|ATCA’s Executive Officer and Board
Role of TCs
2018 ATCA Constitution
Ethics and the ATCA Standard
Intrepretive Guides to the ATCA Standard
TC Training Course
|Vanessa Dumbrell, Executive Officer|
Vanessa commenced work in Therapeutic Communities 15 years ago, supporting clients during their intake and later coordinating transitional housing programs. She expanded this experience working in feminist organisations delivering drug and alcohol and homelessness services to women based in the philosophy of gender informed practice.
|Gerard Byrne, Chair|
Gerard has spent the past 25 years working in the AOD field; and is currently the Clinical Director for The Salvation Army Recovery Services, which covers NSW, Qld and the ACT. He holds Board positions on NADA, Queensland Network of Alcohol and Drug Agencies (QNADA), Alcohol Tobacco Other Drugs Association ACT (ATODA), and has been the Treasurer of ATCA for the past 6 years.
|Carol Daws, Deputy Chair|
Carol Daws has been working in Non-Government AOD sector since 1988. Carol has worked at Cyrenian House in a variety of roles from clinical work through to management and is currently the CEO of Cyrenian House. Cyrenian House operates two Therapeutic Communities (TC) the Rick Hammersley Therapeutic Community (RHTC) in a semi-rural setting in the outer northern suburbs of the Perth Metropolitan area and the other, Serenity Lodge in Rockingham. Within the RHTC it also offers the Saranna Women’s Program to support women with dependent children. Cyrenian House also offers a comprehensive non-residential service that includes outpatient counselling services, prison programs and aftercare for people with drug and alcohol use and associated problems.
|Mark Ferry, Treasurer|
Mark is the Chief Operating Officer with the Ted Noffs Foundation, which provides services for young people in New South Wales and the ACT. He has worked in the alcohol and other drug field for the past 25 years, including working in Therapeutic Communities for the past 15 years. In all this time the vast majority of his work has been with young people, and in the TC context, with young people aged 13-18. Young people form a large part of the people we work with in the AOD sector, yet their voice is not always heard. ATCA has recognised this through their work on the ATCA standards for adolescent TCs and Mark is keen to represent the views and issues of young people, the TCs they are a part of and contribute to the wider issues facing ATCA today.
|Eric Allan, Secretary & Public Officer|
Eric is Executive Manager of Residential Programs Odyssey House Victoria, and a member of the International Advisory Panel for the International Journal for Therapeutic Communities. He has been a Director of the ATCA Board since 2000 and past President 2002/2004. Eric is the treasurer of Visionary images, a community group dedicated to providing real collaborative opportunities between young people, artists, and government a past board member of Reclink Victoria, a not-for-profit charitable organisation dedicated to advocating for and improving access to sporting and recreational opportunities for disadvantaged people and the benefits which flow from this, such as community connectedness and improved health and well being.
|Bernice Smith, Director|
Bernice is CoCEO at Goldbridge Rehabilitation Services on the Gold Coast in Queensland. Bernice was Service Manager at Goldbridge for 5 years from 2010 - 2015 before heading to Toowoomba to become Executive Director of Sunrise Way TC for six months. Bernice was previously elected as an ATCA Board member, however stepped down when she left Goldbridge and went to Sunrise Way.
|Scott Wilson, Director|
Scott is the Director of Aboriginal Drug and Alcohol Council, (ADAC). He is an Aboriginal man from the Stolen Generation. Scott has a background of polydrug use, which brought him into contact with both law enforcement and health agencies during his youth.
|Anne-Maree Kaser, Director|
Anne-Maree Kaser is the CEO of Windana Drug & Alcohol Recovery. Bringing three decades’ experience in health and community services, Anne-Maree joined Windana in 2013 and now leads a significantly expanded organisation, leading a team of 180 to deliver residential and community-based alcohol and drug treatment programs across Victoria.
|Jenny Boyle, Director|
NZ Registered Nurse Post Grad Dip Management Post Grad Dip Mental Health Jenny originally trained as a registered nurse and has...
ATCA has more than 40 members across Australia and New Zealand, who together, provide more than 70 residential services in Therapeutic Communities (TCs) and Residential Rehabilitation Services (RRS). These include both community and prison-based services and are supported by a range of community-based services. These include: detoxification, day programs, family and parent/child programs, employment and housing support and outclient counselling programs.
Residential programs vary in size from 10 to 150 beds, with their residential program length from short to medium to long term. Therapeutic Communities also vary in their program structure and content, some based on a 12 Step Model philosophy, others on a family therapy model or cognitive behavioural interventions, and others with a combination of some or all of the above.
However, all TCs have one important factor in common – they are underpinned by the concept of ‘Community-as-Method’ in which the community itself is seen as the main vehicle for treatment and change. The TC model has proven to be a powerful treatment approach for substance use and its related problems in living (DeLeon, 2000; Magor-Blatch, Bhullar, Thomson & Thorsteinsson, 2014; Vanderplasschen et al, 2012). All TCs take an approach that treats the whole person through the use of peer community, supported by a variety of evidence-based services and interventions related to family, education, vocational training, physical and mental health.
Members of ATCA are diverse in terms of the range of programs offered to meet the particular needs of the client group. In general, programs aim to have enough structure to ensure a degree of order, security and clarity, while allowing room for residents to learn, make mistakes and learn from experience. Therefore, some adopt a more traditional hierarchical model, with graded levels of responsibility within the resident structure, while smaller programs often adopt a ‘flatter’ structure – known within the literature as a ‘democratic’ model.
The desire to continually improve the service offered has led members to consult the research literature, to seek forums for exchange and to encourage client involvement and feedback on all aspects of service delivery. It has also led services to consider means of matching clients to services and to developing new initiatives. For example, brief intervention programs of 4 – 6 weeks are available, acting as ‘transition’ programs to support the client into a longer-term residential TC if needed, or back into the community with the development of appropriate continuing care services. Some programs offer services to clients on opioid substitution therapies, some offer residential withdrawal management services, and other provide a specialist approach, such as for women and families with children, people with co-morbid mental health conditions, young people and victims of physical/sexual abuse. Day therapeutic communities have also been developed by a number of our member agencies.
It must be emphasised that whilst TCs maintain an environment free from illicit drugs and alcohol, this does not mean a rejection of medically prescribed substances. Residents may require psychotropic medication and all agencies have appropriate medical, psychological and psychiatric support. The use of methadone and other pharmacotherapies is supported by a number of TCs, either as a reduction and withdrawal regime, or as stabilisation and maintenance. Other programs offer a range of naturopathic therapies.
Our member agencies are cognisant of the public health risks of transmission of HIV and in particular of Hepatitis C (HCV) and the need to include safe sex, safe needle use and health education messages as part of a harm reduction approach to clients.
Therapeutic Communities provide treatment which fits within the harm minimisation continuum, providing an opportunity for each person to make an individual treatment choice, based on their previous experience and attempts at treatment.
Role of TCs
Many residents entering a TC have previously attempted other treatment pathways – including detoxification, outpatient counselling, pharmacotherapies and other residential services. Many clients will enter a TC a number of times, sometimes succeeding, but relapsing at a later time. Others will respond to treatment at the first attempt. TCs tend to treat those with entrenched and more self-destructive dependence patterns and for whom the prognosis of recovery by less intensive methods may not be as good. It is important to understand that ‘one size does not fit all’ and therefore it is important that clients are offered a range of treatment options.
For many, the TC is an alternative to lengthy imprisonment. This is a positive option for both the individual and society, as the TC provides both a cost-effective option to prison and the opportunity for help and rehabilitation. TCs offer the possibility for complete lifestyle change, and treatment frequently leads to the individual becoming a contributing member of society.
TC treatment costs need to be examined in the context of alternative treatment costs – hospitalisation, imprisonment, the cost to the community, the cost of correctional services and justice interventions. The cost of substance use includes:
- Direct costs – medical care and expenditure, its sequelae and non-medical expenditure i.e. prison, law enforcement;
- Indirect costs – loss of earnings due to death, imprisonment reduced human capital; and
- Psychosocial costs – reduction in quality of life (Pitts, 2009).
It is estimated that for every $1 spent on treatment, there is a savings of $7 through reduced health, welfare and justice system costs. Interestingly, other research puts this savings cost a lot higher – with the World Health Organization reporting a $12 saving for every dollar spent. Most importantly, the person is provided with an opportunity of treatment, and the chance to change their life.
Almost all TCs are non-government agencies and in part reliant on non-government funding. Any cost/benefit analysis should recognise that TCs are one of the few areas of alcohol and other drug treatment where, to a degree, the ‘user pays’ principle has been implemented.
Quantification of individual suffering and despair is difficult, equally so is the value of returning that individual to a fulfilling and productive place in our society. The wholistic approach offered by TCs leads to significant improvement in many areas of individual functioning. Success is also difficult to quantify – abstinence or reduction in drug consumption, shift from illegal to legal drug use, adoption of safe usage practices, improved work performance, reduced criminal activity, improved interpersonal relationships, increased self-esteem are all legitimate areas of success and all areas targeted by TC programs as part of a harm minimisation approach.
Harm minimisation is an approach that helps to focus assessment on the range of factors that are contributing to the harms associated with a person’s substance use (and not just on alcohol and other drug use alone). It then enables us to design interventions to prevent or reduce those harms directly not just by trying to reduce or eliminate AOD use. Harm minimisation has three pillars which are: Harm Reduction, Demand Reduction, and Supply Reduction. Therapeutic Communities, whilst being primarily a tertiary level treatment within the pillar of Demand Reduction, incorporate many harm reduction initiatives into their day to day practice. These include: HIV education, distribution of split/safe kits, education of residents on relapse, the dangers of alcohol, and safer sex practices. Importantly, all our member programs provide family inclusive practices, which aim
TCs are dynamic organisations, evolving and responding to changes in the environment in which they operate, and to changes in client presentations. Agencies encourage continued development and training for their staff, and this is an area where increased government funds and support is necessary. ATCA is grateful in this regard for the financial support of the Australian Government since 2006, which has enabled the establishment of the ATCA Secretariat and the development of the ATCA Standard. We are also grateful for the financial support from the New Zealand Government, which has contributed to the development of the TC Training Course. This was firstly developed under the guidance of Matua Raki for New Zealand TCs, and then adapted for Australian audiences in 2017.
TCs have always provided integration services, however, over the last few years there has been a greater emphasis on re-integration and continuing after-care programs. TCs provide a range of continuing care programs, including half-way houses and outreach services. Programs also foster links with self-help programs, and/or run programs for ex- residents. As TCs have evolved to meet demand and increase their range of services, staffing within TCs has also changed. TCs now employ multidisciplinary teams, including AOD workers, psychologists, medical personnel, social workers, group therapists, vocational trainers, teachers, sports instructors, childcare workers and family support workers. Staffing structures in TCs includes within the range of qualified staff, members who have themselves also completed a TC program. Staff members who bring with them the experience of recovery provide strong role models for residents in treatment and hope in the recovery process.
Like other treatment options, most TCs attract a majority of male clients. ATCA member agencies in the various jurisdictions have implemented a range of strategies to encourage greater female participation – separate women’s program, childcare and parenting programs. The rapid expansion of methadone programs across Australia has also led to the need for creative solutions to the problem of providing support to those who wish to reduce their use. Many TCs are providing this avenue, offering treatment to clients on opioid substitution therapies (OST) who wish to reduce and withdraw, or to stabilise on their medication, within the supportive context of counselling and treatment. We endorse Mattick & Hall’s call for TCs and methadone maintenance programs to work more collaboratively.
Ethics & the ATCA Standard
Providing services based on ethical practice within a quality framework, is of paramount importance to ATCA. We have adopted a ‘Staff Code of Ethics’ and a ‘Client Bill of Rights’, which all members must now incorporate in their programs.
ATCA launched its own ‘Quality Assurance Peer Review’ system many years ago in order to maintain and improve treatment standards within the TC. The nature of the TC means that as part of their daily operation all agencies have in place client grievance procedures and structures which provide checks and balances to staff and which protect client’s rights and provide TCs with a model of ‘best practice in management and client protection and rights’. In September 2009, ATCA launched the National Standards for Therapeutic Communities (Alcohol and other Drug) and Therapeutic Communities Training Package. The project was seen as part of an overall development of national standards for alcohol and other drug agencies, and as such will fit within a National Framework.
Peer reviews commenced against the Standard in 2010. Peer reviews were undertaken by a team trained by ATCA and comprising members who were qualified by both their time within and commitment towards the TC movement in Australia. Work then commenced on gaining formal approval of the Standard by the Joint Accreditation System of Australia and New Zealand (JAS-ANZ). To make the Standard more applicable to residential rehabilitation services, and therefore a more useful tool to a wider audience, some alterations were made to the original work. It was also decided to link this Standard to the ISO 9001 Management Standard to enable organisations to undertake a review against the TC Standard and ensure that all other elements of their business could be reviewed for certification/accreditation purposes in the one process. The First Edition of the ATCA Standard, released in 2013, comprised 13 Performance Expectations, with the elements of the Standard that related directly to the Therapeutic Community model ‘Community as Method’ at its core. Organisations audited against the ATCA Standard are certified members of ATCA and will have in place, in addition to certification/accreditation under the ATCA Standard, an industry accreditation. The ATCA Standard provides a quality assurance tool that specifically maintains the integrity of the Therapeutic Community model.
ATCA’s objective in developing the ATCA Standard, was to ensure the integrity of the ‘Therapeutic Community’ principle is maintained and will continue to stand as a model of best practice in the treatment of substance misuse and co-occurring disorders.
The first aim of the project is to provide specialist service standards which identify and describe good TC practice which could be incorporated into a national quality framework. In 2019, this was achieved with the adoption of the ATCA Standard under the Australian Government’s National Quality Framework. The ATCA Standard will contribute significantly to ensuring the quality and consistency of alcohol and other drug treatment services.
Further aims of the project are to:
- Ensure Therapeutic Communities engage in service evaluation and quality improvement using methods and values that reflect the TC philosophy.
- Develop a common language which will facilitate effective relationships with all jurisdictions (federal, state and territory).
- Provide a strong network of supportive relationships.
- Promote best practice through shared learning and developing external links.
- Build workforce capacity
- Enable Therapy
- Unity within the AOD and comorbidity sector.
- Create an environment for sustaining the ‘career paths’ of trained AOD workers within the NGO sector, including the valued practice of workers with ‘lived’ experience of the field. Therapeutic communities particularly value the experience of staff who are graduates of programs and seek to incorporate learned knowledge and experience into their professional practice.
The ATCA Standard has been designed in two tiers to make it applicable to both therapeutic communities and the wider residential rehabilitation services sector.
The first level of the Standard allows an organisation to gain certification against a set of indicators that are directly applicable to residential rehabilitation service for alcohol and other drug use. For services considering a transition to the therapeutic community model, working with the ATCA Standard will assist in providing guidelines to the expectations of a service that is a therapeutic community. To achieve certification as a residential rehabilitation service, agencies need to meet 80% of criteria numbers 1–6 labelled as ‘essential’. This represents the minimum level of activity required to demonstrate competency in agency practice in the residential rehabilitation setting.
The second level of the Standard allows an organisation to seek certification as a Therapeutic Community. To achieve certification as a Therapeutic Community, 80% of all criteria labelled as ‘essential’ must be achieved (criteria 1–10 &12-13… Expectation 11 is all Good Practice). The essential criteria relate to those policies and procedures which should be in place, to define how agencies identify with the Therapeutic Community model. The service delivery needs of the target community and what management, staff and consumers of the agencies should know about the Therapeutic Community model and delivery are also encapsulated within the criterion.
For agencies that have participated in other quality certification programs, a further set of criterion, called ‘good practice criteria’ has been developed. These criteria are intended to reflect what are sometimes referred to as ‘systems elements’ and are primarily related to monitoring and evaluation of agency practices. Good Practice criteria demonstrate a level of compliance with the Performance Objective which exceeds that required by the essential criteria. Your agency will be awarded ‘good practice’ certification if, in addition to meeting all of the essential criteria, all of the ‘good practice’ criteria are met.
In 2019, the ATCA Standard was again reviewed and a 14th Performance Expectation added. The 3rd Edition of the ATCA Standard addresses Governance and Financial Management. Audits against Expectation 14 are optional. Services wishing to maintain their industry standard will continue to seek certification against the ATCA Standard, in addition to the industry standard, by completing Expectations 1-6 (Residential Rehabilitation Services) or Expectations 1-13 (Therapeutic Communities).
However, services undertaking an audit against the ATCA Standard now have an option to gain full industry accreditation against the ATCA Standard, through the inclusion of Expectation 14.
For Residential Rehabilitation Services, this will require an audit against Expectations 1-6 plus Expectation 14; and for services wishing to be accredited as a Therapeutic Community, the completion of all 14 Expectations will be required.
Interpretive Guides to the ATCA Standard
To date, three Interpretive Guides for AOD Therapeutic Communities and Residential Rehabilitation Services have been developed by ATCA and provide examples of the way in which the criteria contained in the ATCA Standard might be interpreted. These are for adult services, youth services and services working with Aboriginal and Torres Strait Islander populations. ATCA is currently developing an Interpretive Guide for prison-based TCs and other Correctional populations. Each of the guides provides examples of the way in which evidence for a particular indicator may be assessed – recognising that each of these service modalities have differences, but that at the base, the TC method is evident.
Therefore, the Interpretive Guides are not intended to be definitive guides, but rather, to provide a framework for reviewers and agencies to both prepare for and to review against the ATCA Therapeutic Communities and Residential Rehabilitation Services Standard.
TC Training Course
The Therapeutic Community (TC) Training Course has been specifically written for Australian audiences and adapted from the Aotearoa New Zealand context developed by Matua Raki. It is aimed at supporting practitioners working in TCs and other AOD residential rehabilitation services (RRS) or those wanting to work in the TC environment. It is offered in both Australia and New Zealand.
The training course has been developed to assist in expanding the potential ‘TC work-ready’ workforce pool. The key aim of the course is to support AOD practitioners, support workers and other relevant professionals and students to develop knowledge, attitudes and skills that can be applied in the TC context.
The course is suited to those who have a base qualification and/or knowledge of addiction-related practice and who wish to develop knowledge and skills for application in the RRS and TC context.
The TC training is a 17-week course, with each participant completing:
- 48 hours of face-to-face learning facilitated by a
- a 40-hour supervised professional skills practicum in a
- 12 hours of self-directed
- Online cultural competence training module.
Participants who complete all course requirements to a satisfactory standard are awarded a certificate of completion.
Outcomes: Course participants will develop an understanding of TC theory, principles and key concepts and will demonstrate ability to effectively apply this understanding. There is an expectation that those completing the course will have developed an appropriate foundation to support their employment in a TC.
The agencies which ATCA represent all endorse both the value of independent research and the need for increased research to assist us in continually improving the quality of our services. The ATCA website provides papers and presentations from past conferences and links to other websites which include research studies in therapeutic community treatment.
De Leon G. (2000). The Therapeutic Community: Theory, Model, and Method. New York, Springer Publishing Company.
Magor-Blatch, L., Bhullar, N., Thomson, B. & Thorsteinsson, E. (2014). A systematic review of studies examining effectiveness of therapeutic communities. Therapeutic Communities: The International Journal for Therapeutic Communities, 35 (4), 168-184.
Vanderplasschen, W., Colpaert, K., Autrique, M., Rapp, R.C., Pearce, S., Broekaert, E., & Vandevelde, S. (2012). Therapeutic Communities for Addictions: A Review of Their Effectiveness from a Recovery-Oriented Perspective. The Scientific World Journal, http://dx.doi.org/10.1155/2013/427817