Comorbidity treatment service model evaluation

Workforce

Page last updated: August 2009

Roles and qualifications
Staff retention
Volunteering

Roles and qualifications

The survey included questions on staff roles and qualifications. The following staff roles were reported: AOD worker; counsellor; GP; MH nurse; nurse; psychiatrist; social worker; administration staff; manager; domestic staff; gardener; volunteer; and other professional. Not all respondents listed management roles, possibly because management was not one of the categories listed in the survey question (however, they could be listed under the category 'other'). It can therefore be assumed that the proportion of management staff is higher than reported.

As expected, medium and large services employ a greater range of staff compared to small services, although this is not true for all small services. The majority do not engage volunteers. However, one medium-sized combined AOD/MH service reported having more volunteers than employed staff.

Table 13 below lists the proportion of different staff roles per service. The last column provides the total number of EFT for each service.

Another survey question asked respondents to indicate the proportions of the following roles in their service: administrative; clinical; management; other support staff; and other roles. These proportions are presented in Figure 5 below. For the 16 services that provided the requested information it is also noted whether they are a small (s), medium (m) or large (l) service. Overall, large and medium-sized services appear to have a smaller proportion of management roles. However, this is not true for all small services, and two small services did not list management roles.

Respondents were also asked about the minimum required qualifications for the range of staff that are employed or engaged on a voluntary basis. These are listed below.

Minimum qualifications:

AOD Worker
  • Certificate IV in Alcohol and other Drugs Work (n=7)
  • Tertiary qualifications (n=2)
  • four core AOD competencies as outlined by the DHS22 Minimum Qualification Strategy (n=1)
  • Accreditation in community services certificate (n=1)
  • Life skills, reliability, empathy, non-user (n=1)
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  • Degree or diploma (n=4)
  • Social work or psychology degree (n=3)
  • Certificate in counselling or welfare studies (n=3)
  • Certificate IV in Alcohol and other Drugs Work (n=2)
GP
  • Registered GP
Mental health nurse
  • Registered Professional Nurse (RPN) (n=2)
  • Registration, Division 1 or Division 3 (n=2)
  • Tertiary (n=1)
  • Bachelor of Nursing and postgraduate qualification in mental health (n=1)
Psychologist
  • Clinical psychologist, registered (n=3)
  • Relevant/tertiary degrees (n=3)
  • Registered for Medicare (n=1)
Social worker
  • Bachelor Social Work (n=2)
  • Tertiary, degree (n=2)
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  • Drug awareness course, orientation training (n=1)
  • None (n=1)
  • Final year of relevant study (n=1)
Other
  • Youth worker–Certificate IV in Youth Work
  • Remote Community Workers – Certificate IV in Alcohol and other Drugs Work
  • Trainer – Cert IV Workplace Assessment & Training
  • Child care worker – Child Care Certificate
  • Managers – certificate and/or degree plus experience
  • AOD peer educator – Accreditation in community services certificate, cultural knowledge and life experience. On-the-job training provided
  • Clinical Director – high level AOD qualifications, extensive experience
  • Manager – Degree in social work or accreditation in community services certificate
  • Outreach – Certificate IV in AOD or Welfare.
In seven services, all staff have the required minimum qualifications. Overall, the proportion of staff who have completed the required qualifications was high (mean 89%, median 98%). The lowest proportion of staff with required minimum qualifications was 60%. Almost all staff who were lacking the required qualifications were in the process of completing these.

Twelve services reported that their staff have additional qualifications. In one service, 80% of staff have additional qualifications. The additional qualifications listed included tertiary qualifications in psychology, social work, counselling, youth work, law, and business administration; certificates and diplomas in AOD, mental health, motivational interviewing; and frontline management. Further, respondents reported training in a range of psychotherapies (e.g. narrative therapy, cognitive behavioural therapy), first aid, child protection, managing challenging behaviours, cultural awareness, and 'Nuts & Bolts of Psychiatry' (dual diagnosis training).

An Indigenous organisation reported that all staff have training in First Aid, ATSI Mental Health First Aid, Applied Suicide Intervention Skills (ASIST), and all non-clinical staff are trained in how to deal with aggressive clients and basic counselling skills (Accidental Counsellor). Another service noted that mental health staff 'have completed three months rotation in D&A, and are completing dual diagnosis competency training, and several MH clinicians are completing D&A training'. Similarly, a service with a focus on young people reported that youth workers undertake mental health first aid training and AOD staff complete Certificate IV in mental health. One service noted that staff do not have additional qualifications, 'only on the job training through networks'.
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The literature outlines that many AOD treatment models have risen from community recovery movements, embracing the notion of rehabilitation 'with a supportive, self-policing community of peers (such as Alcoholics Anonymous and Therapeutic Communities)' (Burnam & Watkins, 2006, p. 650). As a consequence, the AOD treatment workforce includes a high number of counselling staff with experiencebased rather than formal training. This contrasts with the MH sector which stems from more medicalised and professionalised roots where formal training is provided from within academic departments of psychiatry, psychology, social work, and MH nursing. It was said that, 'these distinctive origins have been associated with divergent treatment philosophies and ideologies' that have created distrust of MH treatment by AOD providers and vice versa (Burnam & Watkins, 2006, p. 650). However, there have been some moves, from within the MH sector, to incorporate aspects of 'social' oriented models into treatment.

The Australian Government has been working to break down barriers between the AOD and MH sectors, by increasing the knowledge of workers in the field of comorbidity about different approaches and understanding of comorbidity. This has been done through initiatives such as DoHA's funding of clinical supervision of psychologists and social worker placements in AOD non-government organisation (NGO) treatment settings, and initiatives to improve clinical expertise in comorbidity and increase networking and communication between GPs, mental health and AOD NGOs.

Overall, our survey found no substantial differences in the required minimum qualification for AOD workers and counsellors in AOD and combined services. This, and the overall high level of qualified staff, contrasts with findings of the literature review.

Table 13: Staff roles (%) and EFT (n)

Service size & type*AOD workerCounsellorGPMH nurseNursePsychiatristPscyhologistSocial workerAdmin.VolunteerManagementOther prof.Domestic, gardeningTotal EFT
s/AOD
50.0
50.0
14
s/AOD
55.2
3.4
24.1
3.4
3.4
10.3
29
s/AOD
100.0
6.5
s/comb
50.0
50.0
2
s/AOD
28.6
14.3
14.3
42.9
14
s/comb
14.2
1.9
37.7
4.7
3.8
9.4
9.4
8.5
10.4
21.2
s/AOD
33.3
33.3
22.2
11.1
9
s/AOD
33.6
15.6
19.5
7.8
19.5
3.9
25.6
s/comb
20.0
40.0
20.0
20.0
5
s/AOD
50.0
50.0
4
s/AOD
33.3
13.3
33.3
6.7
13.3
15
s/comb
41.7
25.0
33.3
2.4
m/comb
12.3
12.3
0.8
3.1
0.5
6.8
1.4
8.2
54.6
73.3
m/AOD
41.7
18.8
1.0
14.6
20.8
3.1
96
m/AOD
43.5
5.8
7.2
11.6
2.9
14.5
14.5
69
l/AOD
67.7
0.7
1.4
1.1
5.4
13.3
4.2
6.3
143.3
l/comb
0.7
0.5
82.7
3.5
4.5
3.3
3.5
1.2
423

* s = small, m = medium, l = large, comb = combined

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Figure 5: Staff roles and service size

Text equivalent below for Figure 5: Staff roles and service size

Text version of Figure 5

Service size & type*OtherOther supportManagementClinicalAdmin.
s
30%
5%
5%
50%
10%
s
10%
7%
20%
43%
10%
s
0%
0%
0%
80%
20%
s
100%
0%
0%
0%
0%
s
0%
0%
25%
65%
10%
s
5%
20%
20%
40%
15%
s
0%
0%
20%
60%
20%
s
0%
30%
10%
50%
10%
s
0%
0%
20%
60%
20%
s
10%
20%
10%
40%
20%
s
0%
50%
25%
0%
25%
m
0%
0%
20%
67%
13%
m
10%
0%
10%
70%
10%
m
0%
10%
5%
70%
15%
l
0%
8%
5%
75%
12%
l
0%
3%
6%
88%
3%

* s = small, m = medium, l = large, comb = combined

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Staff retention

High staff turnover is generally regarded as jeopardising the stability of treatment programs (Flynn & Brown, 2008). An exploratory study of the role of staffing stability in the implementation of an integrated comorbidity treatment program found that most agencies had staffing challenges, with four out of the 11 teams studied almost completely turned over within one year. This level of staff turnover saw a drop in the fidelity of those programs (Woltmann & Whitley, 2007).

Our survey found that the median average number of years that (employed) staff have worked for the service ranged between three years for clinical staff to five years for staff in managerial roles. The person with the longest record of working in the service was a clinician (15 years), followed by a manager (11 years). Five people had been working in the service for 10 years (three clinicians and two managers). See Table 14 below for further detail.

There were no substantial differences in regard to service size and type. Table 15 below provides further information about service type.

Overall, the surveyed services appear to have stable staffing, which, according to the literature, has a positive impact on the quality of treatment.

Table 14: Number of years that staff have worked at the service

Staff role Minimum no. of years (mean; median)Maximum no. of years (mean; median)Average no. of years (mean; median)
Administrative
1.8; 1.0
6.2; 7.0
3.9; 3.5
Clinical
2.3; 1.0
7.44; 7.5
4.1; 3.0
Management
2.3; 1.0
6.8; 7.0
4.5; 5.0
Other support staff
2.2; 1.5
6.2; 7.0
4.2; 4.0
Volunteers
1.2; 1.0
3.9; 3.0
1.8; 2.0

Table 15: Service type and average number of years that clinicians have worked at the service

Service type 1–2 years 3–5 years 6–15 years Total
AOD
5
4
1
10
Combined
2
1
1
4
Total
7
5
2
14
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Volunteering

Nine of the 17 services provided volunteering opportunities, although two of these had no volunteers at the time of the survey. The nature of the volunteering included participation in committees of management or program steering committees, support work with clients, driving clients to appointments, work in opportunity shops, and administrative duties. The contribution made by volunteers ranged from less than one to 400 hours per week. The latter comprised mostly work in opportunity shops.

Footnotes

22 Department of Human Services, Victorian Government

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