Drug and alcohol assessment and treatment services

This service description provides information regarding drug and alcohol treatment services.

Introduction

Parents with problematic alcohol and drug use form a large proportion of the families with whom child protection work. Many of the adult clients involved with drug treatment services are parents. There are also many young people who are clients of child protection who also have drug and alcohol problems and require support and referral to services.

Target group

The alcohol and drug treatment service system comprises a range of organisations that provide voluntary alcohol and drug treatment, rehabilitation, education and prevention services for adults, young people and targeted services for Aboriginal Victorians. For further information go to: http://www.health.vic.gov.au/aod/

Some alcohol and drug services have special programs targeted at families. These include:

  • antenatal and postnatal support
  • family counselling and family therapy
  • specialist residential rehabilitation for families
  • alcohol and drug supported accommodation for women and children
  • domestic violence programs
  • parent support

Eligibility

Note: People with alcohol and drug problems are generally not compelled to accept treatment. Treatment facilities are not secure and alcohol and drug workers have no powers to detain a client who wants to leave.

Practice issues

Below is a brief outline and description of some of the services that may be of use in relation to families involved with child protection including:

  • residential and non-residential withdrawal services
  • residential and home-based rehabilitation services
  • supported accommodation services
  • counselling, consultancy and continuing care services
  • peer support programs
  • specialist buprenorphine and methadone services
  • forensic programs.

Residential services

Residential rehabilitation services provide a 24 hour staffed residential treatment program of an average of four months duration. Residential rehabilitation assists clients to develop skills that enable them to re-enter the community and links them to ongoing community-based services.

Withdrawal services

Withdrawal services include:

  • Home-based and outpatient withdrawal services where clients are managed without admission to a residential service.
  • Residential and rural withdrawal services where treatment is based on a short inpatient stay with follow up managed through community-based treatment services.

These services can also link clients to ongoing services.

Community-based treatment services

  • Counselling, consultancy and continuing care includes alcohol and drug assessment, information, advice, counselling, emotional or therapeutic psychological support, individual advocacy, referral, service coordination and ongoing case management.
  • Alcohol and drug supported accommodation services provide a drug-free supportive environment to help clients strengthen their recovery and reintegrate into community living.
  • Continuity of care/post-withdrawal linkage support ensures that clients discharged from a withdrawal program are linked to post-withdrawal support in a drug rehabilitation program to minimise their chance of relapse and to support their drug-free living.
  • Peer support offers mutual support and information through sharing personal experiences.
  • Koori services include program development activities undertaken by Koori community alcohol and drug workers. Services include health promotion, information, education, developing and maintaining community linkages, referrals, counselling interventions, providing advice to generalist services, liaising with relevant programs and advocating on behalf of young people.

Youth alcohol and drug services

  • Youth outreach workers engage young people in their own environment. Over 70 youth outreach workers maintain regular contact, provide support and ongoing case coordination and assist the person to build a range of support structures.
  • Youth Alcohol and Drug Day program (14 to 21 years) complements youth alcohol and drug treatment services by providing short term life skills, vocational, employment and recreation programs that provide a client pathway after treatment.
  • Youth residential rehabilitation provides a 24 hour staffed residential program with 15 beds for young people aged 15 to 20 years whose drug use causes significant harm and who may have other issues such as homelessness, serious health, psychiatric or psychological problems, legal and physical safety issues. The average length of stay in these services is four months.
  • Youth residential withdrawal provides short term intensive support, time out and drug withdrawal services to young people in a residential setting. These young people may also experience family breakdown, homelessness, serious health or psychiatric problems, psychological issues, serious behavioural issues including offending, and physical safety issues. In Victoria there are six four-bed facilities and one eight-bed facility.
  • Youth home-based withdrawal provides safe and effective drug withdrawal in the young person's home, with medical, pharmacotherapy and supportive care. The six youth home-based withdrawal services support the young person and their carer and family members, and develop links with service systems that have an impact on the young person's life.
  • Youth peer support provides mutual support and information to young people with problem alcohol and drug use. Support is provided by individuals with personal experience of alcohol and drug use.
  • Youth counselling, consultancy and continuing care provides services and supports for young people who have alcohol and drug use problems. Services include assessment, treatment and ongoing case management and may be provided in stand-alone alcohol and drug agencies, community health centres, hospital-based alcohol and drug services or other generalist health and welfare services.
  • Rural rehabilitation provides young adults (18 to 30 years) in rural Victoria with the opportunity to address their alcohol and drug problems and develop skills to re-enter the community. There is a strong focus on life skills development through establishing support links to accommodation, vocational, health and other community-based services.

Pharmacotherapy services

  • Pharmacotherapy Program (e.g. Buprenorphine and Methadone) is community-based with some medical practitioners (mostly community General Practitioners) approved to prescribe pharmacotherapies and approved pharmacies able to dispense the prescribed drugs. The pharmacotherapy development team visits doctors and pharmacies to encourage their participation and coordinates training and networking to support the program.
  • Dispensing Support is an initiative designed to assist clients on pharmacotherapies who are 18 years or under and Youth Justice clients to access treatment without having to pay their pharmacists a weekly fee.
  • The Pharmacotherapy Advocacy and Complaints Resolution Service provides an accessible complaints service to consumers and providers of opiate pharmacotherapy programs. The service offers advocacy, debriefing, referral, information and conciliation between consumers and providers. VIVAIDS is funded to run this service.

Women and family services

  • Royal Women's Hospital Women's Alcohol and Drug Service provides ante and postnatal support for women with alcohol and drug issues at any gestation and up to 48 hours postnatal. Following assessment the woman will either remain with Women's Alcohol and Drug Service for ongoing pregnancy care or be referred to an appropriate service. Other regional hospitals provide ante and postnatal support for women.
  • Women's alcohol and drug supported accommodation services provide short term support in a safe, drug-free environment to women who have undergone a drug withdrawal program or who need assistance to control their alcohol and drug use.
  • Family Drug Information and Support Telephone Help Line a 24 hour service provides access to drug and alcohol counselling, information and referral to services for anyone in the community.
  • Parent Support Programs are therapeutic programs, facilitated by alcohol and drug professionals for adults who are in a parenting role to young people under the age of 21 with problematic substance use.

Other services

  • Four specialist substance use and mental illness treatment teams are located with major metropolitan health services that are currently providing mental health and drug treatment services. These teams also support specialist dual diagnosis workers in rural health centres.
  • Youth Dual Diagnosis Strategy targets young people (16 to 25 years old) with a diagnosed mental illness and serious substance abuse issues.
  • Acquired Brain Injury (ABI) resource workers provide secondary consultation to health workers in management of clients with ABI and alcohol and other drugs (AOD) issues and provide direct AOD counselling to a small number of clients with this dual disability.
  • Court Referral Evaluation and Drug Intervention Treatment (CREDIT) refers offenders with alcohol or drug issues to appropriate drug treatment services as a condition of their bail.
  • Many regional community service organisations also provide drug and alcohol services for families and young people. It may be worthwhile resourcing other regional services.

Considerations for good practice

Several practice issues need to be considered when child protection practitioners refer and work with drug and alcohol services. Balancing factors such as focusing on the child's protection, harm minimisation, relapsing drug and alcohol use and zero tolerance, represent major practice challenges for all practitioners involved. Child protection practitioners should be clear about their operating principles, the treatment methodology and case management. Whilst sound collaboration and consultation are essential for good practice, the safety and best interests of the child are paramount and must be the most important considerations.

Working with other professionals

For child protection, the primary goals are the child's safety, development and wellbeing. Protecting children is the responsibility of the whole community and one specifically shared by those government and non-government agencies that provide any form of care for children and families or who come into contact with them in the course of their work.

In order to provide a more integrated service for children and families, child protection services need to invest energy and resources in strengthening and forming dynamic partnerships between professionals. A commitment to managing differences and resolving conflict that arise is key to building trust and relationships.

Relapsing drug and alcohol use

Central to the challenge of providing alcohol and other drug treatment to parents is that problematic alcohol and drug use is typically a chronic, relapsing condition. Recovery can be a long term process. Children, however, have a right to a safe and secure home in which to grow. Their physical and psychological development cannot be put on hold.

Harm minimisation

Fundamental to the approach of all funded drug treatment services is the principle of harm minimisation. Harm minimisation aims to achieve the best possible alcohol or drug use control outcomes suitable to the capacity and circumstances of the affected individual. From a drug and alcohol treatment perspective there may be occasions where the elimination of a client's drug or alcohol use is not attainable in the short term. Conversely, from a child protection perspective, no tolerance of drug or alcohol use may be crucial to the ongoing protection of a child in their parents' care, particularly for younger children and high risk infants.

Working with young people

Working with young people with alcohol or drug problems will require a different approach again. Research indicates substance abuse often masks trauma and emotional pain associated with the experience of abuse. Any treatment that addresses the substance abuse in isolation without addressing the issues of maltreatment, abuse and neglect is fraught with difficulty.

Critical decisions should be reached as far as possible through a participative process with drug and alcohol treatment services and any other services involved including placement and support, based on clear discussion regarding roles and responsibilities, acceptable behaviour and consequences and provision of safe decision making opportunities for the young person.

Self-reporting of drug use

Practitioners need to bear in mind that many drug treatment services rely on client self-reporting of drug use. This can inaccurately reflect the client's drug or alcohol use. Court ordered drug and alcohol screening can provide a more accurate report of a person's drug use. Careful consideration must be taken in determining the purpose and use of drug screening for clients and their families. Practitioners need to make sure that drug screening is complied with and that there is follow up when a drug screen result is positive.

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