Overview of current issues impacting on the Alcohol and other Drugs Sector NADA Workforce Development Plan: NADA members’ Workshop Monday 16 November am – 12:30pm Novotel Sydney Central, Sydney Professor Ann Roche & Roger Nicholas

Whole rvices rimary health care,  What is workforce development (WFD) ?  The evolution of WFD  Profiles of the national and NSW NGO workforces  Bigger picture influences on the NADA WFD Plan Outline

Whole rvices rimary health care,  ……. a multi-faceted approach which addresses the range of factors impacting on the ability of the workforce to function with maximum effectiveness in responding to alcohol- and other drug-related problems.  Workforce development should have a systems focus. Unlike traditional approaches, this is broad and comprehensive, targeting individual, organisational and structural factors, rather than just addressing education and training of individual mainstream workers (Roche, 2002). What is workforce development?

Whole of populatiot, community services ←Whole of population focus, prevention, social determinants, education, law enforcement, community services ← Primary health care, community services, information services, NSPs, peer support, self help groups ← Specialist assessment and referral, corrections, case management, relapse prevention, community pharmacotherapy, counselling ← Services for people with complex needs, specialist withdrawal management, residential rehab rimary health care, Tiers of AOD work involving different agencies

Whole rvices rimary health care, Phase 1: The Individual Focus  Education and training programs and resources to enhance individual workers’ knowledge and skills  Failed to take into consideration the influence of the systems in which people worked  This approach does not generally lead to sustainable work practice change The Four Evolutionary Phases of AOD Workforce development

Whole rvices rimary health care, Phase 2: Internal Systems Approach  A step forward  Focused on the internal systems in which people work  Education and training seen as a subset of workforce development  Recruitment, retention, leadership, supervision, career development, workforce wellbeing, role clarification  The problem of siloing remained The Four Evolutionary Phases of AOD Workforce development

Whole rvices rimary health care, Education and Training as a Subset of Workforce Development Roche & Pidd, (2010)

Whole rvices rimary health care,  Phase 3: A Human Services Systems Approach  Builds on Phase 2  Recognises that most people with substance use problems don’t access specialised treatment services  More attention to social determinants of health (early life experiences, work, unemployment, social exclusion) as causal factors and response strategies  Adopting broad systems approaches incorporating primary care, hospitals, housing, employment and social support for families and children – multiple doorways and pathways The Four Evolutionary Phases of AOD Workforce development

Whole rvices rimary health care,  Phase 3: A Human Services Systems Approach  Builds on Phase 2  Recognises that most people with substance use problems don’t access specialised treatment services  More attention to social determinants of health (early life experiences, work, unemployment, social exclusion) as causal factors and response strategies  Adopting broad systems approaches incorporating primary care, hospitals, housing, employment and social support for families and children – multiple doorways and pathways The Four Evolutionary Phases of WFD in the AOD Field

Whole rvices rimary health care, Phase 3 (cont): A Human Services Systems Approach  Coordination across a range of systems improves health, social and criminal justice outcomes  Growing expectations for more coordinated and holistic care  Structured relationships with other sectors  Up-skilling of generalist workers The Four Evolutionary Phases of WFD in the AOD Field

Whole rvices rimary health care, Phase 4: Into the Future  Builds on phase 3  Ensure that the AOD workforce has measures in place to identify existing and future challenges. The Four Evolutionary Phases of AOD Workforce development

Whole rvices rimary health care,  The majority are female  The majority are aged 45 years or older  Approximately one third are employed part time  Median length of AOD service is five years  The largest occupational groups are AOD workers and nurses  A substantial number of workers have no formal AOD-specific qualifications. National profile of the specialist AOD Workforce (Roche & Pidd, 2010)

Whole rvices rimary health care, Survey respondents:  Average age 45 years  Predominantly female  7.7 years AOD experience (5.1 years with their current organisation)  Almost half (48%) hold a university qualification and 57% hold a specific AOD qualification  Most common position title: AOD Worker  82% of staff were from an organisation providing residential rehabilitation  <10% identify as ATSI; 13% from a CALD background The NSW NGO AOD sector (NADA, 2014)

Whole rvices rimary health care, Bigger picture influences on the NADA WFD Plan

Whole rvices rimary health care, 1. Ageing Australian Population

* Substance use disorders in over 50s predicted to double by 2020  Greater use when younger continues in later life  Baby boomers’ liberal attitudes towards alcohol / medicines and illicit drugs The baby boomers have arrived!

Whole rvices rimary health care,  ↑ Non-communicable diseases including accumulated AOD harm  ↑ Proportion of population with ↑ rates of AOD use / harm  More complex drug interactions and sensitivities  Ageing AOD specialist workforce + retirement of highly skilled workers  ↑ Competition for workers, especially registered nurses (particularly in the context of globalisation of the workforce) So What?

Whole rvices rimary health care, Projected Employment Change 2011/ /17

Whole rvices rimary health care, 2. Multiple Morbidities * Physical / mental / social health co-morbidities very common among people experiencing AOD harm * Multi-morbidities are the norm among people with chronic health / social problems * Most common among the most disadvantaged * At times current approaches focus too much on single morbidities * Co-location, multi-D teams, inter-professional education, cross sectoral WFD, enhanced in-house generalist service provision, enhanced linkages * Need to balance against the risks of being all things to all people and deskilling of specialists Emerging issues (cont. )

Whole rvices rimary health care, 3.New substances / patterns of use * Synthetics / pharmaceuticals / smart drugs * Enhanced monitoring of Schedule 8 drugs * Pain management 4.New prevention paradigms and treatments * Social determinants of health * Integrated models of care in recognition of multiple morbidities * New pharmacotherapies 5.Enhancing consumer input into care e.g., client- led care (funding implications) 6.Initiation into AOD use at earlier ages Emerging Issues (cont.)

Whole rvices rimary health care, 7.On-going restructuring (e.g., potential integration of AOD and MH agencies) 8.Outcomes- (rather than inputs- or outputs-) focussed funding 9.Downstream effects of current cutbacks in prevention activities 10.Demands for more family inclusive practice 11.Better understanding the effects of parental AOD and co-occurring problems on children Emerging Issues (cont)

Whole rvices rimary health care,  Varies between jurisdictions  Particularly contentious concerning workers with lived experience  “Minimum” versus “essential” qualifications  Lack of minimum standards may lead to AOD field being seen as unprofessional  Only Vic and ACT have mandated minimum Certificate IV qualifications  Who pays for training costs including backfill?  ↑ minimum qualifications = ↑ wages pressure Minimum Qualifications / Accreditation to Work in Specialist AOD Roles

Whole rvices rimary health care,  Disincentive to base level entry into AOD work (??)  Is Cert IV achievable? Too low? Existing staff?  86% of drug treatment managers prefer staff to have higher education qualifications, and one third support graduate minimum qualification levels (Pidd et al., 2010)  Concerns from managers and trainers that the current VET package is too generic (Roche et al., 2012)  Tension between employers and governments (specialised versus generic training)  Matching qualification levels to tasks Minimum Qualifications / Accreditation to Work in Specialist AOD Roles

Whole rvices rimary health care,  Provides an opportunity for the NSW NGO AOD field to set itself up to cope with future challenges and have a sustainable workforce  Provides an opportunity to examine ways of working with other agencies / sectors to better meet the needs of clients with complex needs  Enhances our capacity to reduce AOD harm. In summary the NADA Workforce development plan:

Whole rvices rimary health care, Conclusion