National Alcohol Strategy 2000-2003
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Date of publication: March 2001This is the full text online version of this document. You can also download this publication in PDF format.

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Part Five: Workforce Development

Professional education and training are increasingly being recognised as pivotal in the effective identification, management, and reduction of alcohol-related harm.

Improving alcohol-related education and training needs to be seen, then, as a key component of any strategy to minimise such harm. Although they are not a panacea, appropriate education and training are needed to implement strategies and maximise their impact (Roche 1998).

Broadening the base of education and training

Various types of alcohol-related harm are encountered in a variety of contexts. Minimising such harm is no longer considered peripheral to the responsibilities of those who work in these contexts, or of relevance only to the few who specialise in alcohol-related work.

To maximise the potential that exists in the prevention and management of alcohol-related harm, education and training should, therefore, be broadly based. Involvement in alcohol intervention cannot be expected and will not be realised, or effective, unless a wide range of professionals acquire appropriate knowledge and skills. Consistent with this claim, a New Zealand survey of medical practitioners found positive relationships between levels of training and perceived effectiveness, and between levels of training and active involvement in alcohol intervention (Adams et al 1995).

As well as providing alcohol-related training to traditional health care professionals, such as doctors (especially general practitioners and psychiatrists) and nurses, appropriate training should be provided to others likely to encounter people with alcohol problems. Relevant generalist workers include Maori and Pacific community health workers, social workers, corrections officers, school guidance counsellors, youth workers, psychologists, mental health support workers, police and members of the hospitality industry. Also, the needs of volunteer workers should not be overlooked. A survey of 140 New Zealand community-based social service organisations found that 60% of the volunteers working for these organisations had frequent contact with clients adversely affected by alcohol. The majority (87%) of these volunteers indicated that they would avail themselves of alcohol training if appropriate opportunities were available (Parsons 1998).

In the education of members of a generalist profession, the greatest gains have been made within undergraduate medical programmes. These gains have resulted from dedicated positions being established in each of the medical schools, funded by the Alcohol Advisory Council, to co-ordinate alcohol teaching. The Alcohol Advisory Council recently established a similar position within the Psychiatric Registrar Training Programme at the University of Auckland. Alcohol education is also offered as part of a training programme for primary care workers (including Maori and Pacific primary care workers) in the Auckland region,15 and initiatives are under way to address the alcohol education and training needs of youth workers and mental health support workers.16

Notwithstanding these gains, and despite the recommendations of several national (Hannifin and Gruys 1996) and international (WHO 1990) reviews calling for improvements to the alcohol education and training of generalist workers, the area has received little attention, and remains less than adequate

in most professional training programmes. Where it is provided, it tends to be ad hoc and dependent on the interests of individuals, rather than being a clearly articulated curriculum requirement, or part of a considered workforce development strategy.

A recent review of alcohol education and training in nursing found that while many of the schools of nursing expressed a commitment to the area, teaching on alcohol topics tended to rely on the commitment of staff with relevant expertise (Lightfoot 1998).

Barriers to the development of alcohol education and training in generalist programmes include a lack of resources, lack of appropriate expertise amongst teaching personnel, no recognition of alcohol-related matters as a legitimate area of practice, no recognition of the workforce’s ability to deliver an effective intervention, and overcrowded curricula (Ariell 1999).



Education and training for alcohol treatment specialists

A 1996 survey of managers of alcohol and drug treatment services found that 94% considered specialist education and training to be very important for those working in the alcohol and drug field (Hannifin and Gruys 1996). This view is reflected in one of the Ministry of Health’s targets specified in Moving Forward: The National Mental Health Plan for More and Better Services, which requires that, by 2002, 50% of contracted drug and alcohol services that employ clinical staff include staff members with postgraduate specialty training in drug and alcohol treatment (Ministry of Health 1997c).

Currently a major gap exists between the level of education and training considered desirable and the level of qualifications held. A recent survey of the treatment workforce found that 38.6% had achieved less than a tertiary qualification, and only 16.3% held a postgraduate qualification. Very few (3.3%) held a postgraduate qualification directly related to their work (National Centre for Treatment Development 1998).

A number of barriers to education and training have been identified (Hannifin and Gruys 1996).

• Limited opportunities for appropriate training The situation has improved with the recent development of postgraduate certificate and diploma courses by the universities of Otago and Auckland, and an undergraduate degree programme by the Central Institute of Technology. However, few relevant education and training opportunities exist for those wanting to work from a kaupapa Maori or Pacific perspective, and none yet leads to a nationally recognised qualification such as a national certificate, national diploma or degree.

• Financial constraints A lack of money is one of the barriers most frequently cited by managers wanting to obtain training for their staff.

• Work pressures The pressure of meeting contracted work targets means many managers have difficulty releasing staff to undertake training.

• Geographical barriers Most training is available only in the main centres, which makes it difficult for those working outside these areas to access such training.

• Insufficient inducement Low salary scales relative to other professions, and a lack of career opportunities, have reduced the attractiveness of investing in training.

As well as the education and training needs of those specialising in the assessment and treatment of people with drinking problems, consideration should be given to the education and training needs of those specialising in alcohol-related policy, health promotion and liquor licensing issues.

Education and training for those working to prevent harm

Consideration must also be given to strengthening those workforces that are concerned with preventing alcohol-related harm. Specific training needs for health promoters, including training leading to qualifications as well as on-the-job training, have been identified and should be addressed (Conway 1990; Ministry of Health 1997d). Furthermore, recent studies indicate that greater recognition should be given to the value of health promotion training delivered as an integral component of health promotion initiatives. Community action training, for example, that is provided through formative evaluation projects utilising independent evaluators as ‘critical friends’, is emerging as a useful process for upskilling health promoters who are relatively inexperienced, and those working in rural and remote communities (Conway et al 2000). Also, health promotion training, and in particular community development training, that reflects kaupapa Maori and other cultural perspectives, needs to be further developed and made more widely available.

Like health promoters people involved in the supply of alcohol, especially those working in the hospitality industry, should not be overlooked as important audiences for alcohol education and training. Recognition of this was included in a recent amendment to the Sale of Liquor Act which stipulates that, as from 1 December 2002, no person will be entitled to hold a General Manager’s certificate to operate a licensed premise without a prescribed qualification (Blair and Bennett-Bardon 1999). The qualification is designed to ensure knowledge about, and an ability to implement, responsible host practices. However, others in the hospitality industry, such as bar staff and security staff, require training as well. Bar staff and security staff are able to contribute significantly to the maintenance of safe drinking practices and environments (Chandler Coutts et al 2000). Training will help reinforce that their activities to this end are important areas of their work, and enhance their ability to perform such activities effectively.

Equally important is training for those concerned with the control of alcohol, such as police and licensing inspectors. Repeated calls for increased training for licensing inspectors employed by District Licensing Agencies have been made at successive ‘Working Together’ conferences, hosted by the Alcohol Advisory Council for groups involved in host responsibility and liquor licensing.

Furthermore, since the lowering of the minimum legal drinking age to 18 years, public health groups have emphasised the importance of training for police as a means of ensuring that laws controlling the availability of alcohol are effectively enforced. Indeed, given the many, often potentially hazardous, situations involving alcohol that are regularly encountered by police, alcohol education and training for frontline officers have been identified as a priority (Hannifin and Gruys 1996).

Research plays a central role in shaping the direction of policy, public health initiatives and treatment interventions for the future (Adams 2000). The ability to generate high quality and relevant research, however, is dependent (at least in part) on the existence of an appropriately skilled workforce. To ensure the ongoing provision of high quality research, funders of alcohol research must always keep in mind the need to attract potential recruits, and to support such new recruits to acquire appropriate expertise.

Until there is adequate and appropriate education and training of all relevant personnel, efforts with respect to treatment, prevention and policy development will be hampered (Roche 1998).



Depth and breadth of education and training

Alert to the dangers of ‘one size fits all’ thinking, education and training programmes need to be tailored to cater for the professional and situational requirements specific to each group (Roche 1998). The programme mix should ideally include:

• different levels of training, such as undergraduate and postgraduate, pre-entry and post-entry, basic and advanced

• different types of training, such as formal (qualification-based) and informal (on-the-job) training that is culturally oriented as well as training designed to meet the needs of particular client groups; training that is multidisciplinary as well as training that is discipline-specific; and training that is general as well as training that is responsive to emerging problems and issues.

Satisfying these conditions will require an extensive and diverse array of training opportunities.

Content of education and training programmes

The core knowledge base of the alcohol field has expanded substantially over the past 10 to 15 years. Knowledge of effective mechanisms and strategies by which to prevent, manage or minimise the negative consequences of alcohol use is far greater today than ever before.

However, current practices, and in particular treatment practices, are highly varied. Some have claimed that many ineffective or empirically unsupported modalities are in widespread use, whereas other more effective interventions are rarely used. This perceived situation has led to calls for educators to base their activities on the principles of evidence-based practice, which is seen to include the following general characteristics (Roche 1998):

• critical research findings

• evaluation of clinical practice and services

• feedback from service providers

• measures of health outcomes and clinical audits

• clinical supervision and reflective practice.

The above apply primarily to a health context. Similar sets of guiding principles need to be developed for those working in other contexts, and from different cultural perspectives.

In recent years there has been an increasing emphasis on the identification of core competencies to ensure greater consistency in the nature and quality of practice. In line with this trend, a set of practitioner competencies has been developed and is currently being trialled by the alcohol (and drug) treatment workforce (Alcohol and Drug Treatment Workforce Development Advisory Group 2000). Similar efforts are needed to identify and clearly articulate alcohol-related competencies that could reasonably be expected of professionals working in other sectors.

Placements, practicums and internships are considered an essential component of vocational training. It is through their fieldwork experience that students are able to utilise theory and knowledge acquired in the classroom, test out and practise new skills, and develop a professional identity.

Nonetheless, placements must be well managed to generate positive results. To this end, a recent review of alcohol-related student placements in the Auckland region found few examples of placements that were working well. The availability of placements was limited and the quality variable. This left many students feeling dissatisfied with their placement experience (Health and Safety Developments 1999).

If placements are to be an effective component of education and training:

• a good relationship must exist between the learning institution and the placement provider, and must be maintained by ongoing liaison

• responsibilities and expectations of the student, the placement provider and the learning institution must be clearly articulated and understood by all parties

• regular and appropriate supervision must be provided to students.

Based on the limited evidence available, it appears that insufficient resources are being committed to
student placements. This is clearly an area where improvements must be made.



Effectiveness of education and training

Careful evaluation of educational activities, and the development of an endorsed research agenda focusing on education and training, are critical success factors for improving the quality, effectiveness and efficiency of all types of education.

Evaluation is also needed to identify potential barriers to education, and to ensure that education and training efforts remain relevant and appropriate to the needs of the particular target group(s) (Carnegie 1998).

To date there has been very little comprehensive evaluation of alcohol education and training activities, and consequently little is known about the effectiveness of such activities. Both short- and long-term evaluation studies are needed (Roche 1998).

For evaluation to be useful, it is important that the intent and purpose of education and training are clearly articulated. The effectiveness of any programme can only be gauged in terms of pre-established goals. The provision of education and training initiatives therefore requires precision, both in terms of conceptualising the initiatives themselves, and in terms of expectations and requirements of the end product (Roche 1998).

Wider issues for the specialist workforce

For a complete overview, it is important to touch briefly on a number of general issues relating to the specialist alcohol treatment workforce that have emerged over the last five years.

Size of the workforce

The Mental Health Commission’s Blueprint for Mental Health Services in New Zealand indicates that the treatment workforce is significantly under-resourced in some areas. Whereas the Blueprint recommends that a workforce of 614 full-time equivalent staff (FTEs) is needed to provide community-based assessment and treatment services, the current workforce in this area is estimated at only 262 FTE (Mental Health Commission 1998).

Workforce retention

A survey of managers of alcohol and drug agencies found that nearly half considered the retention of skilled staff to be a problem (Hannifin and Gruys 1996). Low pay and limited career opportunities were the most frequently cited factors contributing to this problem.

Accreditation

Currently there is no requirement for people working in the alcohol treatment field to be accredited. Consistency in the nature and quality of their practice cannot, therefore, be easily assured. The recently developed practitioner competencies could provide a basis upon which to develop an accreditation
system.

Leadership

There is no official body, such as a professional association, that can consider the needs or represent the interests of the treatment workforce. An alcohol (and drug) treatment workforce advisory group, convened by the Alcohol Advisory Council in 1998, has at least partially addressed this deficit.

Future of specialist services

As alcohol (and drug) treatment services are funded from mental health budgets, fears have been expressed that these services may be subsumed by mental health. The majority (59%) of those working in treatment services favour being part of mental health, but with a separate identity (National Centre for Treatment Development 1998). Internationally, however, there is a widely acknowledged need for a specialist workforce as a vital component of a comprehensive therapeutic approach, that is able to respond effectively to people with significant problems (Institute of Medicine 1990), and to act as a resource for primary care and other professionals (World Health Organization 1990).

Objectives: workforce development		Education and training strategies
36	Ensure that a wide range of groups are able to respond to people with early stage drinking problems, and provide appropriate interventions including referral for those with more serious problems.	36.1 36.2 36.3	Promote and support the integration of alcohol education and training into the vocational training programmes of groups likely to encounter people with drinking problems, especially: primary health care workers (including general practitioners, practice nurses, Maori and Pacific community health workers) social service workers (including social workers, corrections officers and youth workers) mental health workers (including psychiatrists, mental health nurses and mental health support workers). Support the provision of short courses to assist generalist workers update and extend their alcohol knowledge and skill base. Support the provision of alcohol training for volunteers working in health and social services.
37	Ensure that effective treatments are provided to people with moderate to severe drinking problems.	37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8	Support the provision of comprehensive, multidisciplinary undergraduate and postgraduate vocational training programmes for people wanting to specialise in alcohol treatment. Support the development of kaupapa Maori education and training programmes, as well as programmes providing education and training from a Pacific perspective. Support the provision of short courses to assist alcohol treatment practitioners in updating and extending their knowledge and skill base, including courses designed to overcome deficits in service delivery (eg, the management of clients with co-existing alcohol problems and mental health disorders). Promote and support new (eg, computer-based) distance learning strategies aimed at overcoming geographical barriers to education and training for treatment practitioners. Address other barriers to training for treatment personnel, especially financial barriers. Promote and support the implementation of a competency-based system of worker accreditation for alcohol treatment practitioners. Increase the number of practitioners employed in community-based assessment and treatment services, to recommended benchmark levels. Address retention issues for alcohol treatment practitioners, especially their low rates of remuneration relative to other types of workers.
38	Ensure the effective implementation of strategies to prevent and reduce alcohol harm.	38.1 38.2 38.3	Promote and support the integration of alcohol education and training into training programmes for health promoters. Support the development of training in kaupapa Maori and Pacific-based alcohol health promotion. Support the provision of short courses to assist health promoters in updating and extending their alcohol knowledge and skill base.
39	Ensure the responsible serving of alcohol and maintenance of safe drinking environments.	39.1 39.2	Support the provision of appropriate training for people working in the hospitality industry, including managers, bar staff and security staff. Promote the adoption of host responsibility policies for licensed premises that specify appropriate training for bar staff and security staff.
40	Ensure that restrictions on the supply of alcohol are effectively enforced.	40.1 40.2	Support the development of relevant training for licensing inspectors employed by local authorities. Maintain training on alcohol-related issues as a priority for police training.
41	Ensure dangerous and potentially dangerous incidents and situations involving alcohol are managed safely.	41.1 42.1	Support the provision of appropriate training for police on how to safely manage dangerous and potentially dangerous incidents and situations involving alcohol. Provide alcohol research scholarships to attract new researchers and help develop relevant research expertise.
42	Support the production of high quality research on alcohol issues.	42.2	Provide a level of funding for alcohol research that is sufficient to sustain a critical mass of relevant research expertise.
43	Ensure alcohol education and training are effective.	43.1 43.2 43.3 43.4 43.5	Promote and support the evaluation of existing alcohol education and training programmes and approaches. Promote and support the evaluation of new programmes and approaches, particularly distance learning approaches. Support education and training programmes based on principles of best practice, in relation to both work and educational practice. Support training that provides opportunities for experiential/hands-on learning. Identify alcohol competencies for different fields of practice.

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15 This is the Tobacco, Alcohol and Drug Programme taught out of the Goodfellow Unit at the Auckland Medical School, funded by the Ministry of Health.

16 The Alcohol Advisory Council has commissioned a review of the alcohol education and training needs of mental health support workers, and the development of an alcohol teaching resource for those training youth workers.

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Related information

Other Ministry of Health Strategies

Alcohol in New Zealand

National Drug Policy website