Priority Area 5: Organisational and system capacity to prevent and respond to amphetamine-type stimulant problems

Table of contents

Priority Area 1: Community awareness and understanding of amphetamine-type stimulant use and related problems
Priority Area 2: The supply of amphetamine-type stimulants
Priority Area 3: The use of amphetamine-type stimulants
Priority Area 4: Problems associated with amphetamine-type stimulant use
Priority Area 5: Organisational and system capacity to prevent and respond to amphetamine-type stimulant problems

Objective

Enhance the capacity of organisations and the broad system to respond effectively to people affected by amphetamine-type stimulants.

Rationale

Evidence-based practice relies on a skilled workforce to interpret and apply the evidence in the context of the unique needs of individuals and diverse communities. For this reason, workforce development has been identified as one of the priority areas of the National Drug Strategy. In the draft resolutions following the December 2006 ‘National Leadership Forum on Ice’, the Ministerial Council on Drug Strategy acknowledged that effective responses will rely on workforce development.

Organisational systems and protocols need to be in place to ensure effective practice, for example to enhance shared care and referral procedures. As with the National Alcohol Strategy and the
National Cannabis Strategy, the National Amphetamine-Type Stimulant Strategy relies on approaches that will enhance and maintain the capacity of organisations and the workforce to develop and implement effective responses to prevent, reduce and treat ATS-related problems.

The organisations and workforce involved in responding to ATS related problems are diverse, including:

Law enforcement staff who disrupt manufacture and supply, minimise the risk associated with clandestine laboratories and/or refer people into diversion programs;
Police who manage people who are intoxicated by ATS;
Teachers who engage at-risk children in school and deliver quality drug education;
Peer groups who provide advice and support;
Needle and syringe program staff who provide advice and referral; and
Clinical staff who engage and retain ATS affected people in effective treatment and respond to the needs of families affected by ATS use.

Ensuring effective responses demands workforce and organisational development strategies for drug problems in general and ATS related problems in particular.

Over the past 15 years, in relation to responding to alcohol and other drug problems, there have been significant improvements in access to quality workforce development programs and initiatives. However, education, training, supervision and organisational support is still limited and it was observed in the consultations that it is important to continue to support pre-service and post qualification workforce development for drug specialist staff, nurses, medical staff, police, teachers, Indigenous health staff, mental health staff and so on.

Particular challenges are evident for ATS related problems because a limited, or relatively recent, evidence base has meant that many staff are not fully informed about the nature of ATS related harm and potential responses. Recent guidelines and protocols for managing ATS problems have been developed (e.g., Lee et al., 2007; McIver et al., 2006), at least for some groups, but they have not been widely disseminated and utilised.

It was suggested there was a need to improve access to out-of-hours support and establish and maintain more effective referral pathways. Across most consultations it was observed that ATS problems are often initially detected in settings such as emergency departments, police services, community health services and/or needle and syringe programs, but poor links with other services (e.g., residential and non-residential drug treatment services; mental health services) create barriers to effective engagement and treatment.

Top of Page

Because they are among the few services that operate out-of-hours, which conversely are highrisk periods for ATS related problems, police and emergency departments are often the first (and sometimes only) contact points for ATS affected people, resulting in suboptimal responses and diversion of limited resources. While a proportion of such individuals exhibit psychotic symptoms
that will require medical management, many have a high level of agitation that requires care, but much less intensive interventions. It was consistently noted that police cells, emergency departments and mental health services are not the best locations to manage these problems. It was observed that the nature of many ATS problems meant that a proportion of those who enter treatment may be experiencing anxiety and/or paranoia, and also find it difficult to establish and maintain relationships with clinicians. While a clinician’s ability to establish physical and emotional safety and build and maintain a therapeutic alliance is critical to all clinical engagement, these skills are particularly relevant to responding to people affected by ATS use. Physical and emotional safety are also important for organisations, including ensuring adequate staff development, supervision and support to enable effective delivery of services, ensuring workplace safety and health and avoiding staff ‘burnout’.

Remote and rural participants in the consultations noted that broad workforce planning contributes to effective responses to drug problems: in some regions, potential and actual shortages of nurses and medical staff limit the ability to implement effective responses to drug problems. While challenges related to recruitment, training and retention of health and other staff are beyond the scope of the ATS Strategy, it is important to acknowledge that access to an adequate and stable workforce will influence the capacity to effectively respond to alcohol and other drug problems in general and ATS related problems in particular.

Recommended actions

[i) Develop the capacity of the workforce to respond to alcohol and drug problems in general and ATS related problems in particular

Support research into workforce and organisational development to enhance responses to alcohol and other drug problems in general and ATS problems in particular.

Ensure alcohol and drug education is integrated into pre-service training for health professionals (e.g., nurses; Aboriginal health workers; medical staff; psychologists) social and welfare staff, corrections staff, youth workers, law enforcement staff, teachers, school and university counsellors and other key groups. Ensure such groups also have access to ongoing professional development related to effective responses to alcohol and other drug problems in general and ATS problems in particular.

Address the particular needs of rural and remote staff who respond to drug problems by ensuring access to professional development opportunities, provision of quality support and supervision and ready access to emerging resources.

ii) Build capacity to prevent supply of ATS

Develop the capacity of the law enforcement sector to prevent the supply and use of ATS in the context of complex and rapidly evolving technological and trade environments, including by:

Enhancing the intelligence capability of law enforcement agencies to enable identification and response to attempts to import and traffic ATS; and
Enhancing the capacity of law enforcement to investigate ATS importation and trafficking.

Top of Page

iii) Develop the capacity of the workforce to address ATS problems

Summarise and disseminate emerging evidence about ATS use and problems to key health and other staff (e.g., GPs; emergency services; mental health staff; juvenile justice and corrections staff; community health service staff; Aboriginal health staff; law enforcement staff; drug specialist staff). This should identify:

Contexts of use that are high-risk for ATS related problems;
Information about the adverse consequences of ATS use; and
Emerging evidence about effective responses to ATS problems and dependence.

Review existing guidelines for managing ATS related problems and protocols for referral, develop and implement an effective dissemination strategy for existing guidelines (e.g., for ambulance officers, police, GPs, emergency department staff) and update and/or develop new guidelines where indicated. Wide dissemination of protocols and guidelines should use evidence-based methods to ensure adoption.

Enhance and maintain the capacity of health staff, particularly drug specialist staff, to:

Implement effective assertive outreach programs to engage and retain in treatment people affected by ATS use;
Establish and maintain an effective therapeutic alliance with people affected by ATS problems and dependence;
Identify mental health problems and distinguish serious and/or enduring mental health problems from more transient consequences of ATS intoxication and/or ‘come down’ effects and withdrawal;
Establish and maintain collaborative relationships with mental health services and staff to effectively manage clients with co-existing drug and mental health problems; and
Implement evidence-based psychosocial treatments and pharmacotherapies and address particular issues arising from ATS use such as poor nutrition, cardio-vascular problems, sleep disorders, injecting behaviour, risky sexual behaviour and relationship problems.

Enhance and maintain the capacity of mental health staff to:

Identify drug problems and establish collaborative relationships with drug specialist services and staff to effectively manage clients with co-existing drug and mental health problems.

Ensure that staff in drug and alcohol and mental health services understand the importance of working with families and working in partnership with other services that cater for families, and have appropriate knowledge and skills in areas such as parenting and child development. Staff need to review and where necessary adapt existing ATS treatment protocols for psychologists and explore the potential of developing and implementing a national ATS workforce development strategy for psychologists in the context of the recent COAG Mental Health Plan that enables access to treatment provided by community and clinical psychologists. Trial and, on the basis of evidence, implement shared care approaches for people affected by ATS use through general practitioners and ommunity health services working in collaboration with psychologists and drug specialist services.

In consultation with Aboriginal and Torres Strait Islander people, develop specific guidelines and protocols for services responding to the needs of Aboriginal and Torres Strait Islander people and communities affected by ATS use. These guidelines and protocols should be accompanied by culturally secure dissemination and workforce development strategies. On the basis of identified need, provide additional resources to ensure access to quality and culturally secure treatment and support services.

Develop the capacity of Needle and Syringe Program staff to:

Defuse potentially challenging/difficult situations;
Engage with ATS users by employing basic communication and engagement skills;
Understand links between ATS use and mental health problems; and
Advise clients about treatment options and how to access support/how to effectively refer people affected by ATS use.

This will include ensuring capacity and strategies to build links with the broader drug treatment and mental health services to develop and maintain referral pathways and providing training in mental health first aid that is specific to Needle and Syringe Program settings.

Given the nature of ATS related problems, identify and/or develop and implement strategies to ensure the physical and emotional safety of staff who respond to people affected by ATS use (e.g., ensure dissemination and adoption of existing clinical supervision guidelines; embrace quality assurance procedures; adopt procedures to ‘avoid burnout’; review adequacy of physical infrastructure of workplaces to communicate and ensure safety).

Ensure the development and delivery of effective workforce development initiatives for law enforcement, health, justice and other key staff regarding the benefits and implementation of the IDDI. Also, educate offenders and the community about the benefits of IDDI.

Top of Page

iv) Build clinical research capacity to respond to ATS related problems

Examine the benefits of developing and investing in a national ATS clinical research network to facilitate capacity to conduct multi-site research into:

The natural history of ATS use and adverse consequences related to short- and long-term use;
Withdrawal management;
Pharmacological and psychosocial interventions; and
Intervening with hard to reach populations, such as those who use ecstasy.

v) Build capacity to respond to the needs of families and children affected by ATS problems

Develop the capacity of the health sector and drug specialist agencies to respond to the needs of families/parents/carers of people affected by ATS use.

Develop and implement protocols and improve the ability of services to respond to families and children affected by ATS use:
Enhance the ability of services to identify parents experiencing ATS problems;

Ensure that services aimed at adults include a focus on parents, and services for children have an improved focus on drug and alcohol problems of the parents of referred children;
Develop referral pathways and services for parents/carers affected by ATS use. This will require strategies across all developmental stages, including pregnancy, during infancy and childhood. Absence of parent friendly services can be a barrier to treatment;
Develop the capacity of children’s services to identify and respond to ATS related risks for children;
Develop protocols and strategies to reduce child exposure to the risks associated with clandestine laboratories;
Enhance the ability to intervene effectively to meet the needs of parents/carers affected by ATS use and their children; and
Enhance the capacity of treatment services to respond to parents with dependent children.
Ensure that drug and alcohol services focus on protecting the children of parents who use drugs such as ATS, and that they form close working linkages with child protection services.

vi) Improve partnerships between drug and alcohol and mental health sectors

Require mental health services (through a top down process) to screen for alcohol and other drug use in their clients as part of standardised assessment. Mental health services should be provided with clinical guidelines and protocols on assessment procedures, brief interventions, and advice giving about the particular risks of ATS use and treatments for ATS use and dependence. Mental health staff should be informed of the implications of ATS use/dependence for effective management of mental health problems (e.g., potential contraindications for some medications) and its potential use by clients to manage ADHD at times. Effective referral procedures and case management protocols should be developed.

Require drug and alcohol services (through a top-down process) to screen for mental health disorders, including depression, anxiety, psychosis and ADHD, in their clients as part of standard assessment. Develop, disseminate and adopt effective management, referral procedures and shared care management protocols.

In partnership between mental health and drug specialist services, develop mental health programs to prevent self-medication with ATS in identified at-risk groups such as those with ADHD, depression and Post Traumatic Stress Disorder (PTSD).

vii) Improve understanding among law enforcement and court personnel about ATS use and problems and related interventions, treatments and other supports for ATS users

Ensure that sentencing judges and magistrates are informed about the forms and properties of ATS in a manner that is relevant for sentencing purposes.

Provide workforce development for law enforcement and justice/corrections staff to ensure:

Awareness of benefits and availability of referral to education, early intervention or treatment for individuals affected by ATS use;
Police capacity to manage people intoxicated with ATS and/or other drugs is enhanced (e.g., with those who exhibit ATS related agitated, erratic and violent behaviour); and
Ensure effective coordination arrangements exist between law enforcement, justice/corrections and drug specialist, general health, mental health, and social welfare agencies.

Develop the capacity of law enforcement staff to recognise and refer offenders with ATS related problems and other drug problems and to provide information and referral to families/carers.
Top of Page

viii) Improve the national response to seized clandestine laboratories and handling precursor chemicals to prevent harms

Ensure training for law enforcement officers is adequate to safely identify and handle precursor chemicals and ATS.

Implement, as appropriate, the national guidelines to assist jurisdictional responses to clandestine drug laboratories, and review as necessary. In relation to this process, ensure effective workforce development for law enforcement and other emergency services to ensure they safely respond to ATS risks including:

Entering and dismantling clandestine laboratories;
Identification and proper handling of precursor chemicals;
Develop protocols/guidelines to assist responsible agencies in the remediation of clandestine laboratory sites; and
Establish effective collaborative linkages or protocols with child protection agencies for the provision of health assessment and care for children exposed to the risks of ATS production and/or distribution.

ix) Ensure capacity building involves key stakeholders

Involve key stakeholders in developing the capacity of the workforce to prevent and respond to ATS related problems. For example, involve key stakeholders from:

Young people’s health;
Gay, lesbian, bi-sexual and men-who-have-sex-with-men networks;
Aboriginal and Torres Strait Islander communities; and
Culturally and Linguistically Diverse communities.

prev page| TOC |next page