Principal Sponsor of the ATCA 2011 Conference
30 May - 3 June, Fremantle, Western Australia
Sponsorship provided for Rural and Remote Workers to attend
the 2011 ATCA Conference, Fremantle, WA
Platinum Sponsor ATCA 2011 Conference
30 May - 3 June, Fremantle, Western Australia
Conference Sponsors
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ATCA Secretariat is financially supported by
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Lynne
Magor-Blatch |
Barry
Evans |
Garth
Popple |
Executive Officer |
Chair |
Deputy
Chair |
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Gerard
Byrne |
Carol Daws |
Eric
Allan |
Treasurer
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Secretary |
Public Officer
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Mitchell Giles
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James Pitts |
Jackie Long
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Director |
Director
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Director |
However, all TCs have one important factor in common - they are underpinned by the concept of 'Community-as-Method' in which the community itself is seen as the main vehicle for treatment. The TC has proven to be a powerful treatment approach for substance use and its related problems in living (DeLeon, 2000). It is a fundamentally self-help approach that treats the whole person through the use of peer community, amplified with a variety of services and interventions related to family, education, vocational training, physical and mental health.
Members of ATCA are diverse in terms of the range of programs offered. This is appropriate as each agency aims to be responsive to the particular needs of its client group. In general, programs aim to have enough structure to ensure a degree of order, security and clarity, while allowing room for residents to learn, make mistakes and learn from experience.
The desire to continually improve the service offered has led members to consult the research literature, to seek forums for exchange and to encourage client involvement and feedback on all aspects of service delivery. It has also led services to consider means of matching clients to services and to developing new initiatives. For example, brief intervention programs of 4 - 6 weeks are available, some programs offer services to methadone clients and groups requiring specialist approaches, such as women, the dually diagnosed and victims of physical/sexual abuse.
It must be emphasised that whilst TCs maintain an environment free from illicit drugs and alcohol, this does not mean a rejection of medically prescribed substances. Residents may require psychotropic medication and all agencies have appropriate medical, psychological and psychiatric support. The use of methadone and other pharmacotherapies is supported by a number of TCs, either as a reduction and withdrawal regime, or as stabilisation and maintenance. Other programs offer a range of naturopathic therapies.
Our member agencies are cognisant of the public health risks of transmission of HIV and in particular of Hepatitis C (HCV) and the need to include safe sex, safe needle use and health education messages to clients.
We do not see recommending such harm reduction strategies as inconsistent with goals of abstinence. Therapeutic Communities provide treatment which fit within the harm minimisation continuum, providing an opportunity for each person to make an individual treatment choice, based on their previous experience and attempts at treatment.
It is important to understand that 'one size does not fit all' and therefore it is important that clients are offered a range of treatment options.
For many, the TC is an alternative to lengthy imprisonment. This is a positive option for both the individual and society, as the TC provides both a cost-effective option to prison and the opportunity for help and rehabilitation. TCs offer the possibility for complete lifestyle change, and treatment frequently leads to the individual becoming a contributing member of society.
TC treatment costs need to be examined in the context of alternative treatment costs - hospitalisation, imprisonment, the cost to the community, the cost of correctional services and justice interventions. The cost of substance use includes:
- Direct costs - medical care and expenditure, its sequelae and non medical expenditure i.e. prison, law enforcement;
- Indirect costs - loss of earnings due to death, imprisonment reduced human capital; and
- Psychosocial costs - reduction in quality of life (Pitts, 2009).
It is estimated that for every $1 spent on treatment, there is a savings of $7 through reduced health, welfare and justice system costs. Most importantly, the person is provided with an opportunity of treatment, and the chance to change their life.
Almost all TCs are non-government agencies and in part reliant on non-government funding. Any cost/benefit analysis should recognise that TCs are one of the few areas of drug and alcohol treatment where, to a degree, the 'user pays' principle has been implemented. Clients contribute their labour to reduce costs (as well as the therapeutic value of work they contribute).
Quantification of individual suffering and despair is difficult, equally so is the value of returning that individual to a fulfilling and productive place in our society. The wholistic approach offered by TCs leads to significant improvement in many areas of individual functioning. Success is also difficult to quantify - abstinence or reduction in drug consumption, shift from illegal to legal drug use, adoption of safe usage practices, improved work performance, reduced criminal activity, improved interpersonal relationships, increased self-esteem are all legitimate areas of success and all areas targeted by TC programs as part of a harm minimisation approach.
ATCA members endorse the thrust of harm minimisation. All have integrated principles into their own programs with a range of interventions, including HIV education, distribution of split/safe kits, education of residents on relapse, the dangers of alcohol, and safer sex practices. TCs are ideally situated to offer this information to very high-risk groups and to be able to reinforce it over time.
TCs are dynamic organisations, evolving and responsive to changes in the environment in which they operate, and to changes in client presentations. Agencies encourage continued development and training in their staff, and this is an area where increased government funds and support is necessary.
Although TCs have always provided some integration services, over the last few years there has been a greater emphasis on re-integration and continuing after-care programs. TCs provide a range of aftercare services, including half-way houses. Programs also foster links with self-help programs, and/or run programs for ex- residents.
As TCs have evolved to meet demand and increase their range of services, staffing within TCs has also changed. TCs now employ multidisciplinary teams, including AOD workers, psychologists, medical personnel, social workers, group therapists, vocational trainers, teachers, sports instructors, childcare workers and family support workers. Staffing structures in TCs includes within the range of qualified staff, members who have themselves also completed a TC program. Staff members who bring with them the experience of recovery provide strong role models for residents in treatment and hope in the recovery process.
Like other treatment options, most TCs attract a majority of male clients. ATCA member agencies in the various states are implementing a range of strategies to encourage greater female participation - separate women's program, childcare, parenting programs.
The recent rapid expansion of methadone programs across Australia will ultimately lead to the need for creative solutions to the problem of providing support to those who wish to reduce their use. TCs are already providing one avenue. Several TCs have programs offering treatment to clients on methadone and other pharmacotherapies who wish to reduce and withdraw within the supportive context of counselling and treatment. As the number of clients on methadone increases, we expect that agencies will develop creative and new ways of responding to these clients. Other programs are also providing the opportunity for clients to become stabilised and maintained on their pharmacotherapy. We endorse Mattick & Hall's call for TCs and methadone maintenance programs to work more collaboratively.
ATCA launched its own 'Quality Assurance Peer Review' system some years ago in order to maintain and improve treatment standards within the TC. The nature of the TC means that as part of their daily operation all agencies have in place client grievance procedures and structures which provide checks and balances to staff and which protect client's rights and provide TCs with a model of 'best practice in management and client protection and rights'.
In September 2009, the ATCA launched the National Standards for Therapeutic Communities (Alcohol and other Drug) and Therapeutic Communities Training Package.
The project is seen as part of an overall development of national standards for alcohol and other drug agencies, and as such will fit within a National Framework.
The ATCA's objective is to ensure the integrity of the 'Therapeutic Community' principle is maintained and will continue to stand as a model of best practice in the treatment of substance misuse and co-occurring disorders.
The aims of this project were to:
- Provide specialist service standards which identify and describe good TC practice which can be incorporated into a national quality framework.
- Enable Therapeutic Communities to engage in service evaluation and quality improvement using methods and values that reflect the TC philosophy.
- Develop a common language which will facilitate effective relationships with all jurisdictions (federal, state and territory).
- Provide a strong network of supportive relationships.
- Promote best practice through shared learning and developing external links.
- Build workforce capacity within the AOD and comorbidity sector.
- Create an environment for sustaining the 'career paths' of trained AOD workers within the NGO sector, including the valued practice of workers with 'lived' experience of the field. Therapeutic communities particularly value the experience of staff who are graduates of programs, and seek to incorporate learned knowledge and experience into their professional practice.
The agencies which ATCA represent all endorse both the value of independent research and the need for increased research to assist us in continually improving the quality of our services.
The ATCA website provides papers and presentations from past conferences and links to others websites which include research studies in therapeutic community treatment.