Positive Futures
Join Alex, as he explores a wide range of topics that matter to our community, from sexual health and harm reduction to social issues and culture. The series aims to find the positives in how we face these challenges and the exciting changes that lie ahead.
Positive Futures
The JustACE program
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The JustACE program is an initiative of the Brain Injury Association of Tasmania, to help those people in the custodial system who may need extra support. Justine joins us for a chat about their program.
Welcome back to another series of Positive Futures, a Red Thread Studio Production. I'm your host, Alex, and I want to broaden the scope of the podcast this year to uncover the wide array of people and organizations that work in our health and community sectors. We'll meet some of the key players and find out what exciting projects and initiatives are happening out there right now, and what our guests are most excited or hopeful for in the future. Today I'm talking to Justine, and she's from the Just Ace program, which is an initiative from the Brain Injury Association of Tasmania, is that right? Yeah. How are you, Justine?
SPEAKER_02Yeah, I'm good, thanks.
SPEAKER_00Thanks so much for joining me. So what does Just Ace stand for? Let's start there for that.
SPEAKER_02Sure. So there's a few different elements to it. Just ACE kind of comes out of the program that we mainly deliver is a cognitive remediation package that is called the ACE package. So it's developed by Neuropsyc Jamie Berry. And it is mainly tailored to working with people that have cognitive impairment but also kind of fall into that space of maybe having drug and alcohol use as well. So there's that element of it. So yeah, just Ace stands for justice, advocacy, connection and empowerment. And then yeah, also kind of leading into the package that we use, which is the ACE package.
SPEAKER_00Yeah, nice. That's also a great pun. So on the word justice. And so I guess we came across you through my colleague Naomi. Actually, I think I did meet you at one of the prison outreach projects. So is that the main function of Just Ace? Like as in a subset of the Brain Engine Tasmania programme, the Just Ace program, obviously, and riffing off that ACE initiative. Do you just work inside prisons? Like I met you at an outreach program where we were there doing an education and health expo, but is that the main arc or you know point of the organisation?
SPEAKER_02Yeah, so um I guess a Just Ace program works across kind of all justice settings. Okay. Um so we do only work with offenders or defendants, but we primarily started working in I guess community and custody when the program was kind of developed. It was developed around the magistrate's court diversion list. Um so in 2013, BIAT helped do a review of the functioning of that list, um, and cognitive impairment was included in that. Right. BIAT for those listening is just amazing.
SPEAKER_00No, I always forget to do acronyms and I use them all the time, and then people are like, I wonder what that is.
SPEAKER_02Yeah, Brain Injury Association of Tasmania is so long.
SPEAKER_00Yeah, so long.
SPEAKER_02Yeah, so um kind of undergoing that review and having cognitive impairment added as a stream for that later led to the realisation that there isn't actually any programs to kind of service that diversionary pathway. So under federal funding, BIAT was given uh funding to develop a project called the RRR project, which it stands for recognise, respect, respond and reform.
SPEAKER_01Yep.
SPEAKER_02Another really lengthy name. Yes, yeah, but essentially that there was a few sub-projects within that funding grant that they had, and just Ace was one of those. So it was really about getting people um with cognitive impairment kind of voices heard, yeah, and also yeah, being able to tailor that kind of having a support avenue, I guess, for the diversion pathway. Is that diversion pathway or just out of yeah, so out of so the magistrate's court diversion list, which is usually mental health diversion list is what most people see it as. There is an aspect of the cognitive impairment diversion in there as well. It's not a greatly known kind of part of the diversion list. And it, yeah, I I guess we're kind of the only program that is there to kind of support that diversion. Unfortunately, at the moment we don't actually have funding to support that program. So we do still do some work where we can off of you know other basically savings and other funding sources where we can to kind of keep some level of support provided there. But I guess the other aspect of it was that more broadly, what is kind of the percentage of people with brain injury in justice systems and how that compares to the community and how their needs are kind of met. Um so we know that there was a study done in a Victorian prison, and it was 42% of male prisoners and 33% of female prison prisoners had a brain injury, diagnosed brain injury. And comparatively, that's only 2% of the general population usually that have brain injury.
SPEAKER_00So it's much overrepresented.
SPEAKER_02Huge, huge overrepresentation. Um, and unfortunately we don't have any statistics here in Tasmania. Yeah, of course. Um which, you know, we would love to support that if we can, but um, yeah, it's a lot of I mean, thinking about that, that's I mean, that's a damning statistic in in many ways, obviously.
SPEAKER_00But just those importance of a program like yours for because I was just doing a bit of background reading before the show. Your can you just explain briefly the sort of breadth of what a brain injury actually entails in the sense of how we conceptualize it? Because it's obviously not just acquired brain injuries from like an accident like most people might think initially when they hear it. Um it covers a broad range of sort of processes, doesn't it?
SPEAKER_02Yeah, yeah, definitely. So I guess there's a lot of different aspects for the way that you can acquire a brain injury and whether that's a traumatic brain injury, um, there's also new neurodevelopmental conditions. We also within kind of our program specifically, we look at cognitive impairment more broadly. So we include things like um autism and intellectual disability, and the reason for that is that it is, you know, getting an actual diagnosis for a brain injury or a lot of these conditions is quite hard in its first kind of instance. So the way that we do it is we look more at how it's impacting someone. So we look at is it impacting their memory, is it impacting their attention, kind of their thought processing um or even emotional regulation is a big one.
SPEAKER_00Yeah. Um I can imagine, especially giving given sentencing and all that kind of stuff.
SPEAKER_02Absolutely, and even just understanding of how that goes. Um so yeah, we whilst we are a part of the brain injury association of Tasmania, we do have that kind of more broad cognitive impairment lens, um, you know, so that people do have support.
SPEAKER_00I mean, because I just found that interesting and I think that it's so easy to make base assumptions when you hear a title or a phrase or a concept you're familiar with maybe but don't understand maybe how far reaching it is. Yep. And I can imagine in all of the settings, because you you work pre- and post-prison, right? As in custody, I guess, or and imprisonment itself.
SPEAKER_02Yeah, so it it's kind of in a in a stage of changing at the moment. So up until April of this year, we worked it kind of from people that we would consider at risk of engaging in the justice system. So it could be that they're starting to engage with police. Um, and and we know that there's kind of quite often there's representation with police where they might be mistaking a brain injury for drugs and alcohol or similar kind of things. So there's working with people at that level, supporting them through court processes, working with them if they're on a community-based order as well, and then also in custody, whether they were on remand or sentenced, and then also through care process as well. So going back into the community and supporting them where we can there, also on parole or bail. Unfortunately, with the state budget, now everything has gone, our funding has been reduced, so we've kind of had to reduce our scope with that. So we're now only working with the remand population. So you had to reduce. Yeah, so we we can still do through care, um, but our referral source needs to be while they're actually on remand. Yeah, gotcha. Um and then, yeah, as I said before, we're also working with a small number of people under st under the magistrate's court diversion list as well, um, where we can.
SPEAKER_00But so that 20 to 30 percent, and talking about the you know the the amount of people you work for. I guess I've got two quick questions just to know a bit more about the program. How many staff do you have then and and how many people you're working with? Like what is 20 to 30 percent of the prison population now? Yeah, so in that transitionary stage.
SPEAKER_02Yeah, at the moment we have um two case facilitators and myself. Um up until kind of doesn't sound like a lot.
SPEAKER_00I was expecting like seven or twenty.
SPEAKER_02Yeah, no, it's not a lot. It's a it's a very small program and we've grown quite quickly. Um up until kind of March of this year, we had three case facilitators myself, and then also had a project officer. Um again with funding cuts comes a reduction in staff. So we're down to two case facilitators and myself. And so we are now looking at a caseload that is quite a bit less than what we did have up until probably early this year. We had about 70 participants that we were supporting actively. And then our wait list was also about 40 as well. So we had a really high number of people seeking support, and yeah, going forward it's probably more probably 45-50 people that we're we're looking to support. Still heaps, isn't it? Yeah, two or three people.
SPEAKER_00And what sort of are there other support networks similar to yours? I'm just thinking of particularly when you mentioned sort of neurodivergent or sort of maybe learning dis difficulties, you know, in schools now we've got sort of more assisted care and things like that, and there's support networks, and there's other organizations doing things in you know, employment pathways or various other areas like that. Are you guys the only one doing sort of the custodial setting environment?
SPEAKER_02Is that yeah, so we're the only organization that has the justice and disability kind of lens and component to it.
SPEAKER_01Gotcha.
SPEAKER_02Um there's other programs that of course work more in justice and more in disability and maybe some overlap, but we're really kind of that bridging point.
SPEAKER_00Yep, yeah. And that stemmed, I guess, just from the Brain Injury Association, not the actual association, but the association with that concept and then and then justice. Yep, absolutely. Interesting. The current project we're running in partnership with you, from our perspective, we're trying to look at this idea of through care and how it can be augmented, I guess, or supported in other ways. What sort of support are we talking about that you offer your clients? So is it like reading cases, help with sentencing, preparing? Because you guys aren't lawyers.
SPEAKER_02No, yeah. So we're um, I guess our backgrounds, we're mainly social workers, mental health nurses, that kind of background. Um, so we don't work in a clinical capacity. Um we support people through, we kind of look at what's going on for that person, look at the likelihood of a cognitive impairment, um, and we do a bit of an assessment around that, um, which is a non-diagnostic assessment, but it tells us the likelihood of them having a cognitive impairment and whether it's likely to be severe. From there, it actually tells us tells us what part of their brain they might need extra support with. Um, so they might need support with their attention or their memory or the certain kind of components of their memory as well. Um, and we then work with them on those either through developing some kind of core individual strategies with them that will support them to either engage in community, engage in housing, maintain housing, but I guess more so engaging with the justice system itself. So, what what part of their kind of cognition or their cognitive impairment might be impacting their engagement with the justice system or their kind of I guess engagement with programs and and things that might help in that rehabilitation space as well. So a lot of it kind of starts off with that assessment and then we do individual cognitive remediation. We deliver what's called an ACE package, which I was saying before. So it is a essentially it's a 12-module package which goes through all the different types of um cognition, so memory, learning, attention, teaches the person about the brain and how it works, and looks at kind of little strategies for each different area and little tasks and routines we can do to improve cognition. On top of that, we do kind of more broad education to people that are working with that person, so stakeholders, support workers, might be custodial staff, prison staff.
SPEAKER_01Yeah.
SPEAKER_02And then a big component at the moment is case management. Yeah, of course. Um so yeah, just addressing kind of all the other needs in that person's life.
SPEAKER_00So yeah, I mean there's so much support needed, isn't there? Especially for some of these, you know, this is a vulnerable population, generally speaking, you know. So in terms of then sort of tying it into this project, what currently the project is designed, as you probably heard in the first episode, we're bringing a sort of clinical health component for for particularly hepatitis C but hepatitis in general and other born virus testing awareness into the stream for just a particular population, particularly with hepatitis C, we know it's high prevalence in prison. And so trying to augment that care pathway and referral networks post-prison. So I guess just briefly in the background in terms of what Just Ace does on post-release, you know, reintegration of the community, what kind of support have you got there going on? Case management, you know?
SPEAKER_02Yeah, yeah. So it's pretty wide-ranging. Yeah, so it can be anything from kind of supporting them to connect in with um, you know, crisis housing accommodation. It also is, you know, accessing medication, turning up for court, all that kind of stuff. So I guess one of the big kind of overlaps that I see with this project is that continuity of care if someone has received treatment or have known how to receive treatment in custody, and then making sure that they understand the process for doing that in the community as well and where they can kind of seek support. And I guess a lot of the work that we do is also around NDIS applications and disability support pensions, um, and really just kind of getting them in the front door of a lot of services. So, yeah, certainly the overlap with the health side of things, and also just making sure that it is really accessible for those people as well, um, particularly with low literacy or you know barriers to communication.
SPEAKER_00And I think it's timely sort of joining of forces because, like you're saying, you know, that it's hard for single organizations to do everything. I mean, it's impossible, literally, that's why there's so many of us, but doing a project like this, I think, in collaboration and sort of finding those gaps and like you said, continuing the care pathway. Broadly speaking, that continuity of care, especially for hepatitis C, I think, with our our clients and your clients being one and the same, if if that affects them. That post-care pathway, I think, you know, do you does it does it seem to you like it'll be a useful partnership in terms of supporting medication and finding a clinic to get tested and you now have a clear understanding, I'm hoping, as a result of the project of where you can might be sending people for those services?
SPEAKER_02Yeah, absolutely. So our um our whole team's kind of done a training with Naomi and Catherine recently, which has been fantastic. But I guess it's what we find with working with a cohort of people that we work with, a lot of it is really relationship-based in how we connect people with services. So having a really good relationship with TASCAD allows us to kind of provide warm handovers and support people actually to come, you know, we can walk in the front door with them and do that with them. So yeah, it just allows kind of a really kind of an approach that's really appropriate for that person and is yeah, which is so important given this cohort as well.
SPEAKER_00I mean, you know, uh as you can might imagine, sort of trust issues can emerge as a result of particularly their way of getting in there. We talked about, you know, sort of police uh interactions earlier on, and you know, it can stem from there. So I think that idea of, yeah, exactly, a known service, a trusted organization, partnerships, you know, it's really how how everything's done and how everything's organized. I think it's gonna be a good project. It's already well on its way, and I think these types of collaborative natures are really important, and it's great to hear about another great programme, you know, and services that we can use, and hopefully, you know, the relationship goes both ways, and if we hear about clients, we can send them your way as well.
SPEAKER_02Yeah, absolutely.
SPEAKER_00Well, thanks so much for giving us an overview there. I think it's you know, we're gonna keep it brief because we've got some other organizations to talk to, and you know, the project's uh coming to its end actually, so we'll give an update on that later on. But I do want to ask you one final question, just in keeping with the whole podcast, which is uh positive futures, as you all know by now, Adnauseum. What's happening in in the just ace space or your own your own work or something that's exciting or positive or hopeful for you for the future?
SPEAKER_02Yeah, yeah. I think it it's a really like ever-evolving space, so there's a lot of things that I'm really hopeful for. I think I'm hopeful for a future kind of within the justice system more broadly that is, I guess, more equipped to respond to not just that behaviour that people are dealing with, but also all the kind of things that contribute to that behaviour, whether it is kind of cognitive impairment, whether it's mental health, homelessness, whatever it is. But I guess I'm hopeful for a future where we start to consider more of those in people's rehabilitation and and journey through the justice system, and that we feel more equipped to do so and have those conversations. I think quite often those factors are missed, which really is quite detrimental to someone either seeking support or um, you know, kind of sticking with it and wanting to continue. I think also I hope for I guess here in Tasmania, a sector where the community sector has more stability and funding and capacity to continue programs like ours in a way that also provides um sustainability for the participants and the people we're working with, but also for our staff. You know, having really regular kind of funding cycles is absolutely contributing to burnout within the sector.
SPEAKER_00Well, thanks so much for coming on the show. It's keeping brief, but it's good, and um, we'll have you again for a future episode, I'm sure. And we're more interested in looking in some of this justice space, I think we'll uh we'll increasingly uh discuss and have some chats with. So thanks so much for joining me, Justine.
SPEAKER_02Awesome, thank you so much.
SPEAKER_00You've been listening to Positive Futures, a red thread studio production. You can find earlier episodes on your favourite streaming service or wherever you get your podcasts.