Jennifer Harland RN MA (App Eth) MSc (Add Std) Grad Cert (MH) Grad Cert (ICU) CDAN
Director of Clinical Services
Karralika Programs In.
ACT, Australia
A strengths-based not for profit organization located in the ACT that offers support and services to individuals with alcohol and other drug dependencies.
It supports individual and their families through the provision through a variety of evidenced based residential and community-based programs and services.
44 bed TC◦ 27 Adult Program◦ 17 Family Program◦ Additional 8 beds in the Transition Program following
graduation of the TC
◦ Solaris Program TC within the Alexander Maconochie Centre
◦ Community Program Nexus Program 7 beds Early Birds Reversed Sober Drivers
To examine the extent to which the Karralika TC program design aligns with evidence based principles for residential alcohol and drug treatment services (with particular reference to the Therapeutic Community model ).◦ Fidelity to the goals and objective of the program
◦ Service delivery
◦ Quality Improvement
◦ Client outcomes
◦ Program outcome measures
◦ Resourcing and staffing establishment
◦ Data collection and outcome measures
Turning Point were commissioned to conduct the evaluation
Karralika Therapeutic Community◦ Short Stay Program (Karuna)
◦ Residential Program for Adults (Karralika Adult TC)
◦ Residential Program for Families (Karralika Family Program
October 2014
Mixed-method design
Qualitative data was derived:◦ from structured interviews:
Current clients (n=22)
Staff members (n=24)
◦ Questionnaires:
Current clients (n=22)
Staff (n=16)
Former clients (n=8)
◦ Audit of current case files (n=18)
Secondary analysis of de-identified matched data from the Network of Alcohol and Drug Agencies (NADA) database and Alcohol and Other Treatment Services National Minimum Data Set (AODTS-NMDS) data (n=109)
Literature review
Review of KPI documentation
Between Nov 2010 and June 2014, 119 clients participated in the Karralika TC Program.
Complete data was available for 109 clients Principle drug of concern◦ Alcohol (36%)◦ Meth / amphetamine (24.8%)
There was a significant increase in reporting of meth/amphetamines as the PDOC between 2010 and 2014
◦ Heroin (19%)◦ Cannabis (16%)
60% of clients reported being concerned about more than one substance
60% reported injecting drug use in the past
Majority of clients were:
Long term drug users
Associated health and well being issues
Had several past episodes of AOD treatment
Involved in other areas of the service system:◦ Justice, child protection, mental health
Clients commonly reported hitting ‘rock bottom’ before entering
The evaluation found that Karralika TC is valued by clients:◦ 100% of clients reported that staff were efficent at
their job
◦ Over 90% of clients reported that they had received excellent service
◦ Over 80% of clients stated that the program was well organized and run well, it met their needs and they would recommend it their friends.
◦ More than half the clients reported that they would come back to the program if they were to seek help again.
• Improvement in physical, psychological health and quality of life of current and former clients.
• The vast majority of clients reported being abstinent from substances during the program.
◦ Former clients reported to being abstinent for up to two years following leaving the service.
Couples and children
Clients on Opioid Replacement Therapy
Clients with co-morbid mental health disorders (included medicated)
Ideological and policy shifts have influenced AOD delivery service across Australia overtime and have direct relevance to the ongoing development of the Karralika TC practice:1. Increased acknowledgement of the complexity
of AOD clients and their individual needs.2. A shift to a more client-centred practice,
moving away from a homogenised program that all clients receive.
3. Professionalization of the AOD workforce to deliver evidence-based interventions including a range of psychosocial and cognitive interventions.
In the context of the sector wide shifts, is to modify the TC model while preserving the elements necessary to retain the therapeutic benefits.
Funding and political environment
Best practice / evidence-based programs
Measuring and promoting outcomes
Multidisciplinary team integrated within the TC theory, model and method◦ Staffing structure – mix of skills and roles
◦ Position descriptions and workplans with measurable indicators clearly articulated
◦ New performance appraisal cycle (June/July)
Program changes◦ Strengthening the Family Program
◦ Amended program timetable (Adult and Family)
◦ Roster to support program implementation
All Staff briefing
Organisational
Chart
Workflow (draft)
Staffing
establishment/
structure
Position
descriptions
Jan
Recruit
. Clinical Director
. Support Workers
Case Managers and
Counsellor/s in place
Roster changes
Program Timetable
April/May
Functional Program
Design review
Plan for Program
enhancements
Staff Performance
Appraisals and new
workplans 15/16
June
All Staff briefing on
progress of Change
Management Plan
Next steps
July
Recruit
•Case Manager/
Coordinator roles
Admin support in
place
September
Karralika Programs Inc. Internal Organisational Chart (March 2015)
Case ManagersFamily Liaison
CounsellorCase ManagersFamily Liaison
Counsellor
Support Workers
Case ManagersFamily Liaison
Counsellor/Educators
Sleepover Staff
Case Manager/ Co-ordinators
Chef
Administrative support
Primary Health Nurse
Transition / Outreach Program
Nexus Men’s Program
Driver / Education Programs
Assessment / Intake /
Pre-treatment
Family Program
Adult Program
Solaris Transition/ Outreach Program
Solaris TC / Graduate Program
Solaris Program ManagerKarralika TC Manager Community Programs Manager
Finance and Administration Team
Director – Corporate Services
Director – Clinical Services
Coordinator
Facilitators
Chief Executive Officer
Mon Tue Wed Thur Fri Sat Sun
Manager 9-5 9-5 9-5 9-5 9-5
Case Manager/Coordinator (business hours)
Various(8.30/9-4.30/5; 11-7 etc)
Various Various Various Various
Case Managers (business hours) Various Various Various Various Various
Family Liaison Case Manager 8-3.30 8-3.30 8-3.30 8-3.30 8-3.30
Counsellor (Day) 8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
Counsellor (Evening) 11-7pm 11-7pm 11-7pm 11-7pm 11-7pm
Nurse 8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
Day Support Worker 8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
8.30-4.30pm
Evening Support Worker 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm 4-10.30pm
Sleepover staff 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30 10.30-8.30
Activities - Monday to Friday
7-9.15am Morning routine - breakfast, mod cleaning, function, medication
Morning routine plus Family Program school run (8.45am)
9.30-10 Morning meeting
10-10.15 Morning Tea
10.15-11.30
Group time
11.30-12 Function, Case management, counselling
12-1 Lunch
1.15-2.45 Groups
3-5pm Exercise , Case Management, Counselling, Personal time
2.45-7.30pmFamily Program school run, Family Time, case management, counselling, dinner, homework, phone calls,stories, bedtime
5-8Function, dinner preparation, dinner, phone calls
8-8.30Concept Group, Check in, medication, tidy up, off the floor 9.30pm
8.30-Housekeeping, prep school lunches, medication
Many of the challenges experienced by the Karralika TC are common to all TC’s who are attempting to meet AOD ‘professional standards’ and to meet the needs of diverse resident populations while retaining the ethos and spirit of the Therapeutic Community spirit.
A clearly articulated and supported change management plan is essential in the success of this process.