Relationship Between Homelessness and AOD Assessment 3 Answer

INTRODUCTION

There has been a long association between alcohol and other drugs with the condition of homelessness. Alcohol and other drug abuse are commonest among homeless exposing them to a wide range of negative health impacts. Hence a comprehensive approach of interventions is required to deal with other associated attributes contributing towards the alcohol and another drug dependency among homeless clients. Due to the diverse population of homeless people including women, children, men, adolescent, various ethnicity addressing needs and goals become a multifactorial issue. These includes addressing poverty, malnutrition, unemployment, physical disabilities, and mental illness, in addition to the complex issues arising from homelessness itself and the use of alcohol and another drug. This paper appraises the relationship between homelessness and AOD use and emphasis on the factor that causes AOD in the selected client group. The paper also discusses the Organisation working for Homeless clients facing alcohol and other drug use. The interventional evidence-based model is discussed in detail with the service offered to the client group under the explained model. 

PROBLEM STATEMENT- CURRENT STATUS OF AOD AND HOMELSSNESS IN AUSTRALIA

As per the report published by the Australian Institute of health and welfare, there has been a strong association between AOD experience among homeless. In the year 2018- 19, 10% of the clients or one in every 10 individuals in the specialist home services in Australia was facing drug abuse and alcoholism ("Specialist Homelessness Services annual report 2018–19, Summary - Australian Institute of Health and Welfare", 2020).  In between the year 2014-2015 and 2019, client-facing alcoholism and other drug abuse were consistently spending more nights in the accommodation shelters. These clients require frequent specialist homelessness services as compare to other client groups. Every two in five or 55% of clients face alcoholism and other drug abuse with homelessness as the first presentation. In 2019, 6% of SHS clients required assistance for their drug use and substance abuse whereas 3% seek advice for alcoholism. As per the data presented by the Census of population and housing, there were approximately 1,16,000 individuals homeless in Australia in the year 2016. Hence the rate of incidence was 50 individuals per 10,000 of population. This includes individual living in temporary accommodation, supported accommodation for homeless, severely clouded dwellings and sleeping rough.    

In another report from the home project, a longitudinal survey among Australians showed that people experiencing housing instability have a higher rate of substance abuse as much as 57% more compared to the other Australian population. For illicit drug use, this percentage is 39% whereas for the use of injectable drugs it ranges to 14% in the period of 12 6 to 12 months. Research from the homelessness services in Melbourne projects that 43% population being homeless has alcohol and other drugs dependency. However, one-third of the reported population base was having an issue before their condition of homelessness ("Specialist Homelessness Services annual report 2018–19, Summary - Australian Institute of Health and Welfare", 2020).   

AOD AND HOMELESSNESS

In Australia, homelessness is steadily rising in the past few years. One in two hundred Australian is currently facing the similar situation on any given night. This has been increased to 4.6% since census data of 2011. Australian department of statistics defines a homeless person as individuals who do not have a long-term suitable accommodation option. The broader definition of it encompasses a larger percentage of the Australian population including people residing in emergency accommodation, refuges, boarding process and people sleeping on the couch or car. Data evaluated from King’s Cross medically supervised injecting centres reported 30% of individuals living in the facility or having unstable accommodation are on higher risk. In 2014-15, 57 percentage of the sample size consume alcohol whereas 39% uses the illicit drugs ("ABS (Australian Bureau of Statistics)-Census of Population and Housing: Estimating homelessness, 2018).

The study also found that 77% of the sample size experiences other co-occurring factors including: domestic violence sexual abuse, underage, above 66 years of age or experiencing mental illness. As per a report, almost 33% of homeless people battled with conditions like mental illness. Mental illness is one of the major causes that lead to drug and alcohol abuse. Some of the common mental disorders imposing struggle to homeless people include delusions, paranoia, schizophrenia, bipolar disorder, post-traumatic stress disorder, depression and anxiety. Along with co-occurring mental disorders homeless individuals also suffers from difficult emotional conditions as well as assaults. The combination of drug use and alcoholism along with other comorbidities is defined as dual diagnosis ("Alcohol, tobacco & other drugs in Australia, People with mental health conditions - Australian Institute of Health and Welfare", 2020). Factors which contributes to homelessness and substance abuse are mainly maladaptive coping mechanism, history of the family abuse, growing up in homeless families with the genetics of substance abuse, co-occurring multiple disorders, early introduction of substance abuse in young age, physical and emotional abuse.          

HOMELESSNESS AND AOD IN SPECIFIC POPULATION

Homelessness with AOD in specific populations like women, young adults and LGBTQ community is more common. Homeless women along with other above factors also suffer from gender-based trauma which increases their predisposition towards drug use. As compare to men’s 30% of homeless women suffer from mental illnesses. 50 to 60% of women suffer from emotional and mental disturbances before their homelessness state, often resulting in alcohol and other drugs abuse (Upshur et al., 2018). Due to the experience of domestic violence and sexual trauma women being victims of human trafficking are more prone to use other drugs like cocaine and heroin. Similarly, LGBTQ suffers from an increased rate of alcohol exposure to other drug abuse. People from the LGBTQ community are 120% more prone to homelessness. Due to internalised feelings of cultural and social exclusion these specific communities are prone to suffer from secondary mental ailments. Anxiety, sadness and loneliness fuel the risk of alcohol and drug abuse among women, LGBTQ and youth. LGBTQ community along with homelessness, are subjected to physical violence and sexual assault on comparison to the heterosexual counterparts (Watson et al., 2020). Meanwhile, homelessness is also common among the transgender community due to their struggle owing to job discrimination. Associated stigma and stereotype within the society related to alcoholism, homelessness, minorities and drug use often act as a cyclic factor on the client as alcoholism in certain cases lead to homelessness and homelessness similarly in many cases causes alcoholism. 

VINCENT CARE – THE ORGANISATION WORKING FOR HOMELESS AND AOD

Vincent care based on the Moto of engaging, enabling and empowering is the leading provider of services that supports people experiencing homelessness with alcohol and dependency in Victoria. Vincent care established in 2003 is based on the mission of Saint Vincent Paul society to serve the disadvantaged Victorians. The vision mission and goal of the organisation are focused on working towards individual either experiencing or at the risk of homelessness with alcohol and drug dependency. The services of the organisation have been established since the past 65 years in the form of Rehabilitation subsidiary and community housing services. Organisation also includes 180 transitional properties on behalf of the director of housing.

In 2018 the organisation launched its homelessness to recovery model which proposes the strategic interventional techniques for addressing the circumstances leading to alcohol dependency and homelessness and then empowering the clients through supported pathways. Organisation offers various streams for the help of the needy individuals which include counselling, residential withdrawal, non-residential withdrawal, residential healthy habit, recovery coordination, therapeutic rehabilitation and pharmacotherapy. Organisation also includes specific services for the challenged and disadvantaged community like homeless, aboriginal and youth.                                

EVIDENCE-BASED MODEL

Evidence-based model influences the drug policy and interventional programmes used in Australia. Evidence base model is focused on the people and their individual's goal setting. Most of the agencies adopt these models in their approach to identify the suitable Intervention techniques they adopt. Organisation believes in advocacy and research to provide social impact on disadvantaged individuals, they conduct researches aimed at providing community changes. Organisation also carry researches to deal with emerging issued from influential leaders, legislation changes, cultural values and shifting of social priorities and resources. Vincent care believes in advocating evidence-based model to develop decisions and conclusion into their programs and services. These evidence-based model, based on recommendations and amendments through government and concerned authority.

Public Health Model- As Adopted by Agency for AOD

Public Hlth model is one of the commonest and crucial models which is being adopted by many agencies working for alcohol and other drugs abuse in Australia. The approach was launched with the national drug summit of 1985 which is further carried out in a national campaign against drug abuse and drug strategy 1992 to 1997 and 1998 to 2003. This model of AOD intervention approach guides the treatment and rehabilitation programs in Australia ("Department of Health | 3.4 Models that help us understand AOD use in society", 2004).           

This model is focused on identifying the three crucial factors and their relationship which leads to alcoholism and other drug dependencies among homeless people. These factors are the agent, host and environment. It addresses the characteristics of the individual, group of the people and their environmental context that influence their disposition towards drug use. This model is based on the philosophy of harm minimisation which acknowledges drug use as the reality within the society and tries to deal with it through interventional goals. The approaches may be redirected toward health promotion and education and print media strategy aiming for risk population. Various interventional techniques are also applied to stop further progress on drug use and its associated health outcomes. These prevention approaches may include relationship, financial, legal and Hospital aid. The organisation provides the public health model through a vast range of services including education plan, health and well-being program and counselling. For the tertiary prevention of the model organisation offer hospital help, financial support, housing options and legal aid. Organisation also provides Residential rehabilitation for the complex need of the client in the hospital set up. 

SERVICES AND PROGRAMS

Quin House

This is one of the oldest houses running for alcohol and other drugs in Victoria.  It is a Specialist alcohol and other drugs residential facility working since 1975. The Quin house is a voluntary program for 12 weeks which has an 11 bedded supporting system through Accommodation rehabilitation services for providing the short and medium-term accommodation for homeless males having alcohol abuse and substance dependence. The program provides intense opportunities to homeless dependent individuals for breaking the cycle of routine social discrimination through accommodation, prevention, well-being and health treatment, life skill development and relationship building. Organisation also provides essential skills required for the support of long-term housing accessibility. 

The Quin house provides skills and strategy necessary for the homeless residence to support the recovery from the alcohol abuse and other drug substance, hence allowing them to work towards more stable housing options. In this interventional service, each residence is provided with a chance to work with a Case Manager who develops an individual treatment plan through identified goals and strategies.  These include issues like physical health, mental illnesses, legalities, trauma, financial issues and breakdown from family ("Quin House | VincentCare", 2020). 

Pharmacotherapy

 If an individual requires assistance to curb the alcohol and other drug dependencies through the help of prescribed medication then they have the option to go with pharmacotherapy. This helps the client in withdrawing or reducing the range of dependency in routine. For this purpose, appropriate support is provided through Vincent care counsellor or worker under the medical guidance.

Reconstructing Life After Dependency

Individual residents who have completed the Quin house stay have the option to transit back into the community through constructing life after dependency programme. This program is supporting accommodation options all across North and West Melbourne. The program offers six-month support to homeless people facing AOD through more stable housing option and developing the life skills required. This service is based on secondary and tertiary prevention of public health model where powerful support tools and counselling is provided through one to one session as well as therapeutic group work. This program provide rehabilitation for the homeless individual so that they indulge back into the community. The eligibility for RLAD programme includes individual either homeless or at risk of homelessness but capable of having independent living. They should be willing to participate in the program voluntarily and should corporate through interactions with other participants, workers and counsellors. They should not also advised more than the maintenance dose of pharmacotherapy.

Substance Treatment and Recovery

The program was purposed in the response of 2014 reforms related to alcohol and other drug use. The program run under the closely associated partnership between the Vincent Care and the Salvation Army. The program aims to provide the holistic treatment approach and support which is flexible and capable of catering different needs. The program is designed to promote the inclusive practices. The after-hours are also available for the services for the individuals who are unable to assess the 9-5 service hours.

Interagency Case Management

Organisation receives a combination of support from other agencies working for alcohol and other drug dependencies in Australia. The Quin House receives state funding from specialist homeless services Funds and Drugs Services Funds. The organisation works along with like Ozanam House, Adult Outreach Team and Ozanam community centres. It also works with local agencies and health services like Wellington House, De Pau House Detoxification centre, Yarra Community Health Services, Royal District Nursing Service- Homeless Person Program and Malthouse Theatre. Agency also receives referrals from other agencies where information is shared through secure mail and referrals meeting the criteria and contacted for formal assessment and enrolment.

MODEL NOT COVERED BY THE AGENCY

Moral model

The organisation does not follow the moral model of drug dependency. In this model, the individual suffering from the condition is considered as weak and addiction is considered as the result of an individual fault in character. Under the model the agency used approaches involving physical punishments like beatings, whipping, fines and public ridicule. This model also includes spiritual intervention as a common directional methodology for treating alcoholism and other drug abuse. Jail sentences and mental hospital admissions are also common approaches used in this model for dealing with people who suffer from long term AOD.

CONCLUSION

Homeless people have the particular inclination to substance use due to social and personal issues resulting in long-term dependencies. Homeless people adapt to drinking, smoking and drug use behaviour which predisposes them to other future health risks. The interventional goals are required to be introduced in early stage for homeless people with AOD. These goals are redirected towards reducing the harms of alcohol and drug through various ranges of approaches. The discussed agency Vincent care organisation working for homeless and alcohol dependency understands the principle of social justice. Through the public health model, they are committed in treating every single individual with dignity and respect regardless of their cultural background, gender, race, ethnic city and sexual orientation.