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