Both employers and out-patient treatment centres are key role players in addressing workplace related substance abuse. On the one hand, employers are directly and indirectly affected by the huge problem of substance abuse. On the other hand, out-patient treatment centres provide, as their core goal, for the treatment of substance abuse and dependency. Due to the extent of the problem of substance abuse, collaborative intervention measures between employers and out-patient treatment centres are essential – especially the involvement of specialists in the treatment of substance abuse. Such a collaboration process requires specific, resolute measures, as well as a structured process in order to ensure sustainability and results. A networking programme that provides the opportunity to implement this collaborative process is proposed. Sound collaborations indeed provide the foundation to establish the networking programme for combating the problem of substance abuse in the workplace. A collaborative effort to address the problem of substance abuse in the workplace requires not only rallying the strengths and resources of both employers and out-patient treatment centres, but also developing a programme with well-defined processes beneficial to both. A qualitative research study by means of a grounded theory approach was conducted to explore how networking between employers and out-patient treatment centres might aid in addressing the problem of substance abuse in the workplace. Article 1 is a literature overview of substance abuse within the workplace and concerns the national directives, legislation requirements and measures of intervention aimed at dealing with the problem. The literature findings reveal clear national directives, legislation requirements and workplace policies, all aimed at providing a well-defined context for employers to manage substance abuse in the workplace. In addition, specialist treatment services are available to assist employers in addressing the problem in the workplace. Internal support structures in the workplace, however, often independently address the problem of substance abuse without involving the specialists. Literature findings indicate, though, that the personnel involved in the internal support structures are often not equipped to deal effectively with the problem. Research findings indicate positive treatment outcomes for employees with substance abuse problems. Statistics, however, indicate that the identification of employees with substance abuse problems is limited and that referrals of employees for treatment are infrequent. Underutilisation of out-patient treatment centres is therefore commonplace. Literature specifically indicates that the majority of employees are moderate drinkers and substance abusers, with only a small number being dependant. It is further indicated that the moderate drinkers and substance abusers account for almost half of the workforce. The critical factor, however, is that these categories of drinkers cause the majority of industrial accidents and are also responsible for the highest absenteeism rate. Prevention measures, sensitising the entire workforce to the early signs and dangers of substance abuse, facilitate the achievement of the best results in combating the problem. With an eye towards this, national directives advocate the following: intensified campaigns to educate people regarding the early signs and dangers of substance abuse, comprehensive prevention measures and increased rehabilitation efforts. Literature identified a limitation to effectively address substance abuse in the workplace, a problem catered for by specialist treatment centres. Article 2 reports the findings of a situation analysis regarding both the concerns and problems of employers and out-patient treatment centres, as well as resources needed to combat substance abuse in the workplace. Representatives from the employment sector, and out-patient treatment centres, participated in the situation analysis. Employees involved in substance abuse treatment programmes also participated in the study. A specific limitation, identified during the situation analysis, was the limited knowledge regarding the negative consequences of substance abuse in general. An unsupportive workplace environment, with regards especially to substance use and abuse, was also identified. Though empirical findings reported the existence of support structures in the workplace, these structures were found to be incapable of dealing with the problem. In the event of substance misconduct, employers are legally obligated to provide treatment and rehabilitation before considering dismissal; however, employers perceived these obligations as additional demands. Employers did not realise the possible benefits of treatment over dismissal. Misinformation and misinterpretation of the legal obligations were also identified during the research study. The stand against the problem of substance abuse in the workplace revealed a limited collaboration between employers and out-patient treatment centres. Employers were often not aware of specialist treatment centres and the available services. A lack of marketing and visibility – on the part of out-patient treatment centres – and an indifference and lack of support in the workplace were regarded as some of the causes for the limited collaboration between employers and out-patient treatment centres. Both ignorance in the workplace about the scope of substance abuse and a general lack of knowledge regarding the problem were identified as further limiting factors. A need for collaboration between employers and out-patient treatment centres was identified, especially if the problems of substance abuse in the workplace were to be successfully addressed. The development of a networking programme for employers and treatment centres was recommended and the core components to establish such a programme were identified. Article 3 discusses the components which were identified during the situation analysis and presents guidelines to develop a networking programme for employers and out-patient treatment centres. The components identified by the participants served as framework for the proposed networking programme. The programme comprises a specific purpose namely collaboration between employers and out-patient treatment centres, specific characteristics to sustain the programme, and the implementation of distinguishable procedures to establish and ensure sustainability of the programme. The purpose of the networking programme is to promote, between employers and out-patient treatment centres, a collaboration that will address the problem of substance abuse in the workplace. Involvement in the programme holds significant potential benefits for all relevant role players; the programme, in other words, advocates benefits for employers, employees and out-patient treatment centres. The proposed networking programme includes specific procedures for establishing and sustaining the programme: Firstly, assessing the limitations, needs and strengths of both the employment sector and out-patient treatment centres; secondly, establishing a network agreement that defines the roles and responsibilities of the role players; thirdly, collectively planning the networking activities and implementation of these plans; and, finally, collaboratively evaluating the impact and effectiveness of the programme. The aforementioned procedures also apply to both the evaluation of the limitations and progress of the treatment programmes, as well as to the evaluation of service delivery of the treatment centres. As it enables the revision of plans that provide individualised services, the continuous reassessment of the limitations and strengths of the networking programme is important. Out-patient treatment centres are considered responsible for initiating the networking programme. Effective collaboration between employers and out-patient treatment centres, as well as quality service delivery by the treatment centres, is regarded as critically important. Ultimately, the networking programme – regarded as a collaborative process between employers, employees and out-patient treatment centres – promotes a partnership geared towards combating the problem of substance abuse in the workplace. The researcher concluded the study with the formulation of a theory regarding the development of a networking programme as its end goal. Also, it is hoped that both out-patient treatment centres and the employment sector (employers and employees) may benefit from it in practice. Eventually, the proposed networking programme was based on the data collected from the situation analysis in this study, the researcher’s experience as a counsellor in substance abuse treatment and her exposure to different networking programmes, as well as supportive theoretical knowledge. A guideline for application of the networking programme in practice is included in the study alongside examples of projects to apply the programme. / PhD (Social Work), North-West University, Potchefstroom Campus, 2014

Both employers and out-patient treatment centres are key role players in addressing workplace related substance abuse. On the one hand, employers are directly and indirectly affected by the huge problem of substance abuse. On the other hand, out-patient treatment centres provide, as their core goal, for the treatment of substance abuse and dependency. Due to the extent of the problem of substance abuse, collaborative intervention measures between employers and out-patient treatment centres are essential – especially the involvement of specialists in the treatment of substance abuse. Such a collaboration process requires specific, resolute measures, as well as a structured process in order to ensure sustainability and results. A networking programme that provides the opportunity to implement this collaborative process is proposed. Sound collaborations indeed provide the foundation to establish the networking programme for combating the problem of substance abuse in the workplace. A collaborative effort to address the problem of substance abuse in the workplace requires not only rallying the strengths and resources of both employers and out-patient treatment centres, but also developing a programme with well-defined processes beneficial to both. A qualitative research study by means of a grounded theory approach was conducted to explore how networking between employers and out-patient treatment centres might aid in addressing the problem of substance abuse in the workplace. Article 1 is a literature overview of substance abuse within the workplace and concerns the national directives, legislation requirements and measures of intervention aimed at dealing with the problem. The literature findings reveal clear national directives, legislation requirements and workplace policies, all aimed at providing a well-defined context for employers to manage substance abuse in the workplace. In addition, specialist treatment services are available to assist employers in addressing the problem in the workplace. Internal support structures in the workplace, however, often independently address the problem of substance abuse without involving the specialists. Literature findings indicate, though, that the personnel involved in the internal support structures are often not equipped to deal effectively with the problem. Research findings indicate positive treatment outcomes for employees with substance abuse problems. Statistics, however, indicate that the identification of employees with substance abuse problems is limited and that referrals of employees for treatment are infrequent. Underutilisation of out-patient treatment centres is therefore commonplace. Literature specifically indicates that the majority of employees are moderate drinkers and substance abusers, with only a small number being dependant. It is further indicated that the moderate drinkers and substance abusers account for almost half of the workforce. The critical factor, however, is that these categories of drinkers cause the majority of industrial accidents and are also responsible for the highest absenteeism rate. Prevention measures, sensitising the entire workforce to the early signs and dangers of substance abuse, facilitate the achievement of the best results in combating the problem. With an eye towards this, national directives advocate the following: intensified campaigns to educate people regarding the early signs and dangers of substance abuse, comprehensive prevention measures and increased rehabilitation efforts. Literature identified a limitation to effectively address substance abuse in the workplace, a problem catered for by specialist treatment centres. Article 2 reports the findings of a situation analysis regarding both the concerns and problems of employers and out-patient treatment centres, as well as resources needed to combat substance abuse in the workplace. Representatives from the employment sector, and out-patient treatment centres, participated in the situation analysis. Employees involved in substance abuse treatment programmes also participated in the study. A specific limitation, identified during the situation analysis, was the limited knowledge regarding the negative consequences of substance abuse in general. An unsupportive workplace environment, with regards especially to substance use and abuse, was also identified. Though empirical findings reported the existence of support structures in the workplace, these structures were found to be incapable of dealing with the problem. In the event of substance misconduct, employers are legally obligated to provide treatment and rehabilitation before considering dismissal; however, employers perceived these obligations as additional demands. Employers did not realise the possible benefits of treatment over dismissal. Misinformation and misinterpretation of the legal obligations were also identified during the research study. The stand against the problem of substance abuse in the workplace revealed a limited collaboration between employers and out-patient treatment centres. Employers were often not aware of specialist treatment centres and the available services. A lack of marketing and visibility – on the part of out-patient treatment centres – and an indifference and lack of support in the workplace were regarded as some of the causes for the limited collaboration between employers and out-patient treatment centres. Both ignorance in the workplace about the scope of substance abuse and a general lack of knowledge regarding the problem were identified as further limiting factors. A need for collaboration between employers and out-patient treatment centres was identified, especially if the problems of substance abuse in the workplace were to be successfully addressed. The development of a networking programme for employers and treatment centres was recommended and the core components to establish such a programme were identified. Article 3 discusses the components which were identified during the situation analysis and presents guidelines to develop a networking programme for employers and out-patient treatment centres. The components identified by the participants served as framework for the proposed networking programme. The programme comprises a specific purpose namely collaboration between employers and out-patient treatment centres, specific characteristics to sustain the programme, and the implementation of distinguishable procedures to establish and ensure sustainability of the programme. The purpose of the networking programme is to promote, between employers and out-patient treatment centres, a collaboration that will address the problem of substance abuse in the workplace. Involvement in the programme holds significant potential benefits for all relevant role players; the programme, in other words, advocates benefits for employers, employees and out-patient treatment centres. The proposed networking programme includes specific procedures for establishing and sustaining the programme: Firstly, assessing the limitations, needs and strengths of both the employment sector and out-patient treatment centres; secondly, establishing a network agreement that defines the roles and responsibilities of the role players; thirdly, collectively planning the networking activities and implementation of these plans; and, finally, collaboratively evaluating the impact and effectiveness of the programme. The aforementioned procedures also apply to both the evaluation of the limitations and progress of the treatment programmes, as well as to the evaluation of service delivery of the treatment centres. As it enables the revision of plans that provide individualised services, the continuous reassessment of the limitations and strengths of the networking programme is important. Out-patient treatment centres are considered responsible for initiating the networking programme. Effective collaboration between employers and out-patient treatment centres, as well as quality service delivery by the treatment centres, is regarded as critically important. Ultimately, the networking programme – regarded as a collaborative process between employers, employees and out-patient treatment centres – promotes a partnership geared towards combating the problem of substance abuse in the workplace. The researcher concluded the study with the formulation of a theory regarding the development of a networking programme as its end goal. Also, it is hoped that both out-patient treatment centres and the employment sector (employers and employees) may benefit from it in practice. Eventually, the proposed networking programme was based on the data collected from the situation analysis in this study, the researcher’s experience as a counsellor in substance abuse treatment and her exposure to different networking programmes, as well as supportive theoretical knowledge. A guideline for application of the networking programme in practice is included in the study alongside examples of projects to apply the programme. / PhD (Social Work), North-West University, Potchefstroom Campus, 2014

South Africa has experienced a drastic shortage of social workers. This shortage has affected many social welfare organizations, particularly those who offer services in the area of substance abuse. According to a recent study conducted by Earle (2008) many reasons could be ascribed to the high social work turnover, these include: poor working conditions; poor compensation of work; lack of resources and support; and increased demands for services. Hence, social workers are experiencing work stress, burnout and compassion fatigue taxing their personal and professional coping strategies which could lead to staff turnover. The primary aim of this study was to understand the work experiences, coping strategies and organisational retention of social workers in Gauteng inpatient substance abuse treatment centres. The study had an exploratorydescriptive design, incorporating both quantitative and qualitative paradigms to explore the work environment of the organisations and participants. Purposive sampling was used to select and divide the participants into three categories: entry level social workers; experienced social workers and social workers that had left the substance abuse field. Data was collected through conducting indepth interviews and through a questionnaire completed by the representatives from in-patient substance abuse treatment centres. This questionnaire was piloted with an in-patient treatment centre in KwaZulu Natal. The results of the quantitative data were analysed using descriptive statistics, which were illustrated via tables and figures and the qualitative data were analysed using thematic content analysis. The main findings of this study confirmed most of the reasons for work stress and burnout that may lead to staff turnover identified in previous studies by Ross (1997) and Earle (2008). These findings are incorporated into a retention model developed by the researcher. The model incorporated five stages: stage one focussed on the reasons for entering the substance abuse field (personal interests, undergraduate studies and/or accidental); stage two explored preparation of social workers by organisations after entry to the field; stage three identified four general factors that effects the sustainability of social workers (external/environmental influences, organisational factors, the type of client population, career opportunities and personal factors); stage four explained the individual differences in coping responses (negative or positive) to job stress either through fight responses, self-care strategies for retention or flight responses, staff turnover; lastly, stage five focussed on what organisations can do to reduce staff turnover. These findings can assist the occupational social worker to identify these retention challenges and develop strategies to reduce the risk of staff turnover.

Masters of Art / High rates of substance use and its associated problems afflict Cape Town, underscoring the need for easily accessible substance abuse treatment. Despite the substantial benefits for both individuals and society at large that substance abuse treatment confers, substance abusers often first have to negotiate considerable challenges in order to access treatment and accumulate these gains. That is, experiencing barriers to accessing treatment, together with the presence of socio-demographic features, rather than “need for treatment”, decides who accesses treatment. Referrals are the gateway to inpatient substance abuse treatment in the Western Cape. While several barriers to accessing treatment have been identified by prior studies, none examine these phenomena from the point of view of the agents responsible for referring substance users for treatment. Moreover, access barriers to inpatient substance abuse services are a neglected area in extant literature. To address this gap, this study explored the perceptions of referring agents‟ of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape. This enabled the researcher to compare existing access barriers to treatment as identified by prior research, to those elucidated in the study. Bronfenbrenner‟s Process-Person-Context-Time model was employed as the basis for understanding identified barriers. In accordance with the exploratory qualitative methodological framework of the study, six semi-structured individual in-depth interviews were conducted with referring agents‟ of differing professional titles who were purposefully selected and expressed a willingness to participate in the study. Interviews were audio-recorded, and transcripts were analysed and interpreted by means of Thematic Analysis. Two broad thematic categories of access barriers were identified: Person-related barriers (denial, motivation for treatment, gender considerations, disability, active TB disease, homelessness, psychiatric co-morbidity) and Context-related barriers to treatment (cultural and linguistic barriers, stigma, community beliefs about addiction and treatment, awareness of substance abuse treatment, affordability/ financial barriers, geographic locations of treatment facilities, waiting time, lack of collaboration within the treatment system, beliefs of service providers‟, lack of facilities/ resources within the treatment system, practices at inpatient facilities, referral protocol and uninformed staff). Results suggest that by targeting the aforementioned barriers, access to inpatient and outpatient treatment services can be improved, and recommendations for interventions are offered in this regard. Ethical principles such as obtaining informed consent and ensuring confidentiality were abided by throughout the study and thereafter.

Thesis (MOccTher)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: The high number of mental health care users requiring care, the quick turnover in psychiatric hospitals and the scarcity of community-based mental health services are some of the factors that have led to a dramatic increase in the number of high frequency users of in-patient psychiatric services. In an attempt to address these issues, an occupational therapy-led day treatment centre was established at Stikland Hospital in the Western Cape province of South Africa. The aim of this study was to determine whether attendance at an occupational therapy-led community day treatment centre for mental health care users affects the use of in-patient services in the Western Cape Province of South Africa. Methods: A pre-test/post-test quasi-experimental study design was used to determine the benefits of the occupational therapy-led day treatment centre. Total population sampling was used. Forty four mental health care users participated in the study. The number of admissions and number of days spent in hospital before and after occupational therapy intervention were compared using statistical analysis. Results: The analysis showed a significant difference in the number of admissions (p = .00) and the number of days spent in hospital (p = .00) before and after the occupational therapy intervention. There was a decrease in the number of admissions of 62.3% after intervention. Twenty-five participants (56.8%) had fewer admissions after intervention than before. Total days spent in hospital for the group showed a decrease of 74.6% after intervention. Days spent in hospital became shorter by up to 7 months after occupational therapy intervention. This indicated a medium effect size (r = .436) for number of admissions and a large effect size (r = .504) for number of days spent in hospital after intervention. The frequency of attending the day treatment centre had no influence on number of admissions (p = .410) or on the number of days spent in hospital (p = .579) after intervention. Conclusion: The findings suggest that an occupational therapy-led day treatment centre is effective in reducing the use of in-patient services within the Western Cape, South Africa. In addition providing a range of opportunities for meaningful participation may be more important than the intensity of treatment when promoting recovery. / AFRIKAANSE OPSOMMING: Agtergrond: Die groot hoeveelhied persone wat psigiatriese sorg benodig, die vinnige omset in psigiatriese hospitale asook die tekort aan gemeenskaps psigiatriese dienste is van die faktore wat lei tot ‘n toename in persone wat gereëlde heropname benodig. As moontlike oplossing vir die probleem is ‘n dagbehandelingsentrum geopen by Stikland Hospitaal in die Wes-Kaap provinsie van Suid Afrika. Die doel van die studie was om vas te stel of ‘n dagbehandelingsentrum, onder leiding van ‘n arbeidsterapeut, effektief is in die Wes-Kaap provinsie van Suid Afrika vir persone met psigiatriese siektes. Metode: ‘n Voortoets-natoets kwasi-eksperimentele studie metode is gebruik om die voordele van ’n arbeidsterapie gedrewe dagbehandelingsentrum te bepaal. Totale bevolking steekproef is gebruik. Vier en veertig persone met ‘n psigiatriese diagnose het deelgeneem aan die studie. Die hoeveelheid opnames asook hoeveelheid dae spandeer in die hospitaal voor en na die arbeidsterapie intervensie is vergelyk. Resultate: Resultate het getoon dat daar ‘n beduidende verskil was tussen die hoeveelheid opnames (p = .00) en die hoeveelheid dae in die hospital (p = .00) voor en na arbeidsterapie intervensie. Die groep se hoeveelheid opnames het met 62.3% gedaal na intervensie. Vyf en twintig deelnemers (56.8%) het minder opnames gehad na intervensie as voor intervensie. Data toon ‘n medium effekgrootte (r = .436). Die totale dae in die hospitaal vir die groep het met 74.6% afgeneem na intervensie. Dae spandeer in die hospitaal het met tot 7maande verkort na arbeidsterapie intervensie. Dit toon‘n groot effekgrootte (r = .504). Die frekwensie van bywoning het geen invloed getoon op die hoeveelheid opnames (p = .410) of hoeveelheid dae in die hospitaal (p = .579) nie. Gevolgtrekking: Die studie het gevind dat, in die Wes-Kaap, ‘n arbeidsterapie gedrewe dagbehandelingsentrum ‘n effektiewe en uitvoerbare opsie is om die druk op binne-pasiënt dienste te verlig. Die studie het verder getoon dat betekenisvolle deelname aan aktiwiteite moontlik belangriker is vir herstel na ‘n psigiatriese siekte as intensiteit van behandeling.