2014 NADA Conference
The Grace Hotel, 77 York St. Sydney
12-13 May 2014

2014 NADA Conference: Diversity Driving Innovation
The 2014 NADA Conference: Diversity Driving Innovation in the non government drug and alcohol sector focused on innovative responses for people with problematic substance use and complex health and social needs.

The program included national and international experts in the field of drug and alcohol and strongly focused on sharing the practice wisdom of drug and alcohol service providers.

Download the Conference Handbook here to read all abstracts and biographies of key note speakers.

A Conference Report can be downloaded here.

Click on the short cuts below to view the abstracts and download presentations from the relevant streams.

Keynote presentations
Aboriginal social and emotional wellbeing
Cultural collaborations
Consumer engagement
Complex clients - diverse responses
Targeted interventions
Sector development
Women's drug & alcohol specialist services stream


A new approach to reducing drunk driving, domestic violence, and other alcohol-related problems: insights from South Dakota's 24/7 sobriety program
Professor Beau Kilmer
Co-director and Senior Policy Researcher, RAND Drug Policy Research Centre;
Professor, Pardee RAND Graduate School, California, USA

South Dakota has undertaken a radical policy experiment to reduce alcohol consumption among driving under the influence offenders and other individuals in the criminal justice system with alcohol problems. South Dakota's 24/7 Sobriety Program (hereafter, 24/7) requires that offenders submit to breathalyser tests twice per day or wear a continuous alcohol monitoring device. Those testing positive or missing a test face an immediate, but brief, jail term.

From 2005 through mid-2012, more than 21,000 24/7 Sobriety participants racked up almost 3.4 million days without a detected alcohol violation. Perhaps more impressive is that the proportion of breath tests ordered and passed exceeded 99%, and this includes failures and no-shows in the denominator. 24/7 Sobriety is getting some of the most problematic drinkers in the state to sharply cut back on their alcohol consumption. Even if most individuals stay in the program for less than six months, 24/7 is having a noticeable effect on public health and public safety in South Dakota.

RAND is conducting an independent evaluation of 24/7 and I will present findings from published and ongoing analyses. The presentation will also address the challenges and opportunities associated with adopting 24/7 in other jurisdictions.

Click here to download a factsheet on the program.

NADA acknowledges the support of the Alcohol, Tobacco and Other Drugs Council Tasmania in bringing Professor Beau Kilmer to Australia.

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Alcohol and Drugs: The Living Impact on Aboriginal and Torres Strait Islanders
Associate Professor Ted Wilkes AO
Chair, National Indigenous Drug and Alcohol Committee; Associate Professor, National Drug Research Institute, Curtin University, Western Australia

History hasn't been kind to Aboriginal and Torres Strait Islanders. The ongoing colonising of the Great Southern
Land is bringing benefits to many but the first peoples miss out. The use of alcohol and drugs in Australia is of concern to all Aboriginal and Torres Strait Islander people.

I propose that we use alcohol and drugs for two reasons; firstly to recreate and secondly as an escape mechanism.

The harmful effects of alcohol and drugs is well known. What of the ongoing living impact on the current and future generations? I aim to explore this impact in this presentation.

Click here to download the presentation.

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Implementing Integrated Treatment for Dual Disorders: Lessons from The Netherlands
Anneke Van Wamel
Research Associate, Program Reintegration, Trimos Institute - Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands.

The presentation will start with an update on Dutch drug policy, which has often been viewed with controversy in the past, and the advantages and drawbacks of this policy. The organisation of health care in The Netherlands will be briefly explained, and the position of mental health care and addiction services in this system. There is growing consensus in the Netherlands (and in many other countries) that integrated treatment of mental health care and addiction care may be the best way to treat patients with severe mental health problems and addiction. The Integrated Dual Disorder Treatment programme that has been established is founded on several key principles, including the provision of integrated mental health and substance abuse treatments, utilizing a multidisciplinary team as the agent of service provision, stage-wise interventions based on the patients readiness to change, assertive outreach to patients and their family members, comprehensive and time-unlimited services, and providers of optimism in the patients capacity to grow and change. However, it has mainly been mental health care institutions that have started to restructure their treatment to better meet the needs of dual disorder patients and to a much lesser extent the addiction care services. The implementation of integrated treatment has proven to be quite a challenge. The results and lessons learned will be shared and recommendations made for any future projects.

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Creating service provider and research partnerships : do we need them and can we make them routine?
Professor Anthony Shakeshaft, Deputy Director, National Drug and Alcohol Research Centre, University of NSW

Service providers are critical to the conduct of high quality, applied research that can effectively and efficiently improve client outcomes. This presentation explores how service providers, clients and researchers might form more effective partnerships to improve client outcomes and the quantity and quality of applied research outputs.

The scope for researchers to develop their research questions and priorities in partnership with service providers will be examined, along with strategies by which service providers might more effectively engage with researchers to develop more evidence based programs and evaluate the impact of their services.
Although there are many examples of where such partnerships have occurred, this presentation will explore whether we need a new framework to create more routine partnerships that simultaneously benefit service providers, researchers and clients.

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Keynote panel day one: Respect, Rights and Reflection: consumer involvement in treatment
Facilitator: Associate Professor Nicholas Lintzeris, Director, Drug and Alcohol Services, South East Sydney Local Health District, NSW Health

Panellist: Professor Carla Treloar, Deputy Director, Centre for Social Research in Health, University of NSW

Trust in health professionals and systems has been associated with a range of positive health outcomes and has been widely documented as essential to effective therapeutic encounters. However, trust is rarely present in health policies or service guidelines, but may be particularly relevant for services for people who experience marginalisation from mainstream society.

This presentation will examine findings related to trust in a range of settings such as needle and syringe programs, opiate substitution clinics offering hepatitis C treatment and from consumer participation demonstration projects in drug treatment services. These data show that clients of drug treatment services make strategic decisions about what information to provide in various settings, what services to approach or avoid and how a deep mistrust of other social systems can impact what happens in health care, including drug treatment. These data also show the facilitating nature that a trusting relationship can have on relationships between staff and clients in drug treatment services and on achieving clients' goals. These data suggest that trust is central in the processes of developing, maintaining, brokering and improving client-staff relationships that are central to effective operations of drug treatment services.

Understanding barriers to clients' trust of drug treatment services is important for understanding both the nature of the relationship between staff and clients, and the reactions of clients' to policies and procedures of the drug treatment clinic, including those designed to build trust.

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Panellist: Teresa Hinton, Researcher and Policy Officer, Social Action and Research Centre, AngliCare, Tasmania

For the past five years the Social Action and Research Centre at Anglicare Tasmania has been researching consumer engagement activities in Australia and internationally across the alcohol and drug treatment sector, mental health services and most recently child protection systems. The research has been used to develop an organisation-wide approach to consumer engagement in Anglicare Tasmania and to piloting a range of approaches. These include promoting consumer representation at an organisation wide level and involving consumers in staff recruitment and training, creating case files, the production of information resources and feedback mechanisms, peer mentoring and support and peer research among others. This work has led to a wealth of information and experience on approaches to consumer engagement and their implementation.

This presentation will aim to profile this work, look at the challenges involved in implementation and share the learnings that have arisen from it from the perspective of service providers and organisations. The audience will gain a practical knowledge of what is involved in making consumer engagement a reality and what this might mean for promoting consumer engagement in the alcohol and drug treatment sector in Australia.

Click here to download the presentation.

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Panellist: John Neville, Consumer Representative

My first experience of drug and alcohol treatment was a referral from my Probation and Parole Officer as part of my supervision. The motivation for attending alcohol and other drug treatment was I had had enough of the merry go round I was on. I wanted to get clean and sober, however I just did not know how. I did not enter treatment with any real expectations. I arrived and immediately felt the culture clash. For example, in custody you do not pass on information, whereas in treatment (residential rehabilitation), it is considered peer support and a part of treatment. The most important part of alcohol and other drug treatment for me was the work therapy. I gained valuable skills, and it gave me the opportunity to be busy, reflect on the program content of the day, and to give back to the community. I also got to form a working relationship with the pastures and livestock supervisor. Another important factor in treatment for me was having a worker I could trust, and who was good for their word. For me, getting clean was easy. However staying clean was the hard part. I think AOD workers need to give practical assistance in all domains of case management, especially in regard to affordable sustainable housing. In treatment, boundaries and the program rules need to be enforced. As in the community, there are laws and rules to ensure safety. I needed to be held accountable and responsible for my choices whilst supported to achieve my individual goals. Consumer participation in treatment is important and should involve options like feedback via confidential client surveys.

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Keynote Panel Day Two: The Future of the Drug and Alcohol Sector in Australia

The Future of the Drug and Alcohol Sector in Australia panel session, facilitated by Gino Vumbaca Executive Director of the Australian National Council on Drugs, provided the national research centres an opportunity to give their insights into our future. Professor Michael Farrell, Director of NDARC; Professor Steve Allsop, Director of the National Drug Research Institute; and Associate Professor Nicole Lee of the National Centre for Education and Training in Addiction then responded to questions from the audience. Topics covered included the positioning of drug and alcohol alongside mental health rather than the merging of the two, workforce development issues, funding uncertainty, and the need for review of Australia's drug policy

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Evaluation of five years social and emotional wellbeing data from an Indigenous residential alcohol and drug program
Martin Billingham1, Ivern Ardler1, Sarah Gaskin2 and Melissa Haswell2
1 The Oolong Aboriginal Corporation, Nowra, NSW
2 Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, UNSW, NSW

Oolong House is an Indigenous run, sixteen week, residential drug and alcohol rehabilitation service for men in Nowra, NSW. On average, 65 percent of our clients are Indigenous. For over five years, we have monitored the social and emotional wellbeing of clients, using a number of screening and assessment tools (e.g. PsyCheck, Drug Taking Confidence Questionnaire, Growth and Empowerment Measure), at intake, midway and on program completion. We present findings of how social and emotional wellbeing and empowerment change throughout a client's stay. Previous analysis has shown that the biggest changes in a client's ability to say no to their drug of choice and psychological distress occur within the first 8 weeks. In contrast, client emotional empowerment has previously been shown to grow significantly throughout their entire sixteen week journey. During the presentation the audience will gain a practical knowledge of how the results of the screening and assessment tools are integrated into each individual case management plan, counselling and holistic recovery journey.

Click here to download the presentation.

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The soft entry approach: Cross-sector partnerships
Michele Campbell and Karina Falconer, Lyndon Outreach Service, Orange, NSW

Rural and remote drug and alcohol workers face many challenges. Isolated clients and communities, Indigenous communities who have had many services come and go; few local staff with knowledge of drug and alcohol practice and lots of driving are the daily reality for community based outreach workers from The Lyndon Community.

The Lyndon Community is one of the largest non government drug and alcohol agencies in NSW and provides most of the available outreach and residential drug and alcohol services in western NSW. Multiple engagement strategies are used and evaluated to meet client and community needs in these diverse communities.

This presentation discusses the outcomes of delivering a soft entry approach via an existing community group (Apollo House) in an Aboriginal community in Dubbo. The Resilience Program is delivered from Apollo House where many social housing residents and Aboriginal families reside. The program is coordinated by Leader in Development, a small non government organisation passionate about strengthening lives and improving wellbeing for disadvantaged people and families. Feedback from a focus group comprised of a variety of community members who have accessed drug and alcohol support in this community will highlight the way day to day practice assesses the suitability and applied evidence of the soft entry approach.

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Culture, identity and a sense of self in recovery
Steve Taylor, Warren Williams and Douglas James, Weigelli Centre, Cowra, NSW

What are the factors that predicate success in recovery? The Weigelli Centre is based in rural NSW on a small farm near the town of Cowra. The Centre runs a twelve week program aimed at reducing the harm to the individual's social and emotional wellbeing and to increase their life chances. Alongside generic factors utilised by recovery based programs across the nation, Weigelli has some unique aspects. Weigelli utilises a holistic lifestyle approach that considers the importance of social determinants in ameliorating the pervasive effects of chronic substance use of individuals, families and their communities. This presentation focuses on the Weigelli program and how multiple factors such as culture, identity and community are considered in the successful recovery from addiction. In addition, discussion is included on the importance of aftercare in reducing harm from substance abuse to individuals, families and their communities.

For more information on the Weigelli Centres program visit www.weigellicentre.com.au

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Improving health outcomes for Aboriginal people with opioid dependency: key components of a substance misuse programme in an urban Aboriginal Medical Service
Dr Jenny James, Sandra Travis and Percy Gordon, Aboriginal Medical Service Western Sydney, Mt Druitt, NSW

There are very large disparities in health outcomes between Aboriginal Australians and other Australians. As well as having a higher burden of physical illness from conditions such as diabetes, vascular and renal disease, Indigenous people face a large burden of mental health distress. Both history and socio-economic health determinants have shaped current patterns of ill health, hence barriers preventing access to appropriate health care occur at multiple levels. AMSWS is an urban Aboriginal Medical Service that provides an opioid substitution treatment (OST) program in a culturally safe and holistic 'one-stop-shop' model of care. The mix of clinical consultation services available to people with opioid dependency include general practice review, GP prescribing of opioid substitution treatments, Hepatitis C clinic, support for social and emotional well-being, chronic disease management, drug and alcohol counselling, harm minimisation strategies, referral and linkage services, and case management. This presentation will describe the model of an OST programme within a community controlled primary health care setting. Examples of barriers that prevent access to appropriate health care will be described. Successful approaches to dismantling these barriers will be examined, along with ongoing challenges to provision of OST in this setting.

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Creating collaborative health promotion partnerships: Aboriginal and/or Torres Strait Islander health professionals sharing learning, developing resources, responding to real needs
Michelle Dickson and Geoffrey Angele, Indigenous Health, School of Public Health, The University of Sydney, NSW

Aboriginal and/or Torres Strait Islander students in the Graduate Diploma in Indigenous Health Promotion (GDIHP) (Sydney School of Public Health, The University of Sydney) developed short films to address health issues related to tobacco use. Community engaged learning and teaching was used to respond to the health needs of Aboriginal and/or Torres Strait Islander high school students who were concerned about high rates of smoking and early tobacco uptake amongst their peers. Learning partnerships were established between enrolled students, The University of Sydney's Social Inclusion Unit, GDIHP alumni, Aboriginal and/or Torres Strait Islander communities, local high schools and South Sydney Rabbitoh's "Souths Cares" program. Over a twelve month period the partners worked together, using health promotion knowledge and skills, social media and digital media to develop health based messages that responded to community identified health issues. Bringing health, education, media and sport sectors together provided an innovative opportunity for shared learning that resulted in the development of health promotion tools that all partners could utilise within their own networks. Triumphs, challenges and lessons learnt all form an important part of this project.

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SMART across cultures
Josette Freeman, Coordinator and Trainer, SMART Recovery Facilitator Training, SMART Recovery Australia, Haymarket, NSW

Indigenous Australians experience health, social and financial problems from drug and alcohol use at a disproportionate rate to other Australians. Indigenous Australians also experience a higher burden of disease attributable to mental health disorders with alcohol and illicit drugs mostly adding to this increasing problem.

Other marginalised groups, including gay, lesbian, bisexual, transgender and intersex (GLBTI) and Cultural and Linguistically Diverse communities are often neglected in their particular treatment needs. SMART Recovery Australia is a community based group program that uses cognitive behavioural tools and techniques. It teaches practical skills in how to manage their addictions and associated behaviours and focuses on the 'here and now'. The key components of the program are building and maintaining motivation, coping with urges, problem solving and having a lifestyle balance.

SMART Recovery Australia has adapted its program to the specific needs in the community including an Aboriginal SMART program, a GLBTI group, Teen/Youth SMART and the Be SMART program for Family and Carers. This presentation demonstrates how SMART Recovery has used the tools and techniques of the program to suit the diverse and complex needs of the community members.

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Mind + Matter Pilot - planning, delivering and evaluating an LGBTI peer support program
Nick Roberts1 and Marcus Pastorelli2
1 Consultant evaluator, Sydney, NSW
2 ACON, Surry Hills, NSW

There are few gay, lesbian, bisexual, transgender and intersex (LGBTI) specific services for people with co-existing mental health and alcohol and other drug issues. Research is scarce in the area of LGBTI people with these comorbidities. This presentation introduces the ACON Mind + Matter Program, a peer support program for LGBTI people, which incorporates diverse activities to address people's issues holistically rather than clinically.

The pilot was evaluated, and the key findings and learnings from this process will be presented. The logistics of conducting this type of evaluation with vulnerable participants is detailed, with tips for services wanting to evaluate their own programs. The various successes, including positive outcomes following the program is discussed, as well as challenges around recruitment and retention of participants. The results of this program and its evaluation for future culturally appropriate service delivery for LGBTI people is discussed. The presentation provides commentary on why and how all services can be LGBTI sensitive and appropriate.

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How 'CALD-client-centred' are AOD services in NSW? A snapshot of our sector from the From First Contact survey
Rachel Rowe1 and Angela Gallard2
1 Drug and Alcohol Multicultural Education Centre, Redfern, NSW
2 Charles Stuart University, Wagga Wagga, NSW

As yet, there has not been a major study of state wide AOD service standards and treatment practices towards clients from culturally diverse and non-English speaking backgrounds. In December 2012, DAMEC's online survey
From First Contact sought to provide an overview of current service approaches, cultural diversity among the workforce, internal procedures and the degree of implementation of state and federal guidelines. This pilot study involved 118 AOD workers, 36% reported for NGOs and 48% reported for NSW Government services.

NSW Government services and NGO services performed similarly across almost all practice indicators. The major difference identified was that in the Sydney metropolitan area, 85% of NSW Government services reported using interpreters on at least one occasion during the previous 6 months, compared with only 15% of NGOs.

Across the board, the findings suggest that a sizable proportion of AOD services in NSW do not have specific policies and procedures to support practitioners to work effectively with clients from CALD backgrounds; and that workforce training options are largely restricted to cultural competency training. Uptake and/or accessibility of other training appears to be very low.
By setting the survey findings against a backdrop of existing evidence, we discuss developments and stumbling blocks in the delivery of effective and accessible AOD treatment to clients from CALD backgrounds. The paper offers ways in which 'CALD-client-centred' approaches can be enhanced across our sector.

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Creating meaningful moments
Bahadur Bryson, Noleen Hoskins, Sam Johnson and Janelle Ghazi, Weave Youth and Community Services

When young people are given opportunities to create powerful and meaningful moments for themselves, and be witnessed in it, a significant long-lasting change occurs. Bush Circle is an experiential, bush-therapy project for young people aged 16-28 experiencing co-existing mental health and alcohol and other drug issues. This 6 week project begins with a 5 day bush camp. Weekly follow-up day trips and group work facilitate integration of insights and learning. Based on a model emphasising real-time experience, practice in emotional regulation, relationship, and connecting with something bigger (nature, culture, and community) young people made powerful changes in their AOD use. This model has extensive research behind it, and this unique project shows remarkable outcomes including improved mental health, identity, belonging, self-esteem and purpose, and decrease in risky behaviour and AOD use.

This project has been created for young people in the Redfern/Waterloo area, and shaped by past participants taking on leadership roles. Bush Circle connects inner city young people (80% of participants are Aboriginal) with the Aboriginal community in the Blue Mountains. This presentation identifies eight main themes, found to support powerful changes in young people. Together we explore experiential and creative ways to put these to practice.

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Using Facebook as a therapeutic tool for young people and their families
Kieran Palmer, Kirk Adderly and Tom Whittenbury, PALM Sydney Program, Ted Noffs Foundation, Randwick, NSW

Since 2010, the CALM (Continuing Adolescent Life Management) Sydney program has been using social media (Facebook) as a therapeutic tool to connect with young people who may require assistance and/or support. The advantage of using social media over other traditional forms of contact such as the telephone, is that young people can access support worldwide, its free for the consumer and the host organisation, conversations can be recorded if needed and it has shown to be less threatening for a young person to ask for support via online media compared to calling a service and/or access a service face-to-face. A further advantage of using social media is that events and information that may be shared with a larger audience, can also be published to service users via Facebook. CALM Sydney has found since using Facebook, it has overtaken the traditional forms of contacting service users and continues to grow each year. Through the success of CALM using social media with clients, the PALM (Program for Adolescent Life Management) program has developed a Facebook page for parents, guardians and other family members of service users who may require support, guidance and information.

Through this presentation the audience will gain a practical understanding of the application and benefits of using social media tools in the treatment, evaluation and follow up of young people suffering AOD and mental health concerns.

Click here to download the presentation.

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The Smoke Break: Implementation of a smoke-free policy at Triple Care Farm
Lara Williamson, Sarah Green and Nichole Sullivan, Triple Care Farm, Robertson, NSW

The direct causal link between tobacco smoke and health problems is well established and documented. Despite this overwhelming body of evidence, comprehensive action to redress tobacco use within the wider alcohol and other drugs (AOD) sector has been noticeably minimal. Organisational culture, staff attitudes, and unsubstantiated beliefs have proven to be the main contributories to the perpetuation of tobacco use within AOD rehabilitation. The non-government sector, has developed some innovative and shining examples of successful change management.

Tobacco control strategies, while making significant headway in the de-normalising of tobacco use within the general population, have not targeted people with substance use disorders, therefore the opportunity for the AOD sector to provide tobacco cessation intervention becomes even greater. It was in recognition of not only the negative health impacts for clients, staff and visitors, but also the structural disadvantages associated with ongoing tobacco use, that the Triple Care Farm program decided to proactively address tobacco cessation. These intervention strategies were trialled, with the ultimate result an organisational change in the form of a tobacco-free program policy.

This paper outlines the process for change, highlighting controversial staff attitudes and culture as well as the policy's impact on intervention strategies, health and organisational outcomes. Triple Care farm acknowledges the support of the Tobacco Control Unit of the NSW Cancer Council throughout this process.

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Consumer Participation in Action - Reflections from a two year pilot in NSW
Nicky Bath, NSW Users and AIDS Association (NUAA), Surry Hills, NSW

Consumer participation and representation is growing in importance across the drug and alcohol sector. However in NSW, the involvement of consumers engaged in drug treatment services remains low. In 2011 the NSW Users and AIDS Association, the state-wide drug user organisation, was funded by the NSW
Health to undertake a two year consumer participation pilot project that was evaluated by the Centre for Social Research in Health. NUAA entered in to a partnership with one rural and one metropolitan pharmacotherapy clinic, and one metropolitan based residential service. The aim of the partnership was to work together to implement activities that had been highlighted in the Australian Injecting and Illicit Drug Users League's Treatment Service Users Project Phase One and Phase Two. This presentation reviews the pilot project and shares lessons learned and important insights that will be helpful for services considering commencing or improving consumer participation activities.

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People Who Inject Drugs: Stigma, Discrimination and Improving Health Outcomes
Fiona Poeder, NSW Users and AIDS Association (NUAA), Surry Hills, NSW

Contemporary research suggests that stigma and the resultant discrimination toward people who inject drugs (PWID) negatively impacts on health and equitable service. Many PWID will defer or refuse treatment rather than subject themselves to real or perceived discriminatory treatment. Additionally, many practitioners are unaware that they are acting in a stigmatising manner. NUAA is utilising a unique training workshop originally developed by the Australian Injecting and Illicit Drug Users League (AIVL) to target health care professionals and students with the view to improving inequities in health service provision. This workshop defines and addresses stigma and discrimination and its manifestation in health care settings, while offering strategies that can be simply and realistically adapted by those working with PWID to challenge stigma and discrimination. These strategies include engagement of consumers in health management as well as addressing and challenging structural discrimination and the language used in our day-to-day lives.

Participants will gain a greater understanding of the impact of stigma and discrimination on PWID on number of levels: individual and public health, and social and community. Additionally, participants will gain an insight on the work NUAA is conducting to address stigma and discrimination and will take away strategies to address and challenge PWID-related stigma and discrimination as individuals, as health care professionals and as members of the broader community.

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The role of shame, guilt and self-forgiveness amongst individuals recovering from drug and alcohol problems
Gerard Byrne, The Salvation Army Recovery Services, Fyshwick, ACT

People with drug and/or alcohol problems often experience feelings of shame and guilt, which have been associated with poor recovery. Self-forgiveness has the potential to reduce these negative experiences. This current cross-sectional study tested theorised mediators (acceptance, conciliatory behaviour, empathy) of the relationships between shame and guilt with self-forgiveness.
A sample of 133 individuals receiving residential treatment for substance abuse completed self-report measures of shame, guilt, self-forgiveness and the mediators (acceptance, conciliatory behaviour, empathy). Consistent with previous research, guilt had a positive association with self-forgiveness while shame was negatively associated with self-forgiveness. Acceptance mediated the guilt and self-forgiveness relationship and had an indirect effect on the shame and self-forgiveness relationship. The significance of these findings in emphasising the importance of targeting acceptance when trying to reduce the effects of shame and guilt on self-forgiveness is discussed in this presentation.

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 Very brief intervention for cannabis use
Etty Matalon, National Cannabis Prevention and Information Centre, University of New South Wales, Randwick, NSW

This presentation is specifically designed for individuals who work within health, education and the justice sector and who engage opportunistically with cannabis users. Very Brief Interventions (VBI's) are aimed at engaging with clients who are indirectly experiencing problems as a result of their cannabis use and are at risk of developing long term cannabis dependence. VBIs typically include; a brief assessment/screen; feedback; psycho-education; self-help material; and assessment of the client's motivation for change.
The overall goal of the VBI is to motivate clients to evaluate their cannabis use with the view to making changes. This VBI is designed to be delivered opportunistically and is appropriate for clients who have not specifically sought help for their cannabis use but whose use is detected as being risky. Training covers a VBI designed for workers who engage with cannabis users which covers rapid and early engagement, brief assessment and feedback in the form of advice and/or information. This intervention is primarily targeted at pre-contemplators and/or ambivalent clients.
Participants will learn how to deliver a 15-30 minute long intervention and will be furnished with the materials necessary to implement the VBI.

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Targeted intensive outreach AOD work with people on release from prison
Mindy Sotiri, Paul Hardy and Community Restorative Centre, Chippendale, NSW

In October 2012, CRC commenced a targeted outreach alcohol and other drug (AOD) program for people on release from prison with complex needs. The transitional AOD program is focused on working with people who have long histories of criminal justice system involvement, long histories of problematic AOD use (related to their offending), histories of chronic homelessness as well as cognitive impairment and/or mental illness. The program is specifically targeted to those individuals who for multiple reasons have had difficulty accessing residential rehabilitation in the community.

This paper overviews:
• Key features of the project (intensive outreach support and counselling for between 3 and 12 months, a flexible and holistic approach to service delivery, and the use of a housing first wrap around support model for populations with multiple and complex needs)
• Primary issues for the clients of the project including barriers to mainstream service provision
• Successes of the project (marked reduction in problematic drug use and associated risk behaviours, and very low rates of recidivism amongst program participants)
• Key challenges for the project (data collection in outreach settings, developing an evidence base for 'what works', working with populations with multiple needs in a siloed service delivery context).

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Involuntary Drug and Alcohol Treatment Unit (IDAT) - What 's it all about?
Lynette Bullen, IDAT, Western NSW Local Health District, NSW

The repeal of the Inebriates Act 1912 in February 2013 saw the formal introduction of the Involuntary Drug and Alcohol Treatment Act 2007 legislating a period of detention of up to 72 days for those person's at significant risk of harm to self or others due to their severe substance dependence and associated behaviours for the purpose of 'assessment and treatment'. The Involuntary Drug and Alcohol Treatment (IDAT) Program provides the practical application of the Act with two facilities in NSW totalling 12 beds. Both IDAT Units provide short term care to involuntary/pre-contemplative inpatients and also offer medium-term (<6months) aftercare services to discharged patients seeking ongoing support. The Unit at Bloomfield Hospital in Orange NSW will be the focus of this presentation as it is the larger of the two Units and has a dedicated ward and staff set specifically for IDAT patients.

Since opening in September 2012 the Bloomfield IDAT Unit has admitted over 60 patients with more than 90% of patients electing to engage in aftercare support on an entirely voluntary basis. Of all admissions to date over 40% of patients do not continue harmful or hazardous levels of drinking 6 months post-discharge. These early findings on IDAT outcomes raise two important questions which are discussed within this presentation:
1. What is it about IDAT that sees so many involuntary patients willing to engage in voluntary treatment following a generally brief admission of only 28 days?
2. What is it about IDAT that enables great outcomes from pre-contemplative clients without relying on Motivational Interviewing or CBT based interventions?

This presentation provides a brief overview of the legislative changes informing the Drug and Alcohol Treatment Act 2007 and focuses on the offerings and limitations of the IDAT Unit for patients, families and community partners before exploring the outcomes achieved with a traditionally challenging client group.

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It's fast, it's quick, it stops me being sick - the challenge of changing injecting routines
Sarah Hiley, Maureen Steel, Nick Van Breda and Ian Flaherty, Sydney Medically Supervised Injecting Centre (MSIC), Kings Cross, NSW

MSIC is a safer injecting facility and harm minimisation service in Kings Cross, NSW. The most commonly injected drug at MSIC is OxyContin in tablet form, which carries further health risks compared to injecting powders. These risks can be minimised by not heating the solution (cold wash) and using wheel filters. In 2013, 33 qualitative interviews with clients of MSIC who inject OxyContin tablets examined acquisition of knowledge of injecting tablets and barriers to changing to a less harmful preparation process. The main barrier was a lack of confidence or trust in the new equipment and uncertainty about the preparation processes. Participants were asked what would make them trial the less harmful preparation process. Responses included being taught the process safely with real OxyContin tablets, with no risks attached and experiencing the after effects of the preparation. A tablet filtration strategy was developed. The top most frequent MSIC injectors of tablets were targeted for the strategy. They were offered a $40 voucher for sitting with a researcher and following instruction on how to prepare their OxyContin tablet for injection using the cold wash method and a wheel filter. A pre and post questionnaire ascertained how effective the strategy had been and whether their opinion of the cold wash technique had changed.

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Identifying and responding to need: managing multiple complex individuals on Opioid Substitution Treatment in residential care and beyond
Carolyn Stubley, WHOS Opioid Treatment Program, Rozelle, NSW

Clients on opioid substitution treatment (OST) often have complex needs; traditional support networks and treatment options are not always an easy fit for these individuals. Offering choice is integral to a client's journey of recovery.

Identifying the treatment needs of the OST client, both within a residential service and in the community, culminates from WHOS 14 years of experience working with OST clients, in Therapeutic Community residential programs, MTAR (Methadone to Abstinence Residential) and RTOD (Residential Treatment of Opioid Dependence) stabilisation service.

New approaches are required for ongoing support to ensure better outcomes for the client group remaining on OST. Improving social connectedness, employment and training opportunities whilst in treatment is integral to support a return to the community for individuals on OST.

WHOS has broadened the scope of treatment options specific to OST clients to include dedicated aftercare and outreach workers, OST dispensing and a Day Program in Newcastle. Nursing staff have increased services for mental health, physical health and OTP initiatives. Quantitative and qualitative findings in the form of client stories, survey and client profile data outline the complexity of the OST clients and what the new initiatives hope to achieve. Further evaluation of WHOS OTP program initiatives will inform future directions and best practice.

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Victorian AOD sector reform: Back to the future
Sam Biondo, Victorian Alcohol and Drug Association (VAADA), Melbourne, VIC

The Victorian AOD sector is undergoing significant reform, with the new system due to begin in July 2014. This presentation outlines the reforms, highlights how the sector has engaged in the change process, discusses the emerging functions of partnerships/consortia and provides insight into the potential implications of this ambitious reform process for consumers, their significant others and broader communities.

The reforms have emanated from a 2011 Auditor General report which highlighted barriers to system access and service fragmentation as important issues negatively impacting the ability of consumers to navigate the service system effectively. Key features of the proposed reforms include a reduction in funded treatment types; a model of centralised intake and assessment; changes in geographic boundaries; development of an activity based funding model; outcomes performance monitoring; changes to the structure of the community opioid replacement therapy system; and adaptations for improved client management systems.

VAADA has taken a lead role in sector consultations to ensure that service provider perspectives have been fed into the process. However the reality of the tight fiscal environment has raised concerns as to how the reforms will be implemented to ensure that service capacity is enhanced.

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Building Capacity to meet the needs of clients with complex issues within a residential Therapeutic Community
Jo Lunn, WHOS, Rozelle, NSW
• Issues: The level of complexity of clients accessing residential AOD agencies is well documented. In 2008
WHOS (a residential AOD therapeutic community) through the Improved Services Initiative was funded to increase the capacity to work with clients with mental health issues. In 2012 WHOS was successful in extending this project for a further three years and in the process broadened the range of complexities targeted by the project to include cognitive impairment, homelessness, involvement in the criminal justice system, Indigenous and CALD status. This paper explores the process and outcomes of organisational change adopted by WHOS to become more responsive to the complexities of the client group that are accessing the organisation.

• Approach: A review of the regular externally generated audits utilising the Dual Diagnosis Capability in Addiction Treatment Index (DDCAT) and the three extensive internal training needs analyses conducted to date over this project. The role of both WHOS internal research and data collection is mentioned.

• Key findings: WHOS was able to transition from an Alcohol and other Drug Treatment Service Only to a Dual Diagnosis Capable treatment service as measured by the DDCAT.

• Discussion and conclusion: The targeted strategies used by WHOS to realise organisational change have had a demonstrated effect on the capacity of the service to cope with the complexity of the client group. The lessons learnt by the organisation from this process in relation to the use of the DDCAT (or a measurement tool), training needs analyses and the use of organisational change principles are applicable to similar organisations attempting to shift an organisational culture or increase the services capacity to work with clients with a range of complex needs. Discussion will focus on providing an overview of this process and encourage participants to apply relevant aspects to their workplace.

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Client Outcomes Management System (COMS): A summary of the results and practical applications for the sector.
Peter Kelly1, Suzie Hudson2, Frank P. Deane1, Amanda L. Baker3, and Carol A. Keane1.
1 University of Wollongong, Wollongong, NSW
2 Network of Alcohol and other Drugs Agencies, Sydney, NSW
3 University of Newcastle, Newcastle, NSW

COMS was developed by NADA to improve the way that routine outcome assessment data were collected and used within the non government drug and alcohol sector. The aim of the presentation is to summarise data collected between April 2012 and March 2013. A total of 37 services, across 28 organisations contributed individual participant data to COMS during this period. The large majority of these services provided residential treatment. During the study period, 3682 participants completed at least one COMS assessment. Alcohol was the most commonly reported primary substance of abuse (43%). Unsafe injecting drug use continues to be a concern for this population. During the first 30-days of treatment, there were statistically significant improvements on measures of symptom distress, substance dependence and quality of life. The COMS project has helped to increase the use of routine outcome assessment measures in the NGO sector. The major strength of the COMS project is that it provides meaningful outcome data that is based on information collected during 'actual' client care. The major challenge for the future development of COMS is improving the 'routine' use of the measures within individual services. Discussion will focus on how service providers could use this data set to conduct their own benchmarking activities.

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Client-based insights into alcohol and other drug treatment services: Unpacking recent changes to the National Minimum Data Set
Tom Baker and Amber Jefferson, Australian Institute of Health and Welfare, Canberra, ACT

Since they began in 2000, the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) collections have provided data on publicly funded alcohol and other drug treatment episodes. These data have been used to inform state, territory and Australian government policies, a range of research activities and treatment service provision. In 2012-13, a statistical linkage key was introduced into the AODTS NMDS. This change enables client-based data to be reported for the first time while continuing to ensure the privacy of individuals receiving treatment. This presentation provides information on the linkage key and its capabilities in the context of the AODTS NMDS collection. The presentation first focuses on the features of the linkage key, paying particular attention to how client privacy is protected.

Second, it highlights the range of client-based insights that will be possible in years to come, including estimations of the number of clients receiving treatment, their geographical remoteness and socioeconomic distribution; patterns of drug use and pathways through treatment; and longitudinal information on different client groups.

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NADA Women's Alcohol and Other Drug Services Development Program
Linda Jenner, Nicole Lee, Jacqui Cameron, Angela Harney, LeeJenn Health Consultants, Melbourne, VIC

With funding from the Australian Government Department of Health, NADA established the Women's Alcohol and Other Drug Services Development Program to build the capacity of specialist women's non government drug and alcohol services to meet the needs of women in NSW. NADA engaged the services of LeeJenn Health Consultants to conduct an analysis of the needs of members that provide drug and alcohol services to women (including pregnant women and women with children), the views and opinions of women consumers, and to develop practice guidelines for workers.

Findings from the project highlighted the increasing complexity of the needs of women entering drug and alcohol treatment, including high rates of concurrent psychological distress and past experiences of trauma. While specialist drug treatment services for women are available in metropolitan areas, waiting lists for places are common. This presentation describes results of the needs analysis and provides an overview of the practice guidelines under development.

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A strengths-based family oriented approach
Dr Latha Nithyanandam PhD, ADFNSW-Kathleen York House, Glebe, NSW

On recognising and responding to the vulnerability, victimisation, stereotyping and overall difference in the bio-psycho-socio-spiritual component of women with substance misuse issues, the importance of considering the family as a unit has come to the focus. While the family and their role in supporting the client during treatment and integrating her back into the community is being addressed, for long term recovery, a total understanding of family dynamics and empowerment to move beyond merely coping is paramount. Addiction affects not only the client but the whole family leading to a dysfunctional pattern of functioning where family members, including children, adopt survival behaviours and roles which could unwittingly sabotage the recovery of the client. Hence a comprehensive approach encompassing interventions not only for the client but also the family including the children is important where the members are equipped to change the patterns that work against family recovery and at the same time empowering them irrespective of the client's recovery. The focus of intervention on the family is twofold - focusing on their own growth and the changes they need to make in themselves as well as learning to support the client in her recovery. This is the model with which Kathleen York House operates.

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Jarrah House - The Way Forward in 2014
Charlotte Pritchard, Liz Fitzgerald and Gabby Munro, Jarrah House, Little Bay, NSW

Jarrah House is a 24 bed residential rehabilitation and detoxification facility for women with substance use issues and their children. Our facility provides a comprehensive treatment program that includes a four week Stabilise
Cognitive Behaviour Therapy program; a six week Skills Dialectical Behaviour Therapy program; art therapy; a Circle of Security parenting focussed program; weekly yoga sessions and individual case management.

Jarrah House is the only residential drug and alcohol service in Australia that allows women to undergo a medicated detoxification whilst maintaining their child/children in their care. The Jarrah House program is driven by the belief that women have the right to make desired changes in their lives in a safe and supportive environment. Referrals are accepted from all over NSW and women who identify as Aboriginal or Torres Strait Islander; pregnant; young; or high risk regarding their substance use are prioritised.

Jarrah House has a research partnership with the University of Technology Sydney which has facilitated the establishment of a research culture within the organisation. Our focus for 2014 is to establish a comprehensive assessment of the children accessing our service that includes appropriate screening tools as an early intervention initiative that will identify children who require intensive support and follow up. Current therapeutic programs and research plans for the future will be outlined.

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How practitioners can better meet the needs of midlife women with alcohol dependence: Results of the Researching with Women in Recovery (RWR) study
Janice Withnall1, Stuart Hill1 and Sharon Bourgeois2
1 University of Western Sydney, NSW ² University of Wollongong, NSW

This study, conducted between 2006 and 2013, explored how alcohol dependent midlife women (35-59 years) in Australia establish and maintain abstinent recovery. Three research outcomes are presented: Early identifiers for preventive recovery; women's Recovery Continuum; and respite care approaches to sustain long-term recovery with comorbid disorders. Participants comprised 246 midlife women in abstinent recovery (2-31 years abstinence) and 106 practitioners (with recognised qualifications in addiction care) working with AUDs clients.

The data were generated in four lines of inquiry, using six methods of collection, and subjected to NVivo text analysis as part of a planned mixed methods triangulation strategy. Over the six Action Cycles of the seven-year study six phases of the women's Recovery Continuum (early abstinence to long-term recovery) were identified and described: 1. Distressed recovery; 2. Enacting recovery;  3. Enabling recovery; 4. I'm in recovery; 5. Complex recovery; and 6. Valued recovery. Options for an agreed sustainable Chronic illness Recovery management plan integrating self-management and wellness monitoring are presented. These include practical healthcare strategies to enable midlife women to maintain self-care and dignity, emotional wellness, enriching relationships and decision-making for purposeful lifespan goals, supported by integrated healthcare and community care partnerships.

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Managing Challenging Behaviour Workshop
Wendy Machin and Rose Gilliver, Kirkton Road Centre, Kings Cross, NSW

This session aims to explore:
• What constitutes challenging behaviours and factors that may contribute to them
• Skills needed to de-escalate situations, and
• Some potential responses to challenging behaviours.

We recognise that participants bring a varying level of skill and experience to the workshop which we aim to utilise and build on to enhance our responses to and management of challenging behaviours. The session is interactive and aims to create a supportive environment for participants to explore what can be a potentially difficult aspect of work in this sector.

We may experience a range of challenging behaviours in our work with this client group. This workshop will provide opportunity to identify behaviours that we find challenging, understand the reasons for these behaviours, the personal and institutional factors that may escalate them and how we might minimise or address these factors. We consider the verbal and non-verbal skills needed to de-escalate, respond to and manage challenging behaviours. Participants will then be able to work through potential scenarios to identify which skills and strategies may be most effective in their workplace.

For more information on this workshop visit http://www.seslhd.health.nsw.gov.au/SHSEH/services/kirketonroad.asp.

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Rising above the high tide - benchmarking for drug and alcohol services Workshop
Julie Nyland, Director, Breaking New Ground and BNG NGO Services Online, Leichhardt, NSW

NADA launched a new resource - Benchmarking Guide for the NSW Non-Government Drug and Alcohol Sector at the conference, and this workshop is a chance to explore some of the questions and issues raised by benchmarking.

This session explores:
• What benchmarking is and is not
• Why an organisation might benchmark
• Using benchmarking to get more out of your data
• The benefits and risks of sharing performance information between services
• Where benchmarking fits in quality management, meeting standards and monitoring performance.

For more information on the Benchmarking Guide click here.

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Screening for cognitive impairment Workshop
Dr Jamie Berry, Director and Senior Clinical Neuropsychologist, Advanced Neuropsychological Treatment Services (ANTS), Strathfield South, NSW

The prevalence of cognitive impairment in a substance use disorder population is high, ranging from 30-80%.

There are many potential causes of cognitive impairment, including substance related brain injury, traumatic brain injury, developmental conditions (e.g. ADHD, learning disability), mental illness (e.g. schizophrenia) and dementia. Cognitive impairment is associated with poorer treatment outcomes in drug and alcohol rehabilitation programs, due to reduced: treatment adherence, treatment engagement, readiness to change self-efficacy, and insight (Copersino, et al., 2009).

The identification of cognitive impairment in individuals in drug and alcohol treatment allows for the application of tailored strategies to circumvent these poor outcomes. This workshop provides training in the identification of cognitive impairment using a brief standardised tool, the Montreal Cognitive Assessment (MoCA), and briefly discusses practical cognitive compensatory strategies that can be applied to optimise drug and alcohol treatment outcomes.

For more information contact visit http://neurotreatment.com.au/.

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