AOD Sector Reforms

Neos Zavrou

AOD Sector Reforms

• • • • • •

THE PROBLEM –

108+ AOD service providers Poor quality data Many barriers Poor service integration Inadequate funding Limited performance management

2011 Victorian Auditor General Report

AOD Sector Reforms

• • • • • • • SOLUTION (Victorian Government): Re-commission *all* AOD Services 30+ service types  6 functions 16 Catchments 2014: Adult (16+) community-based services 2015: Residential & Youth services Activity-based funding model Place-based, integrated services

AOD Sector Reforms

Service Streams

Intake & Assessment Counselling Care & Recovery Non Residential Withdrawal Residential Withdrawal Residential Rehab Youth Services

Key Reforms Affecting Client Referrals Prioritise complex & most in need

• • •

Catchment-based Intake & Assessment

Screening Mandated Complexity Tool Identifies those ready for treatment & substance dependence   Drug use  Legal 

Mandated Assessment Tool

 Risk   Financial Physical & mental health issues  Employment Family & social relationships  Treatment Plan  Housing Strengths & supports

Mandated Assessment Tools

ASSIST

Records substances used & risky / harmful use

Mandated Assessment Tools

AUDIT

Used to identify dependent alcohol use

Mandated Assessment Tools

DUDIT

Used to identify dependent use of drug(s) other than alcohol

Mandated Assessment Tools

Kessler 10 (K10)

Used to determine presence and severity of psychological distress

Mandated complexity tool

1. ALCOHOL AND OTHER DRUGS (AUDIT AND DUDIT SCORES)  Male A1  A2  A3  AUDIT≤15 AUDIT 16-19 AUDIT 20+

Low Risk [A1 and D1]

D1  D2  D3  DUDIT≤5 DUDIT 6-24 DUDIT 25+

Likely Misuse [A1 and D2], or [A2 and D1], or [A2 and D2]

 Female A1  AUDIT≤15 A2  AUDIT 16-19 A3  AUDIT 20+ D1  D2  D3 

both

DUDIT≤1 DUDIT 2-24 DUDIT 25+

Likely Dependence [A3 or D3] or

2. COMPLEXITY (LIFE ISSUES) Is the client’s total K10 score 30 or greater? Is the client homeless? Does the client have housing issues (e.g. living in a boarding house)? Is the client currently unemployed and not involved in study or training?

NUMBER OF “YES” RESPONSES IN THIS SECTION (value between 0-3):

No=0

 No  No  No

Yes1

 Yes  Yes  Yes

Low Risk Likely Misuse Likely Dependence COMPLEXITY = 0

+

COMPLEXITY = 1 COMPLEXITY ≥ 2 Eligibility for AOD Treatment TIER 1 TIER 2 TIER 3 TIER 4 TIER 5

Provide information and advice, psycho education, telephone counselling, brief intervention, etc.

If K10≥30, refer to mental health services If housing instability or homeless, refer to housing services If unemployed, refer to employment services

ADMINISTER FULL ASSESSMENT

Consider referral to face-to-face specialist AOD service or other non-specialist services and programs as required (e.g. physical

health or criminal justice). ADMINISTER FULL ASSESSMENT

Consider referral to face-to-face specialist AOD service and other

non-specialist services and programs (e.g. housing, employment). PRIORITY FOR ADMINISTRATION OF FULL ASSESSMENT

Consider referral to face-to-face specialist AOD service.

Consider recommendation for care and recovery coordination.

Care & Recovery (CRC) & AOD Transitional Housing

• • • AOD Supported Accommodation now part of CRC CRC treatment stream = seamless & integrated care for most complex clients Transitional housing only for eligible CRC clients – i.e. assessed as complex & with treatment have stabilised AOD use e.g.:  Exiting Residential Rehabilitation  Post AOD counselling and/or similar + CRC support + significant reduction in AOD use & risk behaviours + no access to stable accommodation

Facilitating Access & Supporting Treatment

Complexity = Homelessness, housing, employment and mental health (psychological distress):

The sector has been reformed to prioritise

your

clients

Facilitating Access & Supporting Treatment (cont)

Get to know….  • • • your catchment based Intake & Assessment Provider May provide a CRC worker May offer screening & assessments at your sites Your staff can use the tools speed the process  • • your local AOD treatment providers May offer counselling and non residential withdrawal at your sites Can reassess client complexity and reclassify clients even after referral

Catchment Planning

• • o o o o Who is doing catchment planning in your area?

Tell them about your clients & their families: Identified minority/language groups Specific needs not met by AOD services Concerns about identified drugs Resources / ideas your service has or is aware of Ask to be part of the Advisory Group

Questions?