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Ko Celtic clan te hapuKo Michelle Tziarkas ahau

MacdonnellRyanHoobinCampbell

Ko little yellow te waka

Ko Lesbian clan te hapu

Magistrates Early Referral Into

Treatment program&

Therapeutic CommunitiesA bad fit? Or just in need of

adjustment?

Another way to ask this question…..

Are we trying to fit a square peg into a round hole???

What is the MERIT Program ?

•The Magistrates Early Referral Into Treatment (MERIT) program is an inter-agency initiative between four government agencies.

•MERIT is funded under the National Healthcare Agreement entered into by the Federal and NSW State Governments.

•As at 30 June 2011 MERIT operated in 65 local courts around NSW.

•The drug treatment aspects of the program are facilitated by 20 MERIT teams across NSW who are based in Local Health Districts (LHDs) or contracted to Non Government Organisations (NGOs).

STAKEHOLDERS

PROGRAM LEAD AGENCIES ARE:

*Department of Attorney General and Justice

* Chief Magistrate’s Office

* NSW Ministry of Health

* NSW Police Force

KEY STAKEHOLDERS:

- MERIT Teams – New South Wales Australia

- Program Participants

- Residential Rehabilitation Providers Funded to provide MERIT Residential Treatment Beds.

What is the MERIT Program ?The intended MERIT program outcomes, for participants and for the community, are:

• Decreased offending• Increased community protection• Decreased drug use• Improved health and social functioning• Sentences that reflect the improved rehabilitation prospects of

successful MERIT participants.:•Target Population – Adult defendants with illicit drug use problems motivated to undertake drug treatment.•Participants need to be eligible for bail and are closely managed by their MERIT team throughout the program with the magistrate receiving regular reports on participation.•Participants under take supervised drug treatment as part of their bail conditions for a period of approximately 12 weeks.

• Range from 1 to 12 months duration with varying structures, philosophies and interventions.

• Residential treatment guidelines are intended to produce therapeutic change as opposed to residential care environments that are intended as a welfare intervention.

*NSW HEALTH MERIT RESIDENTIAL TREATMENT GUIDELINES (2007)PAGE 7

Residential Treatment *

ODYSSEY HOUSE

• Odyssey House NSW is a long term residential treatment program –with program participants taking on average from 9 to 12 mths to complete the treatment phase of the program – and Odyssey currently has 3 MERIT program funded beds.

– This means

• MERIT clients do not pay an admission fee- but pay ongoing treatment costs.

• Odyssey House staff are not responsible for reporting directly to the courts regarding the MERIT clients progress – they report to the client’s MERIT worker.

• Clients can be referred back to the community and the case management of their MERIT Case Manager/Counsellor –without this being seen as a negative.

ODYSSEY HOUSE MERIT and MERIT BEDS

• Odyssey House NSW also is one of two NGO’s in NSW providiongMERIT services to a NSW Local Court. Odyssey House MERIT team is responsible for the provision of MERIT services to clients who attend Waverley Local Court in the Eastern Suburbs of the Sydney Metropolitan Area.

• Odyssey House is also funded to provide MERIT beds within its residential treatment services – this is a separate agreement and from the above service that we provide as the MERIT team for Waverley Court.

Current service provision

• It is important to note Odyssey House currently provides quality and effective services to participants of MERIT programs from all over NSW. Many clients have chosen to stay on past their MERIT program completion and have gone on to graduate the Odyssey House program.

• The goal of this paper is to look at how we can improve on this service provision, take on feedback – and what is achievable within budgetary and HR constraints.

STAKEHOLDER FEEDBACK

Annually Odyssey House conducts a survey of agencies NSW wide who are potential points of referral for clients to Odyssey House Programs.

Feedback obtained from MERIT teams state-wide has varied greatly in terms of level of satisfaction.

FEEDBACK

Over the last 5 years the feedback received from MERIT teams has varied greatly.

1. There are a number of MERIT Teams who refer consistently to Odyssey House.

2. On the other hand there are MERIT Teams very close to our facilities whose referral rates are very low.

3. Odyssey House program is usually up to 12 mths – MERIT is 3 mths –some MERIT clinicians feel that this is a mismatch- and question the funding of beds in our service – and generally do not refer as a result.

4. Reports of pressure being placed on MERIT clients to commit to long term program.

5. Dissatisfaction from some MERIT teams – re the difficulties they face being able to maintain contact with clients once they enter the community.

ODYSSEY HOUSE PROGRAM REVIEW

New ideas

Review

Innovate

Plan CREATE

Improve

Design BE BRAVE

look at feedback

Step outside the box EXAMINE

CONSOLIDATE

PROGRAM REVIEW PROPOSALS

Issues raised could be addressed by the following modifications to the existing program:

• A designated MERIT staff member – who is aware of each client who is admitted and what their plans and goals are.

• If a MERIT client – is nearing the end of their MERIT treatment time – and they are planning on exiting the Therapeutic Community – this exit should be planned, and managed, including relapse prevention education and a continuing care plan.

PROGRAM REVIEW PROPOSALS

• IN HOUSE EDUCATION– TC clients are very committed to the idea that

everyone needs to be on board with the WHOLE DEAL – the LONG HAUL – people who say – I’m just here to complete my MERIT treatment goals – are likely to be considered uncommitted, just “doing it for court”, not ‘really part of the community’, ‘not to be trusted’.

– These ideas can be entrenched within these environments – and it is not just the clients, staff may often hold true to these old TC values.

– These ideas need to be challenged and differing client treatment plans and individual goals could be, and CAN be supported within TC environments long term , or medium term.

An Examples of a short term program operating within the TC environment.

Between 2002 and 2004 – Odyssey House was funded to provide a

3mth Residential Gambling Treatment Program :

- Gamblers without AOD issues eligible for admission.

- Participants graduated program at the completion of 3 mths.

- Designated staff employed to deliver specific clinical and educational interventions.

- TC Model was not undermined

- TC clients were not disadvantaged and the AOD long term residents supported these clients through their treatment journeys.

- This program ran successfully for a number of years until the funding source was redirected to community based providers.

- Foot note: Odyssey House currently does have a program for AOD/ Gamblers – but it is not of 3 mths duration .

PROPOSAL

Odyssey House is considering implementing: An Odyssey House residential MERIT Program. • 10 to 12 week residential program – with the option to remain

in treatment and complete TC program.

• Would require a dedicated staff member –to deliver specific clinical and educational interventions.

• Clients could complete and exit at the completion of their program, with a transition plan.

• TC model not undermined–clients receive treatment.

• TC clients not disadvantaged – but could provide support.

• This Program could lead to an increase in MERIT client utilisation of our services.

BENEFITS

- Improved client outcomes – with planned exits.

- Higher retention rates – due to modifications in program and attitudes to these clients.

- Possibility of an increase in funding for more MERIT beds in program.

- Able to market this shorter in house MERIT Program as a distinct program- potentially attracting more referrals.

It is less about fitting a square peg into a round hole than it is about solving the puzzle.

Working together to achieve greater outcomes, no matter what the challenge!

• Kia oraKIA ORA