YoDAA provides young peo-

ple and youth workers sup-

porting young people with

substance use related prob-

lems and dependence, with an

easily accessable advice, infor-

mation, referral and network-

ing service for youth specific

alcohol and other drug (AOD)

related needs. As a collabora-

tion of many agencies. YoDAA

provides a one-stop, multi-

channel service with website,

one telephone and email ad-

dress, as well as web chat.

Youth workers can access

online practice tools, research

information, a service finder

and secondary consultation,

and also share their events,

news, experience, questions

and ideas with colleagues from

across the State .

Through some channels, young

people themselves can access

advice and information, rele-

vant web-based content so

that the next step for them in

seeking help or information is

clear. YoDAA Manager Dom

Ennis says that “YoDAA will

enable a more accessable, co-

ordinated and navigable youth

AOD service system in Victo-

ria which will lead to better

outcomes for young people

and encourage consistent, evi-

dence based-based practice

across the sector.”

Youth workers can now ac-

cess the YoDAA website -

yodaa.org.au, the advice–line

te lephone number -1800

458685, contribute to the

online forum and also register

to be updated on training

opportunities.

The service will also extend to

families and schools later in

2014. Mr Ennis said YoDAA is

the first service to provide

YoDAA - Youth Drugs & Alcohol Advice A collaborative state-wide approach to youth drug and alcohol related problems

With permission from Leunig

June 2014 Issue 3

BUDDYS NEWS Building Up Dual Diagnosis in Youth Services with our partners

HYDDI - the Homeless Youth Dual Diagnosis Initiative

BUDDYS

BUDDYS is a Statewide

group of Victorian Dual Diag-

nosis Initiative (VDDI) youth

senior clinicians.

BUDDYS is committed to the

best possible outcomes for

young people through evi-

dence based best practice.

BUDDYS clinicians can sup-

port your agency in building

Dual Diagnosis capacity.

Page 2

headspace Warnambool

YSAS Dandenong - Bree Tapper

NEXUS DD Practice Initiative

Page 3

Monash Health Dual Diagnosis

Service

For Your Diaries

Book Review - Chris Rampling

Page 4

HYDDI -The Road Home- Roadwork in

Progress by Andrew Innes

Page 5

The Road Home cont.

Page 6

Editorial Team contact details

Inside this Issue

such an integrated and co-

ordinated response and will

be the platform for an ongoing

and informed conversation

about youth AOD needs.

“Through YoDAA, workers,

families. young people and

schools can access the most

up to-date AOD information

and quickly connect with the

service best matched to meet

their needs”.

The State`s largest AOD ser-

vice, YSAS - the Youth Sup-

port and Advocacy Service

will run YoDAA on behalf of

partner organisations. Mr En-

nis says: “As a workforce, we

can shape innovative new

practice and also potentially

reach many more young peo-

ple”.

The YoDAA website also pro-

vides access to a Youth

AOD Toolbox with a vast

range of evidence and litera-

ture.

“The power of YoDAA lies in

the collaboration of services”

Dominic Ennis YoDAA Manager

The Editorial team seeks contributions by youth service providers on team innovations and current projects which can inform our readers about your work in managing young people with complex needs. See back page for contact details.

Mark is a hospital trained

psychiatric nurse who has

been involved in dual diag-

nosis work since 1995. “I was hospital trained and

it was in that setting where

I observed many unhelpful

attitudes to substance use

in people with mental ill-

ness. It was easy to tell

people not to use; and of-

ten counterproductive. It

wasn`t until I began work-

ing in community settings

that I found a better way to

understand that substance

use is multi-faceted and

serves various purposes in

my clients` lives. This led

me to realise there was a

need for a more informed

approach to dual diagnosis

treatment. With this

knowledge, I later started

work in the AOD field. I

believe that Motivational

Interviewing and a harm

reduction approach is help-

ful to start engagement

with dual diagnosis clients. I

am now working for head-

space in Warnambool

where bringing the skills I

learned in adult services to

the youth sector is both

rewarding and stimulating. I

was part of the early for-

mation of the VDDI Rural

Forum and have been in-

volved in systems change at

both the state and local

levels. I am keen to see

further service delivery

improvements for clients

presenting with complex

needs; and for the artificial

barriers of the service sys-

tem to be dissolved”

work is assisting staff to

work with clients around

the interaction between

their mental health and

alcohol or other drug use.

A foundation question is

‘what is the person’s rea-

sons for using their drug(s)

of choice and how might

this impact on their mental

health?’ To try and answer

this question we have de-

veloped the Reasons for

Use Package in a Interac-

tive PowerPoint format. It

involves administering the

“Nexus has been commit-

ted to assisting agencies

with implementing dual

diagnosis based interven-

tions for some years now.

We are particularly inter-

ested in user friendly inter-

ventions that assist in

opening up dual diagnosis

conversations with clients

and then providing a guide

as the next step in treat-

ment. Using screens or

other tools can be useful in

this process. We believe a

key area of dual diagnosis

Reasons for Substance Use

Scale and then a series of

interventions that flow

from the client’s responses

to the scale. The RFU

Package is intended as a

user friendly, next-step in

working with clients. We

have been testing the pack-

age with various agencies

and the initial results are

positive.”

Headspace South West Victoria Mark Powell spoke to BUDDYS News about his role at headspace in Warnambool, including providing a thought

provoking quote from philosopher, H.D. Thoreau.

Practice Initiative - NEXUS Dual Diagnosis

New BUDDYS member YSAS Dandenong

team at YSAS around co-

occurring mental health

concerns and substance

use. Bree has been working

in the youth sector since

2011 and is currently com-

pleting Postgraduate Psy-

chology studies. Bree

joined BUDDYS because of

her passion for working

with young people with a

dual diagnosis; and her

desire to support services

to embrace co-occurring

mental health and sub-

stance use concerns, and

to address them as a single

presentation – rather than

two separate issues.

Bree Tapper is a new

member to BUDDYS, join-

ing the team from the be-

ginning of 2014. Bree is

currently working at YSAS

in Dandenong, where she

provides primary assess-

ment and counselling to

young people presenting

with dual diagnosis issues

and also secondary consul-

tation and training to the

Mark Powell

“The question is not what you

look at but what you see”

H.D Thoreau

writer and philosopher

Bree Tapper

Kevan Myers

Simon Kroes

Page 2

Wayne Wright was recent-

ly appointed to the Monash

Health Dual Diagnosis Ser-

vice. BUDDYS News spoke

to Wayne about his role. “I am a social worker who

has worked across the

mental health and alcohol

and other drug sector for

many years. I am a Senior

Youth Dual Diagnosis Cli-

nician with the Southern

Dual Diagnosis Service and

look forward to contrib-

uting to the field. During

my time within the field I

have also seen a shift to-

wards greater integration

of services. I have also par-

ticipated in the trend that

has seen the development

of improved screening,

assessment and treatment

options as the evidence

base has increased to sup-

port a more fully integrated

treatment approach. I understand that we still

have work to perform in

certain areas and look for-

ward to working with our

partners in the region to

meet these challenges. The

recent changes to the wid-

er service system and

changes within the youth

culture require us to be

working in a manner that is

flexible and responsive to

the needs of our communi-

ties. I look forward to

meeting many of you dur-

ing my work and am also

look forward to participat-

ing in the future develop-

ments and activities of the

wider dual diagnosis net-

works; to further enhance

our treatment options and

responses.”

Dual Diagnosis Service Monash Health

Book Review

petrol, through connecting with tribal elders, local community councils and state and federal agencies. The author is a white Aus-tralian with a background in Anthropology who wrote this book “to fulfil an adopted cultural re-sponsibility” of passing on his knowledge . He ap-proaches his task with something of a missionary zeal, including living apart from his wife and children for long periods of time to ensure the continued suc-cess of his cause. Stojanovski delves into many current day issues from an historical view-point which contributes to non-Aboriginal under-standing of Aboriginal cul-ture. The author details the components that have ena-bled the Mt Theo pro-gramme to succeed, in-cluding strategies to en-gage young people, using the “tyranny of distance” to promote engagement, the value of persistence and ‘getting it right’ with

the wider the Aboriginal community. He describes the real life tragedies asso-ciated with petrol sniffing, particularly the impact on the health of petrol sniff-ers. Stojanovski adores desert dwelling and describes his struggles with the materi-alism of non-Aboriginal cultures. Stojanovsky`s central argument is that commitment, building close relationships and supporting the Yuendumu people to take ownership of the programme - that will allow it to become sustainable, in spite of the many barriers he describes in maintaining govern-ment funding and the masses of red-tape in-

volved.

Reviewer Christine Rampling

NEXUS Dual Diagnosis St Vincent`s Hospital

Dog Ear Café How the Mt Theo

Programme beat the

curse of petrol sniffing

Author Andrew Stojanovski 2010.

Hybrid Publishers Melbourne.

The goal of this book is to inform about the preva-lence of petrol sniffing in the remote Aboriginal Yuendumu community, located 300 kilometres west of Alice Springs. It includes insights about successfully working with young people who sniff

Page 3 BUDDYS NEWS

For Your Diaries

BUDDYS will hold

our 3rd Youth Dual

Diagnosis Service

Providers Forum on

October 9th 2014 at

the Department of

Health building

Lonsdale Street.

Planning is under-

way for another

stimulating pro-

gramme.

Our theme this year

is: Youth Dual Diag-

nos is -Complexity

and Diversity. Look

for more details in

the next BUDDYS

News and an an-

nouncement closer to

the Forum about reg-

istration and Pro-

gramme details

through VAADA

news

Wayne Wright Acting Manager Monash

Health Dual Diagnosis

Service

“The Homeless Youth Dual Diagnosis Initiative was established in 2009 in an effort to address the mental health and substance use factors associated with homelessness.”

Since the eponymous gov-ernment white papers were introduced in 2008 as the key strategic plat-forms to halve homeless-ness across Australia by 2020, the phrases “The Road To Homelessness” and “The Road Home” have summoned images of the types of hardships young people who are homeless, experience. The Road Home, to use a meta-phor of traffic control strategies, aims to reduce the flow of traffic to home-lessness, and increase the amount of arrivals home. Project i, the seminal 2003 paper chronicling research into homelessness in Mel-bourne, highlighted youth homelessness on the politi-cal agenda as a burgeoning social issue and a priority to be addressed. In addition to reinforcing prior work conducted by other re-searchers, it laid the groundwork for the devel-opment of the Victorian Homelessness Action Plan. This plan identifies the groups likely to be at high risk of entering homeless-ness, and focuses on early intervention and preven-tion in an effort to divert those from graduating into

chronic homelessness with all its possible sequelae. In 2011, it was estimated that over 6000 young Victori-ans aged 12-24 were homeless on any given night; that is, over 40% of people experiencing home-lessness on any given night in this state. A further al-most 8000 young people were living in caravan parks and overcrowded or improvised dwellings. Many young people who are homeless experience poor mental health, pov-erty, substance use, famili-al and social isolation, and are often victims of vio-lence, disengaged from school, and unemployed. These risk factors can be a precursor to homelessness or the result of episodes of homelessness. Investigating the temporal link between mental health and home-lessness, Johnson & Cham-berlain identified that 40% (227 people) of the sample that experienced mental health issues beforehand were aged 12-24 years when they first became homeless; and, in the sam-ple of those experiencing mental health issues after-wards, 78% (530 people) were aged 12-24 years old when they first became homeless, 2/3 of whom also had substance abuse issues. Hope Street Youth and Family Services have partnered with North West Mental Health (a division of Melbourne Health) as lead agencies to work with homeless youth in the Northern Metro region of the DHS. Funding for this project was provided un-der the National Partner-ship Agreement on Home-lessness through the De-partment of Human Ser-

vices (Housing and Com-munity Building Division); and the Department of Health (Mental Health Drugs and Regions Divi-sion). Hope Street is a spe-cialist youth agency utilis-ing innovative evidence-based and practice-based expertise to respond to youth homelessness. It is Hope Street`s proficiency and range of programmes that resulted in the invita-tion from the departments to be the lead homelessness agency for HYDDI in the Northern Division of Mel-bourne. Hope Street attains better outcomes for home-less young people by providing crisis accommo-dation, intensive case man-agement, specialist coun-selling and advocacy to support young people with their immediate situation and in transition toward self-sufficiency and inde-pendent living within their communities. Hope Street and HYDDI have proven to be a complimentary fit enhancing the existing Hope Street services that assist young people to move out of homelessness and into meaningful and fulfilling independent life-styles. A HYDDI clinician has been embedded within Hope Street since 2012, and therefore well-placed to service Specialist Home-lessness Services, funded youth homelessness agen-cies and programmes within the Department of Human Services Northern division. Referrals are re-ceived by telephone or email from case managers that have concerns about the impact that mental health or substance use issues may have on a young person`s ability to

HYDDI and The Road Home – Roadwork in Progress By Andrew Innes HYDDI Senior Clinician – Northern Region SUMMITT Dual Diagnosis Service.

engage with services and address life issues and cir-cumstances, that are the causes of homelessness. After the initial assessment by the youth homelessness case manager, a collabora-tive approach is utilized to decide the best method to respond to the young per-son`s needs, as well as to enhance the capacity of the case manager. The Key aims of the initia-tive are: -Improved responses to episodes of mental health and/or substance related crises. Primary and Secondary consultations in order to assess mental health and substance use - Advice on strategies of engagement and treatment - Referral for specialist treatment - Co-ordination of services and clinical problem solv-ing - Co-case management - Training & Education - Service development Developing a program such as HYDDI has not been without its challeng-es. Interestingly, these challenges mirror those experienced by dual diag-nosis clinicians working in Mental Health and Alcohol & Other Drug services, in that the specialist services operated without much understanding of the other, although their client group experienced similar diffi-culties. The situation, like that one, continues to be a work in progress. Youth homelessness is as much an area of expertise as dual diagnosis and presents the HYDDI clinician with an opportunity for reciprocal learning and capacity building. Expanding on

Page 4 Issue 3

the point above, whilst many in the youth home-lessness sector have ter-tiary qualifications in that or a related field, mental health and substance use continues to be a perplex-ing issue that adds another layer of complexity when dealing with this vulnera-ble client group. That is not to say that staff are not unwilling or unable to attend to the needs of this group, but negotiating of the mental health and/or AOD service system can be difficult and discouraging. Having the ability to access such specialized input means outcomes for young people will be optimized, and the impact of mental health and substance use on homelessness reduced. For homeless young people accessing services for assis-tance, the stigma associat-ed with mental health and substance use often sees the young person denying any issues, despite their presence. The reasons for this are many; ranging from that perception that they will be denied service, to the other extreme where they think service will want to “cure” them. It is imperative youth home-lessness staff to be alert for mental health and sub-stance use issues, looking out and listening for any indication that the young person they are working with may be experiencing problems associated with them. Actively screening at intake, or as near to first encounter as possible, workers refer people with mental health AND/OR substance use issues for assessment. Such is the extent of co-existence of the two, there is a high

likelihood of uncovering one, whilst assessing for the other. Providing an integrated treatment op-tion is always preferred to working with one problem at a time; as the issues that is not attended to will more often than not derail the work that had been done on the others, bearing in mind that homelessness is also a co-morbidity. The HYDDI initiative was funded for 4 years, with a further year granted for 2013-14. The notion that homelessness, mental; health and substance use are enmeshed as co-morbidities has been wide-ly accepted by researchers, policy makers and work-ers in those fields, and is a scenario played out every-day by young people. The evidence-based best prac-tice for working with the dual diagnoses of poor mental health, and sub-stance use is that of inte-grated treatment. Similarly, the systems approach to remain responsive to homeless youth with com-plex needs should be one of integration of services to address the issues concur-rently. Embedding HYDDI within Hope Street builds upon current expertise of both service systems, and provides reciprocal capaci-ty building opportunities. The Victoria Dual Diagno-sis Initiative provides a framework for initiatives to address youth homeless-ness, with the goals of ear-ly intervention and pre-vention. The Homeless Youth Dual Diagnosis Ini-tiative has demonstrated that is does achieve better outcomes and need to con-tinue to help reduce the number of homeless youth

progressing into chronic homelessness. Case Study - Mike`s Story Mike was admitted to hos-pital after an attempt at suicide. He stayed there for three days, detained under the Mental Health (1986) as there were concerns for his mental health and safe-ty due to the context of a situational crisis and ex-treme alcohol consump-tion. During his stay, Mike was provided with ongoing support from both his Hope Street case manager and the HYDDI clinician. This was an opportunity to integrate clinical expertise and skills to service deliv-ery outside Hope Street, providing a more flexible and improved service re-sponse. Test results, and treatment plans were dis-cussed with the ward Reg-istrar, and discharge plans for Mike could be made with the Allied Health team. After Mike was dis-charged, the HYDDI clini-cian supported Mike`s Hope Street case manager to take an active role in regular assessment of his risk of self harm. Mike declined to take part in an assessment of his alcohol, but staff remained flexible in working around this by continuing to try and build rapport with him. Mike finally agreed to discuss his substance use, and strate-gies could then be em-ployed to give Mike the necessary information to combat his battle with al-cohol. Mike learned about the links between his self-destructive behaviour and the effects of alcohol con-sumption; and a safety plan was developed with him for the future. Hope Street reported back that

HYDDI and The Road Home – Roadwork in Progress By Andrew Innes HYDDI Senior Clinician – Northern Region SUMMITT Dual Diagnosis Service.

the experience has resulted in the team`s increased awareness of mental health issues and confidence in working with young peo-ple with dual diagnosis; and an improved ability to identify early warning signs and triggers of young people with Dual Diagno-sis. References -The Road Home: A National Approach to Reducing Homeless-ness. Commonwealth of Australia 2008. Rossiter, B., Malett, S., Myers, P, and Rosenthal, D. (2003) Living Well? Homeless young people in Melbourne. The Australia Re-search Centre in Sex, Health and Society. La Trobe University Mel-bourne - CHP fact sheet: Youth Homeless-ness in Victoria– Key statistics - Are the homeless mentally ill? Johnson, G., & Chamberlain, C,. 2008. (A paper presented at the Australian Policy Conference, University of NSW, 8-10 July, 2009) - Homeless SAAP clients with mental health and substance use problems. 2004-05. A Report from the SAAP National Data Collection. AIHW Bulletin 51, 2007 - Victorian Homelessness Action Plan 2011-2015. Victorian State Government This article first was first published in in the January 2014 edition of ‘Parity’ the e-newsletter of the Council To Homeless Persons; and reprinted with kind permission.

Page 5 Issue 3

Editorial Team Page 6

BUDDYS seeks contributions to this news letter

We would like to include submissions from anyone with an interest in Youth Dual Diagnosis. We are looking for [but not limited to]:

Developments in your service or team

New research and articles of interest about dual diagnosis with a focus on youth

Highlights and experiences from different programs around Victoria

Innovative ideas in your youth service sector

Examples of practice / intervention tools

Consumer and carer experience and ideas

National or international initiatives of interest

Notice of conferences or workshops

Photos and images

Submissions start at 125 words and written for a target audience from a varied background. Please in-clude links to articles and websites where applicable

Please forward items, suggestions, feedback or queries to the editorial team.

Steve West. Eastern Dual Diagnosis Service -Youth Hub, 43 Carrington Rd Box Hill.

Mobile 0457 544 103. email: steve.west@easternhealth.org.au

Christine Rampling. NEXUS Dual Diagnosis Service Second Floor, Bolte Wing St

Vincent`s Hospital. Mobile 0417051405. email: christine.rampling@svhm.org.au

Andrew Innes. HYDDI – Northern Region SUMMITT DD Service North Western

Mental Health -The Royal Melbourne Hospital. Mobile: 0409 029 102

email: andrew.innes@mh.org.au

“Dual Diagnosis is an expectation

not an exception”

Dr Kenneth Minkoff