Your doctor will form the core of your support team at First Step, providing primary care, planning and referral.
If required, your doctor may formulate a Care Plan with you and will be instrumental in connecting you to other services offered by First Step or to outside referrals if necessary. This may include referrals to psychologists, pyschiatrists and/or mental health nurses among other things. Your doctor is a pivotal part of the team care arrangement you will experience at First Step and may work with you on such things as:
- Replacement pharmacotherapy (methadone, buprenorphine, suboxone or naltrexone)
- Reducing or ceasing your usage of illicit or prescription drugs referring you to the relevant specialists or forms of treatment
- Women’s health
- General medicine
First Step GP's include:
Dr. John Sherman
Dr. Peter Wright
Dr. Niall Quiery
Dr. Robyne Klein
Dr. Caroline Hawkins
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 defines collaboration as bringing professional view-points from different areas of expertise together to better achieve a desired outcome and to better support our clients. We place enormous emphasis on the desired outcome being ‘client driven’. That is, where-ever possible, we aim to help our clients determine the goals they are working towards.
Where this is difficult (due to mental ill-health) we do our best to engage loved ones in the development of these aims. Often initially the aim is simply to prevent death. As clients progress through their recovery journey we encourage them to take more ownership in the development of these outcomes.
From a professional perspective First Step works hard ensure that we protect our culture of collaborative practice. We achieve this in many ways just some of which include:
- Ensuring that our team consists of highly experienced, open-minded practitioners. Each team member intrinsically understands that they are part of a bigger picture. None of our practitioners work in isolation with a client. Some clients require the participation of many practitioners, some only a few. In almost all cases this is a fluid situation that can change rapidly in response to changing needs.
- Ensuring that our team has scheduled time for collaboration. This includes regular morning meetings held prior to clinic opening to ensure that all practitioners are able to contribute to discussions in order to benefit from the wealth of collective experience within the First Step team.
- Ensuring that all practitioners are kept updated with developments in all areas of the clinic (ie new programs coming on board, etc) to ensure that all practitioners stay up to date with all of the services on offer and the ways these services can be used for the advantage of clients.
- Care coordination is also a key component of our collaborative model. Similar to Case management, Care Co-ordination emphasises the integration of practitioner input for the benefit of a client, including such things as the co-ordination of specific case conferencing and of the delivery of services prescribed or recommended by various practitioners.
We work hard to ensure that our team participates in the development of services at the clinic. Responsiveness to changing needs has been a key pillar of the First Step business model (this refers to individuals but also changing community trends that indicate a change is needed in our business model) and we work hard to ensure that we maintain a high level of responsiveness.
An unexpected upside of this model is that it also enables both client AND practitioner to be supported in their management of highly complex illnesses. As a result First Step is able to successfully manage a degree of complexity rarely achieved outside a tertiary (hospital) setting.
First Step has developed many collaborative partnerships over the years with leading clinical and non-clinical organisations to achieve the best results for the people we work with. Collaboration can involve:
- Team Care: collaborative care of patients between First Step and other organisations (eg. Utilising the psychiatry team at the Alfred Hospital)
- First Step clinicians providing expertise and services to other organisations (eg. Our doctors attending clients at Windana Drug and Alcohol Recovery)
- Clinicians from other organisations attending First Step (eg. Gastroenterologists from St Vincent’s Hospital)
- Sharing expertise and customised database tools (eg. With St Vincent’s Hospital) to maximise best practise care across Melbourne
First Step also collaborates with the corporate and philanthropic sectors to ensure its own financial future, and to enable our supporters to contribute to immediate meaningful outcomes as well as lasting change. Philanthropic trusts are involved in First Step Legal, our brand new Case Management and Wellbeing program, capacity building (including marketing), general financial support, crisis (Myki top up, vouchers), clinical data managements and other aspects. View our supporters page here.
To contact First Step to discuss clinical or philanthropic partnerships email [email protected].
First Step also works with local organisations in St Kilda and surrounds to help the community health sector plan and execute collaboratively, and to organise community events such as the World’s Largest Overdose Prevention Training. We also communicate regularly with State Government (particularly the Department of Health and Human Services and the Office of the Minister for Mental Health, Martin Foley) to help the government understand trends in drug use and treatment and to lobby for the needs of the sector.
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:
- Working closely with both clients and family to ensure that the care they receive reflects their personal goals and aspirations
- Working closely with clients to understand & address un-identified areas of unmet need (habitual or assumed)
- 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).
- 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
- 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.