Jennifer Harland RN MA (App Eth) MSc (Add Std) Grad Cert (MH) Grad Cert (ICU) CDAN

Director of Clinical Services

Karralika Programs In.

ACT, Australia

A strengths-based not for profit organization located in the ACT that offers support and services to individuals with alcohol and other drug dependencies.

It supports individual and their families through the provision through a variety of evidenced based residential and community-based programs and services.

44 bed TC◦ 27 Adult Program◦ 17 Family Program◦ Additional 8 beds in the Transition Program following

graduation of the TC

◦ Solaris Program TC within the Alexander Maconochie Centre

◦ Community Program Nexus Program 7 beds Early Birds Reversed Sober Drivers

To examine the extent to which the Karralika TC program design aligns with evidence based principles for residential alcohol and drug treatment services (with particular reference to the Therapeutic Community model ).◦ Fidelity to the goals and objective of the program

◦ Service delivery

◦ Quality Improvement

◦ Client outcomes

◦ Program outcome measures

◦ Resourcing and staffing establishment

◦ Data collection and outcome measures

Turning Point were commissioned to conduct the evaluation

Karralika Therapeutic Community◦ Short Stay Program (Karuna)

◦ Residential Program for Adults (Karralika Adult TC)

◦ Residential Program for Families (Karralika Family Program

October 2014

Mixed-method design

Qualitative data was derived:◦ from structured interviews:

Current clients (n=22)

Staff members (n=24)

◦ Questionnaires:

Current clients (n=22)

Staff (n=16)

Former clients (n=8)

◦ Audit of current case files (n=18)

Secondary analysis of de-identified matched data from the Network of Alcohol and Drug Agencies (NADA) database and Alcohol and Other Treatment Services National Minimum Data Set (AODTS-NMDS) data (n=109)

Literature review

Review of KPI documentation

Between Nov 2010 and June 2014, 119 clients participated in the Karralika TC Program.

Complete data was available for 109 clients Principle drug of concern◦ Alcohol (36%)◦ Meth / amphetamine (24.8%)

There was a significant increase in reporting of meth/amphetamines as the PDOC between 2010 and 2014

◦ Heroin (19%)◦ Cannabis (16%)

60% of clients reported being concerned about more than one substance

60% reported injecting drug use in the past

Majority of clients were:

Long term drug users

Associated health and well being issues

Had several past episodes of AOD treatment

Involved in other areas of the service system:◦ Justice, child protection, mental health

Clients commonly reported hitting ‘rock bottom’ before entering

The evaluation found that Karralika TC is valued by clients:◦ 100% of clients reported that staff were efficent at

their job

◦ Over 90% of clients reported that they had received excellent service

◦ Over 80% of clients stated that the program was well organized and run well, it met their needs and they would recommend it their friends.

◦ More than half the clients reported that they would come back to the program if they were to seek help again.

• Improvement in physical, psychological health and quality of life of current and former clients.

• The vast majority of clients reported being abstinent from substances during the program.

◦ Former clients reported to being abstinent for up to two years following leaving the service.

Couples and children

Clients on Opioid Replacement Therapy

Clients with co-morbid mental health disorders (included medicated)

Ideological and policy shifts have influenced AOD delivery service across Australia overtime and have direct relevance to the ongoing development of the Karralika TC practice:1. Increased acknowledgement of the complexity

of AOD clients and their individual needs.2. A shift to a more client-centred practice,

moving away from a homogenised program that all clients receive.

3. Professionalization of the AOD workforce to deliver evidence-based interventions including a range of psychosocial and cognitive interventions.

In the context of the sector wide shifts, is to modify the TC model while preserving the elements necessary to retain the therapeutic benefits.

Funding and political environment

Best practice / evidence-based programs

Measuring and promoting outcomes

Multidisciplinary team integrated within the TC theory, model and method◦ Staffing structure – mix of skills and roles

◦ Position descriptions and workplans with measurable indicators clearly articulated

◦ New performance appraisal cycle (June/July)

Program changes◦ Strengthening the Family Program

◦ Amended program timetable (Adult and Family)

◦ Roster to support program implementation

All Staff briefing

Organisational

Chart

Workflow (draft)

Staffing

establishment/

structure

Position

descriptions

Jan

Recruit

. Clinical Director

. Support Workers

Case Managers and

Counsellor/s in place

Roster changes

Program Timetable

April/May

Functional Program

Design review

Plan for Program

enhancements

Staff Performance

Appraisals and new

workplans 15/16

June

All Staff briefing on

progress of Change

Management Plan

Next steps

July

Recruit

•Case Manager/

Coordinator roles

Admin support in

place

September

Karralika Programs Inc. Internal Organisational Chart (March 2015)

Case ManagersFamily Liaison

CounsellorCase ManagersFamily Liaison

Counsellor

Support Workers

Case ManagersFamily Liaison

Counsellor/Educators

Sleepover Staff

Case Manager/ Co-ordinators

Chef

Administrative support

Primary Health Nurse

Transition / Outreach Program

Nexus Men’s Program

Driver / Education Programs

Assessment / Intake /

Pre-treatment

Family Program

Adult Program

Solaris Transition/ Outreach Program

Solaris TC / Graduate Program

Solaris Program ManagerKarralika TC Manager Community Programs Manager

Finance and Administration Team

Director – Corporate Services

Director – Clinical Services

Coordinator

Facilitators

Chief Executive Officer

Mon Tue Wed Thur Fri Sat Sun

Manager 9-5 9-5 9-5 9-5 9-5

Case Manager/Coordinator (business hours)

Various(8.30/9-4.30/5; 11-7 etc)

Various Various Various Various

Case Managers (business hours) Various Various Various Various Various

Family Liaison Case Manager 8-3.30 8-3.30 8-3.30 8-3.30 8-3.30

Counsellor (Day) 8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

Counsellor (Evening) 11-7pm 11-7pm 11-7pm 11-7pm 11-7pm

Nurse 8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

Day Support Worker 8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

8.30-4.30pm

Evening Support Worker 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm

Sleepover staff 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30

Activities - Monday to Friday

7-9.15am Morning routine - breakfast, mod cleaning, function, medication

Morning routine plus Family Program school run (8.45am)

9.30-10 Morning meeting

10-10.15 Morning Tea

10.15-11.30

Group time

11.30-12 Function, Case management, counselling

12-1 Lunch

1.15-2.45 Groups

3-5pm Exercise , Case Management, Counselling, Personal time

2.45-7.30pmFamily Program school run, Family Time, case management, counselling, dinner, homework, phone calls,stories, bedtime

5-8Function, dinner preparation, dinner, phone calls

8-8.30Concept Group, Check in, medication, tidy up, off the floor 9.30pm

8.30-Housekeeping, prep school lunches, medication

Many of the challenges experienced by the Karralika TC are common to all TC’s who are attempting to meet AOD ‘professional standards’ and to meet the needs of diverse resident populations while retaining the ethos and spirit of the Therapeutic Community spirit.

A clearly articulated and supported change management plan is essential in the success of this process.

Jennifer Harland

Jennifer.h@karralika.org.au

0418474866

Questions?