“not just drugs 101”
TRANSCRIPT
“Not Just Drugs 101” Working with the Community Service Sector to Enhance
Capacity to Respond to Alcohol and Drug Harm
James Hoey
Logan Alcohol and Drug
Community Liaison Team
Metro South Addiction Services
Weacknowledgethetradi1onalcustodiansofthelandonwhichwemeettodayandpayrespecttoElderspast,presentandemerging.WealsoextendthatrespecttootherAboriginaland/orTorresStraitIslanderswhoarejoiningusheretoday.
DavidRHorton,creator,©AboriginalStudiesPress,AIATSISandAuslig/Sinclair,Knight,Merz,1996.Viewaninterac1veversionoftheAIATSISmapwww.abc.net.au/indigenous/map/HeaderArtworkproducedforQueenslandHealthbyGilimbaa
Service Overview
Addiction and Mental
Health Service
Addiction Academic
and Clinical Unit
Logan Alcohol and Drug Community
Capacity Building Initiative
• The origins…
• The model…
• Evaluation and preliminary outcomes…
• Key learnings…
…and time for
some questions
at the end…just
not this one
Logan
Logan Alcohol and Drug Community
Capacity Building Initiative (LAOD-CCBI)
To enhance the capability of the generalist
health, community, welfare and support
service workforce in Logan in preventing and
reducing alcohol and drug harm
PARiHS: Promoting Action on Research Implementation in Health Services
(Kitson, Harvey & McCormack, 1998)
SUCCESSFUL
IMPLEMENTATION
EVIDENCE -
research, practitioner
& client experience
CONTEXT -
culture of leadership,
evaluation
FACILTATION -
skills, attributes,
purpose
SI = f(ECF)
PARiHS: Promoting Action on Research Implementation in Health Services
SUCCESSFUL
IMPLEMENTATION
EVIDENCE
??????
From the Literature:
• Best methods for delivery of knowledge and
skills = educational activities + ongoing
support (partnership) Bywood, Lunnay & Roche, 2008.
• Identified training needs and content for
non-AOD NGO workforce – this was gap in
research.
• NGO’s needed to be included in decision-
making
EVIDENCE: Training Needs Analysis (TNA)
NGO’s = 25 n = 125 Responses = 233
EVDIENCE: Top 3 Professional
Development Needs
Generalist AOD
1.Improved awareness of
when and where to refer
for AOD support.
2.Improving knowledge re
the actions and effects of
AOD for client groups.
3.Strategies to support
increasing motivation for
change.
Specialist AOD
1.Working with dual
diagnosis (i.e. mental
health comorbidity.
2.Trauma and AOD use.
3. AOD assessment.
EVIDENCE: TNA Thematic Analysis
1. Awareness and willingness to respond to
AOD issues.
2. How can I help MY clients (e.g. specific
population groups – parents, youth, women –
how can innovation contribute to the larger
agenda of the service)
Model • Workshop format - in-house
Workshops x 2
1. Introduction to AOD
2. Conducting a Brief Intervention in
AOD
• Training underpinned by Motivational
Interviewing principles and practices.
PARiHS: Promoting Action on Research Implementation in Health Services
SUCCESSFUL
IMPLEMENTATION
CONTEXT -
culture, leadership,
evaluation
• Key informant
identification and
consultation (onboarding)
• Pre-workshop online
Training Needs survey –
• Importance
• Priority
• Main challenges
Model • Workshop format – in-house
• Workshops x 2
1. Introduction to AOD
2. Conducting a Brief Intervention in
AOD
• Training underpinned by motivational
interviewing principles and practices.
• Foster partnership via pre-workshop
consultation and training needs
evaluation (meeting & online)
• Workshop content tailored to identified
needs (relevance)
• Increase buy-in
PARiHS: Promoting Action on Research Implementation in Health Services
SUCCESSFUL
IMPLEMENTATION
FACILTATION -
skills, attributes,
purpose
Internal and External Facilitation
• Experienced, adaptable and flexible
facilitation.
• Post-training as a function to enhance
internal facilitation.
Model • Workshop format – in-house
• Workshops x 2
1. Introduction to AOD
2. Conducting a Brief Intervention in
AOD
• Training underpinned by motivational
interviewing principles and practices.
• Foster partnership via pre-workshop
evaluation (meeting & online).
• Workshop content tailored to identified
needs (relevance).
• Increase buy-in
• Provision of experienced AOD
facilitator(s).
• Time-limited post-training mentoring
focussed on building legacy/legitimacy
via sustained internal facilitation.
So What Have We Done…
July 2016 to May 2017
40 Organisations
92
Workshops
350+
Participants
280
Subjects in study
Evaluation – Attitudinal Factors • Measured known professional and personal factors which influence AOD
practice as facilitators and barriers.
• Work Practice Questionnaire (Addy et al., 2004)
1. Confidence – “I feel capable to
respond”
WPQ – Individual Role
Adequacy Scale (RA)
Pre; 3m f/up
2. Perceived responsibility – “I should
respond”
WPQ – Individual Role
Legitimacy Scale (RL)
Pre; 3m f/up
3. Professional/personal satisfaction –
“I am willing to respond”
WPQ – Motivation and
Reward Scale (MOT)
Pre; 3m f/up
4. Negatively stigmatising views – “It is
worthwhile responding”
WPQ – Personal Views
Scale (PV)
Pre; 3m f/up
5. Perceived usefulness – “I will use
knowledge and skills from training to
respond”
Perceived Outcomes
Scale (POS)
Post
6. Perceived relevance – “Training was
linked to my situation”
Perceived Relevance
Scale (PRS)
Post
Evaluation – Activity & Qualitative Factors
What Activity When
1. Raising the issue Pre; 3m f/up
2. Providing an intervention Pre; 3m f/up
3. Referral Pre; 3m f/up
What Qualitiative When
1. Valuable elements Pre; 3m f/up
2. Improvements Pre; 3m f/up
3. Barriers to implementation Pre; 3m f/up
Post Training – Usefulness/Utility
1
2
3
4
5
Confidence
Skills
Practical
Team Improved
Pers Improved
Constraints
Post Training – Relevance to Role
1
2
3
4
5
Relevant
Appropriate
Further Learning
Consistent
Removed*
Use Skills
Individual Role Adequacy*
1
2
3
4
1. Experience
2. Responded
3. Confident
4. Knowledge
5. Skills*
6. Competent
PRE
F/UP
*Z = 6.263, p = 0; r = .58
Individual Role Legitimacy*
1
2
3
4
1. Legitimate
2. Reluctant*
3. Colleagues*
4. Uncertain*5. Clear
6. Ask
7. Believe
PRE
F/UP
*Z = 4.529, p < .05, r = .42
Motivation and Reward*
1
2
3
4
Prefer Not*
Refer*
Important
PersonalSatisfaction
Rewarding
Satisfied
Like
PRE
F/UP
*Z = 4.098, p < .05, r = .38
Personal Views*
1
2
3
4
Not Interested tochange
Bring OnThemsleves
Avoid
PRE
F/UP
*Z = 3.159, p < .05, r = .29
Overall Standardised Scale Scores (n = 280)
1
2
3
4
Role Adequacy
Role Legitimacy
Motivation
Personal ViewsPRE
F/UP
Activity
1
2
3
4
Raise Intervention Referral
PRE
F/UP
Delivery Format: Same Day or Split Days –
No Difference Split Day (n = 133)
• RA = 18.30
• RL = 22.35
• M/R = 22.47
• PV = 4.73
• Raise = 2.85
• Intervention = 2.63
• Referral = 2.67
• Utility = 28.38
• Relevance = 27.89
• Satisfaction = 4.88
Same Day (n = 147)
• RA = 18.48
• RL = 22.55
• M/R = 22.55
• PV = 4.70
• Raise = 2.94
• Intervention = 2.59
• Referral = 2.74
• Utility = 28.41
• Relevance = 28
• Satisfaction = 4.89
Feedback – What was of most value…
• Facilitation – capacity to deliver relevant
responses
• Information re AOD
• Tools/resources
• Brief intervention strategies (Motivational
Interviewing)
Evaluation: Phase II
• Partnership with University of Queensland
Department of Sociology (Social Sciences)
• Online survey + Interviews with NGO sample
group
• Deeper review to look at did what was intended
happen:
– Effectiveness of training activities in building
capacity
– Did it result in practice change
– How can we maintain effective partnerships
Key Learning #1
• NGO (generalist) sector are willing partners:
- Inherently high Role Legitimacy scores at
baseline. (Shaw et al., 1978)
- Inherently high Motivation and Reward scores at
baseline. (Skinner et al., 2009)
- Thematic analysis results:
- Aware of issues
- Want to step-up – to a point
- Value partnership approach by not imposing cost.
Key Learning #2
• Not ‘Drugs 101:’
- For relevancy, knowledge and skills need to be
directly linked to larger agenda of
workers/organisations (i.e. child & family support,
DV, youth).
- Training needs to be tailored and adapted to
context – needs stakeholder buy-in.
- Facilitation – credible and with level and
experience to adapt ‘on the run.’
Key Learning #3
• In-house workshops RULE:
– Encourage whole team approach (e.g. maximise
support staff like admin to be involved).
– Helps to problem-solve and establish ‘workflow’
when looking to adapt or introduce practice
change.
Key Learning #4
• Not just ‘train and hope:’
– Build in options for ongoing support to increase
internal facilitation capacity.
– We offered post-training whole of agency
mentoring support but found this problematic.
– Option: Gather together time-limited Professional
Learning Circles –key change enthusiasts from
within organisations who you can go deeper with.
Recommendations
• Specialist AOD services to consider supporting
1 or 2 NGO’s they currently work with who do
not have a formal AOD response.
• Engage and ask to understand their needs.
• Provide training (not in-service) with a focus on
understanding motivation/change and helpful
conversations.
• Use experienced staff.
• Look at options for some time-limited post-
training support to further build internal capacity.
References
Addy, D., Shoobridge, J., Roche, A., Watts, S., Skinner, N., Freeman, T. & Pidd, K. (2004). Work practice
questionnaire: A training evaluation measurement tool for the alcohol and other drugs field. National Centre for
Education and Training on Addictions, Flinders University S.A.
Bywood, P. T., Lunnay, B. & Roche, A. M. (2008). Effective dissemination: A systematic review of implementation
strategies in the AOD field. National Centre for Education and Training on Addiction, Adelaide.
Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: a conceptual
framework. Quality in Health Care, 7, 149-158. DOI: 10.1136/qshc.7.3.149.
Logan City Council websitel www.logan.qld.gov.au
Intergovernmental Committee on Drugs (2014). National alcohol and other drug workforce development strategy 2015-
2018. Canberra, ACT.
Shaw S., Cartwright A., Spratley T., Harwin J. Responding to Drinking Problems 1978 London, Croom–Helm
Skinner, N., Roche A., Freeman, T. & McKinnon, A. (2009). Health professionals’ attitudes towards AOD-related work:
Moving the traditional focus from education and training to organizational culture. Drugs: Education, prevention and
policy, 16(3), p. 232-249.