First Step Approach – Integration

Integration in the context of First Step refers to our commitment to ensure that each client is properly supported in all areas of need.  Mental health and addiction, particularly when they occur together, result in highly complex presentations that span physical, mental & psychological health, legal well-being, social inclusion (or isolation) & meaningful engagement (work or study).  It is essential to ensure that each client is supported in each of these areas as required.  But it is equally important to ensure that changes in one area do not adversely affect other areas of their lives.

This is what we refer to when we talk about integration.

Each recovery journey will encounter circumstances that may require a diversion from some elements of treatment or a doubling down in other areas.  The close working relationship between practitioners (GP’s, mental health nurses, lawyers, psychologists, psychiatrists, care co-ordinators and various other allied health professionals) significantly facilitates this nuanced treatment however it is also crucial that the (sometimes) competing needs be actively integrated.  This may be as simple as ensuring that multiple appointments are scheduled on the one day or as complex as deferring legal matters while health concerns are stabilised.  

The critical part of this model is that it can respond quickly to changing needs either by including additional practitioners or stepping practitioners down when no longer necessary. 

At a community level, integration refers to the efforts of First Step to help community members (at all levels from government to the individual) to understand the wider value of rehabilitation and recovery within the community.   

First Step works at multiple levels to reduce stigma around substance dependence and mental ill-health primarily because stigma dramatically and adversely affects the willingness of individuals to seek treatment (in the first place) and to feel supported in their commitment to treatment in the second. 

We do this via advocacy but also through events such as World’s Largest Overdose Prevention Training.

First Step Approach – Client Care

Client care at First Step involves a fundamental focus on the well-being of clients recognising that this will be different for each individual.

We are committed to ensuring that everybody receives every chance to turn their lives around.  In the first instance that means that (subject to capacity) we will treat anyone that seeks our service:  

• regardless of income (that's why it's free)
• regardless of location (that's why we have no geographical catchment except for a few specific programs)
• regardless of drug use goals (we support harm minimisation goals [to use safely and less] as well as abstinence goals [to stop using])
• regardless of diagnosis (mental health and/or substance use)
• regardless of the way they were introduced to the clinic i.e. no ‘wrong door’

But our client care goals go a very long way beyond that and extend to such things as the following:

1. Working closely with both clients and family to ensure that the care they receive reflects their personal goals and aspirations
2. Working closely with clients to understand & address un-identified areas of unmet need (habitual or assumed)
3. Actively seeking better more innovative ways to work with clients to achieve better outcomes (a significant example of this is the fundamental service provided via First Step Legal, our inhouse, pro-bono community legal service in which our lawyers become part of a triangular therapeutic model of care).
4. Actively examining the work that we do with clients to understand the value that we bring with a view to being able to (a) improve service provision & delivery, and (b)share our learnings with others in the sector
5. At federal, state and community levels seeking ways to give voice to the needs of our clients and this demographic (some of the most disadvantaged in our community)

'Every chance' refers to the breadth of skills in the team, and the fact that we never give up on anybody.  Many of our clients are high functioning people in work and/or study that just need some clinical support.  Others have multiple vulnerabilities and need a full range of supports for some years.  Everybody . . . every chance.

To understand the work First Step does, all at no cost to the client, we can simplify the clinical landscape a little by describing three stages of treatment, and how we work with people in each of these stages.  Of course in the real world these stages overlap, and progress comes in fits and starts (including setbacks), but the Stabilise > Support > Empower model describes our multi-disciplinary service delivery model well.

STABILISE – GPs, Drug and Alcohol Workers, Care Coordinators

When a person first presents to First Step, the initial clinical need is often for safety and stability, and the emotional need is for non-judgemental empathy. In the ‘stabilise phase’ our experienced addiction medicine doctors and drug and alcohol workers quickly intervene to achieve improvements, sometimes life-saving ones, in the client’s mental and physical health.  This may involve the use of prescription medicines and other clinical supports while also working to overcome immediate psycho-social threats such as homelessness or domestic violence.  ‘Harm minimisation’ (doing everything we can to keep the client safe) and ‘dual diagnosis’ (focussing on addiction and mental health simultaneously) are core principles of this work.

SUPPORT – Mental Health Nurses, Gastroenterologists, Psychologists, Psychiatrists and Hep C specialists

Once immediate threats to mental and physical health are minimised, First Step doctors often work with people to develop an individualised Treatment Plan for long-term, team care during this ‘support phase’.  The plan often involves the introduction of our specialised Mental Health Nurses, fully-funded by Medicare to work with our people with whatever level of intensity (daily, weekly, fortnightly) is required to work towards their treatment goals.  During the support phase, people work with their clinicians to overcome long-term factors that are preventing them from achieving the best possible physical, mental and social well-being. First Step also has psychiatrists, gastroenterologists and Hep C specialists whose expertise is called upon when required.

EMPOWER – Lawyers and employment specialists

Before someone can begin to re-engage fully in the community and thrive, they often have serious institutional obstacles to their rehabilitation, such as long-term unemployment and legal concerns (usually dating from before they ever attended First Step).  First Step’s most innovative, non-clinical work is in this ‘empower phase’ when First Step Legal, our no-cost legal clinic, and our Employment Program, work with clients to achieve outcomes that enable them to stay in treatment and get back to work.  Strong relationships with drug courts and employers enable clients attending First Step to achieve outcomes that they themselves may have found hard to imagine when they first attended the clinic.