a. Liaison and advocacy
Traditionally, liaison and advocacy on behalf of individual clients as part of everyday casework has been the main form of ‘collaboration’ that youth AOD practitioners have engaged in with workers from other sectors. This work has been an important contributor to the goal of facilitating access of young people to other services that they may need. Young people often experience difficulties engaging effectively with, or getting maximal benefit, from mainstream health services for example, because of communication difficulties involving health professionals. Practitioners frequently attend health care appointments with young people, effectively acting as interpreters. A spin off from this form of liaison and advocacy is that workers are well placed to help young people work through and process their experiences with other professionals and make decisions about how to proceed, perhaps encouraging continued engagement.
This form of ‘collaborative practice’ in which staff facilitate the delivery of interventions by providers in other services will continue to be an important part of our work, but the context and primacy of this function is shifting towards inclusion of greater sharing and exchange.
The relationship with mental health services provides a useful case study of the principles and issues that need to be considered in understanding and developing collaborative practice. The relationship between AOD and Mental Health Services has been a focus of government policy attention for some years.
Roles in mental health care are changing, and this is changing the nature of the relationship with mental health services. Until recently the relationship might best be characterised as one of referral and advocacy rather than collaboration.
The relationship has been shaped by a relatively clear distinction of roles and limitation in the expertise of staff. Recently these role boundaries have begun to shift. With the employment of more staff with mental health skills, the youth AOD sector has become more involved in assessment and monitoring of mental health status. Increased skill in assessment is also giving staff more confidence in knowing when and how to refer a young person to specialist services. The increased capability of drug and alcohol services in assessment of mental health issues is gaining recognition and helping to break old impasses that have acted as barriers to timely referral.
Despite better skills in identification and assessment and more confidence in making appropriate referrals, other barriers such as the availability of mental health services are impelling youth AOD staff to become more involved in providing mental health care for our clients. Accompanying this shift is a greater reliance on specialist mental health services to provide secondary consultation around dual-diagnosis issues.
Another major focus of our linkage and coordination with other services relates to outreach and engagement activities aimed at facilitating access to our services among young people involved with statutory authorities. An Outreach capacity enables staff to spend time on-site at Child Protection Residential Units and Youth Justice settings, meeting and initiating relationships with young people that workers in those services believe may be reluctant and difficult to engage.
One of the difficulties experienced working with statutory authorities is that the nature of the relationship they have with young people is very different to that of the youth AOD practitioner. The role of Youth Justice for example is strongly oriented to limit setting, conformance with rules, and deterrence in relation to antisocial behaviour. In counterbalance to this, the youth AOD role is to promote personal responsibility, empowerment, and voluntary engagement in pro-social activities. While both approaches are necessary and can complement each other, the style of statutory authorities can discourage voluntary engagement with services if referrals are not managed carefully. Designing and maintaining a referral process that maximises the likelihood of positive engagement is a key focus of current efforts to collaborate more closely with Youth Justice services.
Youth AOD practitioners and workers from Youth Justice services also frequently have different expectations about what objectives are appropriate and achievable in relation to drug and alcohol use by young people.
Mental health and youth justice are two areas in which resources have been made available to invest in the organisational structures and processes needed to build and maintain effective intersectoral working relationships at a system level. Collaborative practice is less well developed in other potentially important areas of practice. For example, linkages with schools tend to be limited to contact around the needs of individual clients. There has not yet been investment in building links at organisational or sector level. Program development at the organisational or system level is necessary in order to overcome systemic barriers that test the capacity of practitioners working with individual clients. Considerable capacity is currently invested in linkage and advocacy at the individual level, but the efficiency or cost-benefit of this approach is open to question. Effective formal collaborative mechanisms at a system level that reduce the need for lengthy advocacy could free up more resources for direct therapeutic service delivery.
Having said this however, advocacy with other sectors is a key starting place for raising awareness about the needs of our client population. Maintaining and enhancing a focus on advocacy at the management level, as well as the individual client level is critical. But advocacy on behalf of our clients is not sufficient to build collaboration at the organisational or system level. Collaboration is a two-way relationship involving exchange. Builders of collaborative processes and structures need to develop their awareness of what other services want from youth AOD services and what is available to offer them for example, the exchange of physical resources including space and equipment. Another major thing that youth AOD services has to offer is expertise in working with a population of young people with multiple and complex needs, a client group that providers in many other services find difficult. This expertise is receiving more recognition from the mental health sector.