National Drug Strategy
National Drug Strategy

National Amphetamine-Type Stimulant Strategy Background Paper: Monograph Series No. 69

5.9 Workforce development

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One issue that was consistently raised during consultations was the need for education and training for workers, and improved integration of client care. It was largely agreed that staff need to be up-skilled in management protocols, including managing acute presentations and providing ongoing care. Turnover of staff due to burnout and safety concerns was raised, as was concerns about attitudes towards ATS users on the part of staff. It was suggested that some staff have negative attitudes to this client group and are consequently judgmental. Furthermore, clients may be seen by several services in different contexts with minimal communication between them. This also impacts on accessing services as consumers are reluctant to have to attend a variety of services. Suggestions included developing Memoranda of Understanding (MOUs), local liaison teams across services providing care from acute inpatient to outpatient, training specialist AOD mental health workers, establishing dual diagnosis units, and inhabiting a common working environment.

The need for training and collaboration was particularly noted in relation to the alcohol and drug sector and mental health. It was suggested that the knowledge of many working in the health and support services is deficient, making it difficult for them to identify the nature of presenting conditions, and whether it is a mental health problem or a drug induced condition. One respondent stated that there was a need for:

It was also suggested that links are weak because services use different practice guidelines and models of care.

A variety of guidelines to manage ATS problems have been developed. Among these are clinical treatment guidelines, developed by Turning Point specifically for methamphetamine dependence. These guidelines, which include a focus on management of acute presentations and interventions for methamphetamine use and dependence, are similarly based on a stepped care approach, defined as: The manual outlines a step-by-step approach to managing methamphetamine-related presentations, illustrated with use of a decision tree (see Figure 1, p. 16 of the manual). Guidelines are provided for managing acute toxicity, managing aggressive or agitated behaviour, managing acute psychotic symptoms, various assessments (e.g., dependence, co-morbid psychological problems), managing withdrawal, harm reduction approaches, brief interventions, and longer interventions based on CBT.

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However, as noted in their submission, Turning Point observed that guideline development is not sufficient: The potential role of psychologists was also discussed, particularly in combination with GP care. One suggestion was to adopt a case management approach between GPs and psychologists in order to provide both pharmacological and psychosocial support and assistance. However, as noted in the submission from the Australian Psychological Society (APS), there will be a need to accompany such approaches with workforce development: In addition to improving training within and coordination across different health services (e.g., alcohol and drug workers and mental health services), this was also needed across sectors, such as between health services and criminal justice. For example, the written submission from the WA Department of the Attorney General stated: The APS, and other submissions, particularly emphasized the need for more coordinated and collaborative responses among services. This included improving pathways between services, establishing effective referral systems and a unified case management approach. In their submission, Headspace not only emphasized the need to ensure a coordinated approach, but noted the need to facilitate multiple entry points into care: Top of Page

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