Developing a First Australian alcohol and other drugs workforce: and why the evidence is not enough Ted Wilkes & Dennis Gray

Ted Wilkes AO

Reducing AOD -related harm among First Australians Evidence for what interventions work to reduce AOD - related harm Evidence for why our interventions have limited effectiveness Why the evidence is not enough

Reducing AOD -related harm To reduce AOD -related harm we need strategies to: address the underlying social determinants which predispose towards, or protect against, harmful use specifically target harmful use itself

A OD -specific strategies to reduce harm Prevent or minimise the uptake of harmful use Provide safe care for those who are intoxicated Provide treatment for those who are dependent Support those whose harmful AOD use has left them disabled or cognitively impaired Support those whose lives are affected by others’ harmful AOD use

Evidence-based interventions Price controls, restrictions on trading hours, fewer alcohol outlets, use of non-sniffable fuel, culturally sensitive enforcement of existing laws Early intervention, alternatives to AOD use, various treatment modalities, ongoing care, relapse prevention Community patrols, sobering-up shelters, and needle and syringe exchange programs

Complementary Action Plan 2003 – 2009 Key Result Areas 1.Enhanced capacity 2.Whole-of-government commitment – in collaboration with the community-controlled sector 3.Substantially improved access to services 4.A range of holistic approaches – locally available and accessible 5.Workforce initiatives 6.Sustainable partnerships in research, monitoring, evaluation and dissemination

NATSIPDS – Priority Areas 1.Build capacity and capability of the AOD service system, particularly Aboriginal and Torres Strait Islander controlled services and its workforce 2.Increase access to a full range of culturally responsive and appropriate programs 3.Strengthen partnerships … between Aboriginal and Torres Strait Islander peoples, government and mainstream service providers 4.Establish meaningful performance measures … that support community ‐ led monitoring and evaluation

Recent AOD use: First Australian vs. Other Australian Rate Ratios Daily tobacco smoking2.5 Two or more standard drinks/day1.3 Recent cannabis use2.0 Recent meth/amphetamine use1.9

Alcohol and other drug related harm among First Australians The high rates of alcohol and other drug use among First Australians is reflected in key indicators of harm including rates of deaths, hospital admissions and imprisonment If we know how to reduce these harms, why are they still with us?

Social determinants of health Cultural determinants Strong, resilient culture 1.The social gradient6.Unemployment 2.Stress7.Social support 3.Early life8.Addiction 4.Social exclusion9.Food 5.Work10.Transport

‘Close the Gap’ and ‘Closing the Gap’ 2005 Social Justice Report released by the Aboriginal and Torres Strait Islander Social Justice Commissioner April 2007 ‘Close the Gap’ campaign launched December 2007 COAG committed to ‘Closing the Gap' in life expectancy between Indigenous and non-Indigenous Australians

Reporting on ‘Close the Gap’ and ‘Closing the Gap’ Steering Committee for the Review of Government Service Provision, Overcoming Indigenous Disadvantage: Key Indicators 2014 The Prime Minister’s Annual Report to Parliament on Progress in Closing the Gap 2016 Close the Gap Campaign Steering Committee, Close the Gap Progress and Priorities Report 2016

Closing the Gap: Prime Minister’s Report 2016 Prime Minister’s Report 2016 among Indigenous Australians

Reducing First Australian disadvantage? No Australian government has committed the resources needed to significantly reduce Aboriginal poverty and disadvantage Saggers & Gray 1991 Aboriginal Health and Society

Evidence of impediments to effective AOD service provision Lack of capacity to meet demand Limited access to a full range of services and/or culturally secure services A shortage of gender-, age- and family-specific services and continuing care and relapse prevention services Service provision is unevenly distributed National funding priorities do not necessarily meet the needs and priorities of particular communities Lack of planning and no model for the planning of service provision

Evidence for the under-resourcing of services

Despite being identified as a priority and funds being specifically allocated for workforce development and capacity building, workforce issues have been and continue to be identified as an impediment to the delivery of effective ATOD treatment services

Staff members from many of the organisations who participated in this study identified inadequate staff training as a barrier to effective service provision — a view supported by the evidence on the limited number of, and funding for, workforce development projects.

Evaluation of alcohol treatment interventions projects in eight community-controlled organisations found they had all been negatively impacted upon by workforce issues

Need to implement customised strategies to meet staff needs – including family and community contexts; adequate and equitable salaries and benefits; and opportunities for career and personal growth

Idealised Model of Policy Making Edwards, 2005 (LMS) Prof Carmen Lawrence University of WA

Factors other than evidence influence policy making  Experience, expertise, judgement  Available resources  Values, ideology and political beliefs  Habit and tradition  Lobbyists, pressure groups and consultants  Pragmatic considerations and contingencies (unexpected events, e.g. GFC) Prof Carmen Lawrence University of WA

Evidence and Advocacy Those who have the evidence and experience must advocate for change AADANT and organisations such as AMSANT can provide leadership but it requires all of us to get behind them because at the end of the day, the evidence is not enough