Family inclusive practice in NSW
non government alcohol and
other drugs agencies
September 2011
About NADA
The Network of Alcohol and other Drug Agencies (NADA) is the peak organisation for the
non government drug and alcohol sector in NSW, and is primarily funded through NSW
Health. NADA has approximately 100 members providing drug and alcohol health promotion,
early intervention, treatment, and after-care programs. These organisations are diverse in
their philosophy and approach to drug and alcohol service delivery and structure.
NADA’s goal is ‘to support non government drug and alcohol agencies in NSW to reduce the
drug and alcohol related harm to individuals, families and the community’.
The NADA program consists of sector representation and advocacy, workforce
development, information/data management, governance and management support and a
range of capacity development initiatives. NADA is governed by a Board of Directors
primarily elected from the NADA membership and holds accreditation with the Australian
Council on Health Care Standards (ACHS) until 2014.
Further information about NADA and its programs is available on the NADA website at
www.nada.org.au.
Suggested citation:
Argyle Research, 2011. Family inclusive practice in NSW non government alcohol and other
drug agencies. Sydney: Network of Alcohol and other Drugs Agencies
NADA CONTACT DETAILS
Robert Stirling
Program Manager
Network of Alcohol and other Drug Agencies
PO Box 2345
Strawberry Hills NSW 2012
Ph. (02) 8113 1320
Email. [email protected]
www.nada.org.au
Family and carer inclusive practice in NSW non government
AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and
Alcohol Family and Carer Project
A report for the Network of Alcohol and Other Drug Agencies (NADA)
September 2011
NADA Mental Health and Drug and Alcohol Family and Carer Project: Evaluation
TABLE OF CONTENTS
Table of figures ................................................................................................................................... 2
EXECUTIVE SUMMARY ............................................................................................................................ 3
Recommendations .............................................................................................................................. 5
1
Introduction ................................................................................................................................... 6
1.1
What is family inclusive practice? ........................................................................................... 6
1.2
Methodology........................................................................................................................... 7
2
Tools for change: Toolkit ................................................................................................................ 8
2.1
The Toolkit .............................................................................................................................. 8
2.2
Toolkit: Usage and value by agencies ................................................................................... 11
3
The Bouverie Centre training ....................................................................................................... 14
3.1
Introduction .......................................................................................................................... 14
3.2
Practice development workshops......................................................................................... 14
3.3
Single session work with families.......................................................................................... 15
4
Seeding grants program ............................................................................................................... 17
4.1
Introduction .......................................................................................................................... 17
4.2
Process and accountability ................................................................................................... 17
4.3
What the seeding grants program delivered ........................................................................ 18
4.4
Project challenges ................................................................................................................. 25
5
Conclusion .................................................................................................................................... 30
5.1
Recommendations: ............................................................................................................... 31
ATTACHMENT 1 – Seeding grant summary .......................................................................................... 33
ATTACHMENT 2 – Single Session Work with Families Training Report …………………………………………….35
Table of figures
Table 1: A continuum of family inclusive practice .................................................................................. 6
Table 2: Resources used in developing family inclusive practice: agency responses ........................... 11
Table 3: Usefulness of Toolkit: Rating ................................................................................................... 12
Table 4: Resources: agency intentions.................................................................................................. 13
Table 5: Seeding grants: project outputs .............................................................................................. 18
Table 6: Project partners....................................................................................................................... 22
Table 7: Project sustainability scale ...................................................................................................... 24
Table 8: Project sustainability scoring .................................................................................................. 24
Table 9: Seeding grants: details ............................................................................................................ 33
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EXECUTIVE SUMMARY
Introduction
This report provides an evaluation of the ‘Mental Health and Drug and Alcohol Family and Carer
Project’ (Family and Carer Project) delivered by the Network of Alcohol and other Drug Agencies
(NADA) between June 2009 and May 2011. The project was funded by the Mental Health and Drug
and Alcohol Office (MHDAO), NSW Department of Health.
Four project elements were evaluated:
The development of a resource toolkit: Tools for Change: A new way of working with families
and carers
A seeding grants program: grants to 22 member agencies to further develop family inclusive
practice
Practice development workshops (The Bouverie Centre)
‘Single Session Work with Families’ (SSW) training program (The Bouverie Centre).
The project elements were evaluated utilising reporting and interviews with grant recipients,
feedback from training participants and follow up interviews. Additional input was also drawn from
the findings of a needs analysis concerning family and carer inclusive practice (see Part B of this
Report)1.
The Toolkit
Tools for Change: A new way of working with families and carers was found to be a highly effective
resource in supporting agencies in developing family inclusive practice, especially when combined
with staff training and establishing referral networks. Some minor areas for improvement were
identified if the document is to be republished in a second edition. The main issue in regard to this
resource was that uptake amongst agencies was a bit lower than could be expected. As such, further
promotion of the resource, including the weblinks and examples of how the resource has been used
in practice would be of value.
The seeding grants program
The seeding grants program enabled the development and delivery of a wide range of new services,
agency organisational development and improved staff capacity, with clear benefits to families.
Most agencies were able to use the grants to develop sustainable practices that continued beyond
1
Argyle Research (2011). Family and carer inclusive practice in NSW non government AOD agencies:
Part B: Needs Analysis.
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the grant funding period. Challenges in sustaining projects were mainly associated with smaller
amounts of funding (under $15,000) and in those agencies without organisational support for family
inclusive practice. Specific challenges arose in recruiting to support groups and in sustaining family
worker positions and partnerships.
If further seeding grants are to be provided to the sector, it is recommended that they be a
minimum of $20,000, and that agencies be required to demonstrate the demand for any proposed
service and to develop a plan to sustain the benefits of the grant.
The Bouverie Centre Training (La Trobe University)
NADA provided brokerage to enable members to access Bouverie Centre training, viz: a) one day
practice development workshop, and b) two day Single Session Work with Families (SSW) training,
booster session, and ongoing support in practice development through the Collaborative Inquiry
Group.
The one day workshop served its purpose in contributing to raising awareness of family inclusive
practice and introducing agency staff to practical strategies in working with families. If this type of
training is to be sponsored again it would be worth determining the demand given the level of sector
development that has occurred in relation to family inclusive practice (that is, most agencies are
now aware of the needs of families and the benefits of including families).
The Single Session Work with Families was also very well received. Participants found that the longer
term training and supportive collegial development facilitated a deepening of practice and shared
learning in overcoming barriers to family engagement. There is a demand for more training of this
type in the sector as agencies move to providing more integrated support of families and
involvement of families in client treatment.
Conclusion
Overall, NADA’s ‘Mental Health and Drug and Alcohol Family and Carer Project’, clearly made a
significant contribution to the development of practice, knowledge and resources within agencies,
and in supporting the ongoing shift of the sector to embrace family inclusive practice. Whilst some
modest changes are recommended, the evidence suggests that seeking funding to deliver a ‘second
round project’ would be of substantial value.
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Recommendations
The recommendations that follow are derived from the findings of the Family and Carer Project
Evaluation and the Needs Analysis (Reports Part A and B).
1) Seeding grants – Round 2: that funding for a further round of grants promoting family
inclusive practice be sought – and, if successful, that funding be used specifically for family
inclusive practice initiatives that promote reflective practice, research and sustainable
organisational development.
2) Training funding: that funding for further sponsored training to the sector be sought– in
particular training that develops higher level skills in: working effectively with families, family
therapy and family inclusiveness in client treatment.
3) Partnerships: that agencies be encouraged to investigate partnerships with specialist family
support agencies in order to develop appropriate and sustainable family programs.
4) Resources: that agencies be regularly reminded of the resource: Tools for Change: A new
way of working with families and carers (Toolkit) and provided with short examples of how
the resource has been used in practice.
5) Information sharing: that a conference or workshop is held annually to enable agencies to
share information and knowledge about establishing and accessing family programs, family
therapy, and the effective inclusion of families in client treatment.
6) Research: that research opportunities and partnerships are investigated to assess the impact
of family inclusive practices on families and client outcomes.
7) Factsheets: that the following factsheets be developed and included in resources provided
to agencies about family inclusive practice:
Working with difficult to engage families – guide to effective practice
A summary of academic work and best practice in family inclusivity in the treatment
process
A set of guidelines for establishing structured family support programs
A set of guidelines for engaging a family worker to ensure sustainable best practice.
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1
INTRODUCTION
This evaluation reports on the Mental Health and Drug and Alcohol Family and Carer Project (Family
and Carer Project) delivered by the Network of Alcohol and other Drugs Agencies (NADA) between
June 2009 and May 2011. The project was funded by the Mental Health and Drug and Alcohol Office
(MHDAO), NSW Department of Health.
Specifically, the evaluation includes the four elements in the project:
The development of a resource toolkit: Tools for Change: A new way of working with families
and carers
A seeding grants program: funding to 22 agencies to further develop family inclusive practice
Practice development workshops: delivered by the Bouverie Centre
‘Single Session Work with Families’ (SSW) training program (and ongoing supervision and
collegial development): delivered by the Bouverie Centre.
1.1
What is family inclusive practice?
Levels of family inclusive practice can be understood as being on a continuum2,3 (see Table 1), with
the starting point of simple recognition that clients have a family and other people who are
important to them4. Practice then develops from offering referrals and information directly to family
members, to providing specific support, through to involvement of the family in the client treatment
process and providing therapeutic interventions to family members.
Table 1: A continuum of family inclusive practice
Level 0
Level 1
Level 2
Level 3
Level 4
Level 5
Level 6
No family
inclusive
practice / no
recognition
of the needs
of families.
Development
and provision
of direct
family
support
programs.
Including
family in the
client
therapeutic
process –
e.g.
mediation,
restorative
sessions and
joint therapy.
Intensive
integrated
family
therapy as
integral part
of client
treatment.
Awareness of
the needs of
families /
family
inclusive
practice.
Information
and referral
for families.
Some family
inclusive
practice: e.g.
Assessment
of family at
intake.
A family
policy.
Informal
support.
Adapted from: Copello, A., Templeton, L. & Powell, J. 2009 Adult family member and carers of dependent drug users:
prevalence, social cost, resource savings and treatment responses, UK Drug Policy Commission (UKDPC)
2
Copello, A., Templeton, L. & Powell, J. 2009 Adult family member and carers of dependent drug users:
prevalence, social cost, resource savings and treatment responses, UK Drug Policy Commission (UKDPC)
3
Patterson, J & Clapp, C. 2004 Clinical Treatment Guideline for Alcohol and drug Clinicians No 11: Working with
Families, Turning Point Alcohol and Drug Centre Inc., Victoria.
4
The term ‘family’ is used throughout this report: this should be understood as being a very broad definition of
family and also refer to carers and other people of importance to a client.
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The level to which an agency develops family inclusive practice is dependent on a number of
variables, including the type of service and client groups, along with the attitudes and knowledge of
staff, and access to the necessary training and resources to develop new practices. Some agencies,
for example, aim to fully integrate families into their clinical practice, whilst, for other agencies,
providing referrals to family support services is considered sufficient.
1.2
Methodology
This report utilises a number of data sources. Including:
Document analysis (Tools for Change: A new way of working with families and carers)
Bouverie Centre post training assessments (workshop and SSW training)
Agency reports (seeding grant recipients)
Follow up interviews (seeding grant recipients and SSW participants)
Family and carer agency survey (see Part B of this report)
The needs analysis (see Part B of this report).
These data sources provide information about the processes involved in each of the project
elements, specific outputs and impacts. In addition, the data is used to help identify the challenges
to the effectiveness of each element, and how these might be overcome in the future. Reference is
made to the continuum of family inclusive practice (above) in examining how the various project
elements have helped AOD services and staff develop greater family inclusivity.
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2
TOOLS FOR CHANGE: TOOLKIT
Tools for Change: A new way of working with families and carers (the Toolkit) is a resource kit
designed to assist agencies in developing family inclusive practice. Presented in an A4 durable folder
with CD-ROM, the Toolkit includes reference material, research and practice examples, tools
(including checklists and audit guides) and referral lists. The resource is also readily accessible online
through weblinks both from the NADA site and others.
The Toolkit is aimed at agencies that are at the beginning stages of developing family inclusivity as
well as those who plan to enhance and improve the support they already provide to families.
Appropriately, the Toolkit contains advice specifically for services working with families of clients
with coexisting disorders, but the principles of practice could be used by AOD agencies working with
a wide diversity of clients and families.
2.1
The Toolkit
2.1.1 Content
The Toolkit is divided into 7 sections:
Working towards family inclusive practice
Practice tips
Service models
Working with a diversity of families
Interventions
Service profiles
Resources for families, carers and services.
As it stands, the Toolkit is an excellent resource that has received a very good response from
agencies (see below). The following discussion outlines the content of each section and some minor
suggestions for improvement that could be considered if the Toolkit were to be updated.
Section 1: Working towards family inclusive practice
The first section covers the ‘why’ of family inclusive practice, through reference to some of the key
reasons for family inclusivity and recent research findings about the value involving and supporting
families. Principles and assumptions underlying family inclusive practice are also detailed, so
providing a contextual understanding for the development of practice.
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Comment:
This section is mostly succinct and easy to read, and only one possible difficulty was noted: that the
list of assumptions of family inclusive practice is quite lengthy and detailed. That is, in addition to the
underlying assumptions, the list includes the reasoning for family inclusive practice and the
challenges and impacts on practice. A briefer set of assumptions may of greater value (for example,
5 key ones), especially given the recommendation to include an understanding of the assumptions in
duty statements (see Toolkit p.9).
Section 2: Practice tips
The second section directly addresses the ‘how’ of family inclusive practice in a simple three page
outline of ‘practice tips’ with references to the tools on the CD-ROM.
Comment:
This section is very straightforward and easy to understand: an agency could be developing effective
family inclusive practice using this information within a short time period. It may be useful to include
some additional practice tips (although noting that these issues are covered in the CD-ROM tools
and elsewhere in the Toolkit), for example:
Include questions about family and people important to the client at intake.
‘Not now does not mean not ever’: return to the question of family with clients at regular
intervals
Develop a list of referral agencies / information pack that can be sent to families.
Section 3: Service models
This section discusses four models of service, presenting snapshots of distinct theoretical models
that can be used to guide family inclusive practice, particularly therapeutic practices, providing brief
details and examples of practice.
Comment:
The described service models are primarily of application at the more involved end of the family
inclusive spectrum, that is, when families are provided with therapeutic interventions or are
included as part of the client’s therapy. It is clearly of value to show these examples given the
diversity of approaches and philosophies within the sector, however, it may also be worth
emphasising that most family inclusive practice can occur independently of any particular theoretical
or philosophical model: for example, as demonstrated in the ‘Interventions’ section of the Toolkit.
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Section 4: Working with a diversity of families
This section covers the issues that can arise when working with families from diverse backgrounds,
including:
Families of young people
Aboriginal families
Families of people of diverse sexuality
Culturally and linguistically diverse (CALD) families
Children of clients
The aim is to assist staff in understanding the different needs of diverse families, and this section
provides useful insights in working effectively with these families and referral sources. Each sub
section was contributed by staff from agencies who work directly with families of each background.
Comment:
Given the diversity of families of clients using alcohol and drug services this information is both
necessary and highly useful. Having contributions from those with direct experience working with
diverse families also gives a high level credibility.
Section 5: Interventions
This section provides an outline of 12 interventions as developed by the Turning Point Drug and
Alcohol centre. These interventions range across the continuum of family inclusive practice and the
information provides a brief snapshot of what is involved in each. Where appropriate, references are
made to the Toolkit CD-ROM to assist in developing a particular intervention.
Comment:
The list of interventions is of high practical value. Agency staff are presented with a wide range of
options that they could choose to investigate and practical means of implementing some of the
interventions. What could be helpful is to clarify some of the common challenges that occur around
interventions, for example, establishing support groups will only work if sufficient family members
are interested and continue participating.
Section 6: Service profiles
Profiles are presented for 7 programs/groups of programs (6 run by NSW NGO alcohol and drug
services and 1 by NSW Department of Health). These profiles give information about the practical
and philosophical approach different agencies have taken to supporting families.
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Comment:
The information clearly illustrates the many different ways that families can be supported and that
agencies can develop ‘their own pathways’. It also provides information about programs that could
be used for referrals by agencies that do not have the capacity to develop comprehensive family
support services.
Section 7: Resources for families, carers and services
This final section provides a referral list, including specialist agencies, websites and written material.
Comment:
A comprehensive list of referrals; updating will be appropriate at some point.
2.2
Toolkit: Usage and value by agencies
2.2.1 Current use of the Toolkit
Agencies were asked about what resources they had used in developing family inclusive practice
(see report Part B). The most commonly used resource was the Toolkit, with half of agencies having
consulted this resource, just above ‘general web resources’ and ‘professional advice – other source’
(see Table 2).
Table 2: Resources used in developing family inclusive practice: agency responses
Resource
No.
NADA: Tools for Change: A new way of working with family and carers
Toolkit
25
%
51%
General web resources
24
49%
Professional advice - other source
21
43%
Academic literature on working with families
20
41%
Family Drug Support - web resources
16
33%
Family Drug Support - professional advice
13
27%
Government health or welfare department resources
Family Drug Help - web resources
12
10
24%
20%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
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Agencies who had used the Toolkit were also asked to rate it by level of usefulness. The Toolkit was
found to be very useful or useful by 80% of these agencies.
Table 3: Usefulness of Toolkit: Rating
Rating
%
Very useful
48%
Useful
32%
Somewhat
useful
20%
Not useful
0%
n=25 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
Some additional comments were also made attesting to the usefulness of the Toolkit, for example:
“It is very nicely presented, we have certainly made reference to it as there has been lots of cross over
with what we have been doing.”
“We refer to it all the time – it has been really helpful, - and the CD-ROM.”
Links to the Toolkit have also been made by a wide range of international and national agencies
including:
Australian Drug Foundation
Alcohol Concern (UK)
NSW Health
Eastern Health Victoria
Victorian Alcohol and Drug Association (VAADA)
Alcohol Tobacco and Other Drugs Council, Tasmania (ATDC)
Family Drug Support, Australia
Odyssey House Victoria
Dualdiagnosis.org
Eastern Drug & Alcohol Service (EDAS): Family Focus Toolkit
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2.2.2 Toolkit: Future intentions
Agencies were also asked about their future intentions in relation to resources that support family
inclusive practice. The Toolkit was the most commonly selected resource, with 65% of agencies
indicating they intended to make reference to it (Table 4).
Table 4: Resources: agency intentions
Resource
NADA: Tools for Change: A new way of working with family and carers
toolkit
Family Drug Support - web resources
Professional advice - other source
Academic literature on working with families
General web resources
In house resources
Family Drug Support - professional advice
Government health or welfare department resources
Family Drug Help - web resources
None
No.
%
32
24
22
21
21
20
20
19
14
0
65%
49%
45%
43%
43%
41%
41%
39%
29%
0%
n=48 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
The intentions to use the resource were also borne out by agency comments, for example:
“I’ve certainly seen it, it’s here on the shelf – and we intend to look at it”.
Given the high level of agencies planning to use the resource it may be of value to remind NADA
members at regular intervals of the resource and its utility in developing family inclusive practice.
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3
3.1
THE BOUVERIE CENTRE TRAINING
Introduction
The Bouverie Centre is a public institute based at La Trobe University, Victoria. It provides training in
family inclusive practice to staff in human services’ agencies. NADA provided brokerage funding to
facilitate the delivery of Bouverie Centre training to staff of NADA member agencies. The training
included:
Practice development workshops
‘Single Session Work with Families’ (SSW) training program (including booster session and
ongoing supervision and collegial development).
3.2
Practice development workshops
3.2.1 Workshop: brief details
This workshop provided introductory training in family inclusive practice. Its purpose was to raise
awareness of the need for family inclusive practice and to provide networking opportunities and
strategies for agencies. Three workshops were held, involving 64 participants.
3.2.2 Workshop: impact
The workshop received generally very positive feedback5, with most participants agreeing it was
useful workshop for their practice; particularly valued was the inclusion of the direct experiences of
family members. Critical feedback was minor and mostly related to the workshop not being of
sufficient depth, however, this may have been an inevitable result from some participants being
beyond an introductory level of awareness and development.
In terms of impact on family inclusive practice within individual agencies or across the sector, a one
day workshop cannot, in itself, be expected to create substantial change. Rather, the function of this
type of workshop is to raise awareness and get staff thinking about strategies they could their use in
their agency. For those agencies already developing family inclusive practice, a workshop of this
nature can assist in gaining support for further organisational development (and perhaps persuade
those who have been reluctant to embrace family inclusivity). Overall, an introductory workshop is
useful for a sector beginning to embrace family inclusive practice. However, over time, as family
5
NADA (2010) Working with families and carers. The Bouverie Centre Workshop. Feedback Report.
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inclusive practice becomes embedded within agencies and within AOD qualifications (e.g. in the
Certificate IV AOD), there would appear to be less need for introductory workshops, and a greater
demand for training that supports the development of therapeutic practices with families.
3.3
Single session work with families
3.3.1 SSW: brief details
Single session work refers to a therapeutic approach that attempts to maximise the value of a single
session: ‘treating each contact as if it may be the last, while laying the foundation for ongoing work if
required’6. The approach is based on the reality that most clients attend only one counseling session,
therefore counselors need to make the most of the first session as if there may not be another7.
The NADA brokerage of training in Single Session Work with Families aimed to:
Increase awareness of family inclusive practice
Improve knowledge, skills and confidence to engage with clients and their families
Improve skills in effectively managing challenges in working with families, including dealing
with family conflict
Assist in developing sustainable organisational structures and processes to support family
work.
The training was provided over two days to 23 AOD workers from 7 NADA member agencies. A
further booster workshop was also provided to participants. In addition, participation was required
in Cooperative Inquiry Group (CIG) meetings. The CIGs were facilitated by a Bouverie trainer; it
aimed to support reflective practice and enable information sharing between agencies, so providing
opportunities to work through challenges in implementing family inclusive practice and working
directly with families. Furthermore, a web and CD-Rom resource is currently being developed as a
result of the training and will be available in 2012 to NADA members and the broader AOD sector.
6
The Bouverie Centre (2008) The implementation of single session work in community health. The Bouverie
Centre, Victoria’s Family Institute: La Trobe University.
7
Ibid.
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3.3.2 SSW: Impact
The post workshop evaluation conducted by The Bouverie Centre demonstrated a very positive
response from participants8; nearly all had found the information and learning very beneficial in
developing family inclusive practice.
In addition, excellent feedback concerning the value of the SSW was received as part of the Needs
Analysis (see Report Part B) and from interviews with individual participants. It was felt that the
longer workshop and the CIG supported the comprehensive development of family inclusive practice
and integration of families into the therapeutic process. Specifically, the following observations were
made:
The model was very powerful and efficient: ‘uses the time really well’.
The model provides another option for working with families.
The model can provide the basis for restorative work, for example, after a client has been in
treatment for some months, it provides a framework for ‘bringing the family in’.
When families are generally from outside the area (as is often the case for regional and rural
based services), the SSW model can work particular well for families when they visit. It is
also possible to use the model with internet technologies (e.g. Skype).
“The training provided ideas and resources on engaging families who were reluctant to
participate.”
“The CIG was very useful in sharing knowledge between agencies as to what worked and
what didn’t. It also provided a safe space to reflect on practice changes and the momentum
to keep developing.”
Aside from the positive feedback, some agency staff did report that the SSW, as it stands, was not
entirely suitable for their client groups. For example a manager of an Aboriginal service noted that
the model did not suit the Aboriginal families with whom they worked: “there is often more than one
identified client and a large extended family network and low literacy levels. Our staff couldn’t work
out how to implement it easily within our program.”
However, generally it was felt that the model could be adapted to be more effective with families
from diverse backgrounds.
Overall, the SSW training has made a good contribution to the development of knowledge and skills
development of participants, and it is definitely training from which managers and workers in the
sector could continue to benefit.
For more information see Attachment 2: Single Session Work with Families Training Report
8
NADA (2011) Single Session Work with Families Training Feedback. Groups 1 & 2.
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4
4.1
SEEDING GRANTS PROGRAM
Introduction
The seeding grants program formed a central part of the NADA Family and Carer project, through
the provision of direct grants to twenty two (22) NADA member agencies to assist in the
development of family inclusive practice. The seeding grants funded a variety of projects ranging
from those on a smaller scale, such as family open days or workshops, through to the development
of comprehensive family support programs. Grants ranged from approximately $5000 to $40,000,
with seven agencies receiving the largest grant available; the total grants pool was approximately
$520,000 (a full summary of the projects is at Attachment 1)
4.2
Process and accountability
In terms of accountability, it is important to assess whether the funding was distributed and spent as
intended, and whether acquittal and reporting requirements of individual agencies were met.
Reports indicated that the assessment and distribution of grant monies was appropriate and
efficient. Project applications were assessed by an independent panel, and funding allocated on the
basis of meeting the program criteria. No problems were reported by individual agencies in
accessing the grant funds.
In terms of reporting and acquittal of funds, the great majority of agencies fulfilled their obligations
in a timely manner. Most of the projects that had experienced delays or difficulties submitted
interim reports, then later provided full reports. Only three agencies did not report adequately on
their projects. However these agencies were followed up verbally and further information was
received.
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4.3
What the seeding grants program delivered
The aim of seeding grants is, as the name suggests, to initiate new development. Ideally too, new
development is sustainable beyond the term of the seeding grant rather than simply ending when
the money does. At their best, seeding grants initiate new practices that continue to develop over
time and foster other positive changes.
This section examines how the grants helped agencies develop new practices and whether these
have been sustained over time, specifically examining the projects in terms of:
Outputs: new services
Impact on family and carers
Organisational change and development
Partnerships
Family workers
Sustainability of projects and changes in practice
Comorbidity issues
4.3.1 Outputs: new services
Project outputs refer to the base achievements of projects without qualitative assessment, so
providing a basic quantitative measure. A wide range of outputs were achieved by the seeding
grants projects, including setting up support groups, policy reviews and establishing comprehensive
family programs; these are summarised at Table 5.
What this output summary demonstrates is that a wide range of new family inclusive activities were
generated by the Seeding Grants program.
Table 5: Seeding grants: project outputs
Activity
No.
Family day
3
Family program
7
Information pack
4
Policy/practice development
8
Resource
5
Specialist family worker*
8
Support group/workshop
11
Travel/accomm. for family
2
Source: NADA Seeding grant agency self reports
*Including specialist consultants and psychology interns
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4.3.2 Improved services to families and carers
One of the main outcomes of the seeding grants program was to improve the support to family
members in order to meet their needs, for example, through providing services to help families cope
better and improve family functioning. The feedback data provided by agencies showed that families
were provided with additional supports across a range of domains, and that this support had a range
of positive impacts and was highly valued by family members. Although it should be noted that
without baseline and follow up data for individual agency projects it is not possible to precisely
measure how levels of support increased or the impacts on families9. These limitations aside, the
domains in which improved support was reported and the observed positive impacts, included:
Increased access to services
o Counseling
o Family support
o Family welfare services
Information and referral
o Information packs and referrals provided at client intake
o More appropriate information for diverse families
Education and awareness:
o Awareness of drugs and drug effects and related harms
o Better understanding of the addiction/dependency and recovery process (including
in relation to dual diagnosis)
Peer support
o Access to supportive groups of other family members affected by substance misuse
o Development of peer networks
Mental health
o Less anxiety, depression, isolation and confusion
Family functioning
o Families beginning the healing process
o Reconnecting with families/ clients returning to their families post treatment
o Improved communication and boundary setting
o Support for the family member during treatment – ‘being on the same team’
Parenting
o Improved self care
o Parents developing their capacity and skills to cope and care for their children
o Parents regaining access to their children/ having improved access to their children
9
In addition, the agencies that did evaluate the impact on families of their projects, generally found that the
number of people involved and the length of time precluded meaningful results at this point.
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The following comments attest to the value of the family and carer support offered through the
projects:
“The creation of a group is a brilliant concept, its therapeutic fulfilment has rippling effect on the
entire household, including parents, children, brothers and sisters, including extended family
members.” (Family member quote)
“All respondents reported relief at having a person available to support them and listen to their
worries and anxieties about their loved one.”
“…family members indicated that targeted interventions that assist them in their struggles would in
turn assist in their efforts of supporting their loved ones.”
“It is better for the clients, their family knows what to expect – and for example that they do need to
be attending certain sessions.”
“It has been our experience that family members have been very enthusiastic in travelling for the
initial information group. Once they have attended on site, met the FASO10 worker, had many
questions answered, then they generally are incredibly enthusiastic to return and engage in the next
level of FASO treatment provided.”
“Another benefit was seeing participants spend quality time with their children having fun doing
things like pony rides, jumping castle, face painting and treasure hunts. The children left with great
memories of the day and knew that mummy was safe.”
4.3.3 Organisational change and development
Organisational change and development is potentially one of the most important contributors to
sustainable change in family inclusive practice11. Changes in agency culture and organisational
policies and processes can make a particularly significant contribution given that these changes are
generally sustainable across staff and funding changes.
The seeding grants program instigated significant change in the practices of AOD treatment services
in relation to family and carer inclusive practice, with 17 agencies making some change to practice in
conjunction or in addition to their seeding grant project (see section below: sustainability).
Traditionally, most AOD agencies have not provided support to client families, nor necessarily
understood why or how they should do so (see Report Part B); there has been little critical reflection
on practice in relation to families. The grants program was embraced as an opportunity by most
recipient agencies to examine the needs of families and carers and how they could be supported.
10
Family and Significant Other
Argyle Research (2011). Family and carer inclusive practice in NSW non government AOD agencies: Part B:
Needs Analysis.
11
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One agency manager commented, for example:
“Had it not been for this grant we would have floundered on for some matter of time thinking we
were doing what was best.”
Specific changes in agency practice associated with the seeding grants included:
Providing information to families
Developing referral processes
Including family related questions at client intake
Being receptive to family contact and questions
Developing a family and carer policy
Providing support to families as part of core services
Providing a specific family worker
Including families in client treatment
These changes to practice are reflected in part in the findings of Part B of this report: Needs
Analysis12. 16 grant recipients completed the survey, and, of these, all except one had undertaken
organisational development in relation to family inclusive practice (the one exception being an
agency who considered themselves already sufficiently family inclusive). This compares with 48% of
the other respondents (non grant recipients) who had undertaken organisational development.
In relation to organisational development, some relevant comments included:
“It became very clear that we had not taken into account our family and carers wellbeing, and that
our service fell short in supporting them, our focus had primarily been the client, and providing
mediation, education etc with families, whilst these elements are an important aspect of working
with this group, our approach now is a more comprehensive holistic approach.”
“We have been able to assist family members in setting boundaries.”
“Awareness was raised amongst programs and staff teams of how important to the client’s
treatment and long term outcomes it can be to involve families and carers when appropriate.”
“With the mental health nurses’ participation in this project there is an increased awareness of
carer/family issues for those with co-occurring mental health/drug & alcohol problems for him.”
“It was discovered that at the conclusion of a client’s treatment the families still had so many
unanswered questions that would be best dealt with in the very early stages of the client’s
treatment.”
12
Argyle Research (2011). Developing Family and carer inclusive practice in NSW non government AOD
agencies: Part B: Needs Analysis.
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4.3.4 Partnerships
Partnerships can be a key element in developing family inclusive practice, potentially enabling an
AOD agency to draw on the expertise of another agency in developing family programs, counseling
and referral pathways. Developing new partnerships in order to improve services to families and
carers was a reported outcome for most of the projects.
The types of partnerships ranged from informal information and referral sharing arrangements
through to high level collaborative efforts. Agencies that were partnered with included family
support services (most commonly, Family Drug Support) and AOD, health and social support
agencies (see Table 6, below).
Table 6: Project partners
Partner agencies
Alcohol Drug Information
Service (ADIS)
Headspace Illawarra
ARAFMI
Holyoake WA;
Blackdog Institute
Illawarra Institute for Mental
Health
Relationships Australia
Jewish House
Richmond Fellowship NSW
Juvenile Justice
Salvation Army Coffs Harbour
Kedesh Rehabilitation Services
Schizophrenia Fellowship
Manly Drug Education and
Counseling Centre
Mental Health Outpatient Service
Mercy Community Services
MH Carers NSW
Mission Australia
National Cannabis Prevention and
Information Centre (NCPIC)
National Drug and Alcohol
Research Centre (NDARC)
Shoalhaven Drug and Alcohol
Service
South West Youth Service
Sydney Clinic
Ted Noffs Foundation
The Fact Tree Youth Service
Department of Community
Services, NSW (DoCS)
Neami
12 Step Fellowship Narc-Anon
Family Drug Support
Northern Sydney Central Coast
Health (NSCCAHS)
WASH House (Women’s
Activities Self Help)
Glen Mervyn Young
Women’s Program
NSW Department of Health
Brookvale Early Intervention
Clinic
Calvary Alcohol and other
drug services
Campbelltown Forum
Sentencing
Carer Assist
Carers NSW
Catholic Community services
Centrelink
Community Members
Community Resource
Network.
Directions ACT
Source: NADA Seeding grant agency self reports
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PFLAG (Parents, Families and
Friends of Lesbians and Gays)
Probation and Parole Service,
NSW
The Sanctuary
12 Step Fellowship Al-Anon
NADA Mental Health and Drug and Alcohol Family and Carer Project: Evaluation
The outcomes of these partnerships were viewed positively. From the perspective of the funded
agencies, partners provided:
Specialist information
Access to training
Shared training opportunities
Assistance in developing resources
Referral pathways (e.g. counseling)
Project collaborators
Partners for other family work.
The partnerships were also seen as helping provide better outcomes for families and clients in terms
of improved service delivery and access, and more cohesive support. Some of these partnerships
were sustained beyond the life of the project, whereas others fulfilled their purpose during the
course of the project.
Family Drug Support – a key partner agency
Family Drug Support (FDS) is an agency that has been funded to build the capacity of treatment
services to work more effectively with families and carers, through its Bridging the Divide program.
Nine agencies utilised FDS training, information or support to assist in the development of their
project. Several agencies reported that the FDS input and training was particularly useful and
beneficial in the systematic development of family inclusive processes and in training of staff in
running family programs and support groups.
4.3.5 Family workers
Eight of the projects engaged a family worker or family specialist, either in the capacity of a project
worker, family counselor, intern psychologist, or external consultant. The reported benefits that
these family specialists brought agencies included:
Organising distribution of information to families
A focal referral person for clinical staff
Providing family counseling
Running group sessions
Building partnerships that support families
Reviewing family inclusive practice in the organisation
Developing processes that ensure family inclusive practice across the organisation
Agencies indicated in interviews that having a dedicated family worker is greatly beneficial in
developing and continuing family inclusive practice, even if employed for very limited hours. These
workers provide a contact point for family members and also for clinical staff for referrals. Also,
highly valued were family specialists who were brought in to help develop clearly defined family
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programs and therapeutic interventions; the seeding grant enabled the agency to utilise specific
expertise to develop a program that was then ongoing.
The main difficulty that arose with engaging a family worker utilising seed funding was that of
maintaining the position beyond the initial funding – this issue is discussed below in ‘Project
challenges’.
4.3.6 Project sustainability
As noted above, a key outcome of a successful seeding grants program is project sustainability. In
order to provide some a measure of project sustainability a simple 4 point scale was developed
(Table 7). This scale was used to measure project outcomes and ongoing development of family
inclusive practice.
Table 7: Project sustainability scale
No.
Description
0
1
2
3
Project unsuccessful
One off project – ended with the grant funding; no or very minor changes
in practice as a consequence of the project,
Project continued and/or formed part of shifts into further family inclusive
practice
A substantial range of other family inclusive practices and partnership
were developed as a result / in conjunction with the grant project
Self reports and follow up interviews were used to score each grant recipient on the scale (Table 8).
Whilst acknowledging these ratings are only ‘estimates based on self report’, they do indicate that
the great majority (17, or approximately 80%) of grant recipients did successfully implement their
project and develop other family inclusive practices. It should also be noted that 10 agencies now
have very integrated family inclusive practices including referral and support services, and, in many
instances, family programs and clearly structured means of including families in treatment. These
agencies can now clearly be seen as offering services to ‘clients and their families’.
Table 8: Project sustainability scoring
Score
Agencies
0
1
1
4
2
7
3
10
TOTAL
22
Source: NADA Seeding grant agency self reports / follow up interviews / agency web sites
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The high level of development can be understood as being in part a consequence of receiving a
seeding grant, but also, importantly that the grant was received by a receptive agency who were
committed to ensuring project sustainability and to developing integrated family inclusive practice.
4.3.7 Comorbidity element
The issue of ‘comorbidity’ is important to address, given that the terms of reference for the NADA
Family and Carers project, including the seeding grants component, was aimed at improving support
to ‘families of clients experiencing comorbidity disorders’.
Some of the seeing grants did specifically aim to improve family inclusivity in relation to families of
this client group (for example, Holyoake’s program, MDECC’s support groups and Kedesh – who are
a specialist facility for comorbidity) – but, overall, most of the grant recipients developed their family
inclusive practice to be inclusive of families of all client groups.
The more general focus should be taken in view of the following:
Between 55% and 75% of clients of drug and alcohol services are likely to be suffering both a
substance use and mental health disorder13.
Most family support programs or family inclusive organisational development cannot be
operationalised to distinguish between the support offered to families on the basis of client
profile.
In this sense a general family program will include both families of those experiencing comorbidity
disorders and those of clients with ‘solely a drug issue’, to the benefit of all families. This outcome
should be seen as a success for the seeding grants program in meeting its aims, with additional
beneficial outcomes.
4.4
Project challenges
Agencies were invited to comment on any challenges that they had experienced during the projects.
Details of these challenges and how they were able to be overcome provides useful information for
future grant recipients and those planning similar projects.
The needs analysis also identified a range of barriers to developing family inclusive practice14 . In
general, similar issues were noted in this evaluation, for example, engaging with families and
13
Teeson, M. and Proudfoot, H. (eds.) (2003). Comorbid Mental Health Disorders and Substance Use Disorders:
Epidemiology, Prevention and Treatment, National Drug and Alcohol Research Centre, University of New South
Wales, Sydney, Department of Health and Ageing: Canberra.
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limitations on funding, although some issues were clearly an artifact of being seeding grants
projects, for example, project funding ending and sustainability. The main barriers to projects were
in the following areas:
Engaging with families
Staff issues
Sustainability/Funding
4.4.1 Engaging with families
Engaging with challenging families is a key issue for family inclusive practice: simply, if a family is not
interested in being involved or supported then it is difficult to include them. Some of the ways in
which difficult to engage families can be encouraged to become involved are discussed in Part B of
this report. For the seeding grants program, the key engagement challenge was attendance at
support groups and workshops.
Some groups were not able to engage any attendees despite intensive promotion of the groups.
Others had very small numbers or found that people dropped out. Agencies in regional areas
particularly struggle as so many of their clients and families are from out of area. Comments
regarding involving families included:
“The response to the establishment of this group was poor. A total of 5 phone calls were directed to
the Coordinator from concerned parents. 2 calls were alcohol related and 3 were drug related. The
discussions lasted from 20 minutes to half an hour and all callers said they would attend meetings
but didn’t.”
“It was surprising that after the initial strong interest from local families and carers that there were
no families or carers expressing an interest in the second family group.”
Some agencies were simply unable to overcome difficulties in engaging families to attend groups.
However, successful means of encouraging participation in support groups (both during and outside
the funding period) included further promotion of the group, outsourcing support groups to other
agencies, and, in one instance, changing the location to another town led to a very successful well
attended group.
The lesson arising from agencies running support groups / family workshops in the seeding grants
program is that they can be highly effective and well attended, but this is not going to be the
experience of all agencies. As such, it would be suggested that if this type of activity is to be funded
that the demand for such a group be established in the first instance. In addition, it may be worth
14
Argyle Research (2011). Family and carer inclusive practice in NSW non government AOD agencies: Part B:
Needs Analysis.
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reminding agencies that family support can be outsourced, with FDS, Holyoake, DAMEC and
SmartRecovery all providing support groups.
4.4.2 Staff issues
A number of agencies reported that it was difficult to engage clinical staff in embracing family
inclusive practice. This difficulty occurred in some instances despite the service making significant
developments in family inclusivity: clinical staff can still feel too time pressured and/or that family
work is not particularly relevant to their work. Engaging with family inclusive practice can
particularly be an issue for long term clinical staff who cannot see any impetus to involve families, as
reflected in these comments:
“Staff members can be judgmental – so we need to show it can be beneficial and that all they need to
do is be respectful of inclusive links with families.”
“Challenges of the project have included engaging all staff and influencing the culture of programs to
embrace family exclusive practice. Different beliefs and values of individual staff in their
understanding of what involving and responding to families and carers means has been a challenge.”
“Working holistically with families and carers is a new practice within the organisation and
Therapeutic Community as a result of the project and it will take time to become part of the culture
of the organisation.”
For many agencies a degree of staff resistance to family inclusive practice is probably to be
expected, for example, this barrier was also observed as being relatively common in the needs
analysis, especially in relation to insufficient staff time (see Report Part B). It was suggested in this
analysis that staff attitudes to family inclusivity are likely to change over time, especially when the
benefits to clients of providing family therapy and including families in treatment processes can be
made apparent to staff, and also, where a family worker can provide direct support to client families.
4.4.3 Sustainability/Funding
Project sustainability is a key outcome of seeding grants, where projects and changes in practice
continue beyond initial funding (see above). Whilst most agencies did manage to implement
sustainable change, a number of issues did arise that challenged sustainability, including:
Engaging a family worker
Sustaining partnerships
Small grants
Family workers
Family workers and family specialists can clearly be highly valuable to agencies in implementing
family inclusive practice and delivering services to families. The main problem that arose in relation
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to these workers was how to continue to deliver the services provided by that worker beyond the
end of the funding period.
Feedback from agencies shows that engaging a family specialist can be part of sustainable practice
but in order to be so a degree of pre planning would be helpful (although recognising that some
agencies may only learn the value of a family worker once they have one). Ideally, if an agency is to
seek funding for a family worker position there is also in place a mechanism to ensure that services
are not disrupted. Some of the ways agencies ensured sustainability included:
Allocating family work to another position
Using the family worker/specialist for a clearly defined project that was completed in the
funding period
Reclassifying existing funding or obtaining further funding for the position
Outsourcing direct services (support groups, counseling) to family support agencies, whilst
establishing clear referral pathways with intake and clinical staff.
Small grants
Eight of the grants were $15,000 or under. While all these grants were acquitted properly by
agencies, questions do arise as to the degree to which smaller grants can contribute to a sustainable
change in practice: for example:
“This project provided funding for a small amount of funds and for only one year. Just as the groups
became successful, the project has finished. A larger amount and longer term funding would be much
more beneficial.”
Mostly the small grants were spent on ‘one off’ type events like family days, supported
accommodation / travel, or support groups that ran for limited weeks. Some smaller grant recipients
did develop higher levels of family inclusive practice, but this was largely due to their own
momentum and commitment rather than the grant itself; the grant provided little capacity for
critical reflection, adjustment of processes and sustainability planning. Issues also arose due to
project challenges (such as support group attendance), as the limited funding reduced the
opportunities for overcoming these barriers.
Sustainable partnerships
The sustainability of partnerships beyond the funding period was another issue that arose. Agencies
were all encouraged to develop partnerships, but some found that these relationships could not be
sustained. For example:
“…the developed partnership will more than likely deteriorate after much effort to initially establish.”
Specifically, partnerships were difficult to sustain where:
they were developed for a specific project that then ended without any plan for ongoing
collaboration
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where an agency was concerned that referring clients to an external partner would impinge
on their own opportunities for further funding.
In some instances short term partnerships are completely appropriate, however, examining whether
and how a partnership is to be sustained are certainly issues that agencies could consider prior to
establishing connections.
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5
CONCLUSION
The NADA Family and Carers Project provided financial assistance, training and resources to support
the development of family inclusive practice in the NSW non government alcohol and drug sector.
Overall, the program clearly made a significant contribution to the development of practice,
knowledge and resources within agencies, and in supporting the ongoing shift of the sector to
embrace family inclusive practice. Whilst some moderate changes are recommended, the evidence
suggests that seeking funding to deliver a ‘second round project’ would be of substantial value.
All the elements of the Family and Carer Project supported the development of family inclusive
practice. These are briefly summarised along with various recommendations that could improve
delivery, if a second round were to be funded.
The Toolkit
Tools for Change: A new way of working with families and carers is a highly effective resource in
supporting agencies in developing family inclusive practice, especially when combined with staff
training and establishing referral networks. If the document were to be republished in a second
edition then some minor refinements could be made (as above). The main issue is that uptake
amongst agencies is a little lower than could be expected. As such, further promotion of the
resource, including the weblinks and examples of how the resource had been used in practice would
be of value.
The Bouverie Training
NADA sponsored the Bouverie Centre in the delivery of two types of training: a one day practice
development workshop and a two day Single Session Work with Families (SSW) training, with
ongoing support in practice development through Collaborative Inquiry Groups.
The one day training served its purpose in contributing to raising awareness of family inclusive
practice and introducing agency staff to practical strategies. If this type of training is to be sponsored
again it would be worth determining the demand given the level of sector development that has
occurred in relation to family inclusive practice (that is, most agencies are now aware of the needs of
families and the benefits of including families).
The SSW training was found to be very useful by most participants, with the ongoing Cooperative
Inquiry Groups being of particular utility in deepening practice and skill development in overcoming
challenges. There is definitely further demand for this type of training, particularly as it supports the
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development of family inclusive practice at the higher end of the spectrum: the key area requiring
further training and support.
The seeding grants program
The seeding grants program enabled the development and delivery of a wide range of new services,
organisational development and improved staff capacity. Most agencies were able to use the grants
to develop sustainable practices that continued beyond the grant funding period. Challenges in
sustaining projects were mainly associated with smaller amounts of funding (under $15,000) and in
those agencies without organisational support for family inclusive practice. Specific challenges arose
in recruiting to support groups and in sustaining positions and partnerships.
If further seeding grants are to be provided to the sector, it is recommended that they be a
minimum of $20,000 and that agencies demonstrate the demand for any proposed service and
develop a plan to sustain the benefits of the grant.
5.1
Recommendations:
The recommendations that follow are derived from the findings of the Family and Carer Project
Evaluation and the Needs Analysis (Reports Part A and B)
1) Seeding grants – Round 2: that funding for a further round of grants promoting family
inclusive practice be sought – and, if successful, that funding be used specifically for family
inclusive practice initiatives that promote reflective practice, research and sustainable
organisational development.
2) Training funding: that funding for further sponsored training to the sector be sought– in
particular training that develops higher level skills in: working effectively with families, family
therapy and family inclusiveness in client treatment.
3) Partnerships: that agencies be encouraged to investigate partnerships with specialist family
support agencies in order to develop appropriate and sustainable family programs.
4) Resources: that agencies be regularly reminded of the resource: Tools for Change: A new
way of working with families and carers (Toolkit) and provided with short examples of how
the resource has been used in practice.
5) Information sharing: that a conference or workshop is held annually to enable agencies to
share information and knowledge about establishing and accessing family programs, family
therapy, and the effective inclusion of families in client treatment.
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6) Research: that research opportunities and partnerships are investigated to assess the impact
of family inclusive practices on families and client outcomes.
7) Factsheets: that the following factsheets be developed and included in resources provided
to agencies about family inclusive practice:
Working with difficult to engage families – guide to effective practice
A summary of academic work and best practice in family inclusivity in the treatment
process.
A set of guidelines for establishing structured family support programs
A set of guidelines for engaging a family worker to ensure sustainable best practice.
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ATTACHMENT 1 – SEEDING GRANT SUMMARY
Table 9: Seeding grants: details
Grant
Type of
Agency
Amount* activity
GLBT specific
ACON
$27,000
resources
Information
and
Adele
$7,600
reconnection
sessions
Develop
family
AdFact
$40,000
support
network
Support
Bridges
$15,000
groups
Family
Buttery
$12,100
Support
program
Family and
Freeman
$10,000
carer support
Family
Holyoake
$40,000
support
program
Family and
carers
Kamira
$28,500
support
program
Kathleen
Capacity
$10,000
York House
building
Research
Kedesh
$23,000
project
Family and
MDECC
$40,000
carer
program
Family
Odyssey
$20,000
support
House
sessions
Family
Oolong
$10,000
Support
Partnership
Peppers
$40,000
and capacity
building
Salvation
$5,000
Family days
Army
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Key activities
Research, develop and distribute resources: 500 Worker
resource/ 5000 Family resource
Family and carer week, providing information sessions
Engage family support worker - establish links to Family Support
agencies, support group, education materials, counselling, one on
one support, visiting programs
Training, support groups, partnership development
Therapeutic intervention, information, web resources, referral,
staff training, policy development
Support group, travel and accommodation support, staff training
Program development, children's program, parents program,
staff training,
Family worker, review of practice and procedures, policy
development, training
Partnerships, information, policy development
Psychological and emotional impact assessment on families
Recruited facilitator, developed day program, partnerships,
review of existing programs
Family group sessions
Travel and accommodation support, family day
Training, dual diagnosis training, referral, counselling, carer
resources, education/support groups, partnership development
Family open days, information, referral to support
NADA Mental Health and Drug and Alcohol Family and Carer Project: Evaluation
Smart
Recovery
$20,000
Existing
program
enhancement
Psychologist (one day/week), resources, training, support group,
facilitator manual
South
Sydney
Youth
Services
$23,000
Young
mothers
program
Support group, staff training, peer review sessions, childcare
Ted Noffs
$43,900
Foundation
Triple Care
Farm
$40,000
WAYS
$6,600
WHOS
Hunter
$20,000
Youth off
the Streets
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$40,000
Argyle Research
Mental
health
promotion
Family
Support
program
Workshops in
schools
Family
Support
Worker
Family
Support
Counselling, group work, building support networks
Resources (family pack), staff training, psychoeducation sessions,
open day, family activities, information sessions, policy
development
Workshops to assist parents and young people address drug and
alcohol concerns
Case management, support and advocacy, referral to FDS
Family support worker: counselling (formal and informal),
support calls, court support, supervised family engagement, staff
training, policy development
Single Session Work with Families Training
Report
Prepared for
NADA Network of Alcohol and Other Drug Agencies
Prepared by
Michelle Wills,
(Project Coordinator)
and
Shane Weir,
(Program Manager)
The Bouverie Centre
Victoria’s Family Institute
La Trobe University
1|Page
Contents
Introduction and summary ............................................................................................................. 3
Administration ................................................................................................................................ 4
Brief description of the questionnaire ............................................................................................ 4
Response to the questionnaires ..................................................................................................... 4
Profiling respondents who completed both the pre and post questionnaires............................... 5
Analysis of the results ..................................................................................................................... 5
Limitations....................................................................................................................................... 6
Appendices .................................................................................................................................... 10
2|Page
Introduction and summary
The existing treatment literature suggests that involving families in the care of those experiencing
problems associated with their substance has the potential to enhance recovery of the primary
client, as well as to help the family function better as a whole.
In 2010, The Bouverie Centre was engaged by NADA to introduce a cohort of direct service workers
to Single Session Family Work. Representatives from seven different services participated in training
and implementation support activities with the view to developing:
•
Increased awareness of family inclusive conduct
•
Improved knowledge, skills and confidence to engage clients and their families
•
Organisational structures and processes to support family work being incorporated into
“business as usual”
Implementation progress and outputs, as well as satisfaction with the training were monitored using
different data collection methods. This particular document reports on the findings obtained from
pre and post questionnaires.
The pre/post questionnaire was designed to tap into respondents’ knowledge, skills and confidence
when working with primary clients and people in their support system.
Altogether, 10 participants completed both pre and post questionnaires. Analysis of the results from
this particular cohort of Beacon participants provided some indication that participation in the
workforce development strategy had had a positive effect on the knowledge and confidence of
clinicians approximately 12 months following initial training. These findings must be interpreted with
caution though given the small sample size on which they were based and that the implementation
process is still in its infancy.
Read on for a more detailed description of the methodology employed, the sample, and analysis of
the results.
3|Page
Administration
A 37 item self-report questionnaire was administered to all participants of the Single Session Family
Work training at the commencement of day one (See Appendix A).
An identical follow-up
questionnaire was sent to the 26 training participants still in active service at the project sites in
March 2011.
Brief description of the questionnaire
Section one of the pre/post survey is designed to provide an indication of participants’ knowledge,
skills and confidence pertaining to working with primary clients and people in their support system.
Section Two taps into attitudes and beliefs about family work and change. Section Three asks
respondents for their views about various formal and informal aspects of their workplace which can
serve to act as barriers or facilitators of change.
Response to the questionnaires
Thirty training participants completed pre-questionnaires. Thirty-eight per cent of those sent postquestionnaires filled them in and returned them to The Bouverie Centre. Altogether, 10 participants
completed both the pre and post questionnaires.
Pre and post evaluation data were analysed using SPSS for Windows. A series of independentsamples t-tests was performed to compare pre-survey responses given by participants who
completed two administrations of the survey with those that only filled in pre-questionnaires. The
average ratings issued by the two cohorts only differed twice at a statistically significant level. On
average, at Time 1 (T1), participants who filled in both pre and post questionnaires rated their
capacity to appreciate the individual perspectives of all those in attendance at a family meeting less
favourably (M=2.89) than those who returned pre-questionnaires only (M=3.75) [t(27)=2.16, p<.05].
Likewise, at T1, the ratio of individual to family work in one’s caseload was considered, on average,
slightly better balanced by those who returned pre-questionnaires only (M=2.90) in comparison with
those who completed pre and post measurements [M=2.10; t(28)=2.29, p<.05].
4|Page
Profiling respondents who completed both the pre and post questionnaires
One male and nine females completed both pre and post questionnaires. Respondents’ years of
experience as helping professionals ranged from 4 to 25, with an average of 9.5 years (N=10). Five
different AOD services were represented in the results (see Table 1).
Table 1 Organisations represented by participants who completed pre and post surveys
Organisation
Drug and Alcohol Multicultural Education Centre (DAMEC)
Dunlea - Youth Off The Streets (YOTS)
Holyoake
Murdi Paaki Drug & Alcohol Network
The Buttery
Analysis of the results
The following analyses are based on the data given by participants who completed both pre and
post questionnaires.
Paired-samples t-tests were conducted to compare overall responses to the survey at Time 1 (T1)
and Time 2 (T2). (Note: Due to the small sample size, it was inappropriate to explore how variables
such as gender, years of experience and organisation in which the respondent was employed
influenced the impact of participation in the project.)
Table 2 presents the mean pre and post ratings of family inclusive practice efficacy. The results from
this particular cohort of Beacon participants show a positive upward trend from Time 1 to Time 2.
Comparison of overall pre and post responses indicates that participants made gains in a range of
dimensions related to working in a family inclusive way. On average, participants regarded their
knowledge of when and how to speak with clients about inviting someone else into session and their
understanding of how to work collaboratively with a client’s family more favourably at T2 in
comparison to T1. Participants also tended to rate themselves as better able to appreciate multiple
5|Page
perspectives of those in the room at T2 than at T1. Differences between the average ratings of these
efficacy items at T1 and T2 were statistically significant.
Table 3 shows that opinions about working with families and change largely did not change
significantly over time. It is interesting to note that from the outset, average ratings of the
statements in Section Two reflected a recognition by participants’ that families are potentially
important resources for clients; that families have needs in their own right and that the inclusion of
families in AOD treatment can add value. Positive attitudes towards family work likely predated
involvement in the project and this positivity did not waver over time.
Once again, Table 4 reveals that evaluation of various aspects of the workplace/ broader
environment known to influence practice change did not alter significantly from T1 to T2. In general,
average responses to this section suggest that family inclusive practice ideals are viewed as
compatible with the values of the organisations represented and that characteristics of the clientele
services are not considered as barriers to working in a family inclusive way. The scores also suggest
that the organisational climate into which the initiative was introduced is considered to be
conducive to change.
Limitations
Caution must be exercised when interpreting the findings. The sample size on which they are based
is very small. Furthermore, the two questionnaires were administered in a compressed time frame
(Pre-July 2010 & Post-March 2011) and it may be too early in the implementation process to
determine the full impact of the workforce development initiative. Therefore the findings are
preliminary. Additional research activities should be undertaken to guide any future formal
evaluation of the program.
6|Page
Table 2 Mean ratings of participants’ knowledge of, and skills and confidence in, working with families
Statement
(Rated on 1- 5 scale, where 1 = strongly disagree & 5 = strongly agree)
I possess adequate knowledge to conduct an interview with families /
more than one person in the room
I am clear about when and how I would invite other people into my
individual client’s session
I understand how to work collaboratively with my client’s family
I am able to engage family members, who have different points of
view, in a session
I am able to work with conflict between family members
I know how to manage a family so that safety outside the sessions is
maximised
I understand how to work with confidentiality in family work
I have skills in engaging all family members
When I work with families I can appreciate their individual perspectives
at the same time
I have confidence in my ability to work with families
Pre
M
Post
M
M
Diff
t
df
Sig. (2tailed)
3.00
3.44
0.44
1.51
8
.169
2.67
3.44
0.78
2.40
8
.043
2.67
3.78
1.11
3.16
8
.013
3.00
3.67
0.67
1.26
8
.242
2.86
3.00
0.14
0.23
6
.829
2.67
3.00
0.33
1.15
8
.282
3.44
3.44
0.00
0.00
8
1.00
3.00
3.67
0.67
1.51
8
.169
2.89
4.11
1.22
2.35
8
.047
2.89
3.22
0.33
0.82
8
.438
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Table 3 Mean ratings of attitudes and opinions towards family work and change
Statement
(Rated on 1- 5 scale, where 1 = strongly disagree & 5 = strongly agree)
Pre
M
Post
M
M
Diff
t
df
Sig. (2tailed)
Family work assists individual clients in treatment
4.00
4.30
0.30
0.76
9
.468
Families contribute to the problem
4.10
4.00
-0.10
-0.20
9
.847
I am willing to try new things
4.50
4.30
-0.20
-0.56
9
.591
Families are important for the ongoing care and support of the person
using substances
Supporting families to reconnect with each other is important
4.20
4.30
0.10
0.26
9
.798
4.10
4.10
0.00
0.00
9
1.00
Family relationships are important
4.50
4.30
-0.20
-0.56
9
.591
Family members need support to cope with the negative effects of
someone’s substance use
Family work is compatible with the way I like to work
4.70
4.50
-0.20
-1.50
9
.168
4.00
4.30
0.30
1.15
9
.279
Families contribute to the solution
3.90
4.40
0.50
1.86
9
.096
Because of my work as a helper, I feel exhausted
3.10
2.90
-0.20
-0.41
9
.693
Promoting relationships is important
4.40
4.50
0.10
0.25
9
.811
My values relating to service provision are at odds with including
families in my work
I am sceptical about the benefits of including families in my work
2.00
2.00
0.00
0.00
9
1.00
2.00
2.00
0.00
0.00
9
1.00
Table 4 Mean ratings of implementation barriers or facilitators
8|Page
Statement
(Rated on 1- 5 scale, where 1 = strongly disagree & 5 = strongly agree)
Pre
M
Post
M
M
Diff
t
df
Sig. (2tailed)
Change is managed well in my workplace
2.90
3.20
0.30
0.90
9
.394
Workers in my team are sceptical about including families in their work
1.90
2.30
0.40
1.50
9
.168
There are opportunities for co-work (working with a colleague) in my team
4.30
3.70
-0.60
-1.77
9
.111
1.90
1.90
0.00
0.00
9
1.00
1.70
2.10
0.40
1.00
9
.343
My immediate supervisor communicates well with employees
3.30
3.40
0.10
0.18
9
.864
Staff members in my team/program are unwilling to try new things
2.20
2.20
0.00
0.00
9
1.00
I feel overwhelmed by the amount of work I have to manage
3.40
3.70
0.30
0.90
9
.394
Caseloads between individual and family work are balanced in my workplace
2.10
3.00
0.90
1.87
9
.095
Family work fits well with the core values of my organisation
4.10
3.70
-0.40
-0.80
9
.443
Stats reporting and other administrative tasks associated with family work are burdensome
3.30
3.00
-0.30
-1.41
9
.193
1.90
2.40
0.50
1.86
9
.096
3.90
3.80
-0.10
-0.26
9
.798
Including families in my organisation is unnecessary due to a lack of demand
Including families in my organisation is not useful due to the client demographic.
There is a lack of cooperation and collaboration between staff in this organisation
We regularly ask clients for feedback about their experiences of coming to our agency
9|Page
Appendices
10 | P a g e
Pre-Implementation Survey
Single Session Family Work
Dear Colleague,
Pre-Implementation Survey
As part of the research, we have prepared a questionnaire that focuses on the process of
incorporating Family Inclusive work in your agency. Your responses will help us map changes
in the Alcohol and Other Drug Sector.
Consent to participate in the research will be implied from completion of the survey. Your
survey has been allocated a code which is known only to the researcher, for the purpose of
comparison with a post-implementation survey that you will be asked to complete in 12 months
time. All surveys will be fully de-identified.
The survey should take around 15 minutes to complete and must be finished in one sitting.
Please respond to each question with the first answer that comes to mind (do not deliberate for
too long). There are no right or wrong answers. Just give the answer that is most accurate for
you.
On behalf of the research team, thank you in advance for taking the time to complete this
questionnaire. Your contributions will play a valuable role in building a richer profile of family
inclusive practices in the AoD sector.
If you have any queries or concerns please do not hesitate to contact us at any time –
Michelle Wills, phone 9385 5100 or email [email protected], or Tina Whittle phone 9385
5100 or email [email protected].
Yours sincerely,
Tina Whittle (Team Leader, Community Services Team)
Sex / Gender
No. of years experience as a ‘Helping
Professional’
(please include all your experience, not
only your time in the AOD field)
Please return to Carmel Hobbs– [email protected] Phone: 9385 5100
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Pre-Implementation Survey
Single Session Family Work
Using the 5-point Likert-scale below, please answer the questions on the following pages:
Disagree
strongly
Disagree
somewhat
Neutral
Agree
somewhat
Agree
strongly
1
2
3
4
5
NB: Please answer every question, regardless of whether you have performed the activity.
Strongly
disagree
Strongly
agree
Section 1: CONFIDENCE
1
I possess adequate knowledge to conduct an interview with
families / more than one person in the room.
1
2
3
4
5
2
I am clear about when and how I would invite other people
into my individual client’s session.
1
2
3
4
5
3
I understand how to work collaboratively with my client’s
family.
1
2
3
4
5
4
I am able to engage family members, who have different
points of view, in a session.
1
2
3
4
5
5
I am able to work with conflict between family members.
1
2
3
4
5
6
I know how to manage a family so that safety outside the
sessions is maximised.
1
2
3
4
5
7
I understand how to work with confidentiality in family
work.
1
2
3
4
5
8
I have skills in engaging all family members.
1
2
3
4
5
9
When I work with families I can appreciate their individual
perspectives at the same time.
1
2
3
4
5
I have confidence in my ability to work with families.
1
2
3
4
5
10
Please return to Carmel Hobbs– [email protected] Phone: 9385 5100
2/5
Pre-Implementation Survey
Single Session Family Work
Strongly
disagree
Strongly
agree
Section 2: ATTITUDE
1
Family work assists individual clients in treatment.
1
2
3
4
5
2
Families contribute to the problem.
1
2
3
4
5
3
I am willing to try new things.
1
2
3
4
5
4
Families are important for the ongoing care and support of
the person using substances.
1
2
3
4
5
5
Supporting families to reconnect with each other is
important.
1
2
3
4
5
6
Family relationships are important.
1
2
3
4
5
7
Family members need support to cope with the negative
effects of someone’s substance use.
1
2
3
4
5
8
Family work is compatible with the way I like to work.
1
2
3
4
5
9
Families contribute to the solution.
1
2
3
4
5
10
Because of my work as a helper, I feel exhausted.
1
2
3
4
5
11
Promoting relationships is important.
1
2
3
4
5
12
My values relating to service provision are at odds with
including families in my work.
1
2
3
4
5
13
I am sceptical about the benefits of including families in my
work.
1
2
3
4
5
Please return to Carmel Hobbs– [email protected] Phone: 9385 5100
3/5
Pre-Implementation Survey
Single Session Family Work
Strongly
disagree
Strongly
agree
Section 3: IMPLEMENTATION
1
Change is managed well in my workplace
1
2
3
4
5
1
Workers in my team are sceptical about including families
in their work
1
2
3
4
5
2
There are opportunities for co-work (working with a
colleague) in my team
1
2
3
4
5
3
Including families in my organisation is unnecessary due to
a lack of demand
1
2
3
4
5
4
Including families in my organisation is not useful due to
the client demographic.
1
2
3
4
5
5
My immediate supervisor communicates well with
employees
1
2
3
4
5
6
Staff members in my team/program are unwilling to try
new things
1
2
3
4
5
7
I feel overwhelmed by the amount of work I have to
manage
1
2
3
4
5
8
Caseloads between individual and family work are balanced
in my workplace
1
2
3
4
5
9
Family work fits well with the core values of my
organisation
1
2
3
4
5
10
Stats reporting and other administrative tasks associated
with family work are burdensome
1
2
3
4
5
11
There is a lack of cooperation and collaboration between
staff in this organisation
1
2
3
4
5
12
We regularly ask clients for feedback about their
experiences of coming to our agency.
1
2
3
4
5
Please return to Carmel Hobbs– [email protected] Phone: 9385 5100
4/5
Family and carer inclusive practice
in NSW non-government AOD agencies:
Part B: Needs analysis
A report for the Network of Alcohol and Other Drug Agencies (NADA)
September 2011
Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
TABLE OF CONTENTS
Table of figures ................................................................................................................................... 3
Executive summary ................................................................................................................................. 4
Recommendations .............................................................................................................................. 6
1
Background..................................................................................................................................... 7
1.1
Introduction ............................................................................................................................ 7
1.2
Family inclusive practice in the sector .................................................................................... 7
1.3
The purpose of this needs analysis ......................................................................................... 8
1.4
Methodology........................................................................................................................... 8
2
The survey ...................................................................................................................................... 9
2.1
Response ................................................................................................................................. 9
2.2
Probable survey bias ............................................................................................................... 9
2.3
Respondent characteristics ................................................................................................... 10
3
Findings ........................................................................................................................................ 13
3.1
Services provided to family and carers ................................................................................. 13
3.2
Family inclusive practice: development, training and programs .......................................... 15
3.3
Partnerships .......................................................................................................................... 18
3.4
Referral agencies................................................................................................................... 18
3.5
Are agencies increasing family inclusive practice? ............................................................... 19
3.6
Future needs and intentions ................................................................................................. 20
3.7
Barriers to developing family inclusive practice ................................................................... 25
4
Where to from here in developing family inclusive practice? ..................................................... 27
4.1
Introduction .......................................................................................................................... 27
4.2
The continuum of practice: where the sector is and where it is headed ............................. 27
4.3
Meeting key needs in developing family inclusive practice.................................................. 28
4.4
Overcoming barriers to family inclusive practice ................................................................. 32
4.5
Conclusion and recommendations ....................................................................................... 36
Recommendations ............................................................................................................................ 37
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Table of figures
Table 1: Service categories – agency survey respondents.................................................................... 10
Table 2: Target client groups – agency survey respondents................................................................. 11
Table 3: Sites – agency survey respondents ......................................................................................... 11
Table 4: Sites – agency locations .......................................................................................................... 12
Table 5: Role(s) of respondents ............................................................................................................ 12
Table 6: Offers services to family and carers ........................................................................................ 13
Table 7: Services offered to family and carers ...................................................................................... 14
Table 8: Organisational development undertaken ............................................................................... 15
Table 9: Training and programs used by agencies ................................................................................ 16
Table 10: Resources used by agencies .................................................................................................. 17
Table 11: Partnerships developed by agencies ..................................................................................... 18
Table 12: Services to which regular referrals are made ....................................................................... 18
Table 13: Family inclusive practice3 years ago ..................................................................................... 19
Table 14: Any family inclusive practice: 2008 compared to 2011 ........................................................ 19
Table 15: Organisational development: future intentions ................................................................... 20
Table 16: New and continuing family services: agency intentions ....................................................... 21
Table 17: Resources: agency intentions................................................................................................ 22
Table 18: Importance of grant funding ................................................................................................. 24
Table 19: Barriers to family inclusive practice ...................................................................................... 25
Table 20: Barriers to family inclusive practice by rating ....................................................................... 26
Attachments
Attachments 1: Family and carer support in AOD services: agency survey.......................................... 38
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
EXECUTIVE SUMMARY
Introduction
This needs analysis reports on family inclusive practice in NSW non government alcohol and other
drug agencies, including current practices, key needs in relation to service provision, organisational
development training and resources. Barriers were also identified, and ways in which agencies could
overcome these barriers were discussed.
The report draws largely from a survey of NADA member agencies, with additional input from
qualitative interviews and the findings of the evaluation of NADA’s Family and Carer grants program
(see Part A of this Report). Responses were received from around 50% of agencies represented by
NADA covering a representative range of service types, client groups and locations – although it was
noted that the survey responses were likely to be biased towards those agencies receptive to family
inclusive practice.
Family inclusive practice: where agencies are currently placed
In terms of current practice the report found that agencies are currently well placed in developing
foundational family inclusive practice, such as providing information to families, informal support,
and referral to specialist family support agencies. Generally, agencies have a higher level of family
inclusivity than they did three years ago, particularly in the provision of family related services.
The majority of agencies have also undertaken some form of organisational development, most
commonly in adapting referral and intake processes. In addition, staff in most of the surveyed
agencies had utilised resources in family inclusive practice and been involved in training or
programs; and two thirds had undertaken some organisational development.
Family inclusive practice: where agencies are headed
Agency intentions are to develop more involved family inclusive practices. The most commonly
expressed intentions included offering structured family programs, engaging family workers and
including families in client treatment, conducting a service audit and developing family policies.
Agencies are willing to examining their current practices and develop higher level staff-skills with the
aim of providing better support to families, and also of involving families, as appropriate in client
treatment, recovery and relapse prevention. This willingness is reflected in agency intentions
relating to new practices, including developing structured family programs, adapting treatment
models and engaging specialist family workers.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Barriers to developing new practices
A number of barriers were identified to developing family inclusive practice. The most substantial
barrier was lack of financial resources. Next more commonly ranked barriers were ‘clients not
wanting their families involved’ and ‘insufficient staff time’. Also ranking as barriers with most
agencies were: geographical barriers, lack of staff knowledge and lack of resources – although the
latter two ranked as relatively minor.
As far as overcoming barriers, around 90% of agencies considered additional grant funding as
important or very important. Some of the means through which agencies had successfully engaged
families were also discussed, including using a broader definition of family, providing numerous
opportunities for engagement during the treatment process, developing partnerships with specialist
family support agencies and utilising technology to engage families living at a distance.
Conclusion
The report considered how the sector could be best supported in further developing family inclusive
practice, given the intentions of agencies to provide better support for families and to integrate
families more effectively in support of client treatment and ongoing well being. It was concluded
that although further grant funding would definitely assist agencies to access training and create
organisational change, a number of other measures are also needed. These included support and
information sharing on how best to develop sustainable family inclusive practices rather than relying
on one off funding. Agencies would also benefit from information on making the best use of
specialist family workers, and how to utilise partnerships and other available resources more
effectively.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Recommendations
1) Seeding grants – Round 2: that funding for a further round of grants promoting family
inclusive practice be sought – and, if successful, that funding be used specifically for family
inclusive practice initiatives that promote reflective practice, research and sustainable
organisational development.
2) Training funding: that funding for further sponsored training to the sector be sought– in
particular training that develops higher level skills in: working effectively with families, family
therapy and family inclusiveness in client treatment.
3) Partnerships: that agencies be encouraged to investigate partnerships with specialist family
support agencies in order to develop appropriate and sustainable family programs.
4) Resources: that agencies be regularly reminded of the resource: Tools for Change: A new
way of working with families and carers (Toolkit) and provided with short examples of how
the resource has been used in practice.
5) Information sharing: that a conference or workshop is held annually to enable agencies to
share information and knowledge about establishing and accessing family programs, family
therapy, and the effective inclusion of families in client treatment.
6) Research: that research opportunities and partnerships are investigated to assess the impact
of family inclusive practices on families and client outcomes.
7) Factsheets: that the following factsheets be developed and included in resources provided
to agencies about family inclusive practice:
Working with difficult to engage families – guide to effective practice
A summary of academic work and best practice in family inclusivity in the treatment
process.
A set of guidelines for establishing structured family support programs
A set of guidelines for engaging a family worker to ensure sustainable best practice.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
1
BACKGROUND
1.1
Introduction
This report provides a needs analysis for the development of family inclusive practice in the non
government alcohol and other drug sector in NSW. Family inclusive practice refers to an approach
that recognises both a) that families1 of clients require information and support and b) that family
involvement in treatment and therapeutic processes can have a positive impact on client outcomes.
Levels of family inclusive practice can be understood as being on a continuum2,3, with the starting
point of the simple recognition that clients have a family and people who are important to them.
Practice then develops from offering referrals and information directly to family members, to
providing specific support, through to involvement of the family in the client treatment process and
providing family therapeutic interventions.
The level to which an agency develops family inclusive practice is dependent on a number of
variables, including the type of service and client groups, along with the attitudes and knowledge of
staff, and access to the necessary training and resources to develop new practices. For example,
some agencies aim to fully integrate families with their clinical practice, whilst for other agencies,
providing referrals to family support services will be sufficient.
1.2
Family inclusive practice in the sector
Within NSW, AOD agencies are at many different stages in relation to family inclusive practice. A few
agencies have demonstrated a long term commitment to supporting families, and others have
routinely provided information and referrals to families without necessarily seeing it as their role to
provide further support. For most, however, the idea of adopting family inclusive practice is
relatively new, where, in the past, family has not been a relevant consideration, or indeed,
understood as ‘part of the problem’.
In recent years there has been a definitive culture change in recognising the need for and adopting
family inclusive practice. This shift has been led and supported by a number of agencies, including:
1
The term ‘family’ is used throughout this report: this should be understood as being a very broad definition of
family and also refer to carers and other people of importance to a client.
2
Copello, A., Templeton, L. & Powell, J. 2009 Adult family member and carers of dependent drug users:
prevalence, social cost, resource savings and treatment responses, UK Drug Policy Commission (UKDPC)
3
Patterson, J & Clapp, C. 2004 Clinical Treatment Guideline for Alcohol and drug Clinicians No 11: Working with
Families, Turning Point Alcohol and Drug Centre Inc., Victoria
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
NADA through its Family and Carer Program4, Family Drug Support who provide direct services to
families and also work with treatment services to improve family inclusivity and The Bouverie Centre
who have provided workshops and training to the sector. In addition, it is important to acknowledge
services such as Holyoake, who have long exemplified family inclusive practice, as well as those
agencies who have recently developed comprehensive family programs.
1.3
The purpose of this needs analysis
NADA has commissioned this needs analysis to identify the areas of family inclusive practice
requiring further development and support. This has involved examining the family inclusive services
and practices agencies currently have in place, the key needs in relation to family inclusive
organisational development and training and resources, as well as identifying the barriers to
instituting new practices and ways in which these barriers can be overcome. Identifying these issues
will assist NADA, State and Commonwealth funding bodies along with specialist family support
agencies in supporting AOD agencies in developing their practice. This will be to benefit of agencies,
and also, ultimately, to clients, their families and carers.
1.4
Methodology
The needs analysis draws primarily from a survey of NADA member agencies (discussed in detail in
the following section – and see Attachment 1). It also draws on the findings from the Evaluation of
the NADA Mental Health and Drug and Alcohol Family and Carer Project5, which forms Part A of this
report. Additional qualitative input was sought from agency staff who had participated in the NADA
Family and Carer Program, either as grant recipients or through the Bouverie Centre training; this
input mostly related to ways of effectively developing family inclusive practice and overcoming
barriers.
4
Argyle Research (2011). Family and carer inclusive practice in NSW non-government AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family and Carer Project.
5
Ibid.
8
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2
THE SURVEY
2.1
Response
The survey aimed to obtain a good representation of NADA member agencies, in numbers and also
in terms of service categories, target client groups and locations.
NADA represents 79 individual non government agencies delivering alcohol and other drug services
at approximately 104 different sites6. Overall, individual responses were received from 49 sites
representing an estimated 37 different agencies. This gave both a site and agency response rate of
just under 50%. In addition, some single responses answered for all the sites of an agency (for
example, all 5 sites across NSW). Taking this into account, a conservative estimate of site coverage is
approximately 72, or 70% of sites.
Overall, this can be considered a ‘good response’ given a typical survey response from NADA
member agencies of around one third7 and also that non participation in a family inclusive practice
survey would be expected from some agencies (e.g. through not being considered relevant to their
service).
See attachment 1: Family and carer support in AOD services: agency survey.
2.2
Probable survey bias
Although the survey sought to include agencies with no family inclusive practice, it is evident that all
survey respondents had either developed practices or had an interest in doing so. Clearly this
suggests a probable bias towards those agencies receptive to family inclusive practice. However, for
the purposes of this needs analysis this did not create a particular problem as its focus was on
identifying the needs and challenges of agencies who have an interest in continuing or further
developing their family inclusive practice.
6
7
As estimated from the NADA membership list, 2011.
As reported by NADA staff from previous membership surveys.
9
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2.3
Respondent characteristics
2.3.1 Service categories
All NADA’s categories of service were represented in the survey responses (Table 1), with nonresidential services, residential rehabilitation and health promotion the three most commonly
represented categories. The distribution of categories of service was fairly representative of NADA
members, noting that most agencies offer more than one type of service.8
Table 1: Service categories – agency survey respondents
Services
No.
%
Non-residential services
23
47%
Residential rehabilitation
22
45%
Drug and alcohol health
promotion
18
37%
Therapeutic community
11
22%
After-care programs
11
22%
Early intervention
10
20%
Detoxification
5
10%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
2.3.2 Target client groups
Surveyed agencies provided services to the full range of target client groups of alcohol and other
drug services, with most agencies providing services to more than one client group. As would be
expected, the most commonly represented target group were ‘adults’, given it is a general and
overlapping category. Services were also provided by around a third of agencies to each of the
following groups: ‘Aboriginal and Torres Strait Islanders’, ‘illicit drug users’ and clients with a ‘dual
diagnosis’.
8
Argyle Research (2008). NSW Alcohol and Other Drug Non Government Sector: Workforce Profile and Issues
2008. Network of Alcohol and Other Drug Agencies (NADA): Sydney.
10
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Table 2: Target client groups – agency survey respondents
Target client groups
No
Adults (18 years and older)
Aboriginal and Torres Strait Islanders
Illicit drug users
Dual diagnosis
Youth (12 to 25 years)
Families
Homeless
Culturally and linguistically diverse (CALD)
Alcohol only
Gay, lesbian, bisexual and transsexual
Males only
Females only
No specific group
31
17
17
17
15
14
10
8
7
4
3
3
2
%
65%
35%
35%
35%
31%
29%
21%
17%
15%
8%
6%
6%
4%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
Other target groups included:
Women with children
Parents with children
2.3.3 Sites
Many NADA member agencies operate from more than one site, with some of the larger NGOs
providing services at 5 or more sites. Amongst survey respondents, just over half of surveyed
agencies (56%) operated from two or more sites, with the balance operating from just one site or
outreach only.
Table 3: Sites – agency survey respondents
Sites
No
%
1
20
41%
2
10
20%
3
5
10%
4
5
10%
5
8
16%
Outreach
10
20%
Telephone
0
0%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
11
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2.3.4 Location
Surveys were received for sites from across NSW, with some single responses covering all an
agency’s locations, and others being location specific. Most responses were for Sydney based sites,
followed by regional centres (Table 4).
Table 4: Sites – agency locations
Region
No.
ACT
6
Sydney
24
Newcastle/Wollongong
11
Regional
20
Rural
8
Remote
3
TOTAL
72
%
8%
33%
15%
28%
11%
4%
100%
n=72 (note this table estimates only due to the wide variations in response details)
Source: Family and carer support in AOD services: agency survey
2.3.5 Role of respondent
Most of the survey respondents were in management positions (Table 5), reflecting that the surveys
were mainly addressed to management. Responses from managers were sought on the basis that
staff in these positions were most likely to have an overview of family and carer practice in their
agency or individual site.
Table 5: Role(s) of respondents
Role(s)
CEO
Manager
Coordinator
Clinical Coordinator
Psychologist
Team Leader
Family Worker
Counsellor
Case Worker
Other
No
%
3
24
5
2
2
5
2
7
2
2
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
12
Argyle Research
6%
49%
10%
4%
4%
10%
4%
14%
4%
4%
Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
3
FINDINGS
3.1
Services provided to family and carers
Agencies were asked whether they offered services to families and carers, what type of services
were currently offered and what services agencies intended to offer in the future, either as
continuing or new services. Those agencies who did not offer services were asked why they did not,
although it should be noted this included only five agencies.
3.1.1 Agencies offering services
The great majority (90%) of surveyed agencies did offer services to family and carers clients (Table
6). Whilst agencies not offering family services were specifically invited to participate in the survey, it
was noted that survey respondents were likely to be skewed to those who did offer services (see
above).
Table 6: Offers services to family and carers
Services
No.
%
44
90%
Yes
5
10%
No
49
100%
TOTAL
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
Do not offer services
Of the five agencies who did not offer services, four did actually provide referral to family support
agencies, with three stating that ‘family support was not the role of their agency’. One agency also
noted that ‘very few clients were in contact with their families’. This latter reason for not offering
family services has previously been reported from crisis services and services for people with chronic
long term substance use issues.9
9
NADA (2008). A report of family and carer engagement by NADA member agencies. Network of Alcohol and Other Drug
Agencies (NADA): Sydney.
13
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
3.1.2 Services offered to families
Agencies offered family support primarily in the form of referrals and informal support (Table 7).
Information packs and family counseling were also offered by around half of surveyed agencies.
Table 7: Services offered to family and carers
Services
Referral to family support services
Informal support
Information packs
Family counselling
Information sessions
Group therapy sessions
Support groups
A family worker/project worker
Family days
Structured family programs/workshops
No.
38
32
25
23
14
13
13
12
11
11
%
78%
65%
51%
47%
29%
27%
27%
24%
22%
22%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
This data shows that the three most frequently offered services (referral, informal support and
information packs) to families were also those of lower impact in terms of staff time and resources.
This is a point of interest because time and resources create substantial barriers to agencies
themselves providing a high level of support to families (see below). However, it should be noted,
that in terms of addressing the direct needs of families, ‘referral of families to other support
services’ and ‘informal support’ are both appropriate and often highly effective forms of family
support10.
Clearly too, significant numbers of agencies are developing more involved forms of family inclusive
practice, such as family counseling and information sessions, group therapy, support groups and
engaging specialist workers.
10
Family Drug Support – communication: Families benefit from receiving counselling and support from
specialist family support agencies and also from understanding the treatment process and having their
questions answered.
14
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3.2
Family inclusive practice: development, training and programs
3.2.1 Organisational development
Organisational development is potentially one of the most important contributors to sustainable
change in family inclusive practice11. Changes to organisational policies and processes can make a
particularly significant contribution given that these changes are generally sustainable across staff
and funding changes.
Nearly two thirds (65%) of the surveyed agencies had undertaken some organisational development
in relation to family inclusive practice, with 55% undertaking more than one development process
(Table 8). Of the organisational development the two most common were changes to referral
processes and the intake process – both of which require relatively minimal resources and staff
input. The next most commonly undertaken were more demanding in terms of resource and time,
viz: changes to policy, changes/development of client treatment models and engaging a family or
project worker.
Table 8: Organisational development undertaken12
Organisational development
Some organisational development
Multiple organisational development processes
None - our service was already sufficiently family inclusive
Changed/added REFERRAL PROCESSES for families
Changed the INTAKE PROCESS to collect family related information
Developed a POLICY for working with family and carers
Changed/developed CLIENT TREATMENT MODELS
Engaged a FAMILY WORKER/PROJECT WORKER
Changed/added INFORMATION PROCESSES to families
Changed a POSITION DESCRIPTION to include family work
None
Conducted a SERVICE AUDIT in relation to family inclusive practice
No
%
32
27
8
18
17
15
15
13
12
10
7
2
65%
55%
16%
37%
35%
31%
31%
27%
24%
20%
14%
4%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: Agency survey
11
Argyle Research (2011). Family and carer inclusive practice in NSW non-government AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family and Carer Project.
12
Agencies were asked to rate the usefulness of the training or program in which they had participated,
however, as these ratings were almost uniformly ‘useful’, or very useful, these ratings have been omitted.
15
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
3.2.2 Training and programs
A number of agencies have been offering training and programs to develop family inclusive practice
to the sector, including NADA through its Family and Carer Program and brokerage of the Bouverie
Centre training and Family Drug Support through its Bridging the Divide program and other family
programs.
Overall, 73% of agencies indicated they had been involved in programs or training, with half involved
in more than one program or form of training (Table 9). This data clearly indicates that agencies are
actively seeking out training and other programs to assist in the development of family inclusive
practice.
Table 9: Training and programs used by agencies
Training or program
Some form of training or program
Multiple forms of training or program
NADA - Family and Carer Grants Program
Family Drug Support - Stepping Stones
Bouverie Centre Training (via NADA)
NADA - Practice Development Workshops
Family Drug Support - other services
Family Drug Support - Bridging the Divide
Family support program - other AOD agency
Family Drug Support – Workshop
State government grants program (to develop family inclusive practice)
Holyoake
Federal government grants program (to develop family inclusive
practice)
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
16
Argyle Research
No.
36
24
16
14
12
12
11
9
7
6
4
3
%
73%
49%
33%
29%
24%
24%
22%
18%
14%
12%
8%
6%
3
6%
Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
3.2.3 Resources
There are an increasing number of resources available to agencies to assist in the development of
family inclusive practice. Staff in the majority of agencies (78%) had consulted at least one resource,
with 62% consulting more than one (Table 10). The ‘NADA Tools for Change: A new way of working
with family and carers Toolkit’13 was used by half of those surveyed making it the most used distinct
resource; general web resources, professional advice and academic literature were also well utilised.
Table 10: Resources used by agencies
Resource
No.
%
Used a resource
38
78%
Used multiple resources
NADA: Tools for Change: A new way of working with family and carers
Toolkit
31
63%
25
51%
General web resources
24
49%
Professional advice - other source
21
43%
Academic literature on working with families
20
41%
Family Drug Support - web resources
16
33%
Family Drug Support - professional advice
13
27%
Government health or welfare department resources
Family Drug Help - web resources
12
10
24%
20%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
Other resources:
NCETA- A family sensitive policy and practice tool kit.
Supervisory roles with organisation.
13
For evaluative comment on this resource see: Argyle Research (2011). Family and carer inclusive practice in
NSW non-government AOD agencies: Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family
and Carer Project.
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3.3
Partnerships
Partnerships can be a key element in developing family inclusive practice, potentially enabling an
AOD agency able to draw on the expertise of another agency in developing family programs,
counseling and referral pathways. Even so, the majority of agencies had not formed partnerships
(57%), with 43% of agencies having developed partnerships in relation to family inclusive practice
(Table 11).
Table 11: Partnerships developed by agencies
Partnership
No
%
Yes
19
43%
No
25
57%
TOTAL
44
100%
n=44
Source: Family and carer support in AOD services: agency survey
Most commonly, agencies had developed partnerships with Family Drug Support, with 9 of the 19
agencies who developed partnerships, mentioning this service. Other agency partners included:
CatholicCare/ Holyoake
Bridges
Bouverie Centre
Salvation Army
Al-anon / Nar-anon
Mental health services
General health services
3.4
Referral agencies
Agencies were asked if there were services or other agencies to which they regularly referred
families. Having a referral network is important because it is an easily implementable measure that
enables families to gain access to specialist services and support. Most responding agencies (76%)
had services to which they regularly provided referrals, whilst 24% did not (Table 12).
Table 12: Services to which regular referrals are made
Referrals
No
%
Yes
31
76%
No
10
24%
TOTAL
41
100%
n=41
Source: Family and carer support in AOD services: agency survey
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The most common referral services were Family Drug Support and general family support services. A
diverse range of other agencies were also used for referrals including local family support and health
services.
Referral agencies:
Family Drug Support x8
Family support service x8
Al-anon/ Nar-Anon x 5
Relationships Australia x4
Holyoake / CatholicCare x5
Family counsellor/mediation x2
Salvation Army x2
3.5
Community Health
Reconnect Tough Love The Deli
Community health
Brighter Futures
ADFACT
DoCS
Are agencies increasing family inclusive practice?
Observationally, AOD agencies in NSW appear to be increasing their levels of family inclusive
practice. To provide a degree of verification of this observation, agencies were asked to rank their
level of family inclusive practice 3 years ago (Table 13) in three areas: family support services, staff
training and organisational development. Examining this table shows that across these areas, in
2008, most agencies either had no family inclusive practice or less than they do now
Table 13: Family inclusive practice 3 years ago
Some,
Family inclusive
but less
Practice
None
than
now
Family support services
Staff training
Organisational
development
Same as
now
Some,
but
more
than
now
Don't
know
N/A
TOTAL
17%
25%
38%
37%
31%
21%
2%
4%
12%
13%
100%
100%
19%
43%
17%
8%
13%
100%
n=49
Source: Family and carer support in AOD services: agency survey
Looking more closely at the question of ‘no family inclusive practice’ it is also evident that numbers
of agencies with ‘any family inclusive practice’ has generally increased over time (Table 14).
Table 14: Any family inclusive practice: 2008 compared to 2011
Family inclusive
2008
2011
Practice
Any
Any
Family support services
Staff training
Organisational development
71%
61%
68%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
19
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90%
75%
67%
Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
The figures in Table 14 indicate that the number of agencies undertaking any family support services
or staff training has increased since 2008, although those undertaking any organisational
development has remained level (although it should be noted that organisational development can
occur more readily on a ‘one off’ basis).
Overall, a trend can be discerned of increasing levels of family inclusive practice. When examining
the future intentions of agencies (Section 3.6 - below) it is evident that this trend is likely to
continue.
3.6
Future needs and intentions
3.6.1 Agency intentions: organisational development
Most agencies (84%) indicated that they were likely to undertake organisational development in the
future in relation to family inclusive practice. (Table 15) In addition, a further 10% considered that
their service was already sufficiently family inclusive, so as to not require further development.
Table 15: Organisational development: future intentions
Future organisational development
Conduct a SERVICE AUDIT in relation to family inclusive practice
Change/develop CLIENT TREATMENT MODELS
Develop a POLICY for working with family and carers
Change/add REFERRAL PROCESSES for families
Engage a FAMILY WORKER/PROJECT WORKER
Change/add INFORMATION PROCESSES to families
None - we consider that our service is sufficiently family inclusive
Change the INTAKE PROCESS to collect family related information
Change a POSITION DESCRIPTION to include family work
None
No.
%
15
15
14
12
9
9
5
5
3
2
31%
31%
29%
24%
18%
18%
10%
10%
6%
4%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
Most commonly the organisational development included changes or development in relation to:
A service audit
Client treatment models
Family and carer policy
Referral processes
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Comparing the intentions of agencies in regard to organisational development to existing
organisational development shows that there is:
Substantial new interest in conducting a service audit (only 2 agencies had already
conducted one).
New and continuing interest in developing client treatment models (with 8 new expressions
of interest, and 7 agencies who had previously modified their client treatment models).
Additional interest in developing a family policy (with 11 new expressions of interest).
Additional interest in changing/developing referral processes (with 8 new expressions of
interest)
3.6.2 Agency intentions: new services to families
Agencies were asked what new family services they intended to offer in the future. Table 16 ranks
intended new services by the proportions of agencies expressing interest. In addition, assuming
agencies who currently offer such services will continue to do so, a total estimate of the proportion
of agencies offering each family service is provided (last two columns)14.
Table 16: New and continuing family services: agency intentions
Service
As new
%
Current
service
+ New*
Structured family
programs/workshops
19
39%
30
A family worker/project worker
15
31%
27
Information packs
10
20%
35
Information sessions
10
20%
24
Support groups
10
20%
23
Family counselling
9
18%
32
Group therapy
7
14%
20
Family days
6
12%
17
Referrals
4
8%
42
Informal support
2
4%
34
%
61%
55%
71%
69%
49%
65%
41%
35%
86%
69%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
*Assuming all agencies currently offering service continue to do so.
This data shows that there is strong interest in providing structured family programs/workshops and
engaging a family/project worker. Both types of services require higher levels of financial and
organisational commitment; how these agency intentions might best be met is discussed below.
14
This question created some confusion for analysis. Agencies were asked which services they would continue
to offer/ or offer as a new service. For a few agencies who left certain items blank, it could be taken that they
were going to cease offering certain services. Whilst this is possible, particularly with services like family days
and dedicated family workers, it also seemed likely that the question was read as ‘what new services are you
intending to offer?’, given that it seems unlikely, for example, that agencies would stop family referrals or
providing informal support. As such, in adding the total who may offer services in the future the assumption
has been made that agencies currently offering services will continue to do so.
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Examining the data that collates new and existing intentions in regard to service provision, it is
evident that should intentions become practice nearly all surveyed agencies will be providing
referrals, provide information packs, information sessions, informal support, counseling, family
programs and support groups – and nearly half will engage a family worker.
There is not a substantial amount of interest in providing family days or group therapy, suggesting
that in the view of agencies, family needs are best met by providing the other types of services, or
the agency structure does not allow for the provision of these kinds of services.
3.6.3 Agency intentions: resources
Agencies were asked what resources about family inclusive practice they intended to consult in the
future. All respondents intended to use some form of resource. The most commonly selected was:
NADA: Tools for Change: A New Way of Working with Family and Carers (Toolkit)(65%) followed by
Family Drug Support - web resources (49%) and professional advice – other source (45%) (Table 17).
Table 17: Resources: agency intentions
Resource
NADA: Tools for Change: A new way of working with family and carers
toolkit
Family Drug Support - web resources
Professional advice - other source
Academic literature on working with families
General web resources
In house resources
Family Drug Support - professional advice
Government health or welfare department resources
Family Drug Help - web resources
None
No.
%
32
24
22
21
21
20
20
19
14
0
65%
49%
45%
43%
43%
41%
41%
39%
29%
0%
n=48 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
3.6.4 Interest in additional training and programs
A general question was asked about the training and programs agencies they believed would be of
benefit to them. Responses were left open given the range of possible options. Most commonly
agencies indicated that they would be interested in receiving training in the following areas:
Single Session Work (as offered by the Bouverie Centre)
Family therapy/group work
Family counseling
Parenting training
General engaging with families training
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These responses reflect the findings throughout this report and of Part A that there is a demand for
further training in higher level skills to work with families.
3.6.5 Other supports
Agencies were asked if there were any other supports that they needed to further develop family
inclusive practice. The responses included:
Translated information in most or all spoken languages of our clients. More resources for
interpreters. Access to spaces to be able to run family therapy sessions.
Literature specifically dealing with families with drug and alcohol is extremely scarce and
also working with CALD clients.
Ways to work homeless families.
Formal training, i.e. the Bouverie equivalent are lacking in NSW. Relationships Australia is
only course and is in Sydney and costs in excess of $12 000.
Financial support for sustainable service delivery. An intensive workshop to increase
group/family therapy skills - up to a week in length or several workshops spread over a year conducted by experienced group/family therapy facilitators.
Just greater funding of course to do more of what we are currently doing well. We are just
commencing two research/evaluation projects into existing services and will need to revisit
this process every couple of years.
3.6.6 Need for grant funding
NGOs are highly dependent on grant funding for their core service provision. Agencies were asked to
rank the importance of additional financial resources to developing, or continuing to develop, family
inclusive practice. Two thirds rated grant funding as very important with a further 20% rating it as
important (Table 18). The additional comments also indicate the importance of grant funding in both
developing new programs and positions and maintaining or expanding existing ones.
These survey responses are also consistent with the feedback from NADA family and carer grant
recipients15 – who observed that grant funding had enabled the development of processes and
programs that otherwise would not have been possible.
15
Argyle Research (2011). Family and carer inclusive practice in NSW non-government AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family and Carer Project.
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Table 18: Importance of grant funding
RATING
No
%
Very important
Important
Somewhat
important
Not at all
important
TOTAL
31
67%
9
20%
4
9%
2
46
4%
100%
n=46
Source: Family and carer support in AOD services: agency survey
Comments:
Grant funding would enable opportunity to employ specialist worker / increase hours of
existing worker /provide outreach worker x 4
NADA has helped fund our Better Relationships and Every Family program which has been a
great success.
Difficult to deliver additional services without additional resources/staffing.
To develop evening groups (2 staff members and room)
CALD clients underrepresented in family service. Outreach programs and providing
appropriate venues for families would be useful.
Currently able to employ Family Support Worker due to a small grant provided by a private
organisation and by several parents.
To enable us to expand our Holyoake groups for family members.
Seed funding via NADA was extremely effective in beginning this process - we now need
additional funding to implement ongoing services
Finances are stretched and it is difficult to start new initiatives without money
24
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3.7
Barriers to developing family inclusive practice
Agencies typically face a wide range of barriers when developing family inclusive practice, these can
include: limited resources, staff time, client opposition to family involvement and staff attitudes.
Identifying the barriers to family inclusivity can assist in providing support and resources to the
sector to help overcome these barriers. In addition, examining how agencies have approached
various barriers can provide helpful insight to other agencies in addressing the same issues.
Agencies were asked to rate a range of possible barriers to family inclusivity, using a four point scale
ranging from ‘not a barrier’ through to ‘substantial barrier’. Table 19 ranks these barriers by
frequency, and Table 20 shows the ratings given to each barrier.
Table 19: Barriers to family inclusive practice
Barrier
Insufficient financial resources
Clients do not want their families involved
Staff do not have enough time
A lack of resource material
A lack of staff knowledge
Geographical barriers
Families not in contact/do not want to be involved
A lack of staff confidence
Families can hinder the treatment process/are part of
the problem*
Focus of our agency should solely be on the client*
Our agency had not considered families as an issue
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
*From a staff perspective
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no.
43
36
36
33
33
33
31
31
%
88%
73%
73%
67%
67%
67%
63%
63%
27
19
8
55%
39%
16%
Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Table 20: Barriers to family inclusive practice by rating
Barrier
Insufficient financial resources
Clients do not want their families involved
Staff do not have enough time
A lack of resource material
A lack of staff knowledge
Geographical barriers
Families not in contact/do not want to be involved
A lack of staff confidence
Families can hinder the treatment process/are part of
the problem*
Focus of our agency should solely be on the client*
Our agency had not considered families as an issue
Minor Moderate
%
%
16%
47%
47%
36%
44%
28%
55%
33%
61%
27%
33%
42%
35%
52%
52%
23%
81%
68%
88%
15%
32%
13%
Substantial
%
37%
17%
28%
12%
12%
24%
13%
16%
4%
0%
0%
n=49 (more than one response possible)
Source: Family and carer support in AOD services: agency survey
*From a staff perspective
Examining this data shows that the barrier that creates the greatest impediment to agencies is that
of insufficient financial resources, rated as a barrier by 88% of agencies. Furthermore, this issue was
rated as more than a minor barrier by 84% of those rating it a barrier.
Other barriers that rated as such with two thirds or more of agencies were:
Clients do not want their families involved
Staff do not have enough time
A lack of resource material
A lack of staff knowledge
Geographical barriers
Of these barriers, geographical barriers were mainly rated as either a ‘barrier’ or ‘substantial
barrier’, with the ratings of the other barriers tending towards minor or evenly divided between
minor and more substantial.
These ratings suggest that some barriers are likely to be reasonably easily overcome, whilst others
are going to require more support and resources. These issues are returned to in the discussion
below.
Interestingly, although perhaps unsurprisingly given the family inclusive perspective of survey
respondents, the two lowest ranked barriers were those relating to the agency position on families:
Focus of our agency should solely be on the client
Our agency had not considered families as an issue.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
4
4.1
WHERE TO FROM HERE IN DEVELOPING FAMILY INCLUSIVE PRACTICE?
Introduction
This report has identified a number of agency needs in regard to developing family inclusive practice.
It has also identified key barriers that prevent agencies from supporting or involving families to the
extent they would prefer. This final section summarises the needs and barriers identified by the
sector and examines different ways in which they could be addressed. This discussion forms the
basis for the recommendations that follow.
4.2
The continuum of practice: where the sector is and where it is headed
As discussed in the introduction to this report, family inclusive practice can be understood as being
on a continuum, ranging from referring families to services through to highly integrated family
therapy and inclusivity in the client treatment process. It was also acknowledged that for different
agencies and client groups it is appropriate to be on different places on the continuum in terms of
family inclusivity.
4.2.1 Where agencies are currently placed
This needs analysis has shown that foundational level family inclusive practice can be readily
developed by interested AOD agencies. The majority of agencies surveyed had referral and informal
support processes in place and were regularly referring families to external supports, with nearly
half providing information packs.
There are also a variety of supports and information sources for agencies wanting to start
developing family inclusive practice. NADA’s work in providing the ‘Toolkit for change’, grant funding
and brokerage for the Bouverie Centre training, has enabled agencies to develop new practices, as
well as increasing general awareness about family inclusivity. Staff from FDS’s Bridging the Divide
program have approached virtually all NADA members in NSW offering assistance in setting up
information and referral processes, as well as providing information about FDS’s own family specific
services for referral. In addition, several agencies including Holyoake, MDECC, Kedesh and
SmartRecovery offer specialised family support groups and services, and there are many generalist
family support services that agencies are familiar with and using as referrals. Agencies are also
utilising general web resources and academic papers to inform their practice.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
4.2.2 Where the sector is headed
The survey results suggest that there is growing interest in developing more involved forms of family
inclusive practice. Agencies are willing to critically examine their practice and develop staff skills with
the aim of providing better support to families, and also of involving families, as appropriate, in
client treatment, recovery and relapse prevention. This willingness is reflected in agency intentions
relating to new practices, including developing structured family programs, adapting treatment
models, and engaging specialist family workers.
The question then is how the sector can be best supported in continuing to develop a higher level of
family inclusive practice.
4.3
Meeting key needs in developing family inclusive practice
4.3.1 New services for families
In terms of new services to families the greatest interest was expressed in developing structured
family programs/workshops and in engaging a family/project worker. Both such developments
require substantial commitment in staff and resources, therefore if agencies are to provide these
services there needs to be careful consideration of the benefits and costs in doing so, and also, in
particular, their sustainability over the longer term.
Providing structured family programs/workshops
A number of NADA members have developed programs for family members of clients,16,17either by
themselves or in partnership with specialist family support agencies, including FDS and Holyoake.
The motivation derives both from wanting to assist families and also from the understanding that
involving and supporting families results in better client outcomes, in the short term and over time.
The programs offer a range of benefits to families including: information about drugs and drug
treatment, developing coping skills, anger management, welfare information and referral, family
therapy, and support for successfully reintegrating the client back into the family.
The advantage of offering these programs in house and in unison with clinical staff is that a good fit
with the client therapeutic process can be maintained and the agency is effectively working with the
16
NADA (2008). Tools for Change: A new way of working with families and carers (Toolkit). Sydney: Network of
Alcohol and Other Drugs Agencies (NADA).
17
Argyle Research (2011). Family and carer inclusive practice in NSW non-government AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family and Carer Project.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
whole family system. However, agencies have reported that the provision of these kinds of services
does come with challenges, including ensuring that:
Family members are located sufficiently close to participate
Staff and resources are available to run the program
Staff are sufficiently skilled in working with families
Clients are willing to have their families participate
Families are willing to participate
It could be concluded that agencies who want to establish structured family programs need to
examine and address these issues if their program is to be effective – noting also that these factors
are some of the key barriers to family inclusive practice generally (see section below – ‘Overcoming
barriers’).
Agencies would also be advised to consider the advantages in working with a specialist partner
agency to collaboratively develop or adapt existing family programs – thereby reducing the demand
on agency resources and staff. They may also find that it can be more appropriate to refer family
members to programs run by external providers.
Do agencies need specialised family workers?
The issue of engaging family workers was discussed in part A of this report18. In summary, engaging a
family worker can bring definite benefits, including:
A focal referral person for clinical staff
Organising distribution of information to families
Providing family counseling
Running group sessions
Building partnerships that support families
Reviewing family inclusive practice in the organisation
Developing processes that ensure family inclusive practice across the organisation
The central issue with engaging a family worker is that of sustainability: most positions have been
part of short term funding so when the funding ceases then so does the position. This is potentially
an issue if the family worker has been providing services to families, such as support groups or
counseling, which then abruptly stop.
Those agencies who have maintained a family worker beyond designated funding period have either
changed position descriptions or adapted their core funding to include a family worker.
18
Argyle Research (2011). Family Inclusive Practice in NSW NGO AOD Agencies: Part A - NADA Family and
Carer Grant Program Evaluation.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
The other issue that was reported with engaging a family worker is that it can impede the
development of family inclusive practice in other staff and at other levels of the organisation as the
view may develop that ‘that’s the family worker’s role’.
Feedback from agencies suggests that if an agency is to seek funding for a family worker position,
ideally there is also in place, one or more of the following factors:
A clearly defined project that can be completed in the funding period – e.g. setting up family
referral and information structures / reviewing the agency’s family inclusivity
A progression plan – e.g. when the funding ceases, allocating part of another position to
family work
Management driven integration of family inclusive practice with clinical services
Investigation of outsourcing of direct services (support groups, counseling) to family support
agencies, whilst establishing clear referral pathways with intake and clinical staff.
4.3.2 Organisational development
The most commonly planned organisational development included:
Service audits
Developing client treatment models to include families
A family and carer policy
Referral processes
Whilst these developments can be implemented by agencies themselves, staff time, resourcing and
insufficient knowledge are likely to create barriers to doing so. However, as such changes tend to be
‘one off’ in nature, they are particularly conducive to being developed using seeding grants (see
Report Part A)19. In addition, it would be worthwhile reminding agency management of the clear
guidelines to organisational development provided in the ‘NADA Toolkit’20, and the support that can
be provided by specialist agencies such as FDS and the Bouverie Centre.
Policy and process review and development: Service audits, and development of family policy and
referral processes
The most commonly intended change to agency process is to conduct a service audit to examine
levels of family inclusivity across the agency, followed by development of a family policy and referral
processes. The experience of agencies who have highly developed family inclusive practice shows
that these three areas are also inter-related: a service audit would be expected to lead to the
development of a family and carer policy and referral processes. For agencies who are interested in
19
Argyle Research (2011). Family and carer inclusive practice in NSW non-government AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family and Carer Project.
20
NADA (2008). Tools for Change: A new way of working with families and carers (Toolkit). Network of Alcohol
and Other Drug Agencies: Sydney.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
undertaking these reviews there is information readily available through ‘NADA’s Toolkit’21: this
resource contains templates for a service audit and family and carer policy development.
The key issue is not then a lack of information but more of having the staff time to examine and
develop new policies and practices. It is of value to acknowledge that where agencies have
successfully instituted change, this has often involved the utilisation of specific grants, specialist
family agencies or funded family workers.
How can families be incorporated into treatment models?
Incorporating families into client treatment is a very challenging area of family inclusive practice
requiring specialist skills and knowledge of clinical workers. The form and substance of family
involvement in treatment also differs greatly across client groups and treatment types, with, for
example, the involvement of parents of an adolescent differing from an adult client’s partner.
Agencies also need to consider their own capacity and that of their families; what might be
appropriate inclusion could range from a single session addressing restorative issues through to an
integrated family therapy approach, examining the whole family system and dynamics in relation to
the client’s substance misuse.
Where there has been successful integration of families into treatment models, agencies have
usually accessed research about current best practices and/or had access to specialist training. It
could also be seen that the open sharing of information from other agencies would be useful, in
particular about what has worked and where the challenges lie.
4.3.3 Further training and programs in family inclusive practice
There is a high level of awareness that working directly with families requires specific skills and
experience. Following the very positive feedback received concerning the Bouverie Centre’s Single
Session Work with Families22, a further sponsored round of this training would be very well received
by the sector. In addition, training on providing family interventions over longer periods would also
be of interest.
21
NADA (2008). Tools for Change: A new way of working with families and carers (Toolkit). Network of Alcohol
and Other Drug Agencies (NADA): Sydney.
22
Argyle Research (2011). Family and carer inclusive practice in NSW non-government AOD agencies:
Part A: Evaluation: NADA Mental Health and Drug and Alcohol Family and Carer Project.
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The other point to note is that agencies who cannot access training to develop skills in their own
staff, can refer families to specialist family counseling and programs if they are not in a position to
offer counseling in house.
4.4
Overcoming barriers to family inclusive practice
The report identified some of the main barriers experienced by agencies in developing family
inclusive practice. The most substantial barrier was that of insufficient resources with a range of
other barriers observed by agencies that were either client related, agency related, or family related.
Ways in which these barriers could be overcome are drawn from Part A of this report23, with
additional information was provided by managers and family workers during follow up interviews.
4.4.1 Insufficient financial resources
Alcohol and other drug agencies are primarily funded to provide direct services to their clients,
therefore providing services to families or undertaking family inclusive organisational development
or training will usually require either additional or reallocated financial resources, at least in the
initial development stages. Agencies have overcome the barrier of a lack of resources in the
following ways:
Seeding grants
The high value of the NADA seeding grants24 demonstrated that one off funding can substantially
assist in developing family inclusive practice, most particularly when it is directed at organisational
change.
Program grants
Some agencies have had programs for families and/or family workers funded through other
Commonwealth and NSW State funding programs. Obtaining this type of funding has involved either
writing specific grant applications or adjusting the terms of existing grants to encompass family work
in the agency.
Other grants/sponsorship funding
Increasing the capacity of staff and agencies in regard to family inclusive practice can also be
supported by other funding sources or means: for example, the NADA sponsored Bouverie Centre
Training and various government or charity sponsored smaller grants programs.
23
24
Ibid.
Ibid.
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Outsourcing
There are a number of services who will assist AOD agencies in developing family inclusive practice
or provide family support services to the families of clients. For example FDS has been
Commonwealth funded to work with agencies to develop family inclusive practice. In addition, FDS
and agencies such as Holyoake provide highly developed support services to the families of
treatment service clients. In this sense, agencies do not have to develop their own support
programs, but instead set up effective referral systems to provide families with information about
available support services (and why they might need such services).
Embedding family inclusive practice
It is also important to note that many family inclusive practices, such as family referrals, providing
information, changing intake processes to ask family related questions, or even involving the family
at various points in the treatment process, do not require substantial resources once established.
Rather, these processes and related skills become part of the organisational framework and can
continue in a sustainable manner.
4.4.2 Client issues
The opposition of clients to family involvement issue creates a difficulty because agencies must
respect client confidentiality and trust, and relationships between clients and their family members
are commonly very strained at the start of treatment. Despite such difficulties, agencies have
successfully addressed the issue of gaining client consent to the contact of their families and
eventual involvement in the treatment process. There are also resources readily available providing
suggestions on ways of involving families of reluctant clients (see for example, the case examples
and references within the ‘NADA Toolkit’).
Broader definition of family
The ‘family’ in family inclusive practice refers to a wide range of people in addition to immediate
relatives and partners. More general questions such as ‘Who is someone important in your life?’ can
ensure that supportive and concerned people are kept informed of a client’s treatment and involved
as appropriate. For example, clinical workers report that sometimes clients want nothing to do with
mum or dad but have no problem with a sibling or other relative.
‘Not now’ does not mean ‘not ever’
Agencies report that one of the most effective ways of gaining consent to family involvement is
asking the client at intervals about their family, and not solely at intake. This involves looking for
‘providing openings for family and carer involvement’. One agency typically waits a few weeks ‘until
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
after the person has settled in and everyone has had a bit of breathing space, then we approach the
question.’ Alternatively, waiting for longer periods may be effective:
‘When a person starts the program they may want nothing to do with their family. After three or six
months in treatment this can change, and they may be willing for their families to be contacted, or
even look at being involved in restorative work. It is important to keep reviewing the question.”
4.4.3 Agency and staffing issues
Agencies identified a number of barriers to family inclusivity that related to agencies themselves and
their staff, specifically, insufficiencies of staff time, knowledge and confidence, and, a lack of
resource material. In addition, staff attitudes to family involvement were seen as creating a barrier.
The first observation to make about these barriers is that with the exception of staff time, agencies
generally rated them as minor. Consistent with this assessment is an analysis that these barriers can
be fairly easily resolved.
Staff time
Workers in the AOD sector often feel pressured by the demands placed upon them. As such, family
inclusive practice can occur as yet another burden, especially for clinical staff. A number of the ways
that this issue can be minimised were discussed above, including embedding family inclusive
practice into processes and engaging a family worker (who does most of the family contact).
In terms of providing family therapy and including clients in treatment processes, it is necessary to
convince staff of the considerable benefits to client outcomes before they can be expected to fully
embrace inclusion. Reportedly, this can be achieved by sharing the research results of studies of
family involvement and also by staff evaluating and reflecting on their own practice, for example:
‘we can see that the clients do better when the relationship with their family improves.’
Staff knowledge, confidence, attitudes and resources
Staff knowledge and skills in family inclusive practice are developed through training and experience
with working with families. In the first instance, general awareness training about the reasons and
principles for family inclusivity can be undertaken, for example with the workshops held by The
Bouverie Centre or FDS. Access to this type of training should be relatively unproblematic given that
agencies do routinely send their staff to short training courses, and sessions can also be held in
house if preferred.
Providing resources would also seem straightforward given the amount of material readily available.
Agencies would likely benefit from regular reminders of the resource material that exists, and also
how other agencies have used the material.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Developing higher levels of skills and confidence do require more time and resources, and the means
of providing more in depth training is discussed above.
4.4.4 Family related issues
In order for families to be involved they have to both be interested and physically available to do so.
The main barriers that prevent families from being involved are that they do not want to engage and
geographic distance.
Family does not want to be involved
With the families of clients with long term substance misuse, it is not uncommon for families to
become estranged and have had nothing to do with the client for years. Here, it may be that the
involvement of family is not possible, at least until long term rehabilitation has been achieved.
With clients who have contact with their families, common sentiments of family members are that
‘he/she is the one with the problem, why do I need to do anything?’ or that the role of the
treatment service is solely to ‘get him/her off drugs’. Agencies who do successfully involve families
take an ‘open but no pressure stance’ and demonstrate concern for what the family member is
going through. This involves sending material or providing referrals for the family to act upon in their
own time, and directly answering any questions about treatment. Once some contact is established,
an entry point to involvement can simply be asking how a family member is going. This can open a
discussion about the typical experiences of family members and the value of getting support and
counseling.
Geographical barriers
With 59% of surveyed AOD sites located outside Sydney or Canberra, and clients often leaving their
home towns or regions to attend treatment, geographical barriers do present a significant barrier to
family involvements. Given the barrier of distance, some of the ways agencies have supported family
inclusivity include:
Referring families to specialist family support services
Utlising technology for counseling (such as Skype)
Directly funding family travel (although this is probably not sustainable in the long term).
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
4.5
Conclusion and recommendations
This report has shown that the sector is developing family inclusive practice, particularly at the
foundational end of the inclusivity spectrum. In addition, information, web resources, referral
sources and external family support services are also well catered for. In short, any NSW AOD agency
who would like to provide information and referrals to family members could readily do so utilising
existing resources and support, and with minimal impact on their other service provision.
It is also important to note that the family support programs and information provided by external
providers are generally of a high quality, and have been developed and offered over many years.
These programs have been demonstrated to effectively help family members in their own coping,
resilience and improving their emotional well being25,26. There are also a number of choices of family
support so that agencies can select those which most closely align with their service. As such, AOD
agencies can be confident that there are many places to which family members can be referred to,
so as to provide them with the information and support they need
The key issues lie in further developing the sector’s capacity in family inclusive practice – most
particularly in staff skills, and in the deeper level of organisational change – and ensuring that the
changes made are effective and sustainable. In addition, agencies need support in overcoming the
barriers to family inclusive practice.
Many agencies noted the need for more resources in further developing their practice, however, the
needs analysis found that although additional funding would be very helpful, it is far more than a
question of simply finding additional money. Agencies require support and information on how best
to develop sustainable family inclusive practices. Of particular utility would be information on
effective use of partnerships and existing resources to implement and maintain changes in practice.
As far as overcoming barriers, some of the means through which agencies had successfully engaged
families were also discussed in this report. These included such measures as using seed funding to
create sustainable change, providing numerous opportunities for family engagement during the
treatment process, developing partnerships with specialist family support agencies and utilising
technology to engage families living at a distance. Interested agencies would also greatly benefit
from the sharing of the experiences of those who have successfully become ‘family inclusive.’
25
Copello, A., Templeton, L. & Powell, J. 2009 Adult family member and carers of dependent drug users:
prevalence, social cost, resource savings and treatment responses, UK Drug Policy Commission (UKDPC).
26
Patterson, J & Clapp, C. 2004 Clinical Treatment Guideline for Alcohol and drug Clinicians No 11: Working
with Families, Turning Point Alcohol and Drug Centre Inc.: Victoria.
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Family Inclusive Practice in NSW NGO AOD Agencies: Part B: Needs Analysis
Recommendations
1) Seeding grants – Round 2: that funding for a further round of grants promoting family
inclusive practice be sought – and, if successful, that funding be used specifically for family
inclusive practice initiatives that promote reflective practice, research and sustainable
organisational development.
2) Training funding: that funding for further sponsored training to the sector be sought– in
particular training that develops higher level skills in: working effectively with families, family
therapy and family inclusiveness in client treatment.
3) Partnerships: that agencies be encouraged to investigate partnerships with specialist family
support agencies in order to develop appropriate and sustainable family programs.
4) Resources: that agencies be regularly reminded of the resource: Tools for Change: A new
way of working with families and carers (Toolkit) and provided with short examples of how
the resource has been used in practice.
5) Information sharing: that a conference or workshop is held annually to enable agencies to
share information and knowledge about establishing and accessing family programs, family
therapy, and the effective inclusion of families in client treatment.
6) Research: that research opportunities and partnerships are investigated to assess the impact
of family inclusive practices on families and client outcomes.
7) Factsheets: that the following factsheets be developed and included in resources provided
to agencies about family inclusive practice:
Working with difficult to engage families – guide to effective practice
A summary of academic work and best practice in family inclusivity in the treatment
process.
A set of guidelines for establishing structured family support programs
A set of guidelines for engaging a family worker to ensure sustainable best practice.
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Family and carer support in AOD services: agency survey
1. About this survey
This survey is about family inclusive practice in AOD services. It asks about current and planned support services provided to family and carers of clients, and family related training and organisational development. The aims are to assess levels of family inclusive practice and to determine the need for family support related training and development in the sector. The survey has been commissioned by the Network of Alcohol and Drug Agencies (NSW) and Family Drug Support Australia (FDS). NADA and FDS were funded under separate grants, but with similar outcomes to support families affected by substance misuse. We have joined together to produce this survey in order to reduce the burden of providing separate surveys seeking similar information. The survey is independently administered by Argyle Research and Training: (02) 4758 7151 ­ [email protected]. Other All survey responses are confidential. The survey is Australian agencies delivering services in the AOD sector, including those who have no family support services. Please complete only one survey per agency, or site if a multi site agency. SURVEY DEADLINE is June 17, 2011. Participants can enter the draw for an iPad2. Page 1
Family and carer support in AOD services: agency survey
2. 1. Is your service delivered by an NGO/charity or through Government?
c Government
d
e
f
g
c NGO/charity
d
e
f
g
Other (please specify) 2. What is your service type or types?
c Drug and alcohol health promotion
d
e
f
g
c Early intervention
d
e
f
g
c Detoxification
d
e
f
g
c Therapeutic community
d
e
f
g
c Residential rehabilitation
d
e
f
g
c Non–residential services
d
e
f
g
c After­care programs
d
e
f
g
Other (please specify) Page 2
Family and carer support in AOD services: agency survey
3. What are your target client groups?
c No specific group
d
e
f
g
c Adults (18 years and older)
d
e
f
g
c Youth (12 to 25 years)
d
e
f
g
c Males only
d
e
f
g
c Females only
d
e
f
g
c Aboriginal and Torres Strait Islander
d
e
f
g
c Illicit drug users
d
e
f
g
c Alcohol only
d
e
f
g
c Homeless
d
e
f
g
c Dual diagnosis
d
e
f
g
c Culturally and linguistically diverse (CALD)
d
e
f
g
c Families
d
e
f
g
c Gay, lesbian, bisexual and transsexual (GLBT)
d
e
f
g
Other (please specify) 4. How many sites does your agency have?
c 1
d
e
f
g
c 2
d
e
f
g
c 3
d
e
f
g
c 4
d
e
f
g
c 5+
d
e
f
g
c outreach service
d
e
f
g
c telephone service
d
e
f
g
Other (please specify) 5. In what town(s) or surburb(s) is your the agency located? (postcodes or names)
5
6 Page 3
Family and carer support in AOD services: agency survey
6. If you are answering only for a specific site of a multi site agency, please state the
postcode of that site. PLEASE LEAVE BLANK if you are answering for the whole
agency.
7. What is your main role or roles?
c CEO
d
e
f
g
c Manager
d
e
f
g
c Coordinator
d
e
f
g
c Clinical Coordinator
d
e
f
g
c Psychologist
d
e
f
g
c Team leader
d
e
f
g
c Family worker
d
e
f
g
c Counsellor
d
e
f
g
c Case worker
d
e
f
g
Other (please specify) 8. Does your agency offer any services or support to the family members, carers or
friends of clients?
j Yes
k
l
m
n
j No (please go to question 11)
k
l
m
n
j Don't know
k
l
m
n
Page 4
Family and carer support in AOD services: agency survey
3. Family and carer services
1. Services you offer to family members/carers:
c Referral to family support services
d
e
f
g
Other c Information packs
d
e
f
g
c Information sessions
d
e
f
g
c Family days
d
e
f
g
c Structured family programs/workshops
d
e
f
g
c Group therapy sessions
d
e
f
g
c Support groups
d
e
f
g
c A family worker/project worker
d
e
f
g
c Family counselling
d
e
f
g
c Informal support (e.g. talking through concerns/questions)
d
e
f
g
c Other (please list any other family support services you offer)
d
e
f
g
5
6 Page 5
Family and carer support in AOD services: agency survey
4. Family support services ­ reasons
1. Some agencies do not offer family support services for a variety of reasons. Is there a
specific reason or reasons why your agency does NOT offer family support services?
c It is inappropriate for our client group
d
e
f
g
c Very few of our clients are in contact with their families
d
e
f
g
c Family involvement has been unproductive in the past
d
e
f
g
c Geographical barriers
d
e
f
g
c Lack of staff time
d
e
f
g
c Limited financial resources
d
e
f
g
c It is not the role of our agency
d
e
f
g
c We refer family members to family support agencies
d
e
f
g
Other (please specify) 5
6
Page 6
Family and carer support in AOD services: agency survey
2. Which, if any, of the following services would you like to either CONTINUE to provide
or PROVIDE as a NEW SERVICE to families of clients in the future?
c Referral to family support services
d
e
f
g
c Information packs
d
e
f
g
c Information sessions
d
e
f
g
c Family days
d
e
f
g
c Structured family programs/workshops
d
e
f
g
c Group therapy sessions
d
e
f
g
c Support groups
d
e
f
g
c A family worker/project worker
d
e
f
g
c Family counselling
d
e
f
g
c Informal support (e.g. talking through concerns/questions)
d
e
f
g
c Other (please list any other family support services you would like to offer or continue to offer)
d
e
f
g
5
6 Page 7
Family and carer support in AOD services: agency survey
5. Staff and organisation development to support family inclusive practice
1. What training or programs has your agency or staff been involved with in relation to
developing family inclusive practice? And how would you rate that program or training?
(select N/A or leave blank if no involvement)
N/A
Not at all useful
Somewhat useful
Useful
Very useful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Bouverie Centre Training
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
NADA ­ Family and Carer j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
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n
j
k
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n
j
k
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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j
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n
j
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j
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j
k
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j
k
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n
j
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n
j
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j
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j
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n
j
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j
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n
j
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n
j
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n
j
k
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m
n
Bouverie Centre Training (via NADA)
Grants Program
NADA ­ Practice Development Workshops
Family Drug Support ­ Stepping Stones
Family Drug Support ­ Bridging the Divide
Family Drug Support ­ Workshop
Family Drug Support ­ other services
Family support program ­ other AOD agency
State government grants program (to develop family inclusive practice)
Federal government grants program (to develop family inclusive practice)
Other (please specify) 5
6
Page 8
Family and carer support in AOD services: agency survey
2. What resources has your agency used to obtain information about family inclusive
practice? And how would you rate those resources? (select N/A or leave blank if not
used)
Academic literature on working with families
NADA: Tools for Change: A new way of working with N/A
Not at all useful
Somewhat useful
Useful
Very useful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
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n
j
k
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n
j
k
l
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n
j
k
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n
j
k
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n
j
k
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n
j
k
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n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
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m
n
j
k
l
m
n
j
k
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m
n
j
k
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m
n
j
k
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n
j
k
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n
j
k
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n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
family and carers Toolkit
Family Drug Support ­ professional advice
Family Drug Support ­ web resources
Family Drug Help ­ web resources
Professional advice ­ other source
Government health or welfare department resources
General web resources
Other (please specify) 5
6
Page 9
Family and carer support in AOD services: agency survey
3. Please indicate the organisational development your agency has undertaken in
relation to families:
c None
d
e
f
g
c None ­ we considered that our service was already sufficiently family inclusive
d
e
f
g
c Conducted a SERVICE AUDIT in relation to family inclusive practice
d
e
f
g
c Developed a POLICY for working with family and carers
d
e
f
g
c Changed the INTAKE PROCESS to collect family related information
d
e
f
g
c Engaged a FAMILY WORKER/PROJECT WORKER
d
e
f
g
c Changed a POSITION DESCRIPTION to include family work
d
e
f
g
c Changed/added INFORMATION PROCESSES to families (e.g. to systematically provide information to families on client wellbeing)
d
e
f
g
c Changed/added REFERRAL PROCESSES for families (e.g. developed referral pathways to family support agencies)
d
e
f
g
c Changed/developed CLIENT TREATMENT MODELS (e.g. included family inclusive elements as part of client treatment)
d
e
f
g
c Other or further detail
d
e
f
g
5
6 4. Has your agency developed any partnerships in relation to developing family
inclusive practice? (if yes, please list partners and nature of the partnership)
j Yes
k
l
m
n
j No
k
l
m
n
Partners' details 5
6
Page 10
Family and carer support in AOD services: agency survey
5. Are there any specific services or support to which you regularly refer families? If,
yes, please provide details.
j Yes (please provide details below)
k
l
m
n
j No
k
l
m
n
Details 5
6
Page 11
Family and carer support in AOD services: agency survey
6. Training and organistional development ­ future intentions
1. How important are additional financial resources (e.g. grant funding) to your agency
developing, or continuing to develop, family inclusive practice?
j Not at all important
k
l
m
n
j Somewhat important
k
l
m
n
j Important
k
l
m
n
j Very important
k
l
m
n
Further comments 5
6
2. How important is advice, training and/or support from specialist family agencies to
your agency developing, or continuing to develop, family inclusive practice?
j Not at all important
k
l
m
n
j Somewhat important
k
l
m
n
j Important
k
l
m
n
j Very important
k
l
m
n
Further comments 5
6
3. What training or programs do you think your agency would benefit from using in the
future in relation to family inclusive practice?
5
6 Page 12
Family and carer support in AOD services: agency survey
4. What resources do you think your staff will consult in the future in relation to family
inclusive practice?
c None
d
e
f
g
c In house resources
d
e
f
g
c Academic literature on working with families
d
e
f
g
c NADA: Tools for Change: A new way of working with family and carers toolkit
d
e
f
g
c Family Drug Support ­ professional advice
d
e
f
g
c Family Drug Support ­ web resources
d
e
f
g
c Family Drug Help ­ web resources
d
e
f
g
c Professional advice ­ other source
d
e
f
g
c Government health or welfare department resources
d
e
f
g
c General web resources
d
e
f
g
Other (please specify) 5
6
Page 13
Family and carer support in AOD services: agency survey
5. What organisational development is your agency likely to undertake in the future in
relation to family inclusive practice?
c None
d
e
f
g
c None ­ we consider that our service is sufficiently family inclusive
d
e
f
g
c Conduct a SERVICE AUDIT in relation to family inclusive practice
d
e
f
g
c Develop a POLICY for working with family and carers
d
e
f
g
c Change the INTAKE PROCESS to collect family related information
d
e
f
g
c Engage a FAMILY WORKER/PROJECT WORKER
d
e
f
g
c Change a POSITION DESCRIPTION to include family work
d
e
f
g
c Change/add INFORMATION PROCESSES to families (e.g. to systematically provide information to families on client wellbeing)
d
e
f
g
c Chang/add REFERRAL PROCESSES for families (e.g. developed referral pathways to family support agencies)
d
e
f
g
c Change/develop CLIENT TREATMENT MODELS (e.g. included family inclusive elements as part of client treatment)
d
e
f
g
c Other or further detail
d
e
f
g
5
6 6. Are there any other supports or resources that your agency would like to access in
relation to family inclusive practice?
5
6 Page 14
Family and carer support in AOD services: agency survey
7. Barriers to developing family inclusive practice
1. What barriers have you observed in your agency when you have been developing or
considering developing family inclusive practice? And how would you rate the barriers
you observed? (please select 'not a barrier' or leave blank if not an issue for your
agency).
Clients do not want their families involved
Families are not in contact/do not want to be Not a barrier
Minor barrier
Barrier
Substantial barrier
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
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n
j
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n
j
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n
j
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j
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j
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j
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j
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n
j
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n
j
k
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n
j
k
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n
j
k
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j
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j
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n
j
k
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n
j
k
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n
j
k
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n
j
k
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n
j
k
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n
j
k
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n
j
k
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n
j
k
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m
n
j
k
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m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
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m
n
j
k
l
m
n
involved
Our agency had not considered families as an issue
Staff have found that families can hinder the treatment process/are part of the problem
Staff do not have enough time to meet the demands of families
Insufficient financial resources to also work with families
A lack of resource material to work with families
A lack of staff knowledge to work with families
A lack of staff confidence to work with families
Geographical barriers (families at a long distance)
Staff believe that the focus of our agency should solely be on the client
Other (please specify) 5
6
Page 15
Family and carer support in AOD services: agency survey
8. Family inclusive practices in the past
1. Three years ago how would you rate your agency's level of family inclusive practice
as compared to now, in relation to:
None
Some, but far less Some, but less About the same as than now
than now
now
More than now
Don't know
Family support services
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Staff training in family j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
issues/support
Organisational development to increase family inclusivity
2. If you wish, please provide any further details or comments in relation to your agency
and family inclusive practice.
5
6 Page 16