Responsibility for the provision of comprehensive and coordinated treatment and support cannot rest solely at the level of individual practitioners or individual services because few agencies are comprehensive enough within themselves to meet all the needs of their clients. Certain functions need to be conducted at the system level, or at the level of service networks. This need for shared responsibility may be one reason why achievement of comprehensive and coordinated care remains so elusive.

In the absence of dedicated resources for system level coordination, these system level functions fall entirely upon the shoulders of frontline and middle management of individual services. There is a perception that relationships are often good between workers at the ground level but that issues at the system level remain to be addressed and that more investment of time and resources is needed at the manager and director level. Part of the problem may lie in communication between levels about what is being done and how relevant activities might be articulated together.

But it is clear that work that has been achieved at the ground level has not always been sustained. This essentially means that resources have been invested and that the returns that might be expected on those investments are not being fully realised.

The issue of housing services and their ability to respond to the needs of our clients illustrates the types of systemic problems that are beyond the capability of front-line workers.

When services have highly structured and rule-based modes of operation, good personal relationships between workers can facilitate flexibility when needed, but building and maintaining these personal relationships is very time consuming and they are vulnerable to changes in personnel. A structured approach involving formal acknowledgement of the types of flexibility regularly needed to achieve an effective service for particular client populations is likely to be more efficient than one based on personal relationships. Such a  formal approach also has more potential to advance and promote organisational and system-level learning about how services can be improved in the future.

Significant barriers exist to the establishment of more formal relationships such as those represented by protocols. As mentioned earlier, the youth AOD client group represent a minor concern to large organisations such as Area Mental Health Services or Statutory Authorities. Other services are unlikely to invest in the work of negotiating protocols unless pressures and supports are applied by government.

This sort of review process can also cycle up to higher levels of organisation to provide feedback that directors can take to their counterparts at regional and state levels.