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van de Ven K, Ritter A, Vuong T, Livingston M, Berends L, Chalmers J, Dobbins T. A comparison of structural features and vulnerability between government and nongovernment alcohol and other drug (AOD) treatment providers. J Subst Abuse Treat 2021; 132:108467. [PMID: 34098205 DOI: 10.1016/j.jsat.2021.108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/13/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Both public (government-run), and not-for-profit (nongovernment) service providers provide alcohol and other drug (AOD) treatment services. Research has rarely studied the structural features of these providers, such as workforce characteristics, procurement arrangements, and funding security. The study reported here sought to document and analyze the differences between these two AOD treatment provider types in Australia. METHODS The study administered an online survey instrument targeted at managers of AOD treatment sites. The survey comprised three sections: (1) the service (e.g., treatment types); (2) workforce (e.g., total number of staff); and (3) funding and procurement arrangements (e.g., contract length). The study completed a total of 207 site surveys. The studied compared government and nongovernment services on structural features that may create a more or less sustainable or vulnerable service (funding arrangements, payment mechanisms, and contract length). RESULTS Government providers were more likely to provide medically oriented treatment types such as withdrawal management and pharmacotherapy, whereas nongovernment organization (NGO) providers were more likely to offer rehabilitation. Consistent with this, government services were more likely to employ medical professionals and nurses, indicative of a more medically oriented workforce, while NGO services were more likely to employ AOD workers, youth workers, peer workers, and counselors. Our data illustrate that NGO services were more likely to be subject to competitive tendering and to have shorter contract lengths, compared with government services, and overall to be more structurally vulnerable. CONCLUSION Despite the reliance on NGOs to provide the majority of specialist care (71% of all treatment episodes in Australia), these services are more vulnerable than their government counterparts. To ensure that a comprehensive suite of treatment services is available, procurement arrangements that support stability and security in nongovernment service providers and government service providers are essential.
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Affiliation(s)
- K van de Ven
- Centre for Rural Criminology, School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia.
| | - A Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - T Vuong
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - M Livingston
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - L Berends
- TRACE Research; National Drug and Research Centre, UNSW, Australia
| | - J Chalmers
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - T Dobbins
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
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Lafferty L, Wild TC, Rance J, Treloar C. A policy analysis exploring hepatitis C risk, prevention, testing, treatment and reinfection within Australia's prisons. Harm Reduct J 2018; 15:39. [PMID: 30075728 PMCID: PMC6091068 DOI: 10.1186/s12954-018-0246-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/27/2018] [Indexed: 12/15/2022] Open
Abstract
Background Hepatitis C (HCV) is a global public health concern. There is a global prevalence of 15% among the world’s prisoner population, suggesting the need for priority HCV treatment among this population group. New highly efficacious therapies with low side effects, known as directing-acting antivirals, became available under Australia’s universal healthcare scheme on 1 March 2016. This creates an opportune time to trial treatment as prevention as an elimination strategy for HCV in prison settings. This paper examines whether policies in Australian jurisdictions support treatment scale-up to achieve elimination among this priority population. Methods A comprehensive search was conducted using Google and other web-based search functions to locate all publicly available policies in each Australian state and territory related to HCV health and HCV-related prison health. Ministers (corrections and health) were contacted from each jurisdiction to identify any additional policies. Inductive and deductive analyses were conducted for each jurisdiction, with documents being assessed against a set of four a priori criteria. Documents included in the analysis were current at 1 September 2017, or 18 months following treatment availability. Results A total of 18 documents were located, including both health (n = 12) and corrections/prison health (n = 6) documents relevant to HCV. Jurisdictions ranged in their commitments for delivering HCV harm reduction strategies and treatment availability within the prison setting. Conclusion Few jurisdictions have updated or published HCV-related health or prisoner health policies following availability of directing-acting antivirals. Current policies do not provide effective support for implementing treatment scale-up that could be possible under universal access to HCV treatment among this priority population.
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney, New South Wales, 2052, Australia.
| | - T Cameron Wild
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney, New South Wales, 2052, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Level 2, Goodsell Building, Sydney, New South Wales, 2052, Australia
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Hyshka E, Anderson-Baron J, Karekezi K, Belle-Isle L, Elliott R, Pauly B, Strike C, Asbridge M, Dell C, McBride K, Hathaway A, Wild TC. Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks. Harm Reduct J 2017; 14:50. [PMID: 28747183 PMCID: PMC5530499 DOI: 10.1186/s12954-017-0177-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, funding, administration, and delivery of health services-including those targeting people who use drugs-are primarily the responsibility of the provinces and territories. Access to harm reduction services varies across jurisdictions, possibly reflecting differences in provincial and territorial policy commitments. We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes of a harm reduction approach. METHODS We employed an iterative search and screening process to generate a corpus of 54 provincial and territorial harm reduction policy documents that were current to the end of 2015. Documents were content-analyzed using a deductive coding framework comprised of 17 indicators that assessed the quality of policies relative to how well they described key population and program aspects of a harm reduction approach. RESULTS Only two jurisdictions had current provincial-level, stand-alone harm reduction policies; all other documents were focused on either substance use, addiction and/or mental health, or sexually transmitted and/or blood-borne infections. Policies rarely named specific harm reduction interventions and more frequently referred to generic harm reduction programs or services. Only one document met all 17 indicators. Very few documents acknowledged that stigma and discrimination are issues faced by people who use drugs, that not all substance use is problematic, or that people who use drugs are legitimate participants in policymaking. A minority of documents recognized that abstaining from substance use is not required to receive services. Just over a quarter addressed the risk of drug overdose, and even fewer acknowledged the need to apply harm reduction approaches to an array of drugs and modes of use. CONCLUSIONS Current provincial and territorial policies offer few robust characterizations of harm reduction or go beyond rhetorical or generic support for the approach. By endorsing harm reduction in name, but not in substance, provincial and territorial policies may communicate to diverse stakeholders a general lack of support for key aspects of the approach, potentially challenging efforts to expand harm reduction services.
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Affiliation(s)
- Elaine Hyshka
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada. .,Inner City Health and Wellness Program, B818 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, Alberta, T5H 3V9, Canada.
| | - Jalene Anderson-Baron
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Kamagaju Karekezi
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Lynne Belle-Isle
- Canadian AIDS Society, 190 O'Connor St., Suite 100, Ottawa, Ontario, K2P 2R3, Canada
| | - Richard Elliott
- Canadian HIV/AIDS Legal Network, 1240 Bay St., Suite 600, Toronto, Ontario, M5R 2A7, Canada
| | - Bernie Pauly
- School of Nursing and Centre for Addictions Research of BC, University of Victoria, Box 1700 STN CSC, Victoria, British Columbia, V8W 2Y2, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 407, 5790 University Ave, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Colleen Dell
- Department of Sociology, University of Saskatchewan, Room 1109-9 Campus Drive, Saskatoon, Saskatchewan, S7N 5B5, Canada
| | - Keely McBride
- Addiction and Mental Health Branch, Health Service Delivery Division, Alberta Health Services, P.O. Box 1360, Station Main, Edmonton, Alberta, T5J 2N3, Canada
| | - Andrew Hathaway
- Department of Sociology, University of Guelph, 50 Stone Rd E, Guelph, Ontario, N1G 2W1, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada
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