Therapeutic Community (TC) Workforce Development Demand analysis report and integrated recommendations.
September 2013
Acknowledgments Matua Raki wishes to acknowledge and thank all the participants who took the time to complete the Therapeutic Community (TC) demand analysis survey. We would also like to acknowledge the Therapeutic Community Working Group that continues to support the development of the Matua Raki TC project which aims to increase the capacity and capability of the TC workforce. The members of this group advised on the need for the demand analysis and the make up of the survey questions. The members of this group are:
Peter Kennerley (Team Leader Addiction Treatment Services, Mental Health and Addictions Programme, Sector Capability and Implementation (SCIBU), Ministry of Health)
Mark Smith (Clinical Lead, Te Pou)
Johnny Dow (Programme Director, Higher Ground)
Nigel Loughton (Director, Odyssey House, Christchurch)
Aukusitino Senio (Tupu, Community Alcohol and Drugs Services, Waitemata DHB)
Justin Lee (National Manager, Rehabilitation Services, CareNZ)
Martin Burke (Consumer Advisor, Southern DHB)
Lynne Magor-Blatch (Executive Officer, (ATCA) Australasian Therapeutic Community Association)
Michelle Hallis (Clinical Leader, Odyssey House, Auckland)
Anna Nelson (Programme Lead, Matua Raki)
Claire Aitken (Programme Director, Moana House)
Paraire Huata (Cultural Consultant, Moana House)
Tangihaere Walker (Principal Advisor, Department of Corrections).
Matua Raki is very grateful for funding from Health Workforce New Zealand who financially support this work aimed at workforce initiatives for the addiction sector.
Disclaimer This report has been prepared by Matua Raki. Its primary purpose is to present the demand analysis findings from a survey on TC training. Within this context any recommendations, opinions or findings are based on facts and circumstances as they existed at the time.
Find out more For further information on this report contact: Anna Nelson Programme Lead Matua Raki Ph: 04 381 6388 Cell: 027 4336530
Contents Acknowledgments ........................................................................................................................................ 2 Disclaimer ..................................................................................................................................................... 3 Find out more ............................................................................................................................................... 3 Introduction .................................................................................................................................................. 5 Aim and Objectives ................................................................................................................................... 6 Method ..................................................................................................................................................... 6 Design ....................................................................................................................................................... 6 Analysis and Results ................................................................................................................................. 6 Limitations .................................................................................................................................................. 11 Conclusions ................................................................................................................................................. 11 Recommendations...................................................................................................................................... 11 References .................................................................................................................................................. 13
Introduction Therapeutic Communities (TC’s) have been operating in New Zealand since the early 1980s to support people to recover from mental health and substance use-related problems. In the past ten years with the establishment of Drug Treatment Units (DTUs) that apply a modified TC model in the prison setting, TC’s have received increasing prominence. This expansion has led to specific workforce development needs which are the focus for Matua Raki’s work, upon request of the Ministry of Health. In 2012 Matua Raki completed a scope entitled Supporting New Zealand's Therapeutic Community Workforce: An investigation of current needs. As a result of this scope a number of conclusions and recommendations were made. The scope identified two main options to help meet the workforce development needs identified by the addiction related TC’s involved in the scope. These were: 1. The development and delivery of a specific TC qualification 2. Incorporation of TC theory and practice into current addiction qualifications The scope concluded that a combination of these options would also be valuable. The scope also identified that while a TC training programme(s) that is able to provide a national qualification or certification recognised by employers and professional bodies (e.g. dapaanz) would be beneficial, it is also important that all addiction practitioners have an understanding of the TC modality. As a result of this scope a working group was formed with representatives from New Zealand TC providers, supported by the Ministry of Health, to collectively refine this vision for workforce development with a focus on implementing the following as they relate to the two options identified above; •
• • • •
Conducting a ‘real demand’ analysis regarding the number of potential students or practitioners who would undertake any TC training programme(s) (including staff and students involved in non-addiction related TC’s). Establishing which option has the strongest support and is most likely to be implemented Identifying what resources are required to deliver the preferred option (organisational support, people, training providers, budget) Identifying potential training provider partners The role of Australasian Therapeutic Community Association (ATCA) and Matua Raki
This report focusses on the demand analysis survey that was undertaken in New Zealand between May-June of 2013
Aim and Objectives The purpose of this demand survey was to ascertain the level of demand in the mental health and addiction sector for a professional development course or module(s) that covered TC theory, process and experience. It also aimed to determine the preferred method of course delivery subject to established demand.
Method A brief online survey was developed and the link to this distributed via the writers Twitter account, the Matua Raki Facebook page, the Te Pou fortnightly e-bulletin, the AOD netlink (an email distribution list supported by the Health Promotion Agency) and was advertised on the Matua Raki website. The intent of the sample process was to get the survey out to as many and as broad a range of people who work in the mental health and addiction sector as possible.
Design The survey was designed by Matua Raki in consultation with the TC working group. The survey consisted of ten questions, with a number of ‘skip logic’ functions embedded in the survey that automatically took respondents to the next appropriate question depending on their answer to the previous one. It’s simplicity and brevity was intentional and the results designed to be read alongside Supporting New Zealand's Therapeutic Community Workforce: An investigation of current needs (Matua Raki, 2012), a report detailing the context of the identified needs of the TC workforce in New Zealand. The first two questions asked respondents about professional background, qualification focus and level of qualification. This allowed us to see the type of people responding to the survey and their involvement in the mental health and addiction sector. The following questions asked about interest in a course or module in TC theory, process and experience and preferred ways to have this information imparted. For current managers of TC’s the survey also asked if they would be able to financially and otherwise, support their staff to attend any such training. The final question asked for the names of TC experienced supervisors who were able to supervise TC staff. The survey has also been adapted to the Australian context by ATCA who are currently surveying the mental health and addiction sector in Australia. Once these results have been analysed they will be considered alongside the New Zealand results. It is hoped that any recommendations that result from these surveys will allow TC workforce initiatives to be available across Australasia.
Analysis and Results Note: Some respondents skipped some questions, and ‘skip logic’ functions were embedded in the survey. This means not all 264 respondents answered all questions. Participants The survey was answered by 264 respondents, 42% of whom described themselves as Addiction Practitioners (n=109). The respondents had a variety of undergraduate, graduate and postgraduate
qualifications in a range of disciplines, typically representative of the New Zealand mental health and addiction sector (Matua Raki,2011). Figure 1 shows that there was a variety of respondents including TC managers (13%, n=34), those currently working in a community TC (21%, n=52), those currently working in a Drug Treatment Unit (in prison) (4%, n=10), previous TC workers (17%, n=43), and those not working in a TC but would like to (26%,n=66). Figure 1: Current level of TC involvement
Interest in a TC course or module Eighty three per cent (n=219) of respondents stated that they would be interested in undertaking a course or module in TC theory, process and experience (Figure 2), the majority (64%, n=131) of those who answered this question would prefer this to be offered in a workshop (Figure 3).
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Figure 2: Desire to undertake a TC course or module
Figure 3: Preferred delivery modality
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While respondents were not specifically asked to provide qualitative comments about these questions, some respondents used the ‘other’ response options to provide some qualitative comments about their interest in undertaking a TC course or module and their preferred delivery modality. Some qualitative comments about these questions include; I am a strong believer in the effectiveness of the Therapeutic Community As a manager this would be helpful for staff I would be interested to purchase services from providers who demonstrate that their staff do have these types of qualifications/experience It would depend on practicality re time away from work site etc Prefer long distance learning either on-line or snail mail A mix to cover learning styles Figure 4 shows that while delivery at postgraduate level (37%, n=77) was preferred over the undergraduate level (23%, n=47), most respondents who answered this question did not favour either as long as it had professional development points attached (52%, n=108). Figure 4: Preferred level of course or module
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Some unsolicited qualitative comments about this question which asked at which level respondents’ would prefer the course or module to be taught at include; Needs to be at more than one level I don’t think such training should be too inaccessible Possibly introductory and then advanced to meet varied needs Respondents were asked about the importance of NZQA credits and/or continuing professional development points. Fifty one per cent of respondents who answered this question (n=105) agreed that both NZQA credits and professional development points were of equal importance, although 32% (n=65) believed professional development points were more important (figure 5). Figure 5: Course or module recognition
Question four asked TC Managers about their ability to support staff undertaking a course or module in TC theory, process and experience. Sixty two per cent of Managers said that they would have the resources (payment of fees, backfill etc.) to support staff undertaking such a course or module. Question five asked relevant respondents about their previous TC specific training. The majority (64%, n=69) of people who answered this question received it through ‘in house’ theory and experiential learning modes.
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Limitations Due to the diverse participant recruitment method, it is unclear how many received notification of the survey, therefore the response rate is unknown. Matua Raki however felt that a sample of 264, while not representative, is indicative and adequate to form some recommendations. In a survey of this manner participants’ reading and understanding of the questions and response options may be open to misunderstanding or alternative understandings to that intended by the survey developer. It is also likely that those interested in TC’s were more likely to complete the survey, thus there is likely to be some respondent bias in the results that should be considered. While both the mental health and addiction sector were surveyed, the survey results do not differentiate between these two sectors. It is likely that given the participant recruitment method, primarily through Matua Raki, that the majority of the participants were from the addiction sector.
Conclusions This survey was undertaken to ascertain whether there was a demand in the mental health and addiction sector for a professional development course or module(s) that covered TC theory, process and experience. It also aimed to determine in what way respondents would prefer to undertake such training if demand was positively indicated. Overall, demand for such a module or training was very clear. Respondents were very interested in having this offered to them as a workforce development initiative. The preference of the respondents was that this be offered in workshop style and that it must have professional development points attached, although NZQA credits were also seen as important. Please note Matua Raki recognise that the mental health and addiction sector in general have a huge desire for training and other workforce development initiatives, and it is likely that any survey offering these would elicited a positive response.
Integrated Recommendations In the past ten years with the establishment of Drug Treatment Units (DTUs) that apply a modified TC model in the prison setting, TC’s have received increasing prominence. This expansion has led to specific workforce development needs which are the focus for Matua Raki’s work, upon request of the Ministry of Health. In 2012 Matua Raki completed a scope entitled Supporting New Zealand's Therapeutic Community Workforce: An investigation of current needs. As a result of this scope a number of conclusions and recommendations were made. The scope identified two main options to help meet the workforce development needs identified by the addiction related TC’s involved in the scope. These were: 1. The development and delivery of a specific TC qualification 2. Incorporation of TC theory and practice into current addiction qualifications
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A number of recommendations can be drawn out of this demand survey and can be seen alongside the previous scope (Matua Raki, 2012) and discussion with the TC working group.
The TC Working Group’s recommendations to the Ministry of Health are:
A module or course that covers TC theory, process and provides some TC experience should be provided to the mental health and addiction workforce. This does not necessarily need to be a ‘qualification’
That the module or course should cover the Drug Treatment Unit (prison) setting as well as the community TC setting and be relevant for those working or wishing to work in both types of settings.
That the TC working group decide on the best way to provide such a module or course. The options identified by the survey may include a stand alone, or a combination of the following approaches; o
At a workshop (64%)
o
Through experiential learning (45%)
o
At an educational or training institute (38%)
o
Online (30%)
That the TC working group support the development of the content and curriculum of this course or module and make sure that cultural competence is threaded throughout.
That the training or course has professional development points attached to it (for example dapaanz continuing professional development points).
That the process allows for the possibility that such a course or module may also be delivered in Australia (pending expected positive demand analysis results from Australian survey).
That where possible Matua Raki and Te Pou should support current mental health and addiction training providers to incorporate TC related material in their current programmes and courses, through the Training Providers Network.
That the Ministry of Health consider re-configuring the current Hoe Tahi addiction scholarships to prioritise those wanting to attend such a TC module or course (even if it does not have NZQA credits attached).
That the Ministry of Health consider the on-going positive value of Hoe Rua addiction internships/work based placements for the development of the TC workforce.
That the Ministry of Health consider funding Matua Raki (who will work closely with ATCA and the TC working group) to develop the TC course or module.
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That all Workforce Centres consider supporting TC’s in their own workforce development initiatives.
References Matua Raki (2011) Workforce and Service Demand Survey. Matua Raki, Wellington Matua Raki (2012) Supporting New Zealand's Therapeutic Community Workforce: An investigation of current needs. Wellington: Matua Raki
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