Pioneering, addiction medicine, wrap-around service
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1 Pioneering, addiction medicine, wrap-around service
2 What is the FSP? Pioneering Founded in 2000 in the heart of St Kilda Not-for-profit with zero fees Non-judgemental, adaptive, patient-focussed Wrap around service Addiction Medicine specialists General medicine Mental Health Nurses Psychological services Psychiatric services Hepatitis C treatment First Step Legal Service Toll Second Step Program
3 People effected Trauma, substance abuse & addiction Over 1500 patients per annum. The following categories vastly over-represented: People from lower socio-economic groups Offenders and ex-offenders Early school leavers First generation Australians with refugee parents People living with mental illnesses Long-term unemployed Survivors of childhood sexual abuse People who are homeless or at risk of homelessness
4 Holistic treatment Trauma & addiction Clinical treatment for addiction Associated clinical treatment Further non-clinical programs We maximise the chances for rehabilitation AND reintegration into society
5 CLINICAL SERVICES
6 Clinical Services Doctors A care plan created by a GP for eligible clients enables Medicare funded team medicine Care Plans Psychologists Mental Health Nurses
7 Clinical Services Doctors Advice on medicines and pharmacotherapy treatments Specialised assessment tools to provide a whole-person approach Support through the pathway of recovery from addiction (including legal problems, housing issues, mental health problems) Psychologists Assistance with navigating the service system (including coordination and linking) Mental Health Nurses
8 Clinical Services Doctors Receive support and care Manage anxiety and depression Repair damaged relationships Heal painful memories and gain insights Psychologists Find new goals and practise new habits Mental Health Nurses
9 Clinical Services Doctors GPs Psychiatrist CAMELOTT model Addiction med. specialists Psychologists Infectious diseases physician (Hepatitis C) Mental Health Nurses
10 FIRST STEP LEGAL SERVICE
11 First Step Legal Service Aims of Objectives To provide quality legal representation to clients of the First and Second Step Programs facing criminal proceedings in the Victorian Courts To provide this service irrespective of the client s financial circumstances To work in conjunction with the health and wellbeing professionals and support staff of the First Step Program To enable the client to make informed and educated decisions with regard to their criminal proceedings
12 First Step Legal Service Person dragged Ongoing treatment, back into their reemployment old scene reintegration into community, growing self-esteem. Dependent drug use Crime Impact on: victim, family/friends, community, public purse, courts etc. Impact on self: Damaged Deeper Unemployment Failing Loss Poverty relationships of addiction health hope Beneficial Poor outcome Well-resourced, Under-resourced integrated representation specialist representation Criminal proceedings for old matters Then, after hitting rock-bottom, building Person resolve and receiving commences sufficient working support towards rehabilitation
13 First Step Legal Service Who qualifies? Criteria who qualifies Must be a client of the First Step and/or Second Step Program; Must have current criminal proceedings in the Victorian Court System; Must intend to plead guilty to some or all of the charges (although this qualification will be reviewed if funding increases).
14 First Step Legal Service The Benefits of Integration Solicitors have thorough knowledge of the client s rehabilitation progress and the workings of the program. Effective communication ensures that appropriate support can be provided during times of increased stress (eg final hearing dates). Submissions in relation to dispositions are supported by professional opinion (reports and oral testimony). Further time can be sought to enable large portions of rehabilitation to be underway by the date of the Court hearing. Courts can formalise rehabilitation by imposing conditions. Relationships with specialist courts can be explored and developed.
15 SECOND STEP PROGRAM
16 Second Step Program History Late 2000 Toll was approached to support the First Step Program. In 2001 the first Second Stepper, a client of First Step, was employed in Victoria. In 2005 the Second Step Program expanded to include people with a criminal record the Second Step Program grew to offer positions in all states creating similar partnerships with other support programs. By 2010 the Second Step Program was operating throughout Australia and in discussions with international agencies.
17 Second Step Program Issues that marginalise people Health Money Housing Legal Transport Crime Family Addiction Second Step Candidate Unemployment
18 Second Step Program The Model Engaged Partner Program Suitable Work Place Work Ready Candidate Mentoring Community Resources and Support Second Step Random Testing
19 Second Step Program Integration of services Government Agencies Access to counselling and treatment Corrections or Parole Boards Secure and Safe Access to health and wellbeing treatments Aware and Supportive of the Second Step concept Financial Management/ Budgeting Partner Program Accommodating court orders Liaise with Partner Program Work Place Accommodating court orders Legal Matters Training Programs Health and Wellbeing Accommodate longer than usual transition periods Accommodate unusual absences
20 Second Step Program Breaking the cycle Marginalisation Engagement and Treatment Supported Employment Reintegration
21 EVALUATION
22 Evaluation The wrap-around service - Does it work? Thanks to the generosity of the Ian Potter foundation we commenced an evaluation of the First Step Legal Service and the First Step Program in September The purpose was two fold: External comparison: Analyse the recidivism rates of the FSP/FSLS clients and compare if possible with recidivism rates of similar categories of offenders that do not have access to the FSP/FSLS Internal comparison: Analyse the treatment regime of the FSP/FSLS clients that reoffended and compare with the FSP/FSLS clients that didn t reoffend
23 Evaluation Whilst not complete we can make the following observations: Only 3 out of 80 (3.75%) FSLS court cases resulted in immediate incarceration see graph 1 Rates of recidivism for FSP/FSLS clients were low for this particular category of offenders see graph 2 There is an inverse correlation between the FSP/FSLS clients that reoffended and the level of treatment that they were receiving from the FSP see graph 3. There are early indications that just over half of the FSP/FSLS clients that re-offended after lengthy periods of rehabilitation did so during periods in which they had ceased or reduced treatment with the FSP. In addition, those that were in treatment at the time of re-offending, committed less serious offences or much less serious offences than those committed prior to engaging with the FSP/FSLS.
24 Evaluation Jail graph re 3% Graph 1 Court Dispositions
25 Graph 2 Evaluation
26 Graph 3 Evaluation
27 Evaluation Individual journey Learnings The evaluation aimed to assess the current client data only, so there are limitations to the conclusions regarding causal effects due to the absence of a control group study and removal of all other influences. Applied for funding to conduct a more extensive evaluation. The aim of the further study is to identify the causal effect of the program and provide the basis for a cost-benefit analysis of the effect of FSLS.
28 Evaluation Why Individual bother to journey evaluate What is the use? Assists to promote and market the FSLS and FSP. Supports advocacy for the concept of multidimensional treatment models. Provides information for the internal assessment of treatments, services and programs.
29 QUESTIONS
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