Changing the Culture of Alcohol Use in New South Wales

May 2004

Section 4: Service Delivery - Health

Government Response

This report in response to the Summit on Alcohol Abuse provides a comprehensive approach to tackle the problems associated with alcohol abuse. It is modelled on the approach adopted following the 1999 NSW Drug Summit.

The Drug Summit 1999 Government Plan of Action for the years 1999/2000-2002/2003 has now been extended, expanded and funded until 2006/2007.

Both this report and the NSW Drug Summit 1999 Government Plan of Action are consistent with the National Drug Strategic Framework 1998-99 to 2003-04: Building Partnerships and the National Alcohol Strategy: A Plan for Action 2001 to 2003-04 endorsed by Commonwealth, state and territory governments.

In relation to health services, a comprehensive NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 will be developed (Rec. 3.6).

Government Response

Referral of patients with alcohol abuse treatment requirements: assessment and referral

Assessment for alcohol problems can range from brief screening interviews by general health care workers that may then lead to early intervention to in-depth measures of a broad range of psychosocial functioning which are required to formulate and evaluate ongoing structured treatment programs.

Best Practice Guidelines: Screening for Alcohol Abuse will be developed and issued by NSW Health in 2005 to be used in clinical settings. These will be based on the standard screening measures such as the Alcohol Use Disorders Identification Test (AUDIT).

The guidelines will promote the practical steps that can be undertaken to screen for alcohol abuse including an assessment of the level of drinking, an assessment of the level of dependence, any physical effects of alcohol use, as well as any psychiatric comorbidity.

Each Area Health Service will develop Integrated Care Pathways (ICP) for patients requiring treatment for alcohol abuse. The use of ICPs will standardise elements of care by providing clarity as to what the client can expect the agency(s) to provide and the roles and responsibilities of the treatment modality within the integrated care system and towards the individual client.

In addition to the above health system assessment and referrals, people can now be assessed and referred to alcohol treatment services through telephone based services including:

§          The Alcohol and Drug Information Service (ADIS) which is a 24 hour state-wide service.
§          Area Health Service Drug and Alcohol Central Intake Services. These provide a single point of entry to the full range of drug and alcohol services (detoxification, support coordination, counselling, pharmacotherapy, residential rehabilitation, and aftercare) via one regional or local telephone number. Drug and alcohol clinicians conduct a triage assessment and assist individuals to determine an appropriate drug and alcohol treatment. Brief counselling and detailed information on drug and alcohol services, including their availability is provided and the clinician is able to negotiate assessment appointments on the client’s behalf.

Management of alcohol abuse as an integral part of all health services

One way of ensuring the management of alcohol abuse is treated by all health service providers when patients with relevant symptoms present is to ensure that all health workers receive appropriate professional education and training.

Ensuring that generalist health and community workers such as nurses, doctors and allied health workers are trained in the early identification of alcohol related problems, and provision of brief intervention, recognises the prevalence of alcohol related concerns in primary health care (Recs. 3.3, 3.4, 3.5 and 3.17).

Every medical student is trained to record a proper alcohol history and hospitals have protocols for addressing alcohol related health problems. This is done primarily through contacting the relevant Area Health Service drug and alcohol provider who then delivers clinical and support programs and services in hospital wards.

NSW Health will develop the next phase of the NSW Drug Treatment Services Plan 2000-2005 for 2006-2015 to incorporate alcohol into its model of care. This will be complemented by the establishment of a service planning template for the establishment drug and alcohol services (including clinical services) in the future.

Specialist workers and services

The nature and efficacy of alcohol treatment suggests there is a continuum of treatment, with brief and early interventions being most appropriate for individuals with low-level problems and more specialist interventions being necessary for individuals with more severe problems.

In addition, the Far West Area Health Service has been funded to employ a Specialist Drug and Alcohol Clinical Consultant to establish appropriate clinical protocols and to build links with local medical practitioners in 2004/2005.

Government Response

Brief interventions generally range from five to 30 minutes and aim to reduce the prevalence of alcohol abuse intervening with risky drinkers before they progress to alcohol dependence.

Interventions include assessment and referral, crisis intervention, counselling, including motivational interviewing, problem solving skills, drink and drug refusal skills, relapse prevention, other skills based training, brief supportive therapy and aftercare.

The interventions can be provided by a range of professionals, including specialist drug and alcohol workers, medical practitioners, psychologists, social workers and community nurses.

NSW Health will continue to support research that clarifies which are the most effective brief interventions and in which circumstances they are most effective for risky drinkers. In particular, outcomes for women and those with concomitant physical and psychological problems will be researched.

NSW Health has trialled the provision of a correspondence based Controlled Drinking by Correspondence Program for non-dependent drinkers operated by Western Sydney Area Health Services. The program is a state-wide program and will be extended to ensure increased access to treatment for working people and people from rural areas.

A Drug and Alcohol General Practitioner Liaison Officer (GPLO) has been funded in each of the 17 Area Health Services (AHS) since the Drug Summit of 1999 and provides assessments of the needs of General Practitioners (GPs) in this area, and develops links between AHS, Divisions of General Practitioners and GPs to meet these needs. An evaluation report on the project is due later in 2004 and will be used to assess and determine the future funding and direction of the project.

See also Recommendations 3.3, 3.4, 3.5 and 3.17.

Government Response

The NSW Drug Treatment Services Plan 2000-2005 provides a set of principles to support equitable access to specialist drug services. In particular, the plan identifies the importance of responding to the needs of young people, people with comorbid health problems, Aboriginal and Torres Straight Islander communities, offenders, people from culturally and linguistically diverse backgrounds, people in rural and isolated areas; and substance using parents and their children.

The Centre for Drug and Alcohol (NSW Health) also works with Area Health Service (AHS) Drug and Alcohol Services to develop and monitor AHS drug and alcohol profiles. These profiles describe the demographics, drug and alcohol issues and services in the region.

Future key initiatives include:

§          NSW Health will prepare a NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 to incorporate alcohol into its model of care and acknowledging the differing social and demographic pressures surrounding equitable access to alcohol treatment and support. Key stakeholders will be consulted in preparing the new plan.
§          This plan will incorporate directions for alcohol clinical services. NSW Health will work with Area Health Service Drug and Alcohol Services, medical experts, and the non-government sector in the development of this plan which will cover all areas of disease prevention, dependence and treatment.
§          NSW Health will undertake a costing study of funded drug and alcohol treatment services, which will be completed in 2004 and will assist in finalising the work of the new plan.
§          All Area Health Services will produce new area Drug and Alcohol Treatment Services Plans 2006-2015 by 2006/2007.

It is recognised that not every locality can have every treatment service type. Improved collaborative partnerships between services sectors across geographical boundaries will assist facilitate access to specialist drug treatment services.

Government Response

Case management and interagency guidelines: area implementation

Drug and Alcohol Case Management Guidelines and a Policy Framework are currently being developed by NSW Health to provide direction to professionals involved in delivering case management to patients engaged in drug treatment. They will include guidelines on interagency referrals, coordinated management and follow-up support for people presenting with drug and alcohol addictions. NSW Health will request Area Health Services to report on progress and implementation (Rec. 3.10).

Area Health Services will be required to provide the Centre for Drug and Alcohol with an Implementation Plan (including key deliverables and timelines) in relation to health intra-service referrals, coordinated management and follow-up support.

An important initiative assisting interagency cooperation and better client case management and referrals will shortly be completed with the finalisation of the new Interagency Guidelines for the Early Intervention, Response and Management of Drug and Alcohol Misuse. These guidelines were a recommendation of the 1999 Drug Summit.

The Interagency Guidelines for the Early Intervention, Response and Management of Drug and Alcohol Misuse provide a framework to assist justice and human service agencies review and develop policies, procedures and practices and workforce development plans in relation to drug and alcohol interventions with their service users.

These new guidelines were developed with input from the Regional Coordination Management Group (RCMG) of the Illawarra/South East Region, together with the Premier’s Department Regional Coordinators and the Drugs and Community Action Strategy (DCAS) Project Manger for the Illawarra Region.

The Child Death Review Team has highlighted the link between parental substance dependence and child death and/or child abuse and neglect, and the guidelines will specifically address child at risk concerns due to harmful alcohol and drug use by a parent/carer.

The guidelines are expected to be released to health services, other agencies, and the NGO sector later this year.

Improving case management

Better inpatient/outpatient interface

Effective referral and linkage between inpatient and outpatient services are vital to access and continuity of care for clients engaged in alcohol treatment.

Area Health Services will develop formal Memorandums of Understanding (MOUs) with social support agencies to ensure clients can easily be referred to appropriate services. Area Health Services will review and evaluate the MOUs in 2007 and all participating agencies will be required to document the changes to systems and process that have occurred as a result of the MOU.

This will also be achieved through the use of Integrated Care Pathways (ICP) for patients requiring treatment for alcohol abuse by each Area Health Service (Rec. 4.2).

Specialist support for general ward staff

Hospitals have protocols for addressing alcohol related health problems. This is done primarily through contacting the relevant Area Health Service drug and alcohol provider who delivers clinical and support services in hospital wards. Through the development of the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015, NSW Health will assess how alcohol consultation and liaison services in hospitals can be improved.

Best Practice Guidelines: Screening for Alcohol Abuse will be developed and issued by NSW Health in 2005 to be used in clinical settings. These will be based on the standard screening measures such as the Alcohol Use Disorders Identification Test (AUDIT) (Rec. 4.2).

GPs support through integrated programs

See also Recommendations 3.3, 3.4, 3.5, 3.17 and 4.3.

Using enhanced primary care Medicare items

In 1999 the Commonwealth Government introduced a range of Medicare items intended to, amongst other things, improve care coordination between General Practitioners and health and other professionals providing care for people of any age with chronic conditions and complex needs.

A person with chronic alcohol dependence or complex needs that include a problem with alcohol is likely to be involved with a range of health and other human services. Enhanced Primary Care Items provide an opportunity and a financial incentive for the person's General Practitioner to be involved in planning, providing and coordinating their care alongside the other service providers.  

NSW Health, through the General Practice Liaison Officer program, will also promote the relevant Enhanced Primary Care Medicare Items to GPs to encourage their active involvement in case management as part of a multidisciplinary team.

New protocols for referral and Integrated Care Pathways, eligibility criteria, and joint working arrangements in each area

NSW Health will develop interagency service agreements and Memorandums of Understandings which will outline referral pathways and collaborative treatment arrangements. NSW Health will request that Area Health Services report on implementation in 2005 (Rec. 3.12.).

In 2005 the Centre for Drug and Alcohol, NSW Health, will also conduct an audit of interagency service agreements that exist between drug and alcohol health services and non-government organisations and other Government agencies that deal with welfare and psychosocial issues related to drug and alcohol dependency in 2005.

Chain of care and linking all levels of services throughout the system

NSW Health is developing state-wide Case Management Guidelines for drug and alcohol treatment based on the chain of care model which represents an effective system for establishing cooperation between all agencies and services. This recognises that when a person makes contact with a link in the chain, they are engaged with all other links, and their movement to another service is managed effectively.

The Case Management Guidelines are being developed under the auspice of the NSW Health Drug Program Council and will be finalised in 2005. Area Health Services will implement the Case Management Guidelines in accordance with local priorities and NSW Health will request a report on progress in 2005.

The NSW Health Drug Program Council comprises each Area Health Service Director of Drug and Alcohol Services, as well as a representative from the Network of Alcohol and Drug Agencies (NADA). The Council advises NSW Health on policy and service issues.

Government Response

A Quality Framework for Managing Drug Treatment Services is being developed by the Centre for Drug and Alcohol in NSW Health, which has established a Health Care Quality Unit. It will be extended to incorporate alcohol treatment. The framework will be finalised in 2005.

The framework is being developed by a Quality in Treatment (QIT) committee of the NSW Health Drug and Alcohol Council. This group comprises senior Government and non-government drug and alcohol clinicians.

The framework will be included in the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015 and will build on the commitments and action concerning the management of the quality of drug treatment services outlined in the 2000-2005 plan, including clinical governance, quality control, quality care indicators, accreditation for all service providers (Government, non-government and private) and outcomes.

The Government recognises the significant contribution made by the non-government sector and is committed to working in partnership with these services. Non-government organisations provide a range of invaluable services to the community and the Government is working with these organisations to ensure they are well resourced and able to deliver quality services. Infrastructure grants were allocated to non-government organisations to improve their capacity to meet accreditation standards by the Government in 2003.

See also Recommendation 3.11.

Government Response

Data collections

Alcohol and Other Drug Treatment Services National Minimum Data Set: NSW Health collects important data and publishes it through this national dataset. It is published through a national report prepared by the Australian Institute of Health and Welfare. However, alcohol involvement in trauma events is not comprehensively captured in these collections.

Inpatient Statistics Collection (ISC): Monitoring secondary and tertiary maladies attributable to alcohol in hospital settings is undertaken through this collection and is currently reported on in the NSW Health Chief Health Officer’s (CHO) Report.

The Australian Alcohol Indicators, 1990-2001 Patterns of alcohol use and related harms for Australian States and Territories: was commissioned by the Australian Department of Health and Ageing and developed by the National Drug Research Institute, Curtin University and Turning Point Alcohol and Drug Centre. It presents health, road safety, industry and survey data to describe trends in risky alcohol use and serious alcohol related harms for all Australian states and territories. It is guided by principles set out in the World Health Organisation’s International Guide for Monitoring Alcohol Consumption and Related Harm (WHO, 2000). The NSW Government continues to contribute data to the National Alcohol Indicators Project and participate in the dissemination of the Project’s findings, where appropriate.

New initiatives to enhance alcohol related data collection are underway or proposed including:

§          Development of new alcohol related questions for inclusion in the inpatient data set for all trauma cases by NSW Health. This will include cases where the patient is not necessarily alcohol affected but where other parties who have contributed to the event are alcohol affected.
§          Establishment by the NSW Health Centre for Drug and Alcohol of an Information and System Integration Committee (ISIS) to identify necessary data development, make recommendations for standardising data collections, develop performance indicators and facilitate reporting by NSW Health to inform effective health care service delivery. The committee includes representation from Area Health Services, Drug and Alcohol Clinicians, the Network of Alcohol and Drug Agencies, and NSW Health Information Management Division.
§          Requesting the NSW Ambulance Service to investigate coding all cases in which alcohol involvement is suspected (see also Rec. 5.18).
§          Improving access to the Mental Health data collection, known as Friendly Information Systems Community Health (FISCH), for identification of alcohol clients.
§          Development of an electronic reporting system for health data collections containing trends in alcohol dependence, disease and treatment.

Measuring outcomes

Measuring outcomes is a key element of improving the quality of treatment services. Client outcomes indicate effectiveness of services. To improve the health system’s capacity to measure client outcomes, NSW Health will undertake a number of actions including:

§          Developing a performance monitoring system for drugs called Drug Related Outcome Population Surveillance (DROPS). This system will be expanded to include alcohol key performance indicators.
§          Defining what treatment outcomes are practically expected and measurable for each treatment modality and publish these in an Alcohol Abuse Treatment Outcome Index. These will be determined in consultation with drug and alcohol experts, clinicians and workers, and will be published as part of the NSW Drug and Alcohol Treatment Services Development Plan 2006-2015.
§          Investigating the current performance measurement systems in the drug and alcohol and health system for capacity to measure the needs of alcohol service outcomes.
§          Assessing the appropriateness and possibility of the introduction of standard treatment outcome measure in alcohol treatment services.
§          Reviewing current performance measurement systems and investigating and developing appropriate, standardised treatment outcome measures in consultation with services providers and affected communities to inform future service planning.

§          Improving data quality on Indigenous status within Inpatient Statistics Collection, the Emergency Department Data Collection and the Alcohol and Other Drug Treatment Services National Minimum Data Set.
§          Ensuring the Brief Treatment Outcomes Measure (BTOM), which is NSW Health’s specific outcome measure for treatment of illicit drugs, is adapted for use with alcohol clients.

See also Recommendations 2.2 and 2.4.

Government Response

Local community action and local solutions are cornerstones of the Government’s approach to tackling the problem of illicit drugs and will be cornerstones of future action to tackle the problem of alcohol abuse.

The Government will continue to build on all existing community networks in tackling alcohol abuse and harm. Key initiatives are outlined in Recommendation 1.5 including the Community Drug and Alcohol Program.

In addition, NSW Health will:

§          undertake an audit of interagency service agreements between drug and alcohol health services and non-government organisations and government agencies that deal with welfare and psychosocial issues related to drug and alcohol dependency
§          encourage Health Promotion Officers and Community Health Services to design prevention and treatment programs that are responsive to local alcohol issues.

See Section 1: The Community, particularly Recommendation 1.5, and Section 5: Injury and Trauma, particularly Recommendation 5.5, and Section 8: Alcohol Related Crime and Anti-Social Behaviour – Part D.

Government Response

This recommendation will be addressed through the proposed NSW Drug and Alcohol Treatment Services Development Plan 2006-2015, Area Health Services Drug and Alcohol Treatment Services Plans and a new Quality Management Framework for Managing Drug and Alcohol Treatment Services.

NSW Health has engaged a health economist to undertake a costing study of each of the treatment streams provided by NSW Health to drug and alcohol clients and establish costing benchmarks.

Wherever practicable, services have been located in areas that have a community in need. For example, since the NSW Drug Summit, a number of key integrated services have been established throughout New South Wales including:

§          the Riverlands Drug and Alcohol Treatment Centre at Lismore
§          new detoxification units at Wyong and Nepean Hospitals
§          new youth residential rehabilitation services at Dubbo and Coffs Harbour
§          Bolwara House at Emu Plains Correctional Centre which prepares women prisoners with a history of drug and alcohol abuse, who have less than six months further imprisonment, for release into the community.

See also Recommendation 3.6.

Government Response

Services for specific groups

Specific groups which are covered by this recommendation include Aboriginal people, young people, culturally and linguistically diverse communities, women, and gay, lesbian, bisexual and transgender people.

Other population groups are often targeted with specific services, such as particular industries and work places.

The Government's Charter of Principles for a Culturally Diverse Society underlines the Government’s commitment to being responsive to diverse communities, and emphasises the importance of recognising cultural diversity in all aspects of managing public sector resources and programs.

Aboriginal people

The Government will finalise the Indigenous Drug and Alcohol Action Plan which has been under development following consultation with Aboriginal communities during 2002 and 2003. Development of the plan has involved extensive consultation with the Aboriginal Health and Medical Research Council of NSW, non-government organisations, Area Health Services and the Commonwealth Department of Health and Ageing.

The action plan will include initiatives to engage Aboriginal community leaders and Elders; promote locally based and locally determined approaches addressing drug and alcohol abuse; provide peer support programs for Aboriginal communities; link local initiatives on intervention, prevention and treatment to employment, transport, housing, recreational activities, cultural programs, and family initiatives; and link drug and alcohol programs to established community networks and infrastructure.

The action plan will build on the direction set out in the National Drug Strategy – Aboriginal and Torres Strait Islander Peoples Complementary Action Plan 2003-2006.

See Recommendations 3.8, 3.18, 3.19, 3.20, 6.19 and 6.20.

Young people

NSW Health will continue to fund a range of services that employ youth staff who can address alcohol related issues including Youth Solutions (Macarthur), Ted Noffs Foundation (Randwick), Fairfield Liverpool Youth Health Team and the Oasis Youth Service (Kings Cross).

NSW Health, in partnership with the Commonwealth Government, funds nine specialist youth health services that provide integrated health services to young people including advice and interventions in relation to alcohol use and related health harms, including:

§          High Street Youth Health Service (Harris Park)
§          Cellblock Youth Health Service (Camperdown)
§          Murlappi Youth Health Program (Chippendale)
§          Crossroads Shoalhaven Youth Health Service (Nowra)
§          Coffs Harbour Outreach Youth Health Service.

One Stop Shop Service Delivery Models have been piloted in the Hunter, Greater Murray and New England Area Health Services as a result of Drug Summit Phase I to provide for the health needs of young people in rural areas.

Phase II of the One Stop Prevention Trials includes an additional pilot program in the Southern Area under the banner of the Snowfields Injury Prevention Service (SIPS). This service aims to reduce the harm associated with drug and alcohol misuse by young people during the snow season.

These pilots aim to improve the health and wellbeing of disadvantaged and at-risk young people from rural areas by encouraging them to access relevant youth, specialist health and welfare services as well as enhancing their participation in local communities.

A new youth detoxification service attached to the inpatient unit at Wentworth Area Health Service will be progressed in 2004. This unit will be monitored and evaluated over the next four years and consideration will be given to expanding this type of specialised treatment service to other areas of need in New South Wales.

See Recommendations 3.9 and 3.21.

Culturally and linguistically diverse communities

A research project commenced in January of 2004 through funding from the Alcohol Education and Rehabilitation Foundation that investigates the patterns of alcohol consumption in six non-English speaking background communities in New South Wales. This will provide an evidence base to develop strategies with relevant community groups to reduce alcohol abuse. The research will identify change and trends in alcohol and substance consumption from the 1992 to 1997 prevalence studies and determine the most effective targeted health promotion approach.

NSW Health will identify and develop best practice guidelines for culturally appropriate and effective residential rehabilitation approaches for specific population groups. These will be developed in partnership with the Drug and Alcohol Multicultural Education Centre (DAMEC).

Supporting culturally appropriate workforce development approaches increases access to services and improved outcomes for clients. The NSW Government will continue to support such approaches, including the NSW TAFE qualifications which include components that address cultural diversity issues.

See Recommendations 7.11 and 7.12.

Women

Studies that have examined the characteristics of women with alcohol and drug problems suggest that because of differences in metabolism, where men and women drink at the same rate, women are at higher risk for liver disease, brain damage, heart disease, violent victimisation, and traffic fatalities.

There also appears to be gender differences in treatment outcome, with women having slightly better results than men in the first twelve months after treatment, and men having slightly better outcomes in follow-ups longer than twelve months.

Evidence based assessment instruments such as the TWEAK can be used for screening women. TWEAK is a five-item scale developed originally to screen for risk drinking during pregnancy. It is an acronym for: T-Tolerance, W-Worried, E-Eye-openers, A-Amnesia (blackouts), and K (C)-Cut Down. TWEAK is one of the few alcohol screening tests that has been developed and validated among women.

The Best Practice Guidelines: Screening for Alcohol Abuse referred to earlier are likely to be based on standard screening measures such as the Alcohol Use Disorders Identification Test (AUDIT) and TWEAK.

See Recommendations 3.6, 3.19, 4.2 and 6.8.

Gay, lesbian, bisexual and transgender people

The Attorney General’s Department employs a Communities Policy Officer to work with community organisations to help reduce the level and impact of homophobic violence, to facilitate service improvement to gay, lesbian, bisexual or transgender people, and to improve access to the legal and justice systems by these communities. Two consultative forums are convened to ensure that the Department's work remains consistent with community views and priorities.

The Attorney General’s Department will ask its gay, lesbian, bisexual and transgender consultation forums to consider the relationship between alcohol abuse and incidents of hate related violence and domestic violence in same sex relationships and advise on appropriate action to address this issue.

In addition, the Attorney General’s Department has provided funding support for a Same Sex Domestic Violence Community Awareness Campaign being conducted by the AIDS Council of NSW (ACON).

NSW Health will work with ACON on the implementation of its Drug Strategy, which outlines how it will work to improve the health of gay and lesbian communities by reducing the harms associated with the use of licit and illicit drugs.

NSW Health will add value to the ACON Drug Strategy through the resourcing of a study to identify the scope and impact of party drugs on the gay, lesbian, bisexual and transgender communities. This study will involve consultations with gay, lesbian, bisexual and transgender people to capture their perceptions of the issues and ideas for potential solutions. This approach will be replicated with other key issues facing the gay, lesbian, bisexual or transgender communities.

See Recommendation 6.25.

Work place support

The Building Trades Group Drug and Alcohol Program has been funded by NSW Health since 1992. In 1996 a foundation was launched to establish a rehabilitation facility to provide treatment to clients of the drug and alcohol program – this is known as the Foundation House Residential Treatment Program.

In addition, the Building Trades Group Drug and Alcohol Committee received a grant from the Alcohol Education and Rehabilitation Foundation to enable apprentices to attend a short course on drug and alcohol safety in the workplace. The course was provided through TAFE colleges in Sydney, Newcastle and Wollongong to more than 1,500 apprentices.

See Section 7: Workforce Capacity.

Government Response

Some Area Health Services employ Aboriginal and Torres Strait Islander Hospital Liaison Officers who provide support and assistance to Aboriginal and Torres Strait Islander patients and families in hospitals and other health care facilities. They help people feel comfortable and safe during their treatment as well as help patients communicate with health care professionals, government agencies and other services while they are in hospital. Often this program is gender based, with one or more male and female Liaison Officers being employed to manage men’s and women’s business respectively.

The Central Coast Health Alcohol and Other Drugs Service employs an Aboriginal Drug and Alcohol Liaison Officer to facilitate and assist Aboriginal people into different drug and alcohol treatment services. The Officer also provides ongoing support during and after treatment and support and assistance to family members as required.

The Government will continue to fund 19 Aboriginal Community Controlled Health Services to provide drug and alcohol services.

See Section 3, Part D: 3.8, 3.18-3.20, 4.13 and 6.19.

Government Response

Approaches to this issue are outlined in the response to Recommendation 3.13.

NSW Health is undertaking a systems analysis of dual diagnosis cases to provide information on prevalence, incident management, clinical pathways and access problems and barriers to service provision. This study will inform the development of future service models developed to treat and support dual diagnosis clients.

The Government’s Advisory Committee on Best Practice Service Delivery for People with Mental Health and Substance Use Disorders, comprising 13 clinical and non-clinical experts, will submit its report to the Government shortly. The report’s recommendations focus on improving service delivery to key at-risk groups (young people, homeless people and Indigenous people) and it proposes that three models of integrated housing and support be trialled.

As a result of the report the Government is considering trialling three possible approaches to the issues of dual diagnosis and comorbidity and these are outlined in the response to Recommendation 3.13.

Mental health will also become a standing agenda item for the Human Services Committee of Cabinet. Issues will be advanced through the Human Services Chief Executive Officers (CEO) Forum, which will provide the leadership needed to ensure whole-of-government services are provided for people with comorbid substance abuse issues and mental illness.

In addition, the Government is reviewing the Mental Health Act 1990 and in doing so, will look at:

§          provision of medical services to involuntary patients under the Act
§          the role of local courts and the Mental Health Review Tribunal in reviewing admissions of people with mental illness to mental health facilities
§          efficient cross-border transfer provisions
§          the transport by police of people with mental illness to and between mental health facilities.

A Joint Guarantee of Service for People with Mental Health Problems and Disorders has also been developed in response to concerns about the need for enhanced coordination between health and housing services provided to people with mental health problems and disorders. It represents a commitment between NSW Health, Department of Housing, Department of Community Services, the Aboriginal Health and Medical Research Council, and the NSW Aboriginal Housing Office to improve outcomes by coordinating service provision and sustaining housing tenancies.

Government Response

Integrated interventions to target alcohol problems throughout life will be promoted. Abuse of alcohol is detrimental at any age, including the harm caused by alcohol abuse when a woman is pregnant or when a man and a woman are planning a pregnancy.

Key stages of the life-cycle where interventions should be programmed include:

Prevention: safer pregnancies

Drinking during pregnancy has been linked with a higher risk of miscarriage, stillbirth and premature deaths. It has been reported that four percent of women who were pregnant in the last twelve months, aged 14 years or over drank the same or more.

Babies affected by alcohol may experience slower growth before and after birth, defects to the face, heart and other organs and mental disabilities. Foetal Alcohol Syndrome (FAS) is also a potential effect of alcohol use during pregnancy. Features of FAS include growth retardation, characteristic facial features and central nervous system anomalies.

Research also suggests that alcohol abuse can also cause male reproductive damage and suggests that both women and men should be educated about the impact of alcohol consumption and pregnancy.

Women generally, and in particular those who are planning pregnancy, need to be aware of the risks of alcohol abuse. Adolescent boys and girls, and women of childbearing age, should be educated on the risks associated with alcohol use and foetal development. Antenatal and postnatal contact with health care professionals provides unique opportunities for intervention.

Current and future key initiatives include:

§          Training provided as part of Aboriginal and Torres Strait Islander Health Work courses includes alcohol prevention skills with a FAS topic.
§          The Coordination of Care of Substance Using Parents and their Infants program has been operating in Northern Sydney Area Health Service since 2001 and is aimed at enhancing the health outcomes for women that are pregnant (and their babies) and using substances, by greater collaboration between maternity, drug and alcohol services, early childhood services and the Department of Community Services. The outcomes of the project include early recognition of risk of harm issues and the development of child protection plans before discharge from hospital, early recognition and treatment of drug withdrawal in the infant and increased support to the mother in the form of early childhood home visiting follow-up.
§          The Chemical Use in Pregnancy Service (CUPS) project in the South Eastern Sydney Area Health Service promotes and facilitates early engagement in antenatal care for pregnant women with alcohol and drug issues through consultation and liaison with the Royal Hospital for Women (RHW), alcohol and drug treatment providers, General Practitioners (GP's) and community services. It is a service initiative funded from drug and alcohol treatment funding.
§          The Australian Paediatric Surveillance Unit, Royal Australasian College of Physicians, is currently undertaking a nation-wide surveillance on the incidence of FAS. The Government will use the data to inform the development of program and service delivery in areas of need.
§          The Government will provide education programs in schools and tertiary institutions on the effects of alcohol abuse on unborn children. Resources to support alcohol education, particularly in the pre-primary and arly primary years, will include activities for students as well as materials to raise parents’ awareness on alcohol related issues such as Foetal Alcohol Syndrome and other ways alcohol consumption can affect their children.
§          The NSW Government, through the NSW Alcohol Communication Plan, will promote and publicise the Australian Alcohol Guidelines, including encouraging alcohol manufacturers to include information about responsible drinking on packaging and labels. The guidelines recommend that women who are pregnant or might become pregnant consider not drinking at all and should never become intoxicated. If pregnant women choose to drink, they should have less than seven standard drinks per week, and on any one day, no more than two standard drinks (spread over at least two hours).
§          The Ministerial Council on Drugs Strategy is also expected to ask the Australian National Council on Drugs and the Intergovernmental Committee on Drugs to monitor and report on overseas developments and international best practice in this area with a view to reducing the incidence of FAS.
§          The Western Australian Child Health Institute has received funding of some $5 million from the Rio Tinto Foundation, the Alcohol Education and Rehabilitation Foundation and some state based governments (WA, QLD, NT) for a range of activities to improve the health of Indigenous children, including the development of strategies to address Foetal Alcohol Syndrome. Any further work by the IGCD in this area should link into this work.

See Recommendations 3.19 and 6.21.

Prevention: families and children aged 0-8 years

Families First is a coordinated, whole-of-government initiative to help parents and carers give their children a good start in life. The program helps parents and carers connect with each other for support and to prevent problems instead of having to cope with more serious issues further down the track. Families First targets children between the ages of 0-8 years old (see www.familiesfirst.nsw.gov.au).

Families First services have been designed for parents who are expecting new babies and caring for young children. The Families First program provides a framework where early childhood nurses visit new mothers at their own homes and provide support and assistance.

NSW Health will implement the Families First Practice and Planning Guidelines for Families Who Need Extra Support. These guidelines outline outcomes to be achieved for children and families, and set out principles and approaches to be considered when delivering services for families requiring intensive support.

The Government is implementing the Aboriginal Child, Youth and Family Strategy, which enables efforts and resources to focus on improving outcomes for Aboriginal children, young people and their families and communities. The strategy builds on the existing early intervention and prevention planning and service development processes of the Families First initiative. It recognises the need to establish partnerships with Aboriginal communities to address a broad range of issues that impact on their lives.

The Department of Community Services has a growing focus on a prevention and early intervention framework to assist vulnerable children and families, including the Vulnerable Families Project. This target group for the project is first-time families of children aged 0-5 years, where there are a number of vulnerabilities, including parents who abuse alcohol. Its goal is to identify vulnerable children and families, who are at high risk of entering the child protection system. Amongst other elements the project will focus on case management and use strategies such as intensive home visiting by qualified professionals to support vulnerable families.

In addition, the project will promote access to specific services, including drug and alcohol services, to support families with particular needs. The Vulnerable Families Project will commence in 2003/2004 in Bankstown, Blacktown, Maitland and Tweed Heads and then roll-out progressively across the state over the next four years. Planning is already under way to identify sites for implementation in 2004/2005.

Specific strategies are being implemented to assist Aboriginal families, in crisis and facing risk factors such as alcohol abuse. For example, the Intensive Family Preservation Service (Aboriginal), run by the Department of Community Services, aims to help Aboriginal families in times of crisis, and where child protection concerns exist. Initially two new services will be established in Bourke and Wollongong, with other services being implemented in later years. Programs supporting effective parenting should provide a fundamental platform for long term prevention of alcohol related harm, amongst other factors.

The Department of Community Services will undertake further research on the best ways to support parents dealing with issues of alcohol abuse. This research will inform a range of initiatives that provide information to parents and engage the community.

See Recommendations 6.7 and 8.49.

Young people: 8-16 years old

The Commission for Children and Young People has also produced the Ask the children series to make childrens' views on different topics available so that they can be considered when developing messages and services. An additional information sheet on alcohol abuse and drinking will be developed in 2004 to add to the series. This will provide an insight into what children and young people know about alcohol, why they drink, how they obtain alcohol and how and where they access help when they need it. The information sheet will be available on the Commission’s website.

The Department of Education and Training will investigate establishing an Aboriginal school and community alcohol project that coordinates a range of broad and targeted strategies developed within an Aboriginal cultural framework. This would involve the development of education resources that can be used by teachers working with Aboriginal children and their parents. The project would be overseen by a Reference Group.

If feasible, the project would initially be piloted in a small number of communities possibly including a metropolitan community, a community in Western New South Wales and a community in the Broken Hill area.

See Recommendations 1.10, 1.11 and 6.5.

Older people

Most people consume less alcohol as they grow older. However, some continue to drink and others take up drinking later in life, often after retirement or loss of their spouse.

The alcohol problems of older people are recognised less reliably and are more likely to adversely affect health. Cognitive function is more likely to be impaired. Interactions with prescription drugs are a particular hazard. Older people can benefit from treatment, provided this is offered to them in an appropriate context. Treatment services should be sensitive to the needs of the older patient/client.

The Pharmacy Guild of Australia is working with the Alcohol Education and Rehabilitation Foundation (AERF) to produce the Australian Alcohol Guidelines on pharmaceutical prescription slips nationwide, with particular messages for older people (Rec. 4.22).

Early intervention and information strategies will be developed for older people including the correspondence based Controlled Drinking by Correspondence Program.

Government Response

See Section 8 Part J – Managing intoxicated persons in public places.