Rethinking AOD service design: Person centred care vs system efficiency
Picture this. You’re sitting across from someone in a residential program who’s finally opened up. They’re telling you about the role of their drug use and aggressive behaviour in their marriage break down – something they’ve never been able to talk about before.
It’s a critical breakthrough and an opportunity to support important behaviour change.
You know what you need to do next. Slow it down and get the full picture. Work with the person to find the strategies and tools they need – ones that will actually fit into their life outside of rehab.
But in the back of your mind, there’s another voice.
How much longer do we have until discharge? How quickly do I need to close this file? Who’s waiting next?
This tension sits at the heart of alcohol and other drug services.
We want to be person centred. We know we have to be. But the system rewards speed.
The evidence has been telling us the same thing for years. People do better when care is responsive to their needs. People do better when they stay engaged and when they’re supported to stick with treatment long enough to achieve their treatment and support goals.
Retention in treatment is one of the strongest predictors of long term outcomes. But the people who need the time are the least likely to get it.
The person managing trauma, mental health challenges and unstable housing doesn’t fit neatly into a standardised care pathway or a clean intake discharge cycle.
Their progress is not linear and their motivation fluctuates. They might disappear for weeks and come back ready to try again.
That’s the work. But our systems aren’t built for this level of flexibility.
Most services are funded to move people through. Fixed packages, activity targets, waitlist pressures. It might make sense on paper – see more people, reduce delays and improve access – but the real world doesn’t work that way.
We’re forced to take an approach that’s centred around what can be counted, rather than what actually counts.
Activity is easy to measure – 20 sessions, 15 episodes, six week wait time.
The things that matter most are hard to capture. How do you measure the slow rebuilding of a life?
Funding cycles that reward short term numbers over long term impacts have unintended consequences: people leaving before they’re ready, stories being retold over and over as they cycle through services, and practitioners carrying the weight of decisions that just don’t sit right.
We shouldn’t have to choose between person centred care and system efficiency. We should design for both, deliberately.
Treatment matching is one part of the puzzle – intensity has to match need and complexity. Clear triage and risk assessment processes are key for this.
We need flexible stepped care packages that can move with people instead of fixed session caps and binary entry exit pathways.
Success shouldn’t be indicated purely by how many people we see, but by how many we actually help. This means measuring retention, stability and outcomes alongside access.
When we get it right early, we reduce pressure everywhere else in the system.
It’s not about doing more, but about doing it properly.
Service and workforce improvement can be challenging. The real world is messy, and working on the frontline you need clear practical solutions that work.
We provide practical tailored solutions for any service who works with people who use drugs. We support better responses to alcohol and other drug issues in mental health, primary care, welfare, justice and education sectors, as well as the specialist alcohol and other drug sector. Learn more about how 360Edge can help your service.
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