| 4. In which ways is the initiative creative and innovative?
The key concepts behind the Cure & Care model are that services are provided according to clients’ needs, holistic and they are invited to attend voluntarily, when they are ready. The tagline for this model is “We Care, We Serve”.
The objective of our transformation services is to meet the expectations of society and our stakeholders and is in line with the Malaysian Government Transformation Program and “1Malaysia People First, Performance Now”.
There are currently five (5) services offered under this model, they are:
1) Cure & Care 1Malaysia Clinics
2) Cure & Care Service Centre (CCSC)
3) Cure & Care Rehabilitation Centre (CCRC)
4) Cure & Care Vocational Centre (CCVC)
5) Caring Community House (CCH)
Cure & Care 1Malaysia Clinic
In July 2010, the first Cure & Care 1Malaysia Clinic (C&C 1Malaysia Clinic) was launched. AADK introduce the open access concept in which all members of the society may come in voluntarily to seek treatment. This concept is in line with the treatment and rehabilitation methods recommended by the World Health Organization (WHO). Drug dependence is a chronic relapsing brain disease. In view of this, medication aided treatment methods is necessary.
From DRC to Clinic
PUSPEN C&C CLINIC
Admission by law Voluntary admission
Focus on abstinence-based rehabilitation only Focus on Medical Services and Treatment
‘Cold Turkey’ Detoxification Medication-Aided Detoxification
Treatment only for Opiate Dependency Treatment also for other substances such as ATS/Opiates etc
Treatment Duration: 1-2 years Treatment Duration: 1-3 months
Clients treated in 21 PUSPEN in 2012 – 5,473 (capacity 6,050) Clients treated in 10 C&C Clinic in2012 – 12,766 (equivalent to capacity of 42 CCRC)
Manpower resources - 105 Manpower resources - 69
Food costs per Resident throughout duration of treatment: RM2,880 Food costs per Resident throughout duration of treatment: RM720
As of December 2013, there is a total of 12 Clinic C&C 1Malaysia operating nationwide.
Cure & Care Rehabilitation Centre (CCRC)
In 2012, AADK have converted PUSPEN centres into Cure & Care Rehabilitation Centres (CCRC) and the services offered will also be transformed so that we can offer better choices and flexibility to our clients to undergo treatment.
Comparison of existing and new programs
Existing Program New
12 months and above under Section 12(1) APD 1983 Duration 6 months & based on client’s performance assessment under Section 12(2) APD 1983
Phases 1,2,3 and 4 Phase Based on client’s performance assessment
Each client goes through the same program based on schedule and within the given phase Focus Of Program Clients recovery needs, evaluation according to client’s category & client’s level of severity
8 elements & therapeutic community – hard to implement
Roll Call – 8-10 times Approach Friendly, fun and easy to implement
Roll Call – 4 times
Emphasis on individual counseling and non-uniform Implementation Mechanism Focus on systematic and uniform group activities in accordance with client’s recovery plan
Cure & Care Vocational Centre (CCVC)
In 2012, AADK established the Cure & Care Vocational Centre to assist recovered drug users who are no longer drug dependent to provide skills training, career advice and secure job placements. Course offerings are comprehensive, taking into account the market needs for jobs, and the strengths and interests of existing clients. CCVC was established with the purpose of providing more than just skills training: from a standard vocational training centre, CCVC also acts as a one stop centre for career advice, talent management, works adjustments and job placements.
Cure & Care Service Centres (CCSC)
The management and program delivery at the CCSCs consist of 2 models:
Model A – Management And Programs Are Managed by AADK fully
Model B – Management And Programs Are Managed By NGOs fully
PK AADK CCSC
Based on existing facilities only Based on hotspot areas
Only offers re-entry program with no choices CCSC Model offers program choices
Clients Recovery Needs
Unsystematic programs that do not meet clients recovery needs Structured programs that meet clients recovery needs
Implemented by AADK alone Implemented as a collaboration between AADK, NGOs and local communities
Programs offered did not follow client category nor severity of addiction Programs offered according to client category and severity of addiction
As of December 2013, 53 CCSC are operating nation wide.
Caring Community House (CCH)
Caring Community House (CCH) is an institution in a community that is driven by an appointed committee among the local community. CCH was introduced to strengthen the role of the community in carrying social responsibility and provide support to the community members involved in drugs. CCH offer services such as psychosocial program, counseling as well as a centre for spiritual, sports and community program.
As of December 2013, 76 CCH are operating nationwide.
Cure & Care Vocational Centre (CCVC)
Employment and financial stability form important components of the rehabilitation and recovery of our clients and their return to become functioning, productive contributors to society. In 2012, AADK established the Cure & Care Vocational Centre (CCVC) to assist recovered drug users who are no longer drug dependent to provide skills training, career advice and secure job placements. Admission is voluntary and is opened to all individuals with drug problems. Accommodation, food, insurance and training materials are provided. CCVC also provides a Call Centre that serves as a hub to arrange
job placements for all skilled clients throughout the country. Course offerings are comprehensive, taking into account the market needs for jobs, and the strengths and interests of existing clients. CCVC was established with the purpose of providing more than just skill straining: from a standard vocational training centre, CCVC also acts as a one-stop centre for career advice, talent management, works adjustments and job placements.
| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
NADA Transformation program is formulated in accordant to the expectations of society and our stakeholders and is in line with the Malaysian Government Transformation Program (GTP). The transformation program was not only design to achieve the 6th NKRA but improve NADA delivery services. The transformation program was discuss and further detail out with multiple government agencies through the aforementioned CRIME and Drug Labs.
On the implementation side, NADA also enlisted the help of relevant stake holder such as the NGO, other government agencies, ex-client and also the local community.
NGO’s play a role in the delivery of Treatment and Rehabilitation Programs. Exploiting the strength of the NGO, strategic partnerships are form with identified NGO’s and they are given opportunity to manage programs in CCSC through outsourcing.
A number of Ex client who have been able to stabilize their drug dependency are appointed as Peer Support Workers (PRS). They act as mentors for clients on their path to recovery. They are involved in outreach work, run Peer Support Groups such as Narcotics Anonymous (NA) and also help in referring clients to other services.
Creating relationships and smart partnerships with other ministries and agencies to increase treatment and Rehabilitation services and to solve not only drug related problem but others problem face by clients such as medical assistance, no identification document, homeless and etc. Other agencies that are involve including the Ministry of Health (MOH), National Registration Department (JPN), Departemt of Islamic Development Malaysia (JAKIM) and etc.
Empowering the community to be involve with drug rehabilitation through the establishment of CCH. The program mobilizes local communities to assist in monitoring the progress of clients through a concept that utilizes existing resources and strengths within the communities.
| 6. How was the strategy implemented and what resources were mobilized?
The transformation program that was introduces is a paradigm shift in designing, planning, delivering and serving clients. Central to this transformation is that we would work within the existing frameworks and with the existing resources.
NADA transformation program introduce new and innovative services but utilizing existing resources such as converting existing compulsory rehab centre to Clinic C&C 1Malaysia and converting existing PUSPEN to CCRC. This conversion only involves upgrading the necessary facility to provide a more conducive environment to perform rehabilitation and recovery program.
The new programs introduce by NADA such as the Clinic C&C 1Malaysia a based on the concept of Open Access and clients come in voluntarily to seek treatment. This alleviates the risk of this clients running away and thus require less workforce to supervise and in term of program and safety. Clinic C&C only require 69 personnel compare to 105 personnel for traditional PUSPEN. This free up
valuable resources to be remobilize and deployment into other segment of NADA services. NADA also prioritize the placement of its staff based on their core competency. Experience and trained counselor are place in the front liner to fully utilize their expertise. Suitable training is also provided to staffs based on their required job scopes.
Principally, NADA receive no additional funding to fund the implementation of its transformation programs. NADA fully utilize the existing Operating Expenditure (OE) and Development Expenditure (DE). NADA reprioritize it spending based on the requirement of the transformation programs.
NADA do receive funding aid form the GTP and NKRA initiative. The fund receive is more of one-off nature and to achieve specific goal under the stated initiative. For the most part, the receive fund does help in the transformation program but not a major contributing factor in NADA transformation implementation.
| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The transformation of NADA’s treatment and rehabilitation program is a quantum leap and has sparked a phenomenon in the treatment and rehabilitation landscape in Malaysia. This positive transformation indirectly helped drive the GTP.
The effects and outputs of NADA’s transformation can be seen from the following perspectives:
i. Hopes of Stakeholders and The Community – The paradigm shifts in modern thinking changes the negative misperceptions that the society stigmatizes towards the drug addicts as a whole. Society is more open and clients are more committed in getting treated and rehabilitated. The involvement of individuals in volunteerism antidrug activities during their productive age motivated the stakeholders to provide full support in treatment and rehabilitation programs for the drug addicts. In effect, the planned transformation not only constitutes the institutional approach program, but also for clients who are inside community.
ii. Crime Rate Reduction – Successful in helping the government achieve the first NKRA initiative in reducing street crime rates involving drug addicts. There has been a 39.9% reduction in street crime compared to the baseline in 2008.
iii. Increase Customer Access – Increase in the number of clients accessed. The society became more open-minded and this development created awareness amongst the drug dependents and gave them strength to come forward voluntarily to receive treatment and be rehabilitated. The number of clients admission for voluntary treatment at the rehabilitation centers in 2009 was 615 clients and 564 client in 2010. The increase in number of client receiving voluntary treatment is a listed below.
CLIENT REFERENCES & ADVOCACY TOTAL
CUMULATIVE JAN - NOV 2013 3574 3487 5638 12,699
CUMULATIVE 2012 5043 3854 3869 12766
CUMULATIVE 2011 3028 2259 4080 9367
CUMULATIVE 2010 666 772 117 1555
2010-2013 12,188 10,272 13,612 36,387
iv. International Recognition – International bodies and community recognize the transformation by NADA and became the best example of open-access services.
“The people of South East Asia have been searching for alternatives to the compulsory treatment system. We are most impressed with the Cure & Care approach. Though only just over one year old, your C&C Model holds great promise for the future of Malaysia and the region. Keep up the great work! Malaysia leads the way!” (Gary Lewis. Regional Representative, UNODC) 2011.
v. Service Effectiveness – Able to introduce a comprehensive and systematic treatment model by combining psychosocial and medical programs. A study titled ‘Transformation From Compulsory Drug Detention Centers to Ambulatory Care Programs’ by University Malaya (UM) on 2012 to assess the effectiveness of the C&C 1 Malaysia Clinic Sungai Besi and clients’ attitudes towards the services received. This study shows that 94.4% of clients confessed that the C&C treatment reduced their drug addiction cravings and they satisfied with the services provided by the C&C Clinic staff. 90% of clients were prepared and willing to recommend C&C services to peers with drug problems.
NADA as a government agency, has successfully delivered on our mission whilst also adhering to the 1Malaysia concept. “People First, Performance Now”. As a result, NADA continues to be recognized both nationally and internationally and most importantly, our services are felt by the people we strive to serve. By using new media NADA also committed in delivering message and knowledge through anti drugs campaign. Mia and Adam’s Story was new approach using to attract people and increase awareness about drug abuse. It can be accessed through the website www.wecareweserve.org.
| 8. What were the most successful outputs and why was the initiative effective?
The progress and performance of transformation program is constantly monitor by various committee at NADA head quarter level. Most of the committee is chair by NADA’S Director General. This is to cut on red tape and any major decision can swiftly be decided.
In addition to the decision making process, NADA has also design and implemented an online management system for its clients called MyAADK. The system objective is to modernize NADA clients managements system including profile management, treatment record, recovery program and past cases. The system can be accessed in all NADA offices nationwide including all of Clinic C&C 1Malaysia, CCRC, Triage (client assortment centre), CCSC dan district offices. The system is develop internally with consultation from Malaysian Administrative Modernization and Management Planning Unit (MAMPU) and assistance from technical officers from National Registration Department (JPM)and Royal Malaysia Police (PDRM).
NADA frequently report the performance of its transformations program to the various stake holders. This is to ensure that NADA receive feedback on the implementation of its programs. One such occurrence is NADA presented changes on its transformation program to the Delivery Task Force Meeting on Crime Related Issues chaired by the honorable YAB Tan Sri Deputy Prime Minister on 28 April 2011. List here is a list of the most recently presentation to the stake holders.
Meeting Chairman Date
Treatment and Recovery Task Force
(Jawatankuasa Bertindak Rawatan dan Pemulihan) Y.B Datuk S. Subramaniam
Minister of Health
17 October 2013
Committee on Prevention, Education and Publicity
(Jawatankuasa Bertindak Pencegahan, Pendidikan dan Publisiti) Y.B Dato’ Sri Ahmad Shabery Bin Cheek
Minister of Communication and Multimedia Commission
29 October 2013
Task Force Of Drug Law
(Jawatankuasa Bertindak Penguatkuasaan Undang-undang) Y.B Datuk Dr. Wan Junaidi Tunku Jaafar
Deputy Minister of Home Affairs
18 November 2013
National Social Council
(Majlis Sosial Negara) YAB Tan Sri Dato’ Hj. Muhyiddin Yassin
Deputy Prime Minister of Malaysia
9 December 2013
| 9. What were the main obstacles encountered and how were they overcome?
Ensuring the NADA Cure & Care model is rolled out by:
1) Sustaining key stakeholder support and buy-in for the transformation
2) Promoting and sustaining the new brand of NADA as an organisation
3) Reducing the stigma against people who use drugs in the community and helping clients return to be functioning individuals
4) Deepening of engagement with key stakeholders particularly NGOs, community and the public sector
5) Further exposure to best practices models internationally to continue alignment of approaches
6) Disseminating learning experiences and outcomes and gain international support and recognition for the organisation
Returning clients to become healthy, functioning individuals by:
1) Providing nationwide reach and coverage of services to meet the service needs
2) Ensuring positive outcomes for clients in treatment that meet their expectations
3) Providing a comprehensive suite of treatment options that addresses all medical and psychosocial needs of clients
4) Providing skills, training and creating employment opportunities for AADK clients
Empowering and engaging all levels of staff by:
1) Upskilling, empowering NADA staff to enable them to design and implemented Programs
2) Building capacity and increasing professionalism of NADA staff to deliver services and when facing clients, partners and stakeholders
3) Engaging NADA staff at all levels to sustain the transformation journey, and aligning their behavior to meet the organisation’s expactations
4) Recognising their efforts and achievement in order to sustain the buy-in of the transformation
Innovating to ensure implementation success by:
1) Strengthening the execution of the transformation by establishing supporting infrastructure to meet the estimated targets
2) Corporatisation on treatment and rehabilitation services
3) Laveraging on IT to monitor and deliver services for clients