Preparing for assessment

As an alcohol and other drugs support worker, you do not work alone. You are an important part of a coordinated effort of people working in the healthcare, legal, community, and government sectors across Australia. In Australia, all people who work in the alcohol and other drugs space are guided in their actions by a national policy framework. A policy framework is like an umbrella that covers and guides the way you work.

In Australia, the policy framework that guides people working as alcohol and other drugs support workers is the National Drug Strategy 2017-2026. The aim of the National Drug Strategy is to ‘build safe, healthy and resilient Australian communities through preventing and minimizing alcohol, tobacco and other drug-related health, social, cultural and economic harms among individuals, families and communities.’ The National Drug Strategy has three main focus areas:

1. Demand reduction. Demand reduction focuses on delaying or preventing young people from starting to use alcohol and other drugs, reducing use of alcohol and other drugs, and supporting recovery from addiction to alcohol and other drugs.
2. Supply reduction. Supply reduction focuses on using strategies to minimize production, supply and distribution of illicit drugs, and to limit the use of alcohol and prescription opiates. This is where most police activity is focused.
3. Harm reduction. Harm reduction focuses on strategies to support optimal health and reduce the harm that substances cause for users, their friends and families, and the broader community.

Harm reduction strategies differ from strategies focused on criminalization, where resources are used to police alcohol and drug use, arrest people and build prisons. By contrast, a harm minimization approach seeks to minimize the harm that alcohol and other drugs cause, without stigmatizing, criminalizing or rejecting users.

The benefits of creating safe, inclusive spaces for people to work through their alcohol and other drug issues spread through the whole society. Having quality AOD support programs reduces the harm associated with abuse of alcohol and other drugs. According to the National Drug Strategy, the harms of alcohol and other drugs include the following:

• Health harms, including: road accidents and trauma, chronic and preventable disease, mental health issues and injury.
• Social harms, including: violence, criminal justice issues, domestic and family violence, intergenerational trauma and childhood neglect, abuse and trauma.
• Economic harms, including: healthcare costs, law enforcement costs, decreased productivity, and the perpetuation of marginalization and intergenerational social and economic exclusion.

We know from the report titled ‘Alcohol and Other Drug Treatment Services in Australia 2018–19’, published by the Australian Institute of Health and Welfare, that around 12% of the thousands of clients who sought AOD support services in 2018–19 were minors (aged under 18). This highlights the need for support workers to be familiar with the legislation around the care and protection of children and young people (‘young people’ in this case means ‘teenagers’).

The purpose of child protection legislation (laws and acts) is to enable state and territory authorities to intervene in family situations where there are allegations of risk or harm to children or young people. As a support worker, there will be situations where you may need to report suspected abuse or neglect of children and young people. This legislation enables you to do so and governs the way support services are provided.

Resources

Legislation differs between states and territories. The relevant acts for each state and territory in Australia are as follows:

• Australian Capital Territory: Children and Young People Act 2008
• New South Wales: Children and Young Persons (Care and Protection) Act 1998
• Northern Territory: Care and Protection of Children Act 2007
• Queensland: Child Protection Act 1999
• South Australia: Children’s Protection Act 1993
• Tasmania: Children, Young Persons and Their Families Act 1997
• Victoria: Children, Youth and Families Act 2005
• Western Australia: Children and Community Services Act 2004

Talk to your supervisor and more experienced peers about which aspects of the legislation in your state or territory they have seen enacted over their years as AOD support workers.

While it is often non-government service providers that provide support with alcohol and other drugs assessment and treatment, you will still need to be familiar with the legislation around drug and alcohol treatment.

State and Territory Acts

Australian Capital Territory

• Medicines, Poisons and Therapeutic Goods Act 2008
• Liquor Act 2010
• Mental Health Act 2015

New South Wales

• Drug and Alcohol Treatment Act 2007
• Drug and Alcohol Treatment Regulation 2017
• Mental Health Act 2007

Northern Territory

•  Misuse of Drugs Act 1990
• Kava Management Act 1998 (designed to reduce kava supply)
• Alcohol Reform (Substance Misuse Assessment and Referral for Treatment Court) Act 2011
• Mental Health and Related Services Act 1998

Queensland

•  Drugs Misuse Act 1986
• Mental Health Act 2016
• Liquor Act 1992 (recognises banning orders imposed by a court)

South Australia

• Public intoxication Act
• Tobacco & E-Cigarette Products Regulation Act 1997
• Mental Health Act 2009

Tasmania

• Public intoxication Act 1984
• Tobacco & E-Cigarette Products Regulation Act 1997
• Mental Health Act 2009

Victoria

• Public intoxication Act 1984
• Tobacco & E-Cigarette Products Regulation Act 1997
• Mental Health Act 2009

Western Australia

• Public intoxication Act 1984
• Tobacco & E-Cigarette Products Regulation Act 1997
• Mental Health Act 2009

Mandatory reporting laws require people in specific professions to report suspected cases of child abuse and neglect to government child protection services. Professionals, including doctors, nurses, teachers, and people who deliver healthcare services wholly or partly to children, are required to report suspected cases of child abuse and neglect.

When working in AOD support services, it is probable that you will eventually work with children and young people experiencing abuse and neglect at home (family abuse is a known risk factor for substance use and misuse). For this reason, you must understand and follow the mandatory reporting requirements for your state or territory.

Resource

When someone discloses abuse to you, you are in a privileged position to help that person feel heard, believed, validated, and supported. Furthermore, you can help ensure they receive the help and safety they need. The resource below provides guidance on how to respond when a child or young person discloses abuse to you: ‘Responding to Children and Young People’s Disclosures of Abuse’ from Child Family Community Australia

Rights and Responsibilities in AOD Support Work

Clients, support workers, and employers all have rights and responsibilities. The following table provides examples:

Professional Boundaries

Support workers need to be consistent in maintaining professional boundaries and duty of care. You are not a client’s friend; you are their support worker. You can best support your client and protect your own wellbeing by establishing clear, consistent boundaries with each client from day one.

• Role model worker and client relationship, not friendship
• Boundaries
• Respect client privacy
• Lift confidentiality when legally necessary (e.g., when informed of risk to a child)
• Do not follow, ‘friend’ or stalk clients on social media.

For example, it would be a breach of professional boundaries to:

• Accept a social invitation from a client (even if you get along well)
• Divulge personal information about yourself and your private life to a client
• Share personal contact information, such as your private number, address, social media or private email with a client
• Interact with a client outside of work hours or outside designated workspaces
• Keep information about risks to a child ‘our secret secret’ at a client’s request (e.g. the client asks you to keep secret the fact their partner smokes meth around their baby and becomes enraged).
• It would also be unprofessional to look through a client’s social media or their friends’ and family’s social media.

According to Queensland Health, boundaries are important for the following reasons:

• To empower the client to receive objective and professional support
• To reduce the risk of worker stress and burnout
• To reduce the risk of unreasonable or personal demands from the client or their family members
• To create clear expectations around respect and behavioral norms, reducing the risk of situations getting out of hand
• To avoid the client favoring some support workers over others
• To avoid the client experiencing setbacks or a personal sense of loss if you stop working for the service
• To reduce the future risk of clients reacting badly to boundaries or limits being introduced later, if you did not set clear boundaries from the start

Duty of Care

Duty of care is a key aspect of legislation and codes of practice. Support workers must always work with duty of care in mind. Duty of care is especially important when working with minors.

Duty of care means that we have an obligation to ensure that clients are not exposed to harm while engaging with our services. When we apply duty of care, we need to consider the present situation, as well as any foreseeable risk of harm.

Foreseeable risk of harm means we need to consider the future risk our actions, words, or lack of action might pose for our client’s well-being. Legally, duty of care includes the requirement to record or report the risk of:

• Suicide
• Self-harm
• Harm to others
• Child abuse

In such cases, refer to your state’s legal requirements and your workplace’s policies and procedures.

So, duty of care includes ensuring our client’s rights are maintained, and we take reasonable care to ensure no harm comes to our clients. This can include:

• Being aware of the different levels of vulnerability and resilience of different clients. For example, what might be different in how you would conduct an appointment with a new client who is recently drug-free, has family support, and is now wanting to work on their coping skills, compared with the support you would offer to a family sexual abuse survivor who is using alcohol and cannabis daily and currently couch surfing with friends and acquaintances (who are also using drugs and alcohol)?
• Being aware of the nature and foreseeable nature (likelihood) of harm that could occur to a client. For example, has a client disclosed that their partner can be violent, and that the client is planning to leave them very soon?
• Being aware of the decision-making capability of a client. For example, if your client is currently using meth, what guidance might you give them if they tell you they are planning to quit their ‘stupid job’ at their supportive (and patient) uncle’s automotive workshop and move to a city where they lack family support?

Codes of Conduct

Specific codes of conduct inform the way you work. These range from workplace policies to industry and professional codes of practice, to local and federal government policies and standards. For example, it is expected that support workers and their employers will always be non-discriminatory in all workplace practices.

Make sure you have an up-to-date copy of your workplace’s code of conduct and consider which acts are relevant to your workplace’s codes. For example, it is likely you will follow workplace and professional and industry codes of conduct governed by your state’s or territory’s mental health acts, workplace health and safety acts, racial discrimination acts, and more.

Dignity of Risk

In healthcare, duty of care must be balanced with dignity of risk. ‘Dignity of risk’ means we keep the client’s rights and their capacity to make decisions about their care and their health in mind. Dignity of risk includes allowing clients to learn from mistakes that may occur owing to their decisions. For example, a client may choose to leave a residential program or not complete an early intervention program, even though we think it would be beneficial for them to continue. We must respect their right to choose and meet them where they are in terms of their willingness to change.

Confidentiality

Confidentiality is the legal requirement that anything a client shares with you or your organisation (electronically, in writing, verbally) remains just that – confidential.

There are national and state laws that protect each client’s right to privacy. For example, the Privacy Act 1988 is a national law governing how information is collected, stored, shared, retrieved and destroyed by organisations, including government agencies.

It can be helpful to ask each new client what their understanding of confidentiality is and clarify this for them if needed. This also creates an opportunity to explain the specific legal circumstances where normal confidentiality may be lifted. Discussions around confidentiality are an essential part of healthcare provision.

When you work in alcohol and other drugs support, it is sometimes necessary to share confidential information about a client with another support worker, community organisation or health organisation (such as a hospital, for example). Wherever possible, the client’s informed consent should be sought and granted before sharing their private information with other organisations.

In some cases, it may be necessary to share confidential information without the client’s consent, because of other legal obligations.

You need to know the specific legal circumstances where normal confidentiality may be lifted, which include:

• If a client threatens to harm themselves or others
• If you believe someone might harm a child
• If the client gives their consent for you to share their information with other health professionals involved in their care
• If the client gives their consent for you to share their information with family members or other people of their choosing
• Where notes are subpoenaed or court-ordered, or where information is required for other legal proceedings (e.g. investigation of a crime)
• Where a client has a noticeable health condition (e.g. an infectious disease such as hepatitis, coronavirus, HIV, syphilis and measles). This is so steps can be taken to prevent and minimise the spread of infection, and so health authorities at state and territory level know where in the community indicant diseases are being found.

Informed Consent

For a client to really transform their addiction, they need to be a fully informed and empowered participant in their own care and treatment. Even in circumstances where a client is not in a program by choice, their informed consent is an essential part of the process. Informed consent is when a client has their proposed care and treatment, and the terms around it, explained to them. The client must give their permission to be provided with this proposed care or treatment.

Informed consent means that:

• The client is provided with all relevant information
• The client has the capacity to comprehend the information, without linguistic or other barriers
• The client willingly consents, without being forced or coerced.

Informed consent relates to the client understanding and consenting to:

• The proposed treatment program, including the outcomes, implications, risks and benefits
• Other treatment options where appropriate, including the outcomes, implications, risks and benefits
• Who will be involved in the treatment program, why, and in what capacity
• Why the client’s information is being collected and what will be done with it.

A client needs to be given detailed information and the chance to ask questions about their proposed care and treatment, and to have any risks and benefits explained to them for consent to be informed.

Keep in mind that a person currently under the influence of drugs and alcohol is not considered to be legally capable of giving informed consent for care and treatment. However, where immediate intervention may be necessary to prevent death, informed consent will not be required – this will normally be a job for paramedics to decide.

Also keep in mind that you will often work with people who do not speak English as their first language. Interpretation services may be necessary to obtain truly informed consent from these clients.

Case Study

Sitting Down With a New Client

Support worker Pieta sits down with new client Will. She hopes to do a needs assessment, but first, there are some legal procedures to complete.

Pieta offers Will water and apologises that he has had to wait for 15 minutes. She asks Will if the room is warm enough for him, as it is a cold winter’s day, checks his preferred pronouns, then asks if he can tell her what his understanding of confientiality is. Will looks nervous, saying, ‘You can’t tell anyone what I tell you, eh?’

Pieta takes the opportunity to affirm this and explain that confidentiality could be lifted if there are safety concerns for Will or others. Will nods but seems agitated. He suddenly stands up and says he is ‘just not sure about this.’ Pieta remains calm and tells him he can choose to leave if he wants, or they can reschedule if he would like to come back with a support person.

Will pauses, looking upset. Pieta says softly that she would be glad to have the chance to find out how she might help him. Will sits down again, and Pieta suggests they take a moment, sharing that she remembers feeling nauseated with nerves at her first AOD appointment. Will visibly relaxes and says, ‘Okay, let’s do this. But I might need a ciggie soon!’ Pieta laughs and invites him to ask any questions as they go and says that ‘All questions are good questions.’

Pieta explains that she is going to do a needs assessment for Will. She explains how this will work and that she needs to obtain Will’s signed agreement to this. She also checks he is over 18 and invites him to ask questions. With Will’s understanding of confidentiality confirmed, his questions answered, consent obtained and confirmation received that Will is legally an adult (so there are no mandatory reporting issues to take into consideration), Pieta and Will can now begin his needs assessment.
 

Human rights are principles based on the equality, dignity, and freedom of each person, which apply universally regardless of a person’s behavior.

Unfortunately, people affected by dependency on alcohol and drugs can be discriminated against, treated in ways that minimize their dignity, or stigmatized (regarded as unworthy).

Discrimination can occur in the following ways:

• A person might be denied care. For example, a medical receptionist refuses to book in someone to see a doctor because the person is a known drug user, or because other healthcare users may complain that addicts are taking appointments from more ‘deserving’ patients.
• A person might be viewed as a ‘lost cause’ by service providers if they relapse, or relapse repeatedly.
• A person with a history of an alcohol or drug use disorder(s) might face difficulty in accessing employment.
• The friends or family of a person with an AOD disorder might find they are discriminated against. For example, a child whose mother is recovering from alcohol addiction might be the only child not invited to her classmate’s birthday.
• Others view hardship as being deserved by a person with an AOD issue. Sadly, it can be common that when a person dies from drug overdose, some people will view the tragedy of their death as diminished because they were a drug user. For this reason, families affected by this type of loss may feel unable to speak openly about what caused their loved one’s death.
• A person reaching out to AOD support services might come across discriminatory attitudes because of their cultural background or because English is not their first language.
• There may be more barriers in accessing funding to improve AOD services because other causes are viewed as more worthy. Healthcare must be equitable by law. We must never discriminate or tolerate discrimination against clients on the grounds of their health needs, gender identity, sexual orientation, disability, age, ethnicity, religion, criminal record, HIV or AIDS status, and more. Each state and territory has anti-discrimination legislation, and you need to be familiar with the legislation for your state or territory.

When conducting an assessment, you can play your part in ensuring services are free from discrimination by:

• Checking preferred pronouns as a standard part of beginning an appointment
• Remaining non-judgmental about a person’s history of AOD use and what they share about their life
•  
• Using a thorough assessment tool that helps you start to clarify all the areas where the client is needing support (e.g. safety, housing, employment, and/or grief)
• Accepting that sometimes appointments will need to be rescheduled so interpreters can be arranged.

The anti-discrimination act for each state and territory is as follows:

• Australian Capital Territory: Discrimination Act 1991
• New South Wales: Anti-Discrimination Act 1977
• Northern Territory: Anti-Discrimination Act 1992
• Queensland: Anti-Discrimination Act 1991
• South Australia: Equal Opportunity Act 1984
• Tasmania: Anti-Discrimination Act 1998
• Victoria: Equal Opportunity Act 2010
• Western Australia: Equal Opportunity Act 1984

LGBTIQ Community and Healthcare Discrimination

The LGBTIQ community is frequently discriminated against in many ways, including when they use healthcare services. Watch this video to hear a group of people who identify as belonging to the LGBTIQ community share their experiences of discrimination when accessing healthcare: ‘LGBTIQ people talk about their experiences accessing healthcare’ from North Western Melbourne Primary Health Network.

watch

Cultural competence

All support workers need to develop their skills for working in cross-cultural situations. This means being aware of people from different cultures' values, beliefs and practices. When we maintain cultural awareness, AOD service delivery is more appropriate, respectful, effective, and free from discrimination.

There are a lot of professional and legal responsibilities involved in conducting an AOD needs assessment. With time and experience, running these appointments will become second nature to you. The following are some key areas to understand.

REMEMBER: Always cover confidentiality and obtain consent.

As discussed, when you sit down with the client, there will first be some housekeeping to do:

• Check their understanding of confidentiality. Explain when confidentiality may be lifted.
• Explain how the assessment will proceed: the time it will take, that the client will be asked a lot of questions, that the purpose is to formulate an individualized treatment plan for them, what will happen in the coming weeks, what responsibilities or choices they have.
• Obtain their consent to treatment.

Responsibilities in Allocation and Referral

Your workplace will have policies and procedures around registering new clients and how clients are allocated to team members. You need to be familiar with these policies and procedures to ensure informed consent is obtained, registration forms are completed, and clients get the best support. For example, your workplace may allocate clients to support workers based on the workers’ areas of expertise.

If you find yourself allocated a client whose needs or most urgent needs fall outside your scope or your organization’s scope, you will need to refer the client to another service. For example, a client may come in seeking help with a mild drinking issue, and you learn their child recently died and they are struggling with insomnia and have self-harmed. Immediate referral to a GP and a psychologist specializing in grief support would take precedence at this stage. You would still assess them, but you need to ensure holistic support and that the client is getting the expert support they need.

There will be many circumstances where you need to refer a client, or where a shared-care approach is needed. Your client and their family members (e.g., spouse, parents, partner, and children) may benefit from accessing other healthcare services, such as a GP, counsellor, family support group, nutritionist, or detox and withdrawal service. It will depend on the needs of the client. AOD clients may:

• Want to commence, change, or come off medication
• Have experienced past or recent trauma
• Be experiencing health issues linked to their alcohol or drug use (e.g. weight loss, cravings, tremors, insomnia, paranoia, anxiety, unemployment, and strained personal relationships)
• Have family members who need to be supported in understanding what their loved one is going through and to have space to voice their concerns, hurt, anger, and frustrations.

Be clear on your organization’s role and who your target clients are (e.g., men, women, youth, 25+, Aboriginal and Torres Strait Islander people, young mothers, early drug users, LGBTIQ people experiencing severe addiction).

Ensure you stay within your scope and refer when needed. This is in the best interests of your community and is part of your duty of care.

Determining Readiness to Change

It will be important to find out what the client most wants help with and how motivated they are to change. Simply asking, ‘How motivated are you, on a scale from 1 to 10, to make changes for your health?’ can open this conversation. This can also be a good opportunity to find out what they are getting out of their alcohol or drug use. If, for example, marijuana is helping them sleep, then you and the client will need to discuss healthier strategies.

Keep in mind it is not your job to rescue or fix clients. Clients must always do the day-to-day work of recovery themselves. You and other health professionals are there to guide them. Sometimes a person will not be ready to change, and this usually becomes apparent soon after their first appointment. In such cases, you can let them know your organization is always only an email or phone call away should their circumstances change. However, it is important to remember the decision might not always be the client’s – it might be court-ordered, for example.

Conducting the Assessment

With time and experience, you will become more skilled at asking the questions that will assist in clarifying the client’s needs and the most helpful treatment.

The following is key information you need to obtain to begin to form an understanding of the client’s needs and ensure duty of care.

• What is the client's name, age, address, gender, and preferred pronouns? Are there any religious or cultural considerations?
• Is anyone in their family or close to them also using substances?
• What is their current level of risk in terms of self-harm or harm to others?
• What is their current level of risk of exposure to bloodborne diseases?
• What is their lifestyle like? Are they overworked or chronically sleep deprived? Do they demonstrate any awareness of self-care?
• Do they have secure housing? Are there any pending legal issues (e.g. custody of children, or court hearings)?
• Do you have the expertise to help the client?
• Which of your referral partners will this client most benefit from seeing (e.g. psychologist, GP, counsellor, women's refuge, or withdrawal and detox support)?

When asking clients about their alcohol and/or drug use, find out if certain situations or emotions are triggers for using or for using more. For example, do they drink more when they have had a hard day at work or when they are with certain people? Do they use drugs to help them feel more confident in work or social situations?

Ensure that all intake forms, referral letters, and any other documents related to the client are marked as confidential.

If documents are electronic, they will need to be stored with password protection to maintain confidentiality. Any hard copies should be secured in a locked cabinet, in keeping with privacy laws. If you are going to refer a client, always send the other service provider copies, never the original documents.

Common Coexisting Health and Other Issues

Clients may present with the following health conditions and situations:

• Life Situation:
  • Abuse or domestic violence survivor
  • Migrant History of trauma
  • Loss of relationships owing to addiction
• Mental:
  • Anxiety, depression Paranoia Agitation
  • Hallucinations
  • Impacts on youth brain development
• Physical:
  • Weight loss
  • Skin and vein damage Lack of hygiene Slurred speech
  • Dark circles under eyes Fidgeting/clenched jaw
• Emotional:
  • Poor self-esteem Grief
  • Post-traumatic stress disorder (PTSD), complex
  • post-traumatic stress disorder (CPTSD)
  • Mood swings
• Intellectual:
  • Memory loss
  • Poor concentration

Observing the Client

In all healthcare situations, you will pick up on things that are not communicated or not communicated directly. For example, a client may repeatedly mention grief (without specifying a loss or death) or say things such as ‘people think I’m depressing.’ It will also be common for people to say things such as ‘I smoke a bit of meth sometimes’ or ‘Yeah, I drink now and then.’

Take the opportunity to gently question the client when you notice things like this. Find out more about what they are experiencing and ask them to clarify what they mean by frequency/amount words or phrases such as ‘a bit’ or ‘now and then’ (e.g. is it several times a day/ daily/several times a week/weekly?). Remind them this is a safe space where they can talk about things. Always have tissues at the ready in an interviewing room.

In AOD settings, you will also notice things such as skin health, ability to concentrate, willingness to make eye contact, eye clarity, mood changes, lucidity, sweating, shaking, twitching and the person’s overall vitality (or lack of).

Sometimes, people are heavily focused on or reject the diagnosis or diagnoses they have been given. It can be much more helpful to focus on their symptoms, such as insomnia, racing heart, overactive mind, intrusive thoughts, anxiety, and overwhelming sadness or anger.

Some people might talk, talk and talk. Strive to find a balance between letting them tell their story – because no one may have really listened to them before – and keeping the session on track. For a one-hour appointment, a guideline could look like the following:

• 5 minutes to get settled (discussing confidentiality and consent)
• 20 minutes to let the client talk (while you actively listen and observe)
• 15 minutes to ask the client questions and check you have understood
• 10 minutes to talk over treatment and next steps
• 5 minutes for you both to ask any remaining questions
• 5 minutes to wind up the session – this can be a good time to thank them for sharing difficult things with you, tell them you are glad they came in and confirm when they will next hear from you or another health professional.

It is important to remember that time will not always be the guiding nature of the sessions. In the first instance, and if you are the client’s first point of support in their journey, it is important to build trust and a space they feel comfortable in. Once you are further along in the program, you might feel more comfortable being able to run the session. Do not feel defeated if you have a whole session with a client and do not get the answers you were hoping for; these things can take time.

Case Study

Letting Observations Guide Questioning

Grace, a support worker, is conducting a needs assessment with a 19-year-old client, Ellis. Ellis has asked for neutral pronouns, sharing that they are ‘gender questioning at the moment.’ Grace knows that members of the LGBTIQ community are often more vulnerable to discrimination and abuse. She notes that, while Ellis is smiling and chatty, they are constantly apologizing unnecessarily, their clothing looks a little lived in, and they have a fading black eye and what looks like a painful tear injury around an ear piercing.

Grace instinctively asks Ellis about their living situation, and Ellis becomes quiet. They share that last week they were kicked out of the family home for being ‘queer,’ and their family is very religious. Ellis starts to cry and shares that they have felt so controlled by their strict father for so long and so unable to be themselves. ‘I think that’s why I started drinking, started using drugs,’ Ellis says. Grace asks further questions, and Ellis shares that they have experienced physical, verbal and emotional abuse from their father and one sibling. Ellis is now staying at an acquaintance’s flat but says it is a ‘party house’ and they do not always feel safe there or have any privacy, and the electricity just got cut off.

Grace tells Ellis she will put through an immediate referral to get Ellis an appointment with social services and to get support with a living allowance and finding suitable accommodation (including emergency transition accommodation). Grace also offers to connect Ellis with a nearby counselor who is well respected in the queer community.

Ellis agrees but says they need time to think when Grace asks if they would consider speaking to the police about the family abuse they have endured.

Given what Ellis has shared, Grace feels the AOD comprehensive assessment will be best, as it will help determine the risk of further family violence occurring, as well as clarify Ellis’s current substance use and mental wellbeing. But before they begin this lengthy assessment, Grace gently offers Ellis a hot drink and some biscuits, and tells them she is glad they came in.

Watch

Watch the video below for an example of a doctor discussing alcohol use with a client: ‘Doctor uses motivational interviewing to discuss alcohol use’ from the PreventionInstitute1

There are many free and professionally approved AOD needs assessment tools. These tools are often specific to certain age groups or certain types of substances. These tools can help you determine a client’s current patterns of use and the severity of their dependence.

Which tool you use will depend on your organisation’s scope of service (e.g. your organisation specialises in support for alcohol use disorders), your client’s age, and whether you want to assess solely for substance use or comprehensively for substance use, mental health, and risk of self-harm.

Flinders University and the NCETA provide a range of assessment and withdrawal tools relevant to Australian contexts: ‘AOD Screening & Withdrawal Tools Collection’ from NCETA and Flinders University.

Assessment Results and Referrals

You will need to clearly document the results of the client interview and the assessment tool, and let the client know what the next steps are (this is often known as the ‘treatment plan’). Your report must be:

• Factual
• Non-judgemental
• Respectful
• Free of assumptions
• Written clearly
• Dated and signed

Explain to your client the results of their assessment. For example, what does their assessment indicate about the severity of their current use? Do they appear to be at risk of blood-borne diseases? Is there a clear need for immediate social services support? This can also be a good time to acknowledge your client’s bravery in coming in and sharing things that are not easy to talk about. Inform your client about what referrals will take place, and whether these appointments will be made for them or if they need to book them.

A key advantage of assessment tools is they provide defined guidelines around the results (e.g. a client’s score will indicate the severity of their dependence). This not only helps guide treatment but it also helps you determine if your organisation and its scope of service are the right fit for the client.

For example, if your organisation’s scope of expertise and target clients are men and women in the early stages of alcohol and drug use, a client whose score shows severe alcohol and meth dependency will need to be referred to an organisation that can meet their needs. In such a situation, carefully explain to the client why your organisation is not the best one to meet their needs, and the specific services to which you can refer them (and any family members, if relevant). This is the purpose of assessment: to help clients get the right support for their individual situation, in a timely manner.

Always keep in mind the following legal requirements around referral:

• Check that your client understands the options you have explained to them. For example, ensure your client knows that detox at a treatment centre in the nearest city will need to happen before a therapy-intensive residential stay closer to home.
• Ensure the client understands their responsibilities in relation to treatment options. For example, ensure the client understands that they have the right to dignity of risk and to not take up treatment options (unless their consent is governed by a guardian or legislation).
• Make a referral only with client consent.
• Provide copies (not originals) of case notes, assessment results, and any other relevant information to referral partners. Ensure all hard copies and electronic files are marked 'confidential'. Electronic files that are shared may also be password protected. Your organisation will have a privacy and confidentiality statement to accompany all electronic messaging and transfers of files.

Watch

Family Drug Support offers their 28-hour flagship program, SteppingStones, for parents or family members of a person using alcohol or drugs. The course covers everything from the emotional rollercoaster to implementing boundaries and keeping safe. Watch the video below to learn more about the program: