implementation plan 2009 - 2015 - matua raḵi...the addiction treatment sector has historically...

Implementation Plan

2009 - 2015

The Matua Raki Implementation Plan 2009 - 2015 was commissioned by the Ministry of Health

May 2009

This document is available on the website of Matua Raki: www.matuaraki.co.nz

PO Box 25056 Panama Street Wellington 6146

New Zealand

http://www.matuaraki.co.nz/

Foreword The addiction treatment sector has historically been relatively self-contained and self-reliant. It has been made up of a workforce with a vocational passion, commitment to people and to reducing harms from alcohol and other drug (AOD) and problem gambling. To some extent that is why the National Addiction Centre (NAC) as an acknowledged leader in the sector, with established relationships with sector stakeholders nationally as well as internationally, was offered in 2004 the opportunity to develop a workforce development programme and strategic plan for the addiction treatment sector.

Matua Raki has been the smallest of the four national workforce programmes with a focus on building the capacity and capability of the AOD treatment workforce. More recently this has also included consideration of the needs of the problem gambling treatment workforce.

Many of the challenges which Matua Raki will respond to in the next six years are national and systemic workforce issues. Other challenges involve developing our capacity to engage with addiction treatment services to strengthen their workforce infrastructure and organisational development as well as supporting the transfer of appropriate skills at an to a wider range of workforces.

Over the next six years we intend to continue to be a significant resource at all levels of workforce development – national, regional and local – to progress the vision of a highly skilled, well supported and effective workforce that contributes to the minimisation of addiction-related harm.

This Implementation Plan was developed at the request of the Ministry of Health to guide future Matua Raki workforce development activity and the timeframe for the plan is aligned to that of Te Tahuhu (MoH, 2005) and Te Hononga: Connecting for greater wellbeing (MHC, 2008).

Matua Raki proposes to consult on this document with the newly established Matua Raki Advisory group in the first instance, and then thereafter a range of other stakeholders including:

The National Committee for Addiction Treatment (NCAT)

The Drug and Alcohol Practitioners Association Aotearoa New Zealand (DAPAANZ)

Matua Raki Pouwhakahaere group,

Matua Raki Consumer leadership group and the

National Pacific Treatment Forum

The final document will be agreed to by the Ministry of Health.

Contents

Introduction ........................................................................................................................... 5

Section 1: Foundations for Implementation .......................................................................... 7

1.1 The Strategic Plan: Key Goals ............................................................................... 7

1.2 The 10 Year Vision of the 2005 Strategic Plan ...................................................... 7

Section 2: Addiction Workforce Development ...................................................................... 9

2.1 Introduction ............................................................................................................ 9

2.2 Strategic Implementation Goals for the Addiction Workforce 2009 - 2015 .............. 9

2.3 Consultation and Communication ....................................................................... 10

2.4 Facilitation of Local Workforce Development Planning ........................................ 11

2.5 Competency Development and Application ......................................................... 12

2.6 National Planning: Supporting Relevant National Developments ......................... 13

2.7 Regional Planning: Supporting Regional Workforce Development Coordination .. 14

2.8 Workforce Information ......................................................................................... 15

2.9 Training Pathways ............................................................................................... 16

2.10 Technological Development ................................................................................. 19

2.11 Evaluation and Service Modelling ........................................................................ 21

Section 3. Specific Populations Workforce Development .................................................... 22

3.1 Māori Workforce ................................................................................................. 22

3.3 Pacific Workforce ................................................................................................. 23

3.4 The Consumer & Recovery Workforces ............................................................... 26

3.5 Consumer Advisors/Advocates/Representatives ................................................. 28

3.6 Peer Support Workforce ...................................................................................... 30

3.7 The Youth-Focused Workforce ............................................................................ 32

3.8 Nursing Workforce ............................................................................................... 35

3.9 Opioid Treatment Workforce ................................................................................ 38

3.10 Problem Gambling Workforce .............................................................................. 39

Section 4: Workforce Initiatives to Support Integrated Practice ........................................... 41

4.1 Introduction .......................................................................................................... 41

4.2 Primary Mental Health Initiatives ......................................................................... 41

4.3 Co-Existing Addiction and Mental Health Issues .................................................. 42

4.4 Broadening Cultural Capability and Capacity ....................................................... 44

Appendix 1: Matua Raki 2008 Statement of Intent (excerpt)................................................ 46

Bibliography ........................................................................................................................ 48

Implementation Plan 2009 - 2015 of 49 April 2009

Introduction

Purpose This plan is intended to continue earlier work carried out by Matua Raki to enhance the capacity and capability of workforces that contribute to the minimisation of addiction-related harm. The 2005 Strategic Plan set broad objectives for addiction treatment workforce development and this implementation plan describes a framework from which possible areas of priority can be identified for future progression.

Scope The specialist addiction treatment workforces remain our core focus however this plan also recognises the interconnectedness of the workforces that respond to people with addiction-related issues specifically mental health services, primary and public health services, those working in criminal justice and youth-focussed services. This plan gives possible options to bring to reality the intention that ‘every door is the right door’ for those who need services. This plan also responds to the strategic vision for integrated service delivery described in Te Hononga 2015 (MHC, 2007).

As well as continuing to progress initiatives involving the interface between the Criminal Justice and the addiction treatment sector, Matua Raki must also continue to demonstrate leadership in developing a workforce capable of addressing coexisting addiction and mental health issues.

Strategic Drivers The following Ministry documents provide Government policy and priorities for mental health and addiction for the 10 years between 2005 and 2015, and an overall direction for achievement of the identified leading challenges:

Tauawhitia te Wero: Embracing the Challenge (MOH 2005),

Te Tāhuhu, The Second New Zealand Mental Health and Addiction Plan mental health and addiction plan (MOH 2005) and

Te Kokiri: The Mental Health and Addiction Action Plan (MOH 2006).

Of the ten leading challenges within Te Tāhuhu, three are most pertinent to this plan:

A leading challenge for workforce development ‘Workforce and Culture for Recovery’.

The aim of this challenge is to “Build a mental health and addiction workforce – and foster a culture amongst providers – that supports recovery, is person centred, culturally capable, and delivers an on-going commitment to assure and improve the quality of services for people.”

A leading challenge for Addiction. “Improve the availability and access to quality addiction services and strengthen the alignment between addiction services and services for people with mental illness….”

A leading challenge for Māori Mental Health. “Continue to broaden the range, quality and choice of mental health and addiction services for Māori, with immediate emphasis on:

- enabling Māori to present earlier to mental health and addiction services


- promoting choice by supporting the implementation of kaupapa Māori models of practice

- increasing Māori participation in the planning and delivery of mental health and addiction services for Māori.”

In He Korowai Oranga the principles of partnership, participation and protection articulates Māori expectations of their relationship with the Crown in the health and disability sector. The overall aim of He Korowai Oranga is whānau ora: Māori families supported to achieve their maximum health and wellbeing. Te Puawāiwhero, the second Māori mental health and addiction national strategic framework 2008-2015 emphasises the need to prioritise Māori, build on the gains and to be responsive to Māori. In terms of workforce development this means utilising Māori leadership in the addiction treatment sector and building kaupapa ake and Māori responsive services that integrate cultural and clinical competence in their day to day-to-day practice.

This implementation plan, in conjunction with Kia Puawai te Ararau, asserts improving health gains for Māori as a key priority for Matua Raki. Te Hononga 2015 (MHC 2007), provides a vision for the mental health and addiction workforce and also for the workforce across other sectors. This vision requires appropriate transfer of skills and a common focus on recovery, whānau ora, family well-being and social inclusion (p47).

To further addiction treatment workforce development, a continued whole of systems approach is necessary, with specific strategies that target recruitment, retention, leadership, core competencies, career pathways, organisational culture, evaluation and research, policy development that work alongside nationally and regionally coordinated opportunities for workforce development gains.

A whole of systems approach also requires Matua Raki to support a public health approach to issues such as substance misuse and gambling. This means that in our work we will support services in the context of their communities to promote physical environments that maximise health and minimise individual and community harm.

Matua Raki will provide leadership, support innovation and design and deliver the workforce programme to be consistent with priorities for action to progress the objectives of these Government policies and priorities.


Section 1: Foundations for Implementation

1.1 The Strategic Plan: Key Goals

The Matua Raki Strategic Plan identified that there was a lack of capacity and a lack of capability in the sector to address the demand for services. In terms of capability, the three key issues were a lack of training generally, a lack of evidence-based training specifically, and application of competencies.

The plan described the following key goals:

Increase the size of the dedicated addiction treatment workforce;

Widen the scope of practice to effectively encompass changes in patterns of substance use;

Combine the humanistic treatment approaches with evidence based best practice;

Improve responsiveness to Māori through Māori service and workforce development;

Improve responsiveness to youth;

Increase responsiveness to Pacific people;

Increase responsiveness to other populations with special considerations;

Develop of career pathways;

Develop the consumer workforce;

Improve competency of managers and leaders; and

Further development of specialist addiction treatment services.

1.2 The 10 Year Vision of the 2005 Strategic Plan

In 10 years’ time, a passionate and committed addiction treatment workforce with a sound infrastructure will competently provide accessible and effective service to reduce addiction-related harm and improve health. The progress to achieving this vision will probably require two or three stages and this is the journey of Matua Raki.

Specifically, the workforce of 2015 will:

Be made up of about 1,500 dedicated addiction treatment practitioners; one-third of whom will have addiction-related graduate qualifications, another third will have addiction-related postgraduate qualifications, while the remaining third will have training related to their level of clinical responsibility.

Assist, expertly, tängata whaiora/clients and their whänau/families with a range of addiction-related problems, as well as a range of coexisting disorders and problems

Use interventions that are people oriented, culturally sensitive, scientifically based, and responsive to ongoing consumer input and feedback


Work in a balanced set of cost-effective treatment services that facilitate positive outcomes

Respond to the needs and aspirations of Mäori tängata whaiora/clients and their whänau

Respond to the needs and aspirations of Pacific peoples

Be culturally responsive when helping Asian peoples and people of other ethnic groups as well as clients with needs based on age, gender, sexual orientation, or migration or refugee status

Be recognised and rewarded for their skill and have appropriate career pathways

Be supported by highly competent managers, clinical leaders and management systems

Be responsive to and supportive of colleagues working in the full range of health services, especially primary care and mental health, and in corrections.

The vision of the 2005 Strategic Plan maintains its relevance in 2009 and beyond. Achievement of a number of many of the Strategic plans aims and objectives are currently work in progress.

Refer to Appendix 1 for the 2008 Matua Raki mission, vision and values statement.


Section 2: Addiction Workforce Development

2.1 Introduction

The addiction treatment sector has been characterised by commitment and passion. The name Matua Raki reflects the sectors striving for excellence and the National Addiction Treatment Workforce Development Programme’s purpose of developing the capability of the addiction sector.

As a small sector, and one that mostly developed separately from general and mental health, the addiction treatment sector has historically taken responsibility for its own development. Future workforce development for the addiction treatment sector must be grounded in the sector and be one of partnership with services and agencies within the sector otherwise Matua Raki potentially risks becoming irrelevant to the delivery of quality services.

In this context, Matua Raki contributes uniquely to the development of the addiction treatment workforce development infrastructure by:

providing a cohesive approach across the breadth of workforce development activities;

informing national service development initiatives as to implications and opportunities for workforce development;

addressing systemic obstacles to workforce development at the regional and national levels;

supporting service workforce development across a breadth of service delivery models at the local level;

supporting sector developments in the context of the wider mental health and other sector developments;

supporting and maintaining a range of networks within the sector;

coordinating across agencies and areas of specialisation;

maintaining information, records and databases which inform sector workforce development;

being a conduit of information from and to the sector; and

promotion of the sector.

2.2 Strategic Implementation Goals for the Addiction Workforce 2009 - 2015

The following goals for workforce development in the Addiction Treatment Sector have been identified:

Goal One Local workforce planning, aligned to national and regional strategy.

Goal Two Access to dedicated consumer support and advisory resources.


Goal Three The workforce has contemporary and integrated core competency and training pathways.

Goal Four Experienced and specialist practitioners are supported to develop their expertise through targeted support for research, evaluation, supervision, and opportunities to mentor and be mentored.

Goal Five Access to national workforce development opportunities and resources.

Goal Six Systematic data collection to assist planning.

Goal Seven Addiction treatment services support the consumer’s journey of recovery, individual and family and whanau well-being, and social inclusion.

Goal Eight Enhanced competence of Māori practitioners and increased responsiveness of non-Māori service providers to Māori.

Goal Nine Pacific Addiction treatment workforce has greater determination of workforce development needs both for Pacific services and for responsiveness by non-Pacific service providers.

Goal Ten Enhance capability of those responding addiction related issues to address coexisting addiction and mental health conditions.

Goal Eleven Collaborative and corroborative working relationships with other workforce development groups

Goal Twelve Development of responsiveness to emergent populations such as migrant groups

2.3 Consultation and Communication

Matua Raki proposes to regularly communicate with the sector through:

participation in regional hui and local initiatives

participation in NCAT

participation in addiction leadership days

the Matua Raki web site

the Matua Raki Advisory Group

Matua Raki coordinates a number of networks:

National Training Providers’ Network

Pouwhakahaere Leadership Group

Consumer Leadership Group

These networks support information flows which inform Matua Raki activities and support dissemination and implementation of initiatives in workforce development.


Consultation and Communication Priorities

To inform and to be informed by the addiction treatment sector:

Specific Actions Key Stakeholders Timeframe Lead

2.3.1

Maintain a Matua Raki Advisory Group

TRM, NCAT

2009

Matua Raki

2.3.2

Maintain a Matua Raki presence at regional & local hui and utilise these to inform and be informed

Regional WFD Coordinators, Regional addiction stakeholder

groups

2009 ongoing

Matua Raki

2.4 Facilitation of Local Workforce Development Planning

A key function of a national workforce development programme is to provide support so service providers can develop relevant workforce development plans. It is at the local level that strategic imperatives for workforce development become most clear, and these can help inform regional and national strategy and initiatives.

Support from Funding and Planning Portfolio Managers is an essential part of the local workforce planning process. Along with General Managers and Clinical Directors (in DHBs), this ensures that local planning processes have the mandate to proceed and to support incorporation into District Annual Planning processes.

Data required to support local workforce planning includes data relating to their region on workforce capacity and capability and gaps, access to training and education, access data per population with a breakdown of age and ethnicity, workforce trends, best available data on evidence based practice and best practice for service delivery.

An essential ingredient for planning local workforce capacity and capability is the further development and application of national competencies for the sector. Local Workforce Planning processes use competency documents to support a service to identify their current capacity and capability in relation to national competencies.


Facilitated Local Workforce Infrastructure Priorities

To support addiction treatment service providers to develop their own organisational capacity to plan their workforce needs:


2.4.1

Investigate a model for local workforce development piloting

Addiction treatment sector, DHB Planners & Funders, General

Managers, NGO senior staff, Local & Regional

WFD Coordinators

2009

Matua Raki

2.4.2

Build participant evaluation into a local workforce development model

Addiction treatment sector, independent

evaluator

2011, 2013

Matua Raki

2.5 Competency Development and Application

The Ministry of Health has developed Let’s Get Real: Real Skills for people working in mental health and addiction. These are being finalised following implementation of tools via Te Pou.

In 2008 Matua Raki sub-contracted the Drug and Alcohol Practitioner’s Association Aotearoa New Zealand (DAPAANZ) to review the existing Practitioner Competencies (ALAC 2001) to incorporate competencies related to working with clients in the Criminal Justice system.

In 2008-09 Matua Raki will again contract DAPAANZ to complete a full review of the Practitioner Competencies and that these will contribute to the development of a nationally recognised set of competencies for problem gambling. There is also potential for inclusion of core competencies which relate to the tobacco cessation workforce.

The reviewed competencies need to have alignment with the Lets Get Real competencies and the explicit competency requirements that are being developed within the review of the Nationwide Service Framework.


Competency Development Priorities

To support the review and maintainence of sector competencies:


2.5.1

Consultation on scope and governance (kaitiaki) of the competencies, future planning and cycles of review established

MOH, ALAC, DAPAANZ, NCAT,

NPTF, Problem Gambling sector

2009 MOH & Matua Raki

2.5.2

Communication and dissemination plan for competency roll-out

MOH, ALAC, DAPAANZ, NCAT,

NPTF, Problem Gambling sector

2009-2010 Matua Raki &

DAPAANZ

2.5.3

Evaluation of application of sector competencies in practice

DAPAANZ, Addiction treatment sector, tertiary education

providers, independent evaluator

2010, 2013 Matua Raki

2.6 National Planning: Supporting Relevant National Developments

Matua Raki is involved in a number of national developments that inform and are informed by our workforce development perspective. These include:

the National Strategic Framework review,

the development of national guidelines for co-existing substance use and mental health disorders, and

a range of relevant developments in primary mental health and population-specific initiatives.

This work is essential to ensure that future developments are cognisant of workforce implications. Participation by Matua Raki requires that this implementation planning process include some flexibility to respond to new challenges and opportunities as they arise.

Due to the number of over-lapping areas of focus between the workforce development programmes (Te Rau Matatini, Te Pou and Le Va, Werry Centre) the Director will lead discussions with other programme leaders to identify areas for joint project planning within this Implementation Plan. A Communication Strategy will:

Identify key messages of relevance to more than one sector

Disseminate information to the relevant workforces in a timely way

Participate in each others’ sector days to receive feedback on joint activities


National Development Participation

To inform and to be informed by national and regional strategic development activities:


2.6.1

Participation in national developments

MOH, other Ministries, DHBNZ

2009

Matua Raki

2.6.2

Work with WFD Programme Leaders to identify areas for joint planning & communication

Director with other WFD Leaders

2009 MOH

2.7 Regional Planning: Supporting Regional Workforce Development Coordination

The regional infrastructure for mental health and addiction workforce development has seen the development of regionally led initiatives such as cross-training for co-existing disorders, competency implementation, and technological solutions for linking clinicians, as well as recruitment and retention initiatives.

The local workforce planning processes acknowledges the potential of the Regional Workforce Coordinator as a participant and resource person. In turn, regional workforce initiatives are informed by the gap analysis undertaken at the local level in this planning process. It also allows Matua Raki to add value to, and avoid duplication of, regional workforce initiatives responding to specific population needs such as those of Pacific workforce development, Asian workforce development and migrant and refugee workforce responsiveness.

Matua Raki undertakes to include and support the Regional Mental Health and Addiction Workforce Coordinators in sharing information and in planning and evaluation processes. Matua Raki will also work with DHB Planners and Funders in seeking their involvement in and support for regional addiction service planning and development.


Regional Development Priorities

To inform and to be informed by regional workforce development activities:


2.7.1

Work with Regional WFD Coordinators to share regional plans and initiatives with the addiction treatment sector

Regional WFD Coordinators

2009 ongoing

Matua Raki

2.7.2

Maintain a Matua Raki presence at regional hui and networks and utilise these to inform and be informed by

Regional WFD Coordinators,

Regional Addiction Stakeholder groups

2009 ongoing

Matua Raki

2.8 Workforce Information

Within the addiction workforce there are diverse modes of service delivery, ranging from DHB provider arm specialist services, community and residential services, kaupapa Māori services, Pacific agencies, and community organisations with multiple funding contracts.1

Much of what we know about the addiction treatment workforce has come from three sources of data:

MOH funded FTE and bed days data;

National Addiction Centre telephone surveys;

DAPAANZ membership numbers and demographics.

Each data source has its own limitations in being able to accurately quantify or describe the dedicated alcohol and other drug treatment workforce. All future stocktakes need to be coordinated with those being undertaken by the other workforce programmes and information shared.

Both workforce data sources are invaluable to form a baseline of data for measurement of growth, changes in demographics and changes in clinical practice of the addiction treatment workforce. These data sources also support quantifiable measurement of the impact of workforce development activities.

Workforce data is important information for providers of addiction treatment services. The Stocktakes provide regionalised and local data sets on the current workforce to support planners and funders and local services to analyse and plan for future

1 A description of the workforce responding to people with addiction issues is given in the 2005 Matua Raki

Strategic Plan Discussion Document (pages 34-41).


workforce development. Stocktake data is made available to the sector in both hard copy and electronically via the website.

Workforce Information Priorities

To collect and maintain systematic data collection on the addiction sector workforce:


2.8.1

Stocktake of the MOH contracted addiction treatment provider workforce and dissemination of findings.

Whole of sector Biannual Matua Raki

2.8.2

Commission updates on the Telephone Surveys.

These could include

Māori workforce

Pacific workforce

Experience in mental health settings

Nursing workforce

Youth focused workforce

NAC 2009 – 2010 Matua Raki

2.9 Training Pathways

There is already strong Matua Raki engagement with tertiary education providers through the National Tertiary Education Providers’ Network. This group is a stable network of teachers in undergraduate and graduate programmes from universities and technical institutions in New Zealand. Matua Raki supports the Network with providing a coordination resource to schedule and hold meetings, funding support to attend and, recently, by providing professional development opportunities for lecturing and tutoring staff. Matua Raki will continue to support the National Training Provider Network meetings as well as scheduling regular visiting of providers individually or regionally to communicate national developments and to identify opportunities for training developments which support workforce development. With the forecasted changes to post-entry clinical training and the integral role that tertiary education providers have in workforce development, Matua Raki will maintain and further develop the networking and engagement opportunities with training providers (Tertiary Education Institutions, Private Training Establishments, service trainers).


To support strong training and career pathways, Matua Raki will need to be leading and participating with a three pronged approach: entry level, graduate and post-graduate. At entry level, the review by Careerforce of the National Mental Health Support Worker Certificate has been identified as a key area of activity to integrate addiction content into this certificate (NZQA Levels 4-6). As a pan-sector programme, this integration will also support the goal of skills transfer to other health and caregiver workforces in disability and aged care.

A range of private training establishments (PTEs) also provide training, for example, the Pacific Centre for Motivation and Change, Blueprint, Moana House, Abacus. Where the training is NZQA accredited, as in the case of the Moana House Level 6 Diploma Te Taketake, Matua Raki will support these providers to promote their training and to look at access to training issues, for example, opportunities for distance learning methodologies and scholarship support.

There continues to be a gap in providing even generic training in addiction at undergraduate level in general health related qualifications.

At post-graduate level, Matua Raki is a member of the Skills Matter Board and will continue to advocate for sustainable post-graduate programme funding for the addiction sector and support for the tertiary education providers involved.

A scan of the current education and training environment shows various degrees of willingness to encompass addiction treatment curricula, and variable capacity and capability to focus on addiction treatment. A further activity is to work with providers of related training to progress generic skills sharing and responsiveness of other key sectors, notably primary health, mental health, social and community workers.

A further area for Matua Raki is to promote access to bi-cultural and cultural safety and competence training, leadership and management development opportunities, supervision training opportunities and incorporation of consumer and cultural perspectives into training and development opportunities. It is proposed that Matua Raki deliver Leadership Seminars for leaders in the addiction field both as stand-alone opportunities and in conjunction with other leadership programmes such as Blueprint.

A new role within Matua Raki of Training and Development Project Leader will work to maintain these relationships, support the development and promotion of training pathways, and support access to training and professional development opportunities, including support for new learning technologies.


Training and Development Priorities

To support the providers of training and education to the addiction treatment sector:


2.9.1

Maintain support for the National Tertiary Education Provider Network

National Education Provider Network

2 x annual Matua Raki

2.9.2

Broker communications between the national agencies so that providers inform and are informed by significant developments

National Education Provider Network, Tertiary Education Commission, Skills Matter, Careerforce

Ongoing Matua Raki

2.9.3

Support Careerforce to review the Mental Health Support Worker Certificate to incorporate addiction curricula

Careerforce, DAPAANZ

2009 Matua Raki &

DAPAANZ

2.9.4

Promote distance learning models including local tutoring and supervision, to providers without national reach

National Education Provider Network,

PTEs, Regional WFD Coordinators

2009 ongoing

Matua Raki

2.9.5

Support training & professional development with a bi-cultural and other cultural competence focus

Pouwhakahaere Roopu, NPTF, Asian

Health networks, National Education Provider Network, PTEs, DAPAANZ,


2009 ongoing

Matua Raki

2.9.6

Support the inclusion of consumers in training and professional development provision through supporting consumers to up-skill as trainers and participants in curriculum development

Consumer Network, National Education Provider Network, PTEs, DAPAANZ,


2009 ongoing

Matua Raki



2.9.7

Deliver seminars for leaders in the addiction field to support leadership collegiality and knowledge and skill development

Addiction sector 2010 Matua Raki

2.10 Technological Development

Central to our national role is the ability to collect and disseminate information to the sector. Whilst we now have basic website functionality, Matua Raki requires enhanced web functionality to establish a clearing house function across a broad range of purposes, topics, and sub-specialties.

Increasingly the sector has access to computers and the internet although this access should not be assumed to be available for the entire workforce. The way of the future, however, is to access web based technologies for everyday information, registration for events, discussion forums, and e-learning, searching for best practice literature and tools and providing discussion fora which support information sharing between providers and leaders in the addiction sector.

Matua Raki will also support the addiction sector’s knowledge of the activities of other workforce activity in the Mental Health and Addiction sector: other workforce focussed infrastructure (DHBs and NGOs); other workforce programmes; and the Regional Workforce Development Coordinators. Matua Raki would also like to be able to better identify for the sector links to other sites, both national and international.

Matua Raki will develop a fit-for-purpose website and by 2015 the website needs to support emerging technologies in electronic learning and communication. Matua Raki also has an opportunity to plan for the utilisation of new technologies in video conferencing and teleportation technology.

Technological Priorities

To develop the Matua Raki website as a high quality web clearing house:


2.10.1

Development of a fit-for-purpose website

Current linked programmes and bodies eg NAOTP

2009 ongoing Matua Raki

2.10.2

Development of e-learning capabilities

2010 ongoing

Matua Raki


2.11 Evaluation and Service Modelling

A number of evaluation service modelling opportunities have been identified throughout this plan. The following are mechanisms for identifying, supporting and promoting such activities.

Infrastructure Evaluation Priorities

To provide opportunities for evaluation and service modelling and dissemination of information:


2.11.1

Identify opportunities for grants to support evaluation and service modelling in the addiction sector.

NCAT/Te Pou Research,

Universities, private contractors

Ongoing Matua Raki

2.11.2

Coordinate fora to share findings with clinicians and leaders.

Tertiary education providers, addiction treatment services

Annual Matua Raki

2.11.3

Develop training for managers/team leaders to up-skill leadership in audit and evaluation activities and to support cross-evaluation activities between services

Whole of sector By 2010

Matua Raki

2.11.4

Support and participate in Cutting Edge Conferences

DAPAANZ 2009

ongoing DAPAANZ


Section 3. Specific Populations Workforce Development

3.1 Māori Workforce

Two key activities have informed this section of the Implementation Plan: the development of a history of the Māori addiction treatment sector 1980-2008; and the input from the Pouwhakahaere Leadership Group.

During the last year, a large number of interviews with key figures within the Māori addiction treatment sector have informed He Tete Kura, a Māori addiction history monograph. This book describes the progress and trends for Māori workforce and service development over the last almost three decades:

“… the need to increase the capacity and capability of the Māori workforce. Capacity in terms of numbers and capability in terms of delivering a Māori -responsive service that makes a difference… Increased priority given to an education (professionalised) pathway has resulted in traditional pathways of recovery into the Māori AOD workforce being reduced. This in turn has affected the critical mass of potential kaimahi entering the addiction treatment sector.”

many of the activities in this plan relate to development of the recovery workforce as well as continung to support, pathways for Māori into the addiction workforce. Supporting career development for Māori in the addiction sector and support for Māori to lead, continue to innovate and to mentor, are essential for the growth and retention of skilled and culturally competent Māori in the sector.

“Another constant theme to emerge is the essential role of whanau, hapu, iwi and community and how those links have anchored the sector throughout its development….There is a risk that if workers become overly focussed on professionalisation, and services become more driven by contract and contract compliance, then a vital and core element of Māori -focused addiction treatment will be lost. Therefore, in order to ensure a continued collective foundation there is a need to continue to:

Build, strengthen and maintain links between whanau, hapu, iwi, community and the sector around the country

Explicitly foster a collective whanau approach in the Māori addiction treatment sector and workforce;

Work more as a unified and collective sector to achieve whanau ora for Māori with addiction-related issues and problems.”

Māori Workforce Priorities

Increasing the capacity and the capability of the Māori workforce and of responsiveness to tangata whaiora:



3.2.1

Develop the kaiwhakatere leadership group into a Pouwhakahaere roopu that is assumes more of a leadership role. .

Māori leadership, NCAT, DAPAANZ,

MRAG Quarterly Matua Raki

3.2.2

Support Māori representation on such groups as NCAT, DAPAANZ.

Pouwhakahaere Roopu

2009 ongoing

Matua Raki

3.2.3

Enhance non-Māori competency (enhancing cultural fluency) as well as the competence of Māori practitioners.

DAPAANZ 2010-2015 Matua Raki &

DAPAANZ

3.2.4

Develop supervision and mentoring for Māori practitioners (development and implementation)

Pouwhakahaere Roopu

2009-2015 Matua Raki

3.2.5

Support the evaluation of Māori practice (broadening the evidence base).

Pouwhakahaere Roopu


3.2.6

Support kaupapa recovery whānau and particularly its relationship to recruitment and career paths.

Pouwhakahaere Roopu


3.2.7

Work with training providers to integrate Māori responsive content.

Pouwhakahaere Roopu, National

Tertiary Education Providers’ Network


3.2.8

Continue to support a system of scholarships, work placements, secondments and other incentives which will attract new and mature recruits.

Pouwhakahaere Roopu

2009 ongoing

Te Rau Matatini &

Matua Raki

3.3 Pacific Workforce

The Pacific Mental Health & Addiction Workforce development landscape is evolving to meet the challenges identified in the Matua Raki Strategic Plan 2005-2015. The


Matua Raki Strategic Plan identifies benefits for Pacific workforce development will most likely occur through prioritising recruitment and retention and training objectives.

This relates to the following objectives in the 2005 Strategic Plan:

Objective 17:

Implement strategies to attract and retain more Pacific [and Asian] practitioners to careers in the addiction treatment field.

Objective 20:

Identify and promote effective training and education for practitioners to increase clinical and or cultural competence and leadership ability, so that they can help people with a range of contemporary addiction-related problems.

Since this plan was written, significant developments have occurred. These include:

the establishment of Le Va – Pacific Mental Health and Addiction workforce unit within Te Pou - launched in 2008;

the development of Seitapu: Pacific Mental Health and Addiction Cultural and Clinical Competencies (Polutu-Endermann 2007);

the planned review of the AOD Practitioner competencies to include Pacific competencies aligned with Seitapu; and

the development of Effective Interventions accelerated workforce development programme.

In the light of these developments, the first task is to consolidate the infrastructure for Pacific workforce development, through:

a. strategic alignment between Matua Raki and Le Va; and

b. establishing capacity within Matua Raki to support alignment and coordination with Le Va and to provide internal Pacific capacity to other Matua Raki activities.

Strategic and Resource Alignment

A critical success factor will be the alignment of workforce development activity between Matua Raki and Le Va. The essential next steps are to encapsulate the ‘good will’ that exist between these organisations and to consider how both organisations will add significant value to Pacific and non-pacific people working with Pacific peoples.

It is clear that to grow the capacity and capability of the Pacific workforce innovation grounded in Pasifika values and within a holistic concept of well-being will continue to be required. Enhancing the capability and responsiveness of the non-Pacific alcohol and other drug and problem gambling workforce needs to include the proactive development of cultural competency ‘training’.


Matua Raki and Le Va are strongly supportive of a developing a collaborative focus, and a ‘coordinated’ and cohesive approach to grow the Pacific Addiction Workforce. Following recent discussions between the workforce programmes, two options have been identified:

Option 1: Matua Raki could establish a Pacific Leadership Group.

Option 2: Matua Rakii consider the National Pacific Treatment Forum (which is also undergoing change) as a potential Pacific Reference Group.

Option 1 is the preferred option.

A common theme emerging from all consultations has been the importance of establishing a Pacific Workforce addiction coordination role. This would enhance the flow of information and opportunities for Pacific Peoples within the addiction sector and support coordination with Le Va. It would also allow Pacific input into other Matua Raki activities, and support Pacific input into a wide range of activities such as the primary mental health care initiatives and effective interventions projects.

Workforce Development for Pacific

Once the alignment between the two workforce programmes is formalised, it is expected that Matua Raki will support Le Va in its activities in its workforce development for Pacific workforce. Likely activities include:

The following activities are foundational ones, in recognition of the need to formalise coordination of activities between Matua Raki and Le Va.

Pacific Workforce Priorities

To support the Pacific addiction treatment workforce to have integrated responses to their workforce development needs

Specific Actions Key Stakeholders Timeframes Lead

3.3.1 Formalise links between the Le Va Reference Group and Matua Raki

Le Va 2009

Matua Raki

3.3.2 Employ a Pacific Project Manager within Matua Raki who has operational links with Le Va and NPTF

National Pacific Treatment Forum

2009

Matua Raki

3.3.3 Identify Pacific capacity and a process for the incorporation of Pacific addiction treatment competencies into the AOD and problem gambling sector review

DAPAANZ

Le Va 2009

Matua Raki &

DAPAANZ


3.4 The Consumer & Recovery Workforces

Matua Raki held a forum in May 2008 to gain input from people in the addiction workforce who have a personal recovery perspective and/or consumer experience. This forum was a unique opportunity to bring together leaders with diverse roles.

It was identified that there are three parts to the Recovery workforce:

1. Practitioners and service leaders with a recovery background

2. Consumer Advisors and Consumer Advocates/Representatives

3. Peer Support workforce

Matua Raki activity to support the Aotearoa Alcohol and Other Drug Consumer Network will continue to be inclusive of a broad definition of this consumer network to include not only those in dedicated Consumer positions but to be a national forum for those with a recovery background.

The foundations of addiction treatment lie in a community focused, peer support model. Attendees at the forum reinforced the essential place of those in the workforce with personal experience of addiction and recovery. This encompasses people working across a range of service models and roles and with a variety of qualifications and skills.

Despite being a varied category of workforce, the following were identified as being elements held in common:

a foundation of personal experience (phrased as ‘QBE’ or Qualification By Experience);

a sense of mandate from a community to give back (hapu/iwi based, using community based or programme based);

need for tikanga competencies (for Māori working with Māori but also for all services responding to Māori ); and

practitioner competencies (Let’s Get Real and the sector practitioner competencies).

In order to support the consumer workforce to identify ongoing workforce issues and to support consumer participation in Matua Raki activities, Matua Raki proposes the following annual structure:

a Consumer Leadership Advisory Group to Matua Raki (a formal structure as per the structure used for the Pouwhakahaere Roopu)

Fund an agency to coordinate a kaupapa whanau hui (provision of set funds for them to determine the nature of the hui)

The kaupapa whanau hui would support those with a Māori recovery journey working in kaupapa whanau models to meet for support and further development of


these models. The kaupapa whanau hui would feed into the Consumer Leadership Advisory Group through a position on this group.

Practitioners with a Recovery Background

The addiction field has always had a significant proportion of workforce with a personal experience of recovery. Even more widely, there is a significant portion of the workforce with personal experience of addiction in their family. There is, therefore, a strong vocational component in recruitment to and retention in the field.

The Matua Raki Strategic Plan identified a possible trend since 1998 of a reduction of numbers of people in the workforce with a recovery background. If confirmed, this would have alarming implications for our addiction workforce both as an ageing workforce and one that depends upon people having a passion and commitment to addiction issues. Given current general public attitudes towards working in the addiction treatment field, it will be difficult to attract sufficient young graduates who do not have a vocation for this area of work, and/or to compete with other parts of the health system to attract workforce.

Many addiction treatment services, particularly residential and therapeutic community programme models of treatment, identify and mentor graduates of the programme who then contribute in various ways to the service. In some instances services offer positions and training to promising graduates of the treatment programme as a way of sustaining their workforce.

Recommendations from the forum included:

acknowledge the value, and grow the proportion, of those in the field with personal experience of recovery;

acknowledgement at commencement of employment with a service of both the value and risks for a person in recovery working in this field and negotiation of a self-care plan in the event of relapse;

peer support supervision opportunities as supervisee or supervisor;

training and development plan to include mentoring;

DAPAANZ to support and acknowledge the importance of a recovery journey and take a lead role in supporting the recovery workforce gaining registration.


Recovery Workforce Priorities

Supporting the increased capacity and capability and support for those who enter the workforce from a personal recovery journey:


3.4.1

Identify projects with a de-stigmatisation focus and incorporate a focus on recovery ‘heroes’ to support recruitment and retention of people with a recovery background and a vocation to work in the field.

Addiction Consumer Network, Addiction services

2010 Matua Raki & Mental Health Commission

3.5 Consumer Advisors/Advocates/Representatives

Attendees at the Matua Raki Recovery Workforce Forum identified that there was little consistency of expectation and role among the dedicated consumer positions in services and that practices in employing and supporting dedicated consumer roles (advisors/ advocates/ representatives) tended to be a dependent upon individual managers.

It was also identified that there is poor role definition in the sector relating to the positions of advisor, advocate or representative. Some good practice models were described but these are not well disseminated or promoted.

Attendees recommended the following:

Stocktake of the dedicated Consumer FTE workforce;

Guideline development for Consumer Advisors with clarification of the differences between this role and that of an advocate or representative;

Training and development for those in dedicated consumer roles including auditing training to support consumer participation in service audits;

Support for those in consumer roles to participate in training provision (both in-service and educational institution), and training and support to do this.

Support the development of consumer leaders as mentors for those consumers entering the workforce through mentoring training opportunities, for example, peer supervision


Consumer Advisors/Advocates/Representatives Workforce Priorities

Acknowledging and supporting the importance of the dedicated Consumer roles in the workforce


3.5.1

Include Consumer positions in the information collected in the Matua Raki sector stocktake and include demographics, background and role information.

Addiction services; Alcohol & Other Drug Consumer (AOD) Advisors; peer-led services

Annually

Matua Raki

3.5.2

Identify current best practice in the sector in the establishment and implementation of dedicated consumer roles and disseminate.

Addiction services, Funders and planners and consumers

employed in roles i.e. advisors and

advocates, Consumer Advisor training providers,

Blueprint for Learning

Commence 2009

Matua Raki

3.5.3

Matua Raki to work with regions and services to create and support dedicated consumer advisory roles to ensure consumer participation and evaluation of service delivery, policy development and workforce planning.

Addiction services; DHB funders and

planners, AOD (incl. gambling)

consumers, Regional Workforce

Development Coordinators

2010 Matua Raki

3.5.4

Establish a Consumer Leadership Advisory Group to meet four times annually to identify workforce development needs and to participate in Matua Raki workforce development planning.

AOD (incl. gambling) consumers

Annual Matua Raki



3.5.5

Fund further Consumer Auditor training (as per 2008 project) and support a growing pool of consumer auditors to make themselves available to providers in this role.

Accredited Auditing Training Provider;

AOD (incl. gambling) consumers, Contract a Accredited Audit Training Provider

2010, 2012

Matua Raki

3.5.6

Fund Māori-specific Consumer Auditor training to support culturally appropriate auditing within kaupapa Māori service settings.

Accredited Auditing Training Provider, Kaupapa Whanau (AAODCN) and Kaupapa Māori

Addiction services; addiction service

2009, 2011, 2013

Matua Raki

3.5.7

Support consumers to attend the existing peer supervision training opportunities in 2009 for Consumer Advisors to train as peer supervisors and in future years as available.

Dedicated AOD Consumer Advisors;

Kites, AOD (incl. gambling) consumers

2009 and future years as available

Matua Raki

3.6 Peer Support Workforce

As addiction treatment services develop to meet the need of the client population there is a growing recognition of a peer support role that complements addiction treatment services. The addiction peer support workforce may also include services that do not have a mental health and addiction contract but who have a peer workforce who engage and support people who access addiction treatment services, such as the Needle Exchanges.

Currently the only dedicated addiction peer-led support and advocacy contract is Te Whanau Manaaki O Manawatu (MidCentral DHB). This area of service delivery and consumer need is more commonly and undertaken by a voluntary workforce.

The Alcohol Drug Association New Zealand (ADANZ) is contracted by the Canterbury DHB to provide peer support and advocacy: the Addiction Advocacy Service for consumers of addiction treatment services. There is also a Counties Manukau DHB initiative to support the development of an emerging alcohol and other drug (including gambling) consumer network and workforce.

There is a need to develop and strengthen peer-led services and workforce that has the capacity and capability to offer support and advocacy for consumers along the continuum and is complementary to existing addiction treatment services. Many peer support workers would fit into the AOD Support Worker category created at the end of 2006 within the DAPAANZ scopes of practice and registration levels:


“AOD support workers work under the direction of a registered AOD practitioner in a variety of clinical and cultural contexts. AOD support workers utilise knowledge and experience to provide evidence based interventions to support people to address AOD related issues. The responsibilities of AoD support workers include assisting individuals, families, whanau and groups to address identified AoD related issues by performing delegated interventions from the AoD treatment plan.

A certificate in AOD studies at a minimum of level 5 on the NZQA Framework is the prescribed qualification for registration as an AoD support worker.

Matua Raki affirms the value of the Peer Support workforce as complementary to clinical service models and proposes the following actions:

Championing

with funders and planners the development of peer support roles within peer-led and other addiction treatment services.

Supporting

the contracted and voluntary Peer Support workforce to:

receive appropriate clinical and cultural training;

develop those seeking to gain higher qualifications to practice both within the Peer Support model and to have career pathways into clinical services;

engage with clinical services to support inter-service referrals (to both inform clinical services of their model and to access specialist expertise from the clinical service);

evaluate this model of service delivery;

extend this model of service delivery in the non-government organisation sector

provide support to participate in training opportunities for those undertaking peer support roles voluntarily.

Utilising

the Peer Support workforce to:

grow a Māori focused workforce founded on whānau ora with a mandate to work with iwi, hapu and whānau;

provide peer supervision to people with a recovery background working in the addiction sector;

include peer support service models in the scholarship, secondment, and internship initiatives;

support Le Va to consider the development of Pacific models of Peer Support services.


Peer Support Workforce Priorities

Advocacy for the concept of peer support and peer-led organisations and support for this nascent addiction workforce to develop


3.6.1

Identify the peer support service models and workforce within the addiction treatment sector.

Support evaluation of peer support in the addiction sector.

Champion further development of peer support within peer-led and other addiction service models to funders and planners.

Peer support service providers,

Consumer Leadership

Network, DHB Funders and

Planners, Addiction (including problem gambling services)

Commence 2009

Matua Raki

3.6.2

Support the development of/access to training and access to scholarships for those in the peer support workforce, including:

peer supervision training programme

Motivational interviewing training

whānau ora training opportunities e.g. Te Korowai Aroha

Peer support service providers, Training providers; Addiction (including problem gambling) services, Consumer

Leadership Network

Commence 2009 and as

training available

Matua Raki

3.7 The Youth-Focused Workforce

In 2007 and 2008 Matua Raki collaborated with the Werry Centre to hold meetings at Cutting Edge for addiction workers with a youth focus. As well as the need for specialist development in the area of youth with alcohol, other drug and gambling issues, it was agreed that there is a general need for all health and associated workers employed in working with adolescents to have an increased awareness and responsiveness to mental health and addiction.

Matua Raki will ensure that a youth focus is maintained across all relevant areas of addiction workforce development. Additionally, we propose specific activities focused on those workforces working with youth.


All specialist addiction treatment workers working with young people should have:

an understanding of adolescent development;

knowledge of alcohol and other drug use and problem gambling patterns for youth, be informed around the different types of substances used by young people, how these substance work and their effects, harm reduction/minimisation techniques and what is involved in a withdrawal/detoxification process;

knowledge of coexisting mental health issues for youth and the relationship between adolescent alcohol and drug and mental health issues with abuse, neglect, domestic violence and/or parental alcohol and other drug use;

Knowledge of best practice treatment interventions for young people with alcohol and other drug and gambling issues and associated mental health problems;

the ability to deliver culturally appropriate interventions, have an awareness of the impact alienation from culture has on wellbeing, and be able to access cultural expertise;

the ability to work with families and whanau or to access support to do this.

There are also multiple workforces in the wider health and related sectors who engage with youth with addiction issues. These include workforces in primary healthcare, education, justice and the social service sectors.

Sector competencies for the Child and Adolescent Mental Health workforce incorporate screening, assessment and intervention for alcohol and other drug issues for their client group (Real Skills Plus, Werry Centre, 2007). The Werry Centre will be a key partner in all workforce development initiatives led by Matua Raki. There are mutual benefits: to support the specialist CAMHS workforce to up-skill in alcohol and other drug and problem gambling interventions and referral; and to support the addiction workforce to up-skill in mental health interventions and referral.

Matua Raki proposes to support the production and dissemination of resources for workforces working with youth with Addiction issues.

Matua Raki will support youth-appropriate service delivery models, including culturally appropriate service models, and proposes a range of workforce initiatives.


Youth-focused Workforce Priorities

To support the workforces working with young people and their families


3.7.1

linking youth-focused resources and tools to enhance competencies in working with youth with alcohol and other drug issues

Addiction sector, (WDHB), National Tertiary Training Providers, NAC, Werry Centre;

proposed Youth Justice Centre of

Excellence, Education,

MSD/Youth Affairs

2009 ongoing Matua Raki

3.7.2

Coordinate a one day national symposium for researchers with a youth focus to present to research peers and to leaders in the youth/addiction sector

Researchers, clinicians,

2009, 2011, 2013

Matua Raki, NAC,

University of

Auckland

3.7.3

support lead clinicians and academics

Grant Christie (WDHB)

Ria Schroder (NAC)

Sue Bagshaw (198 Service)

Helen Moriarty (Otago)

2009 and ongoing

Matua Raki & Werry Centre

3.7.4

Work with Kina Trust to develop a training programme to be offered to adult addiction and mental health services in the identification of, and interventions for, children and youth of their client groups

Kina Trust, Addiction services, Adult

Forensic Services, Te Pou, CYF

Commence 2009

Matua Raki & Kina Trust



3.7.5

Support evaluation of youth focused service delivery models, including Māori and Pacific service delivery models to support an evidence base for wider application

Identified services (Addiction services,

CAMHS, youth services), Other

workforce programmes,


2010 and ongoing


3.7.6

Support dissemination of alcohol and drug use research findings from the University of Auckland Youth 2007 survey

Werry Centre

(University of Auckland School of Population Health)

2009


3.8 Nursing Workforce

In 2005/06 a National Nursing Reference Group was established to gather regional input on advanced nursing practice and to promote national leadership amongst nurses working in the Addiction treatment sector. For detailed information refer to the report Advanced Practice Nursing Strategy for the Addiction sector (NAC/Matua Raki 2008).

The report identified current barriers to advanced practice nursing roles, recruitment strategies, professional development and support needs for this workforce, and a number of recommendations for the implementation of advanced practice clinical roles in addiction within a broader advanced practice nursing role framework.

The vision is to achieve a mix of advanced clinical roles within different service settings, developed in relation to local and regional needs and population needs.

To achieve this vision a whole system approach is needed involving local, regional and national collaboration. The following proposals would be led by senior nurses, with the support of Matua Raki and the involvement of professional bodies, District Health Boards and the other workforce development programmes.


Nursing Workforce Priorities

To support the nursing addiction treatment workforce


3.8.1

Promotion of a national framework of advanced practice nursing roles (clinical, research, education, advisory/leadership, management) for the Addiction treatment sector.

DAPAANZ,

NZ and Australasian Mental Health and Addiction Nursing

bodies, NAC

Commence 2009

Matua Raki

3.8.2

Co-ordination with other workforce programmes of workforce activities for clinically focused advanced practice nursing, including Māori and Pacific.

Te Pou Mental Health Nursing Leadership

Manager and nursing leaders within Matua

Raki, the Werry Centre and Te Rau Matatini

Commence 2009

Matua Raki

3.8.3

Continuing promotion of a national network of advanced practice nurses working in the Addiction treatment sector with support for a nominated co-ordinator to promote nursing leadership within the Addiction treatment sector.

Drug and Alcohol Nurses of Australasia

(DANA), NAC

2009 and ongoing

Matua Raki

3.8.4

The development of a document that describes academic pathways for advanced practice nurses working in the mental health and addiction field under the umbrella of Te Ao Maramatanga (New Zealand College of Mental Health Nurses) and the Drug and Alcohol Nurses of Australasia (DANA), in collaboration with interdisciplinary and nursing postgraduate education providers and the New Zealand Nurses Organisation.

DANA, NAC, Te Pou Mental Health Nursing Leadership Manager and nursing leaders

within Matua Raki, the Werry Centre and Te

Rau Matatini

By 2010 Matua Raki



3.8.5

The development of advanced practice addiction nursing standards via input to the review of Standards of Practice for Mental Health Nurses to be undertaken in 2008 by Te Ao Maramatanga (NZCMHN).

Drug and Alcohol Nurses of Australasia (DANA) and Australia

nursing academics

By 2010 Matua Raki

3.8.6

The establishment of a national Nurse Practitioner group with a nominated co-ordinator to provide peer support for nurses working in the Addiction treatment sector on the Nurse Practitioner pathway and profile the role of Nurse Practitioner.

Drug and Alcohol Nurses of Australasia

(DANA), NAC By 2010

Matua Raki

3.8.7

Support providers to undertake strategic and operational planning, in relation to other practitioner roles, for clinically focused advanced practice nursing roles, including Nurse Practitioner within Addiction treatment services, supported by the National Committee for Addiction Treatment, the National Association of Opioid Treatment Providers, members of the Chapter of Addiction Medicine within the Royal Australasian College of Physicians, the Drug and Alcohol Practitioners Association, Aotearoa-New Zealand.

Addiction treatment service managers, clinical and nursing

leaders and directors of nursing in collaboration

with planners and funders,

Commence 2010

Matua Raki



3.8.8

Establishment of Nurse Practitioner trainee and intern posts (in response to identified client and service need) for nurses on the Nurse Practitioner Pathway who are supported by their service clinical and management leadership group and organisation/regional nursing director/leader.

Addiction service managers, clinical and

nursing leaders and regional/local directors

of nursing in collaboration with

planners and funders,

2009 and ongoing

Matua Raki & Te Rau Matatini

3.9 Opioid Treatment Workforce

The Ministry of Health has led the review of the Opioid Treatment Substitution Guidelines and the development of an OST Training Package aimed at all Opioid substitution treatment providers, including GPs and Pharmacists, prison medical staff and Primary MH Coordinators.

Matua Raki proposes to support the implementation of these Guidelines and Training Package, utilising the Matua Raki website.

Opioid Treatment Workforce Priorities

To support the specialist opioid substitution treatment workforce


3.9.1

Dissemination of revised OST Guidelines on Matua Raki website

MOH, NAOTP, Specialist Services

2009

Matua Raki and

MoH/ NAOTP

3.9.2

Support the OST Training Package

MOH, NAOTP, Specialist Services, Consumer Advisors,

National Training Providers Network, Pharmacist Guild, Corrections staff

2009

Matua Raki and

MOH/ NAOTP



3.9.3

Identify other opportunities for the sharing of information and to support the model of shared care (specialist with primary):

NAOTP, Specialist Services, Consumer Advisors, National Training Providers

Network, Pharmacist Guild

2009 ongoing Matua

Raki & Te Pou

3.10 Problem Gambling Workforce

The Problem Gambling workforce is a small but important part of the addiction treatment workforce. The development of problem gambling services has been separate from mental health and addiction services, as has the funding. Yet this workforce has developed out of the alcohol and other drug workforce, draws on the same theoretical underpinnings and range of treatment modalities and responds to a high degree of coexisting problems in their respective points of entry. The problem gambling workforce, whilst small (perhaps 140 workers), has specialist skills in problem gambling treatment and in public health advocacy.

Addiction workforce development should therefore be approached in an inclusive way to maximise knowledge, resource and outcomes for improved capacity and capability to respond to people with addiction and coexisting issues.

Both the problem gambling specialist workforce and the alcohol and other drug workforce would benefit from shared workforce development activity, and both need resourcing to support screening in a range of settings and by a range of other workforces. A paper presented to the Addiction Treatment Leadership Day by Sean Sullivan (Abacus, October, 2007) identified that the problem gambling workforce would benefit from a wide intervention approach and an increased range of skills to respond to coexisting disorders.

Problem Gambling Workforce Priorities

Add content following discussion with MOH and Problem Gambling stakeholders


3.10.2

Enhancing gambling practitioners competency

MOH, Abacus, AOD and PG providers

2009 onwards

MOH &



3.10.1

Support DAPAANZ to integrate AOD & PG workforce practitioner needs

MOH, Abacus, AOD and PG providers

2009 onwards

MOH & DAPAANZ


Section 4: Workforce Initiatives to Support Integrated Practice

4.1 Introduction

Matua Raki has a number of opportunities, and will identify further opportunities, to support integrated practice between workforces and sectors so that any door is the right door for people with alcohol and other drug and or problem gambling-related issues. The vision is to transfer an appropriate level of skill – and confidence – to other workforces so that they are responded to holistically, with referral to specialist services as appropriate, and shared care management between services, as appropriate.

4.2 Primary Mental Health Initiatives

The Primary Mental Health Care Initiatives funding package to Primary Healthcare Organisations (PHOs) has seen the establishment of a mental health workforce in general practice settings. A Matua Raki review of the initiatives [McDowell report on Ref] by Professor MacAvoy found that “only 2 of the one page summaries specifically mention alcohol and drug issues” and “service user data indicate that of the 4,365 reasons for presenting only 115 (3%) were for alcohol dependence syndrome and 19 (<1%) for substance abuse not alcohol.” However, in telephone interviews Prof McAvoy made with key players from several of the projects “revealed estimates of up to 10% of clients having associated AOD problems.

The low numbers of recorded alcohol and other drug presentations has a chicken and egg effect: practitioners do not feel able to or willing to explore alcohol, drug and gambling issues with their patients unless the presentation is severe. Practitioners are therefore reinforced in believing that addiction is a specialist area.

The following is an extract from the Matua Raki report by Professor Brian McAvoy (unpublished, 2007):

“Among key objectives of the New Zealand Health Strategy is the identification and minimisation of the use of tobacco, alcohol and other drugs, reducing suicide rates and violence and promoting population lifestyle change.[Ref] …Primary care practitioners (general practitioners, practice nurses and mental health workers) can also undertake brief interventions, counselling, relapse prevention, and refer patients with more severe and complex problems to secondary care and specialist services.” (p1)

Matua Raki will work with the Ministry of Health primary care team and with Te Pou to identify and support workforce development of primary mental health professionals and liaison between them and specialist addiction treatment services.


Primary Health Workforce Priorities

To support the primary healthcare workforces to respond to tangata whaiora with alcohol and other drug and problem gambling problems


4.2.1

Create a ‘kit of resource material including clinical tools for dissemination to Primary Mental Health Coordinators in PHOs and to other primary health care workforces via the Te Pou website.

Matua Raki, ALAC & Te Pou

By 2009

Matua Raki,

ALAC & Te Pou

4.2.2

Use local workforce development planning processes to support liaison between primary & secondary services in their locality/region

Addiction treatment services

Commence 2009

Matua Raki

4.2.3

Support evaluation of primary care settings where responses to alcohol and other drug and problem gambling initiatives are in place.

PHOs and their relevant secondary addiction services,

iwi provider services, Pacific

services

Commence 2011

Matua Raki

4.2.4

Identify other primary health settings (such as Family Planning clinics and one-stop shops) and social services (such as family violence intervention agencies) for similar (as above) initiatives

Addiction treatment services and

relevant primary settings in their

locality

Commence 2012

Matua Raki

4.3 Co-Existing Addiction and Mental Health Issues

In Te Kokiri Leading Challenge: Addiction, we have a clear strategic national direction requiring addiction services to improve their capability to respond to coexisting mental health presentations and for mental health to improve their capability to respond to coexisting problematic substance/gambling and dependence presentations.

In New Zealand there have been a number of locally and regionally led initiatives where champions of co-existing capacity development have been building awareness, debating alternative service delivery mechanisms, searching for


international resources and developing local ones. Such workforce initiatives are vulnerable to staff turnover, one-off funding and one-off training.

Co-existing problems are now accepted to be the expectation and not the exception. The development of ‘Dual Diagnosis’ services went some way to build responsiveness to consumers with a co-existing disorder. These services have well developed expertise, with one (Dual Diagnosis team, CADS Auckland) also having expertise as a training provider. However, in the typical scenario where mental health and AOD teams do not respond to dual diagnosis, the presence of a DD service may inadvertently reinforce the status quo.

With 30-50% of clients in mental health services and 70% in alcohol and drug services having some kind of dual diagnosis problems (Todd), there is better recognition now that the way forward is the development of the whole of the mental health and addiction sectors’ capacity and capability to respond to co-existing presentations for their respective client groups. Problem gambling services now more routinely screen for depression and anxiety and also report that coexisting disorders are the exception rather than the rule.

To both ensure a consistent approach nationally and to maximise expert resources in coexisting responsiveness, it is essential that the workforce programmes act in concert to develop a programme of resources applicable to the many parts of the mental health and addiction sector.

Matua Raki is currently involved in the national project to create a guidance document for services and to support the review of and dissemination of the NZ Guidelines for Coexisting Disorders Management.

A 2007 Matua Raki report ‘Mental Health and Alcohol and Drug Co-existing Disorders: An Integrated Experience for Whaiora?’ captured the views of both the addiction and the mental health sector workforces on integrated practice. Whilst finding some improvement in the level of service provision for people with dual diagnosis, it also identified that the prevailing model was still that of parallel with high levels of antipathy between the sectors at both leadership and practitioner level.

A more recent Mental Health Commission report ‘Getting it Right for People with Co-existing Mental Health and Addiction Problems’ (MHC 2008) identified that not only is a coherent national approach required, but also a fundamental shift in understanding and attitudes across the mental health and addiction sectors.

This report refers to the States Services Commission publication, ‘A Framework to Help State Agencies Co-ordinate Effectively’ (SSC 2008), which identifies three dimensions for successful co-ordination – mandate, systems and behaviours. Workforce development initiatives for integrated service responsiveness must therefore encompass these dimensions. Essential to this is supporting local champions to provide the leadership, disseminate resources, train and support teams and practitioners and problem-solve barriers to collaboration.


It is important that New Zealand have a nationally consistent approach with a stepped process for supporting integration. This includes: national competencies; a suite of culturally appropriate resources suitable for mental health teams, addiction teams, primary healthcare teams, services working with youth; guidance on care pathways and examples of best practice in collaboration and systems integration; resources for tertiary education providers; access to local and regional expertise, particularly clinical supervision; audit structures and tools; research and evaluation to inform future practice.

Co-Existing Addiction and Mental Health Workforce Priorities

Respond to the developments of the national guidance documents with an initial 3 year workforce plan for supporting integrated service delivery.


4.3.1

Promote the revised Te Ariari Ō Te Oranga: The Assessment and Management of People with Co-Existing Mental Health and Substance Use Problems 2008 (Fraser C Todd)

NAC, MoH 2008 Matua Raki

4.3.2

Develop initial 3 year workforce plan.

MOH 2009 – 2011 Matua Raki & Te Pou

4.3.3

Develop a second 3 year plan, continuing the above, also further developing research and evaluation activity:

Support for nationally aggregated service data, outcomes measurement data, audit results, further research activity.

MOH, Matua Raki, Te Pou, Te Rau Matatini, Werry Centre, Le Va,

DHB Funder and Planner arms,

Addiction Services (including Problem

Gambling), Forensic Services,

Corrections

2011-2015 Matua Raki & Te Pou

4.4 Broadening Cultural Capability and Capacity

As a national programme, Matua Raki will work with District Health Boards to support analysis of the capability and capacity gaps in their workforces through the local workforce development planning processes. This process will support DHBs to identify their local population needs, their current responsiveness, their workforce capacity and their current capabilities to respond to specific ‘hard to reach’ or high need populations. Included among these are a range of Asian populations, refugee and migrant groups, and gay, lesbian and transgender communities.


Some DHBs have recognised priority populations and developed initiatives at the regional and local levels: needs analysis; development of policies; training and development resource development; and the identification of practitioners with cultural competence to provide consultation and supervision to the wider workforce.

Matua Raki will support the wider dissemination of the approaches developed at a local and regional level so that small resources can be shared for people with needs in areas of the country where their needs are less visible.

Cultural Capabilities Workforce Priorities

Support local and regional responsiveness to particular populations


4.4.1

Utilise workforce planning process to identify and enhance local and regional responses to broadening cultural capacity and capability.

Regional Support Agencies, DHBs,

Asian Mental Health networks, Refugee

and Migrant services, Addiction services (including Problem

Gambling)

2009 – 2015 Matua Raki

4.4.2

Support dissemination of the approaches developed at a local and regional level.

DHBs, Addiction services (including Problem Gambling)

2009 – 2015 Matua Raki

4.4.3

Support resource development and review of culturally-specific material to support outreach and effective engagement with small or sub-cultural groups:

service providers

tertiary training providers

DHBs and NGOs leading responses to

particular groups, Rainbow Recognition

Group

2009 Matua Raki

4.4.4

Review the Making Visible resource Rainbow Recognition

Group 2009

Matua Raki


Appendix 1: Matua Raki 2008 Statement of Intent (excerpt)

Matua Raki Mission, Vision and Values

Our Mission

Our Vision

The Matua Raki Way

Development of workforces that support consumers and tangata whaiora, their families and whanau to minimise addiction-related harm.

People who experience alcohol and or other drug and or gambling problems have access to a highly skilled, well supported and effective workforce and services.

Matua Raki is:

Grounded in the experience of the consumer and committed to de-stigmatisation and celebration of the consumer journey; and

Grounded in the experience of the practitioner at the point of service delivery.

As a national programme, we are:

Fair in distribution of effort and resource;

Inclusive, seeking collaborative approaches to workforce development;

Solution focused, delivering relevant solutions to workforce barriers and workforce development opportunities;

Facilitative – inspiring, empowering and informing;

Efficient – making quality decisions and applying project management methodology to deliver on time and on budget.


Matua Raki Principles and Purpose

Guiding Principle

Our Purpose

Matua Raki Workforce Development is about:

Supporting the workforce to reduce the harms from alcohol, other drugs and gambling

Supporting local service and regional workforce development infrastructure

Supporting sector identity and respect for the sector

Valuing and connecting with related workforces

Growing and supporting new workforce – including Māori , Pacific, the recovery/peer workforce and a multi-disciplinary workforce

Building the responsiveness of services to respond to levels of need for Māori

Growing core competence in teams to meet the needs of their setting and their population

Growing specialist capacity within, or availability to, teams to meet the needs of their setting and their population

Sharing innovations and evidence based and experience based best practice

Valuing diversity in the workforce – provider diversity, treatment diversity, knowledge and experience

The Matua Raki Strategic Plan identified as a guiding principle that workforce development must support tangata whaiora/client-oriented service delivery.

This means that Matua Raki is client-focused in its mission, vision and values. To support this, Matua Raki has its own capacity for consumer guidance and input across all activities in the form of a dedicated Consumer Project Manager and support for a regular forum for consumers in leadership roles in the sector.


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