INTRODUCTION

The second year of sedqa’s operations was marked by substantial increases of clients using the care services, rapid expansion of prevention programmes, increased cost effectiveness, improvement in quality control and recruitment of professional staff.

Sedqa is currently providing treatment and care services to circa 700 clients every month. This does not only include substance abusers, but also their families and significant others who seek our services. The quality and accessibility of the various services continued to improve and evidence of this is not only the increased frequency of service utilisation, but also the positive results that ensued from our evaluation and overview exercises that are regularly conducted for each service. This approach will be further strengthened by the introduction of a structured outcome monitoring system and standard diagnostic tools during 1997.

However, 1996 will be especially remembered for the launching of various prevention programmes particularly those targeting primary and secondary school pupils. A nine year school based prevention programme was introduced in all private and state schools. Manuals for every school teacher were prepared and distributed. Most of the teachers have undergone basic training on this manual. No less than 25,000 school children would have gone through this programme in 1996/97 scholastic year. Concurrently, extra curricular programmes and parental skills programmes continued to enhance the realisation of the global approach strategy. This concept was translated in concrete terms with the introduction of community based prevention programmes, workplace programmes and the media. The first drug and alcohol campaign was also launched during 1996 with over 600 slots appearing on two local TV stations.

The recruitment of professionally trained personnel continued, although we are still facing shortage of experienced staff on the local labour market. In spite of this, sedqa ‘s staff are highly trained. Six have at least a Masters degree while forty-seven staff members hold at least a university diploma or first degree. During 1996, three staff members pursued further post-qualification training in the addictions field. Undoubtedly, the staff remains sedqa ‘s greatest asset. Sedqa personnel have gained a reputation for dedication, professionalism and loyalty enabling a marked difference in the lives of our clients abusing drugs and alcohol as well as in societal perceptions towards substance abuse and substance abusers. An emphasis on quality, coupled with professionalism, had a direct effect on the cost effectiveness of our services. Unit costs have gone down on all major programmes. We expect this trend to continue by improving our already good cost control structure, thereby releasing resources to introduce new programmes.

The profile of the drug problem remained high throughout 1996. However, the impact of the various interventions are being felt. The general public is much more aware about the drug problem and interested in open debate. People want to be involved and want to do something about it. These pro-active attitudes are encouraging and appear to be gaining momentum. The drug problem is now viewed as a national problem beyond parochial and political interests. The concept of the global approach and idea of togetherness is steadily becoming a reality. However, realism and objectivity are certainly very important factors in this sector. We are still learning and gaining experience. We are still at the early stages of building sustainable services that are able to respond adequately to the changing needs of the clients. Therefore, sustained investment in personnel and training is the key factor for cost effective programmes that can have a lasting impact on the drug and alcohol problem in Malta.

REPORT ON KADA

K.A.D.A. was set up primarily for the purpose of recommending policies and general strategies to be adopted by the Government in combatting drug and alcohol abuse, to create appropriate fora for discussion on such policies and strategies, to oversee the quality of services and to encourage initiatives in the fields of research, education and training.

K.A.D.A., which brings together experts and operators coming from government departments, voluntary organisations and the professions, is chaired by Magistrate Dr. David Scicluna. During 1996, K.A.D.A. met seven times.

The Commission has three Advisory Boards, one dealing with Prevention chaired by Rev. Fr. Savio Vella, one with Treatment and Rehabilitation chaired by Dr David Cassar and the other with Illicit Trafficking chaired by Mr Herbert Agius. All three Chairmen sit on the Commission thereby contributing to co-ordination between the respective sectors.

One of K.A.D.A.’s first priorities, since its inception, was to review the national policy in the drug sector. In its document submitted to Government, K.A.D.A. has emphasised a drugs and alcohol policy which (while maintaining a strict stance against the legalisation of drugs) aims to enhance positive attitudes, an intersectoral approach with the active participation of all members of society and international co-operation. K.A.D.A. has also endorsed the setting up of the Spark programme for young offenders and a variety of prevention programmes for young drug offenders and a variety of prevention programmes initiated by sedqa. It is also in the process of formulating proposals for amendments to existing legislation.

The Advisory Boards have provided important fora for the cross-fertilisation of ideas and objectives, enhanced co-operation and co-ordination of activities, the monitoring of the effectiveness of prevention, treatment and rehabilitation programmes, and collaboration in law enforcement operations. Furthermore, both governmental and non-governmental organisations represented on the Boards provide sedqa’s Research and Evaluation Team with valuable statistics on a monthly basis which are being evaluated every quarter. Such regular evaluation of trends allows for a more proactive, policy-making approach and facilitates networking between various agencies in the drugs sector.

The "Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control" adopted in 1987 by the United Nations Conference on Drug Abuse and Illicit Trafficking is still endorsed by K.A.D.A. as a formidable basis for the continued development of anti-drug strategies.

 
LEGISLATION

Already in 1986, Malta’s drug laws had been amended to introduce severer penalties for drug traffickers, freezing and forfeiture of assets, the concept of conspiracy to sell or deal in drugs, and limitations in the granting of bail to persons charged with a trafficking offence. In 1994, the Dangerous Drugs Ordinance 1939 was further amended, introducing the possibility of coerced treatment, controlled delivery and financial investigations and extending the definition of a trafficking offence to include even an offer to sell or deal. These amendments also provide for the control of precursors and increases in punishment in the case of trafficking in or within a 100-metre perimeter of a school, youth club or centre or any place where young people habitually meet, or where a drug has been supplied to a minor, a woman with child or a person following a programme for cure or rehabilitation from drug dependence. The Prevention of Money Laundering Act was also promulgated in 1994.

1996 saw Malta acceding to the 1988 United Nations Convention against Illicit Trafficking in Narcotic Drugs and Psychotropic Substances. Regulations were enacted regarding the extradition of individuals for the trafficking offences as are indicated in the Convention to such countries that are Parties to the Convention and with which Malta does not already have extradition arrangements in this respect.

Furthermore, the Dangerous Drugs Ordinance was again amended to introduce life imprisonment as the maximum punishment for a trafficking offence and to provide for the procedure to be followed for the enforcement of investigation orders, temporary seizure orders and confiscation orders issued by judicial or prosecuting authorities outside Malta as well as in respect of co-operation to suppress illicit trafficking at sea. The manufacture, transport, or distribution of any equipment or materials knowing that they are to be used in or for the cultivation, production or manufacture of a dangerous drug has been made a criminal offence punishable as a trafficking offence.

The efficacy of penal legislation goes a long way towards the suppression of illicit trafficking. It is thus the maxim to continue evaluating and strengthening existing legislation with a view to close up loopholes by which drug traffickers and their accomplices may escape prosecution and conviction.

 
RESEARCH

RAPID INFORMATION FEEDBACK SYSTEM

The cornerstone of sedqa's research strategy is its rapid information feedback system introduced towards the end of 1994. This allows for the ongoing monitoring and analysis of significant trends in treatment, rehabilitation and prevention. Emphasis is also made on monitoring trends in the criminal justice sector. Some of the most salient features of these trends in 1996 included the following:

• Consolidation of Drug Enforcement Efforts by the Police Drug Squad

1996 recorded a consolidation of drug enforcement operations. As the diagram below indicates, these have been characterised by the intensification of drug control efforts by our police drug squad, recently set up to enhance the specific allocation of police resources to the investigation, control and detection of illicit drug activity. The core operations of this agency involve the strategic deployment of counter-drug personnel and high-level inter-agency liaison processes. These activities facilitate the gathering of intelligence, information and evidence required to procure an effective police response to extra-legal, drug-trafficking operations.

Last year the drug squad was also responsible for a significant magnitude (in terms of local standards) of drug seizures. These included:

• Cannabis Resin: 109.3737g and 788.2g during March and July respectively.
• Cannabis Grass: 7217kg in August
• Crack: 157.9344g in January
• Ecstasy: 555 pills in January
• Heroin: 2070.4g in November
 

These seizures re-affirm the market presence of "traditional" illicit drugs, particularly Cannabis and Heroin. One may also note hefty ecstasy seizures; thereby attesting an increasing demand for recreational drug consumption. Monthly records for 1996 also denoted an Increase in the number of court arraignments for trafficking charges and a considerable increase in the number of drug-related detainees at the Corradino Correctional Facility.
 

• Continued Involvement of the Armed Forces of Malta in Anti-drug Operations

Throughout 1996 the Armed Forces continued to effect two major anti-drug activities; namely vehicle road blocks and the boarding and searching of vessels. Examination of relevant data records for 1996 highlight the intensification of AFM anti-drug operations over this period.

The low apprehension rate recorded in the data may be expected considering that AFM anti-drug operations are generally based on a random, "hit-or-miss" basis without a priori intelligence and information collation and dissemination exercises. The guiding tenet or rationale of these operations is the reinforcement of a "zero-tolerance" approach that is aimed to dissuade potential drug traffickers/users from indulging in transgressional activity.

Other than directly countering the proliferation of illicit drug use, the marked presence of AFM roadblocks also serve to deter the promulgation of high-risk behaviour. Seasonal factors and climatic conditions also influence the frequency vessel searches and boarding exercises. These are intensified at the beginning of the yachting season and throughout the Spring/Summer period. It must also be stressed these AFM operations are not exclusively counter-drug measures but are also intended to address inter alia pre and post-crime investigations, prison escapee searches and suspected trafficking of illegal immigrants.
 

• Extensive Use of Syringe Distribution Service

Malta’s public health authorities provide a syringe distribution programme intended to minimise health risks associates with syringe exchange amongst intravenous drug users. The following tables clearly denotes a consistent increase in the number of syringes distributed in 1996.

EVALUATION OF SERVICES AND OUTCOME MONITORING

Other than producing the now firmly established monthly and quarterly data reports, one the major priorities of the RET throughout 1996 has been the formulation of a service evaluation and outcome monitoring exercise for the various entities within sedqa entrusted with detoxification, residential and community-based treatment. The target date for the completion of this comprehensive formulation exercise is set for June 1997. It is expected that the evaluation process will consist of:

(i)     the updating of monthly data reporting efforts recording operations at various sedqa units and divisions (this should facilitate an on-going evaluation process of the Agency’s drug and alcohol services);

(ii) the implementation of specific, cross-sectional evaluation exercises commissioned to external parties;

and

(iii) the development, formulation and implementation of an outcome monitoring exercise.

Throughout 1996 the Research and Evaluation Team also commissioned a study investigating problems related to the industrial sector. This research study effected by Drs Noel Vella and Mark Gauci from the Health and Occupational Safety Unit focused on assessing attitudes of managerial staff from local manufacturing industries towards alcohol and drug abuse at the workplace.

The survey, conducted in April 1996 and its findings officially presented in December 1996, involved a sample of 764 managers from 250 companies in Malta and Gozo. One of the most salient features of this report was that whilst the majority of respondents considered drug use as unacceptable (88%) and harmful (86%), only fifty percent of mangers surveyed considered occasional drug use as having lasting effects. Moreover, 8.5% of those surveyed claimed that they had used drugs in the past and 5% stated that they knew workers within their company who took drugs at work. This figure rose to 13.6% for workers who took drugs away from work. 21% knew workers who drank alcohol at work, whilst this figure doubled to 43% for alcohol consumption off work. It was also interesting to note that 56.4% of managers felt that there is need to introduce pre-employment drug testing on workers. 92% of the total number of managers tested felt that there is a need to increase workers’ awareness with regard to the effects of drugs and alcohol use.

Apart from the elaboration of findings, the study’s final report entitled "Drugs and Alcohol in the Workplace: The Managerial Perspective" also includes a discussion of the implications of research results. This study has certainly continued to consolidate sedqa’s fact-finding efforts in the drug and alcohol sector.

 
ALCOHOL CENSUS DATA

Another major project embarked by the RET in 1996 was the quantification of data on alcohol consumption trends emanating from the 1995 national census. Over a hundred tables comparing alcohol use amongst the Maltese population to other variables were formulated. This tabulation exercise involved consideration for various demographic criteria, including, age, gender and regional distribution of respondents and social stratification indicators such as educational attainment, literacy rates and income and occupational status demarcation criteria.

The tables with different variables were presented to the Central Office of Statistics. The processing of relevant data is still in its computation phase and final results are expected by June 1997.

As in previous years, throughout 1996, the Research and Evaluation Team at sedqa also assisted in a series of quantitative and qualitative studies on drug-related issues undertaken by students from the University of Malta following diverse academic courses. The main role of the RET in these projects is a supervisory one, with RET expertise assisting and monitoring project formulation and implementation. Some of the studies in progress throughout 1996 included:

• Healthy Lifestyles and Substance Abuse: A Survey amongst Primary School Children

Following completion of this survey’s data collation phase, the RET is assisting in the definition of cross-tab cases. This study is being effected by Ms Jeanette Calleja in the process of her B.Ed. dissertation and involves a survey assessment of substance abuse consumption patterns amongst 400 school children aged between 9 and 10 years of age.
 

A Preliminary analysis of the links between Habitual drinking and Alcoholism in Malta

This year the RET also assisted Mr Christian McCarthy (a social anthropology student, from the University of East London) in a study on teenage habitual drinking and alcoholism in Malta. The final paper entitled "Toward an Understanding of the relationship between Teenage Habitual Drinking and Alcoholism" was the end product of a preliminary, exploratory study conducted by Mr McCarthy on the potential links between alcoholism and habitual teenage drinking in Malta.

Although the study’s findings suggest that there is no single determinant of alcoholism, dysfunctional family dynamics and peer-pressure appear play a very influential part in the development of alcohol dependency. Moreover, research results indicate that alcohol is used as a substitute for unrewarding lives. This study, albeit, a preliminary project, highlights the necessity of undertaking further analyses of the socio-cultural, psychological determinants of alcohol abuse.

• Substance Abusing Adolescents and their Families

The RET’s supervision and assistance has also been enrolled for this BA (Hons) Youth Studies dissertation undertaken by Ms Jackie Drury. This study attempts to assess the impact of adolescent drug misuse on family dynamics and to propose recommendations for reinforcing the role of the family within treatment strategies.

• Law Enforcement: A Tool to Combat the Drug Problem

• Primary Indicators of MDMA Use in Malta

• Study on Treatment Demand

• National Reports

• Working Group on the Use of Data: Identification of Survey Population of potential information users

Corroboration between the RET at sedqa and the Council of Europe’s Group of Epidemiological Experts in Drug Problems was further manifested throughout 1996 in a questionnaire exercise delineated potential information users of Pompidou data in Malta.

Throughout last year, sedqa’s RET was also responsible for overseeing and updating library resources at sedqa’s national prevention centre. Several students, sedqa staff and professionals in the area regularly make use of the Agency’s library which has an abundance of updated literature on a myriad of drug-related issues, including aids prevention, licit drug use and WHO and UNDCP updates.

 

Primary prevention is considered as a long-term, arduous process. Iit is aimed at socialising individuals within behavioural parameters that advocate healthy life-styles. This can prove to be a mammoth task as it may entail confronting traditional cultural attitudes that condone licit drug and alcohol use and more contemporary societal trends that may, in part, convey the acceptability of recreational drug use.

These prevalence of such attitudes in Malta was clearly reflected in the results of the ESPAD survey conducted locally in March 1995. This survey sought to examine the attitudes and habits with respect to certain substances and leisure time activities among school children born in 1979. It was effected simultaneously in 30 European countries, including Malta.

The most prevalent use and abuse of substances observed amongst the respondent population was alcohol. Only 8% of 16 year olds (boys and girls) had not had consumed alcohol at least once in their lives. This is a strong reflection of the acceptance of alcohol within our society and indeed, within our families. Moreover, 50% of 16 years old students actually report taking alcohol on 20 or more occasions in their lives. More than one third of the respondent group recorded being drunk at least once over the previous 12 month period. 5% (1 in 20) of the total number of respondents reported drinking beer almost daily. 7% reported drinking liquors almost daily. ‘Binge drinking’ (more than 5 drinks in a row) was also quite common.

Alcohol drinking was reported to start at quite an early age in children. 33% stated that they had their first beer at age 11, whilst 2 of every 5 students (41%) claimed to have consumed wine before this age. Also notable were trends related to tobacco and drug misuse.

Cigarettes are experimented with by more than 1 of every 2 students (55%). 13% report this to have taken place by the age of 11. Most of those who smoke are reported to have consumed their first cigarette before the age of 14 years.

Daily smoking is a general tendency between 13 and 15 year olds. This trend holds true for both boys and girls. 15% report smoking at least one cigarette per day while another (important) 16% report smoking just one on a daily basis - and thus also at risk of taking up the habit in a greater way.

The ESPAD survey further substantiated trends related to illicit drug consumption previously noted in the 1991 Caritas/Pride study. Both studies attest a low-age threshold for experimentation with illicit drugs. The so-called "soft drugs" are often the first to be tried out. In the ESPAD study, 8% of the respondent group reported experimentation with Marijuana or Hashish at least on one occasion.
 

A new and worrying trend is the finding that inhalants or solvents constitute the most commonly abused drug amongst secondary school attendees in Malta. 17% report at least one time experimentation (boys and girls), 5% on more than 5 occasions. Fortunately, few students (<1%) actually report regular recent inhalant use (that is, on more than 10 occasions in previous 30 days).

The other notable trend relates to the use of tranquillisers or sedatives. Approximately 8% reported to have used these drugs illicitly (12% report these to have been medically prescribed).
 

Experimentation with other drugs is also a threat. 2% report lifetime use of Ecstasy (mostly <5 occasions). Figures for other drugs include 1% for both amphetamines and crack, 2% for cocaine and a considerable 13% reported having mixed alcohol with various pills on at least 1 occasion. Overall, just over 10% of the male cohort and 7% of the female cohort recorded having experimented with illicit drugs by the age of 16 at least once.

This data has provided the direction for sedqa’s primary prevention strategy. From the outset it was decided that the Agency’s prevention programmes should not only aim at providing information about potentially harmful psycho-active substances but also to instil a strong conviction in people that drug use is not conducive to healthy life styles. As a result, it was also decided that sedqa’s primary prevention strategy is to initiate programmes very early in the lives of individuals and to sustain the effort for a long period of time. In this way one hopes to influence the opinion and attitudes of individuals so that they make informed and positive decisions when confronted with decisions related to alcohol and other drugs. In this respect, sedqa has prepared a nine year educational programme which will be extended to include kindergarten and the Junior College.

The second consideration that one has to keep in mind when speaking about primary prevention is that it has to permeate through diverse sectors to be effective. Our strategic plan targets the family, schools, local communities, professionals, the media, leisure time and the work-place. Naturally, programmes in these areas have been prioritised according to the availability of human and financial resources, expertise, co-ordination with other agencies and other considerations. For the past year, schools, the media, communities and the work-place, in this order, have been our top priorities.

As the national co-ordinating agency for drug and alcohol services in Malta, sedqa's primary objective is to execute policy precepts prioritised by the Government of Malta. At present, Malta's drug prevention policy emphasises a comprehensive strategy aimed at securing demand reduction. This does not exclude consideration of other important policy objectives, such as harm minimisation and addressing the needs of more specific high-risk or drug-using categories. However, any revision of the direction of national policies requires empirical reflection on the quantity, quality, longevity, sustainability and measurable outcomes of prevention programmes. Considering that our prevention strategy is still in its infancy, it is still premature to contemplate major changes to the direction of the broad objectives of our national drug prevention policy. Moreover, any prevention programme has to be evaluated in the short term and more appropriately, in the long-term to ensure an informed, decision-making process.

We shall now review the progress of various initiatives taken by sedqa targeting areas that may be deemed essential for the realisation of a comprehensive primary drug prevention policy.

The Family

Parental Skills Programmes

Following last year's pilot programmes and the subsequent evaluation, the Agency, launched its parental skills training programme Inrabbu 'l Uliedna Ahjar. By December 1996, 47 courses were initiated and conducted. These included 29 courses aimed for parents of under twelve year-old children and 18 courses for parents of teenage children. Furthermore, 10 of these courses were held in Gozo. A total of 845 participants followed and conducted these programmes and an average of 18 participants were present for each course.

This response is a reflection of the prioritisation of drug prevention among parents and of their interest to gain, and improve, parenting skills. The Agency is also planning to increase the number of courses as a result of their increasing demand. Sixty-six new facilitators, are, in fact, expected to start parental skills instruction shortly.

Thus, members from the community, various organisations and schools will be able to organise and implement parental skills programmes. Throughout 1996 various parental skills courses were successfully facilitated by members of voluntary organisations, such as the Cana Movement and Moviment Era Gdida, various schools and local community associations. In fact, 45% of parental skill programmes throughout 1996 were co-ordinated following a demand from particular communities and organisations whilst 38% were co-ordinated through schools. The remaining 17% were organised directly by sedqa’s prevention team in response to demands made by the general public as a result of media coverage of parental skills programmes or on recommendation by participants who had already followed one of the Agency’s courses.

A formal evaluation exercise effected at the end of each course heightened the need to develop a parent’s manual in Maltese. The Agency immediately reacted to this feedback and introduced a Maltese version of the manual in January 1997.

The Agency also developed its own video clips in Maltese addressing characteristics of the local family context. These will replace the American videos which were previously being used during the courses.

Education

Programmes in the Primary School Sector:
 

Tfal Favur Ambjent Liberu (TFAL)

TFAL is a prevention programme aimed chiefly for primary school, Year 3 to Year 6 pupils. Moreover, it also targets teachers and parents. The programme has three main components: a series of seven weekly 45-minute talks delivered by sedqa personnel; a manual for teachers consisting of 30 lessons in prevention; and concurrently, a seven session course in parental skills.

During the 1995/96 scholastic year, the first part of the programme (BABES), comprising of seven weekly, 45-minute sessions, was delivered to nearly all Year 3 to Year 6 pupils attending nine schools. The programme makes use of puppets as a medium to convey prevention messages. Between October 1995 and May 1996 we managed to reach 1800 students in 73 classes. These efforts involved 500 sessions and approximately a total of 400 hours of prevention work. Each student was presented with an attractive folder, hand-out material, a certificate of participation and a book-mark. Teachers and headmasters were asked to evaluate the programme. Their positive feedback urged us to go ahead with our original proposal of extending the programme to all primary schools in Malta and Gozo.

In fact, during the summer of 1996, sedqa sponsored Mr Paul Pace’s visit to the US to undergo an instruction course leading to certification as trainer for BABES facilitators. Subsequently, six other people were trained to deliver the programme. At present, BABES is being reserved for all Year 3 students. By the end of the 1996/97 scholastic year our Babes facilitators would have instructed some 5000 students in the 90 primary schools in Malta and Gozo.

BABES covers only one year of the prevention programme for Primary schools. For Years 4, 5, 6, sedqa’s prevention team prepared 30 presentations (ten for each year) which are delivered by the class teacher. This programme makes a first attempt to cover three main areas in the child’s life where prevention may be appropriate, that is, mental health, social relations and, the correct use of medicinals. Printed manuals are available for all teaching staff.

Meetings for both teaching staff members and parents have been scheduled. An emphasis on parent participation has been made so that parents are informed about those programmes that their children will be participating in and to enlist their support. We also stress the need for parents to attend one of the Parental Skills Programmes which sedqa is organising in all the schools in Malta and Gozo.
 

JEANS Programme & The Cross-Curricular Approach

Jien Nghozz Sahhti or, as it is more commonly known, JEANS, is a five-year prevention programme for secondary schools. This programme is based on the "global approach" rationale for drug education programmes, which implies addressing a wide ranging target-audience, including teachers, students and their parents in all secondary schools in Malta and Gozo. This rationale also employs a cross-curricular or intra-curricular approach that allows every subject teacher to partake in the delivery of the programme; truly transforming it into a collective effort by the whole school.

Given the importance of the JEANS programme for the implementation of the national drug prevention strategy, a concerted policy formulation exercise was undertaken throughout the 1995/96 scholastic year to ensure the long-term development of this programme.

A series of important decisions were undertaken in this policy-building exercise, including:
 

• Since some initiatives in this area, particularly, with regard to lifeskills teaching, are already undertaken by the Guidance and Counselling Unit within the Department of Education, emphasis should be based on the need for inter-agency co-ordination to avoid unnecessary duplication.
 
• The cross-curricular prevention programme shall target tobacco (Form I), alcohol (Form II) and other drugs (Form III).
 
• Teaching staff, in the participating schools shall be provided with 10 lessons on alcohol to deliver them to their students and provide feedback for evaluation purposes.
 
This programme development exercise culminated in the presentation of three volumes comprising around 18 lessons for each of the forms and targeting various areas of study in October 1996. These were further augmented by additional material provided by the Education Officers of the Education Department, the publication of 12 educational leaflets and an information booklet for parents to support the programme.

Throughout the current scholastic year, members of sedqa’s prevention team are visiting each secondary school individually and instructing teachers on the use of the programme material. It is expected that by the end of the 1996/97 scholastic year the JEANS programme would have targeted 65 secondary schools with a student population of 15,000 students.

Peer Leadership Programme

Peer Leadership training has matured into an established part of the Jeans Programme. Twenty-eight weekend programmes catering for 745 young people were held between July 1995 and December 1996. A hundred of these participants also attended the one day follow-up programme intended to reinforce the skills of those displaying greatest leadership potential. A large number of the participants originated from private and church schools; although the interest of state schools was also notable. sedqa now also has its own residential training centre at Luqa that may be utilised to host this programme.

Generally, the response from participants was very re-assuring. The diagram below, for example, depicts results of an evaluation exercise conducted at the end of these peer leadership training sessions. Evaluation results indicate that over 90% of the participants were satisfied to one extent or another with the overall delivery and format of the training programmes.

Throughout 1996 peer leaders were encouraged to make use of their training. A number of projects were carried out in various schools. These included anti-drug graffiti, plays, mimes, exhibitions, discussion groups, PSE lessons to younger students, a parent-student debate, a sports day, and alcohol and drug free parties.

 
Karaoke

In an effort to address leisure interests of our teenage student population sedqa’s JEANS programme also aims at conveying prevention messages through popular music mediums. The Agency’s "karaoke" initiative, introduced in the 1995/96 scholastic year, is clearly a concrete step in this direction. It ensures an informal and participative educational setting and has proved highly enjoyable with students. Each activity generally takes around half an hour and is held during break time. Paul Buhagiar directs the music and Albert Debono, following the piloting of the project, assumed the role of animator during each activity. A booklet with the lyrics of 12 popular songs was prepared and distributed amongst the participants.

To date, a total of 3000 enthusiastic students has participated in these karoake sessions with the strongest response being recorded in girls’ secondary schools. In an evaluation study effected amongst a selected group of respondents amongst four secondary schools where sedqa karaoke sessions were effected, more than 90% of the interviewees sustained their support for this project. 95% of the respondents asserted that the songs used conveyed a strong prevention message. These results clearly verify the major success of sedqa’s karaoke initiative and augur well for similar leisure-focused projects planned for the future.
 

Teacher Training

Teacher training is one of the major priorities of sedqa’s strategic prevention plan. Throughout 1996, six half-day consultation-cum-training seminars were held for training
co-ordinators nominated by the nineteen schools participating in the JEANS programme. sedqa’s prevention team also held a series of meetings for staff members from particular schools following requests from training co-ordinators. A total of 120 teachers attended these meetings.

Another programme which was not specifically designed for schools but which attracted a large number of teachers was the "Basic Course for Community Services". Three basic courses were held during the period under consideration with an average attendance of 50 participants per course. One should also note that several of our Parental Skills and Peer Leadership programme facilitators are teachers. Consequently, during the last two basic courses we have included a special three-hour session addressing school-related problems. It is envisaged that for the next course to be held in June 1997, a special invitation will be issued to all teachers in Malta and Gozo.

Sedqa’s strategic drug prevention plan emphasises the development of community prevention programmes. The community prevention approach is defined as "the wick to find specific solutions adapted to local needs.....if you want, however, to act in a community perspective , a certain number of conditions have absolutely to be respected" ( E. Servais - Before It’s too Late, 1988). One of the most crucial of these conditions is that preventive action must open itself to the entirety of the local community. This implies trying to actively involve all age groups, all life spheres, all social levels and, of course, the mobilisation of local associations and above all local authorities, such as, the local councils. sedqa recognises the strength and potential of the local government to support prevention community-based programmes and moreover, to promote a substance abuse free culture amongst community members. In 1996, the community dimension of sedqa’s prevention programmes received added impetus with closer liaison with local councils and several community-based organisations.
 
 

Suldati tal-Komunita’

In collaboration with the Zejtun Local Council, in November 1996, sedqa, launched the pilot phase of a structured, community-based prevention programme, entitled ‘Suldati tal-Komunita’. This programme aims at empowering leaders within the community to develop leadership skills. We believe that to assume adult roles, young people require pro-active attitudes and leadership skills. The main philosophy behind this programme is to purposely seek to build leadership competencies in participants. The topics covered during this course include project development, team building, motivation, leadership styles, conflict management and resolution, money management, social marketing and evaluation skills.

More Collaboration with Local Councils

On the initiative of sedqa together with the Tarxien Local Council, 13 local councils from the Southern Region of Malta got together to discuss and develop action plans based on the United Nations’ Conventions on Narcotics (1961), Psychotropic Substances (1971), and the Illicit Trafficking of Narcotics and Psychotropic Substances (1988). These discussions concluded with a half day seminar in November 1996. The seminar was attended by representatives of organisations from the respective localities, as well as other prominent figures, including parish priests and representatives of the Customs Department, the Police Force, the Ministry for Justice and Local Councils.

Furthermore, the thirteen local councils represented at this seminar signed a resolution committing themselves to strive for an alcohol and drug free environment through human resource development and financial investment in the drug prevention sector. Moreover, the role of local councils as potential links between sedqa and those members of the community who require the services of the Agency was emphasised.

Prevention Talks

Meeting the ever-increasing demands for talks on drug prevention is an on-going task at sedqa. sedqa’s Prevention Team delivered 163 talks at various localities in Malta and Gozo in 1996. More than 13,000 individuals attended these talks that targeted diverse community groups, including, parents, student groups and local youth centres. A considerable number of the participants were parents. These constituted more than 58% (7685 parents in real terms) of the total number of prevention talk participants throughout 1996. Such numbers clearly reflect an increased community awareness of the drug problem in Malta.

Basic Course for Prevention Services in the Community

This 24 hour course caters for individuals and groups that are motivated to undergo drug prevention training. The course was held four times over the past 18 months, attracting a total of 170 participants. Respondents have been of varying ages and backgrounds: young people, adults, university students, teachers, customs officials as well as voluntary workers with other agencies such as OASI and Caritas.

The course deals with various topics including group dynamics, adolescent psychology, the main drugs of abuse and their effects, ethical and social issues, the role of the media, legal aspects, international perspectives and care and prevention services available locally. Course sessions are generally administered in the format of lectures or discussion panels and participants are encouraged to voice their opinions and queries. Adjustments and changes have progressively been made to the course based on the participants’ feedback and evaluation.

Following the Basic Course a number of participants have gone on to take further specialised training as facilitators of prevention programmes. sedqa can now call upon 44 qualified parental skills facilitators, 35 trained peer leadership programme facilitators and 38 public speakers who can give talks on various issues relating to drug prevention.

Grants to Non-Government Organisations

In 1996, more than 20 organisations benefited from sedqa’s "Grants to NGO’s" scheme. Besides financial assistance, totalling around Lm 600, these organisations were also given other forms of on-going support, such as the printing and the provision of promotional material and assistance at exhibitions and other public events.
 

The S.A.F.E. Programme

S.A.F.E. is the latest programme developed by the Agency’s prevention team. The Substance Abuse Free Employees Programme, as the name itself suggests, specifically targets the industrial workforce. The programme is moulded on the rationale of Employee Assistance Programmes (E.A.P.s) implemented abroad. A study carried out by Dr. Mark Gauci and Dr. Noel Vella aimed at assessing the attitudes of managers toward drug use also acted as an impetus for the setting up of this programme. This study’s findings clearly highlighted the urgency for the introduction of a prevention programme addressing the industrial sector.

Moreover, it prompted sedqa’s Prevention Team to develop an E.A.P. aimed at helping management in the industrial sector to reinforce a drug and alcohol prevention policy whilst safeguarding the rights and health of employees. sedqa’s S.A.F.E. programme, thus, is structured to cater for the needs of the employees whilst prioritising increased awareness of the health and safety risks associated with drug abuse at the workplace. During programme sessions employees learn about different types of drugs (including alcohol and tobacco) and their effects on the body. Furthermore, key persons at the workplace, such as, supervisors and shop stewards are trained to recognise signs of abuse and how to deal with such situations. S.A.F.E. also provides information on the Agency's care services. It discusses how these can be accessed through the existent referral system or through self referral.

Given its relatively recent introduction in December 1996, S.A.F.E. is still in its piloting phase. So far, two companies have participated in the programme whilst a number of other companies have also shown interest in adopting the programme at their workplace. The feedback obtained from the participants of the two pilot programmes indicated that awareness and education programmes were of strong relevance as most knew very little on the subject. The participants strongly appreciated sessions dealing with legal drugs, such as alcohol and tobacco, as most had some experience with either one of these substances. It was noted, that following these first S.A.F.E. sessions a number of inquiries were made at the offices of the care services. This response proved encouraging as one of the basic objectives of the programme is to assist prospective clients to access the Agency’s care services and hence urge them to seek help whenever they feel the need.
 

The role of the Communications Department at sedqa is to co-ordinate the Agency’s public and media relations and to implement social marketing campaigns aimed at making the general public more aware of the services offered by sedqa, and how to access them.

Given the Agency’s social concerns, marketing sedqa’s services necessitates a different approach from business marketing strategies. The Agency’s promotional campaigns are directed towards sustaining the goals of sedqa’s primary prevention policy interventions.

These do not only prioritise the provision of information about potentially harmful psycho-active substances. Rather, they are also an attempt to convince as wide an audience as possible that drug and alcohol use are not conducive to healthy living.

To achieve this aim, the Communications Department makes extensive use of the media available on the local market, including newspapers and radio and television stations. The use of these media requires careful planning to exploit their utilisation to the maximum. Commercial advertising often depicts licit drug consumption behaviours, such as alcohol use, in a positive context without negative consequences, or with positive rewards. The challenge is to ensure a clear representation of potential health risks associated with substance abuse.
 

The Print Media

Press releases and articles about sedqa`s services have appeared in all local papers, both in English and Maltese. The following table records the frequency and the type of newspaper insertions relating to sedqa throughout 1996:

Sedqa also maintains a regular output of its own print productions. There is a strong public demand for accurate and up to date information about drug abuse and about the prevention and care services offered by sedqa. To meet this demand sedqa is continuously publishing leaflets, booklets, readers and manuals that are written and edited by the Prevention Team in liaison with research consultant Dr R Muscat.

The Prevention Team distributed 87,383 leaflets in strategically targeted areas in Malta and Gozo in 1996. The targeted areas included various schools, industrial zones and specific localities. A considerable number of leaflets, around 22000, were distributed at the national annual trade fair in June, where sedqa participated in the national pavilion on social development. sedqa’s stand focused on prevention programmes in schools and included a children’s activity area, with Zazu making a series of regular appearances. Around 4,000 children visited this children’s activity area every weekend throughout the duration of the annual trade fair.

Radio Programmes

Following the success of a parental skills series on Super 1 Radio and Radio 101 in 1995, one of the major priorities of the Communications Team at sedqa throughout 1996 was the presentation of structured series of radio programmes on a larger number of radio stations. These programmes emphasised familiarisation with the Agency’s services and educational information examining physiological and psychological health risks associated with drug and alcohol abuse. The following table illustrates the series of programmes that were featured on local radio stations throughout 1996:

Each of these series consisted of thirteen programmes, most of which were live and included phone-ins from the listeners. These programmes were further complemented by a number of one-off programmes, where sedqa employees were invited as guest speakers on drug-related issues.

Television Programmes

OWKEJ and Inrabbu `L Uliedna Ahjar were the two major television projects initiated by sedqa throughout 1996.

OWKEJ

The popularity of OWKEJ stems from the innovative format of this educational children’s programme. OWKEJ attempts to reinforce in children positive notions of healthy living and to encourage children to develop and practice their talents.

Sedqa`s standpoints on drug prevention and healthy living are basic elements in the programme. However, OWKEJ’s production team avoid presenting prevention messages through a patronising approach. Rather, the prevention content of the programme is subtle and entertaining. ZAZU, the colourful, animated character, now synonymous with sedqa, is one of the means employed to pass on these messages.

The issues tackled in the programmes include peer pressure, courage and self-esteem, coping skills, rudimentary information about drugs and alcohol, and child abuse. These issues are analogous to those tackled in sedqa’s TFAL programme now firmly entrenched in primary school curricula. This parallelism allows for the supplementation of drug prevention media programmes with a school-based drug prevention approach. This helps to increase the effectiveness of our national prevention strategy as it facilitates the diffusion of prevention messages in different institutional contexts. OWKEJ was first televised on TVM in October 1996 and has established itself as a regular, weekly programme since then. Moreover, it has maintained a very substantial amount of popularity with both adult and younger audiences.

Inrabbu `L Uliedna Ahjar

This joint project with the Malta Broadcasting Authority entailed the video production of a parental skills course in Maltese. The script for Inrabbu ‘l Uliedna Ahjar was intended to ensure that this production appealed to the local cultural context. It was filmed totally in Malta, with Maltese actors and presenters. The video was completed in five months and was subsequently aired on the Community Channel.

The ZAZU Campaign

ZAZU is the name of the animated character developed by sedqa, following the results of the European School Project on Alcohol and Drugs (ESPAD) effected in 1995. These results confirmed the need for an educational campaign that informs young children about the problems caused by alcohol abuse and other addictions.

These results provided the motivation behind the creation of the ZAZU campaign. ZAZU’s witty dialogue and amiable character have become an endearing and colourful part of children’s conversation. His nonchalant, yet resilient disposition also ascertains the conveyance of worthwhile, effective information related to drug and alcohol misuse, peer pressure and healthy living. The campaign is taking diverse forms, including ZAZU’s increasingly popular TV slots, community outreaches and regular appearances in the OWKEJ programme.

To date, five Zazu television slots have been developed. These cover a variety of drug-related issues, including social drinking, drinking and driving, traditional attitudes condoning alcohol use in the family and the relationship between peer pressure and alcohol use. These slots are televised daily on TVM, Super 1 and Channel 12, two to three times a day on each channel. Since Zazu’s introduction on the airwaves in June 1996, more than 1350 Zazu slots have been aired on local television stations.
 

Sedqa’s involvement in the drugs sector is guided by an active recognition of the need for ensuring on-going training for all human service professionals engaged in related areas. Throughout 1996 two major events characterised this process; the Agency’s annual national conference and a one-day seminar examining research-related issues. In both instances, the major objective was bringing professionals together to analyse and discuss current trends and thus ascertaining close familiarisation with contemporary service-delivery, research and policy-making standards.
 

Annual National Conference

Secondary prevention programmes aim at minimising opportunities for drug abuse particularly those most at risk. They involve identifying high risk population categories and developing project initiatives that deviate or divert the potential drug user toward pro-active, normative behaviour.

On a long-term basis, tertiary drug prevention models seek to dissuade habitual drug users from continued drug use. Tertiary prevention initiatives encourage abstinence through community-based and residential services that provide opportunities for treatment, rehabilitation and societal re-integration. A comprehensive drug prevention strategy at the short term, however, must also aspire to secure symptomatic control through detoxification programmes and to minimise the health risks associated with drug abuse both for the individual and society. Methadone programmes, syringe distribution and aids prevention are all initiatives guided by a harm reduction philosophy that emphasise risk-awareness and safer-drug use.

Sedqa’s global drug prevention approach takes into account all these divergent aspects and is continually upgrading the level and type of its care service delivery to secure that the needs of both high risk and habitual drug users are addressed. The Agency has also recognised the need to provide community-based and outreach services to drug users to ensure a wider client base.

Building on the Care Services’ significant accomplishments in 1995, the Agency’s main thrust in the treatment sector last year centred around the consolidation of a holistic approach, the improvement of systems and procedures for delivery of services and the organisation of human resources and service structures.

The needs presented by drug using clients to care providers are multidimensional. The problems for which they seek help are often complex, with somatic, physiological, social, legal, psychological and psychiatric ramifications. A growing understanding of the drug and alcohol problem and a more pro-active response to the multidimensional needs of the drug/alcohol abusing clients has led to the development of a more comprehensive approach to drug/alcohol care at sedqa. In several countries the bio-psycho-social model was adopted. This was a development upon the traditional medical/psychiatric model. Physical dependency on a substance is now seen as just one of the problems to be considered when designing a care plan for a client. sedqa’s Care Services have also adopted this model. This entails the availability of a variety of professional disciplines that give comprehensive care within an integrated continuum of services that offers, contact, support, treatment, rehabilitation and aftercare. The organisational structure of the service delivery units within the Care Services Division reflects this bio-psycho-social continuum.

Sedqa’s Care Services are broadly subdivided between Drug and Alcohol Care Services. The biggest challenge in this sector has been to achieve the right balance between service expansion and cost-effectiveness. The trend for de-centralisation within the Agency’s care services is proving both efficient and cost effective. While each unit manages its own fixed budget, output is increasing steadily, thus contributing to reduced unit costs. At Komunita‘ Santa Maria, for example, unit costs have gone down to LM12.42 per bed night from LM37.60 in 1993.

One should also note that during the period being reviewed, the drugs rehabilitation programme was assessed and amended with the result that the average duration for those who completed the programme, doubled from 163 days to 321 days. At Dar Impenn, a change in the treatment system brought about a reduction in unit cost from LM 52.15 to LM38.01 per bed night. Similar observations may be forwarded for individual contacts and group contacts at Dar Zerniq. While in 1995 one group contact cost LM1.72, in 1996 this went down to LM1.29. However, a comprehensive appraisal of these units requires a more detailed analysis of the diverse services pertaining to sedqa’s Care Services Division.
 

Drug Care Services   

Drugs Community Services

Concerted efforts have been undertaken by sedqa to consolidate community-based, outreach and family services. Data records reporting on non-residential service delivery denote a relative consistency in the volume of client groups utilising community-based services. Apart from their cost-effectiveness, community-based services facilitate, inter alia, the drug user’s possibility of retaining employment, thereby sustaining the livelihood of dependants within his or her family structure.

• Incidence

In 1996, 891 attendees made use of the Drug Community Service (DCS) at sedqa. This implies an increase of 53.1% (an increment of 309 attendees in real terms) over the previous year where a frequency of 582 drug community service attendees was recorded. These records denote that last year the average attendee frequency per month increased to 74.2 from 48.5 recorded in 1995.

Another interesting aspect emanating from the data is the significant number of foreign clients making use of sedqa’s drug community services. These accounted for 5% of the total client population recorded in both 1995 and 1996.

• Referral Sources

• Age Structure

Equally indicative is the increase in the younger age groups pursuing drug community services. 14% of the total number of attendees in the third quarter 1996 pertain to the 14-19 cohort. This high frequency trend amongst the lower age groups is indicative of a consistently growing young drug abusing population. It has also been observed that younger clients are not essentially "recreational" or occasional drug users. Rather, the general trend observed is a marked shift from experimental use of MDMA (Ecstasy) and cocaine to a more pronounced heroin dependency problem.

• Gender Distribution

The gender structure of DCS attendees remains predominantly male, with female clients in 1996 accounting for 18% of the total number of DCS clients. It may be noted, however, that the proportion of female clients in relation to the total DCS client population in 1996 registered a marked increase over 1995. In 1995, the frequency of female clients amounted to 13% of the total DCS client population.

• Number/type/location of sessions

A marked increase was registered in the number of DCS sessions in 1996 over the previous year. These sessions generally involve counselling or group therapy. In 1995, the total DCS session frequency reached 1537 sessions, implying an average monthly frequency of 128 sessions. In 1996, 2970 sessions were recorded, indicating an average of 247 sessions per month. A large proportion of these sessions were held at the Drug Community Service Team’s base at Dar Gubbio, although one may note that home visits also constitute a mainstay of the DCS Team’s operations.
 

Sedqa’s Family Services constitute another cornerstone of its community-based drug service delivery. The aim of the Family Services is to assess, support and offer therapy to families having a complexity of needs emerging from drug abuse. While all the service delivery units of the Agency maintain links with relatives or significant others of clients in care, families needing specialised or long-term interventions are referred to the Family Team. Home visits, support, counselling and group psychotherapy are provided. Families are also encouraged to participate in parallel to the therapeutic process of the drug/alcohol dependent.

• Incidence

Data records attest that an average of 77 clients per month were in contact with sedqa’s Family Services in 1996. This accounts for an increase of 30 clients per month over 1995 where an average monthly frequency of 47 clients was recorded.

• Age Structure

Data records for 1996 indicate strong representations of adult, middle-aged clients and a younger client group. Considering that the Family Services’ client groups involve family units, comprising the substance abuser, his/her partner, dependents, siblings and/or parents, it is expected that this cohort records a varied representation of age-groups.

• Gender Distribution

A notable feature of the data is the relatively high number of female family members (mainly the partners or mothers of substance abusers) in contact with the Family Service. In 1996, the female attendee cohort accounted for 52.2% (483 attendees in real terms) of the total attendee population (925 attendees in real terms). This denotes a significant increase over the previous year. In effect, in 1995, 48.2% (248 atendees in real terms) of the total number of family service clients (514 attendees) were female.

• Number/type/location of sessions

Data records indicate a marked increment in the number of sessions effected by the Family Team in 1996 when compared to 1995. The total number of family sessions, in fact, increased from 1579 sessions in 1995 (144 sessions per month) to 2330 sessions (an average of 194 sessions per month) in 1996. These data are indicative of the Agency’s efforts to effectively address the needs of a constantly increasing client population. This can be considered as an achievement which fulfils a major objective of the Agency which is to reach, contact and attract persons with drug/alcohol related problems, including significant others. We are conscious, however, that there are still several people who have never been in contact with our services and need to be attracted and served. Our targeted clients are not just the misusers and abusers but also family members and significant others. The latter, particularly children, are still a small proportion of persons being supported by our services. We also need to be better equipped to follow-up another target population - ex-clients who have broken contact, and persons who have been referred to our services but who never made use of them. Efforts in these areas are being planned for the near future.
 

One of the longest-standing services in the drug sector in Malta, the Detox Out-Patient Centre aims at attracting and assessing drug abusers and to provide medical, social and psychological treatment to a diversity of clients. Medical treatment is given to drug dependents on a drop-in basis or by appointment. Patients are detoxified and stabilised by pharmacological treatment while withdrawal symptoms are managed by substitute therapy. Physical complications are concurrently addressed. In addition, clients are offered social support, and support counselling. They are motivated and assisted to proceed to further treatment and rehabilitation in other therapeutic programmes.
 

• Incidence

• Upgrading of detoxification service delivery standards, with the service now more focused on a client-oriented approach, taking into account the importance of support/motivational counselling and relapse prevention
• Review of client suspension policy: clients are now not suspended after submitting positive urine samples. A client is only being suspended following use of violence with the staff
• Higher incidence of lower-age cohorts (15-19) receiving outpatient methadone treatment
• Higher incidence of female clients & foreign clients
• The revision of methadone dosages in terms of contemporary methadone dispensation standards
• Increased frequency of long-term prescriptions

• Regional Distribution

Detox in-patient programmes are largely intended for the provision of a controlled, residential environment for the detoxification process; thereby aiming to monitor symptomatic behaviour and to act as an antecedent to the rehabilitation process. While being treated for withdrawal symptoms, patients are provided the appropriate psychological support. They are also motivated and assisted to proceed to the next stages of treatment and rehabilitation.

• Incidence

Data entries for 1995 and 1996 indicate that the total number of clients following drug detox in-patient programmes increased significantly over this bi-annual period. The following diagrams highlight a series of salient aspects related to this area:

• Age Structure

• Gender Distribution

• Referrals

This is a rehabilitative programme intended to provide individual support and to ensure the community re-integration of clients completing physical detoxification and who have support from their immediate environment. Clients are assisted in preventing relapse. The programme caters for regular individual and group counselling, social activities and after-care sessions. Families are also strongly involved in the programme’s therapeutic process.

It is clear, that in spite of its recent formal introduction in October 1996, this service is providing active support to detoxified clients. A total of 37 clients were following community-based follow up early this year. Also indicative is the high retention rate (73%) of the programme and the diversification of the referral process.
 

Drugs Residential Rehabilitation Programme - Komunità Santa Marija

Komunita’ Sta Marija is a residential centre that provides a therapeutic, rehabilitative environment for motivated drug abusers. The centre provides opportunities for behaviour modification and stresses the necessity of the re-integrative process of residential treatment. It comprises two main units; the Merhba (Orientation) Unit and the Formazzjoni Unit. The centre also includes a re-entry unit that is aimed at facilitating the community re-integration process. In the re-entry process, courses are provided in various skills to cope with every day living. Assistance is given to solve any pending employment, housing, legal, family and inter-relational problems.  

• Incidence Trends

• Age Structure

• Gender Distribution

Spark is intended to provide alternative experiences to young persons denoting symptoms of drug/alcohol related problems. It is mainly a socio-educative programme that is preceded by a series of preparatory sessions on individual and group basis.

Preparations were undertaken in 1996 for the development of a secondary prevention programme for high-risk, male adolescents . The setting up of the programme included a seminar-based workshop for professionals held on 16 November 1996. The seminar, aimed at creating awareness amongst professionals on secondary prevention issues, was very well attended and was characterised by a highly-charged and animated debate amongst those present. These included members of parliament and the judiciary, magistrates, social workers, probation officers and high-ranking police officials. The various points of discussion raised throughout this seminar proved fruitful for programme formulation efforts. This programme-building exercise culminated in the official launching of the piloting phases of the Spark programme in January 1997.
 

Support Services to CCF

Inmates with drug and/or alcohol related problems who are resident at the Substance Abuse Therapeutic Unit (SATU) are provided with individual counselling, group therapy, social skills, health care, occupational activities, and adult education sessions by sedqa staff. The Agency accepts referrals to its own alcohol and drug services. More recently, sedqa also came into an agreement with the prison authorities to offer similar support to YOURS (Youthful Offenders Unit for Rehabilitative Services). This unit was specifically set up to offer a segregated, therapeutic environment for young prison inmates.

At November 1996, a total number of 14 inmates (circa 6% of the total prison population) were following on-going rehabilitation at the Malta prisons. The consistency in the number of inmates following SATU programmes is primarily due to a low drop-out rate, indicating positive client motivation and the assimilation of normative behavioural patterns. The efficacy of the multi-disciplinary therapeutic team at the SATU is certainly another key consideration in this regard.
 
 

Alcohol Care Services

Sedqa’s Alcohol Care Services, based at Dar Zerniq, aim to attract and respond to the needs of alcohol abusers and their families by providing support at community levels. Observations in this section shall be categorised in terms of the diverse groups in contact with sedqa’s Alcohol Community Services.
 

Alcohol Community-Based Day Rehabilitation Programme

This programme caters for the social, psychological and emotional needs of clients and co-clients. Day participants are offered group and individual support. Group psychotherapy is provided to problem drinkers, their relatives and significant others. Clients also benefit from occupational and social activities and follow-up and aftercare sessions.

• Incidence

• Age Structure

• Gender Distribution

• Number/type/location of sessions

This programme provides a stabilisation period to clients with severe dependency problems. The duration of stay is adapted to the client’s individual needs. Residents also benefit from the therapeutic programme offered to clients within the day programme.

Sedqa records register a significant decrement in the number of clients following residential treatment between 1995 and 1996. Throughout 1995, 11.75 clients per month were following residential treatment for alcoholic dependency. This contrasts with the monthly average of 8 residents per month recorded in 1996. An evaluation study effected this year assessing operational and policy issues related to sedqa’s alcohol residential programme, has however, heightened encouraging treatment outcome results and a low relapse. The following table extracted from this evaluation study examines the impact of the alcohol residential rehabilitation programme on twelve former participants of the residential programme. It is clear that such factors must be borne in mind when attempting to interpret such data.  
 

Since its inception, sedqa has given priority to the training and personal development of its employees. It believes that human resources play a very important role in ensuring a quality service. Driven by this conviction, sedqa’s Training Department has developed training courses tailored to suit the client’s needs and sponsored employees to participate in other training activities on the Island and abroad.
 
Funding our research and training activities

So as not to rely solely and wholly upon Government funds sedqa is always on the lookout to tap funds which may help it to fulfil its training needs. Funds through the Council of Europe have been made available for employees to utilise for their training abroad.

Training Policy

An official Training Policy has been drafted and approved by the Agency’s management team during 1996. The aim of the policy is to establish guidelines for the Training Department, the Management and course participants. These guidelines ensure equitable distribution of training opportunities between employees.

Induction Training

All new employees undergo an induction course before they start off on their job. The aim of induction training is to introduce recruits to all staff and explain to them the objectives of their respective unit and of all the other units within the Agency. Detailed descriptions of unit functions, client profiling systems, symptoms of misuse, the nature of the Agency’s therapeutic interventions, procedures and staff roles are also given.  

Intermediate Course in Carework

Following the positive outcome of the first "Intermediate Course for Careworkers" effected in 1995; last year the training department organised a more specialised and intensive course for careworkers. The course consisted of a series of formal lectures by experts in different fields, a placement and a number of tutorials addressing the personal needs of each participant. Together with the pool of sedqa’s careworkers, two participants from other agencies in the field were invited for this training programme. 

Student Placements

Sedqa has built a reputation for offering useful and worthwhile placements for University students pursuing a career in the welfare professions. Throughout the last academic year the Agency provided placements for students from the Institute of Social Work, the Psychology Department, the Institute of Health Care and the Institute of Youth Studies. During these placements students worked closely with their field supervisors and key workers in the different units of the Agency. In 1996 sedqa also hosted three students from Germany and two from Romania.

Placements at "Comunita Incontro"

All careworkers at the Agency’s "Komunita’ Santa Marija" participated in a two week placement at one of the Comunita Incontro centres in Sicily. As the Agency’s drug residential programme is also inspired by Don Pierino Gelmini’s Comunita Incontro rationale, our careworkers require were given the opportunity to acquire experience in these communities. Last year the Agency’s unit leaders also participated in a leadership course in another community in Italy.

Outreach Skills

Four community workers from the Drugs Community Team were sponsored on placement in the United Kingdom. The APA Project at Tower Hamlets, Druglink in Wakefield and Phoenix House in Sheffield provided a valuable setting for learning outreach skills. Each participant was closely supervised by experienced personnel from the organisations with which the placement was organised.  

Skills Training Course for Correctional Officers

An inter/intrapersonal skills course was organised for correctional officers based at the Substance Abuse Therapeutic Unit within the Corradino Correctional Facility. Correctional officers from other divisions of the prison were also invited for this course. This training programme complimented other training initiatives undertaken as part of the prison reform which heightens the importance of correctional officers in the rehabilitative process of prison inmates.  

Advanced Regional Seminar by DEA

Building upon the success of a similar course held in 1995; Malta hosted another, more advanced DEA seminar last year. Twelve local participants and eighteen foreign nationals from diverse Mediterranean countries attended this advanced regional seminar. The seminar had two primary aims; one was to disseminate knowledge acquired in the USA amongst colleagues in the Euro-Mediterranean region, and, secondly, to facilitate networking between key professionals in the area.

Community Service Scheme

Five students coming from the Psychology Department and the Institute of Social Welfare spent their summer work phase with the Agency. While helping with administrative duties, the students were given the opportunity to observe our professionals whilst carrying out their duties.  

Postgraduate Diplomas and Degrees

The Agency has always encouraged advanced education for its employees. Two employees were sponsored for further training this year. A Social Worker from the Drugs Community Services is currently undergoing a Diploma in Substance Misuse with University of East Anglia and a placement with Lifespan in Cambridge. A Psychology graduate is also in UK pursuing a one-year, full time course leading to an MA degree in Counselling Psychology. Throughout 1995/96, the Agency also sponsored a medical officer to undergo further studies in the addictions area. The candidate successfully completed an MSc programme in Addictive Behaviour at St.George’s Hospital Medical School, London, UK. This course of studies included the presentation of a dissertation entitled "Prevalence of Childhood Sexual Abuse in Maltese Substance Abusers attending Services".  

Training in First Aid

With the collaboration of the Malta Red Cross Society a basic course in First Aid has been implemented. Fourteen members of staff from various units and departments within the Agency received instruction on first aid in case of injury or at work.  

Telephone Helping Skills

Community workers from the Drugs Community Services, Alcohol Community Services and Dar Impenn have received training on how to render an effective service to our clients over the telephone. This skill-based course has helped the workers to respond better to those using this service and to manage abusive or phoney calls. The participants also proposed innovative measures to ensure smooth referral.
 

Administration

Administration back up had to face considerable challenges particularly because of the growing needs of an expanding organisation handling major structural projects without increasing personnel in this section. The major projects were the setting up of the National Centre for Prevention at Sta. Venera. This focal point houses the Prevention Team and has conference facilities for meetings. This premises was connected to Dar Gubbio, which houses the Drug Community Services and thereon benefiting from economies of scale. The Centre was officially inaugurated on 27 August 1996 by the then Prime Minister, the Hon. Dr. Edward Fenech Adami. During July, the then leader of opposition and present Prime Minister, the Hon. Dr. Alfred Sant, toured sedqa’s facilities. Other major projects included the refurbishing of the training centre at Luqa. This facility provides sleeping quarters for 30 people, and a dining and group work area. Peer Leadership Training is conducted during the weekends thus sparing the costs of hiring an alternative venue.  

The previous St. Mary Hospital which currently houses the Komunita’ Sta. Marija Drug Rehabilitation Service, was given a thorough facelift with new bathroom facilities, an extension of the existing kitchen and a landscaping project. The I.T. section started giving limited support to PC users at the Agency. It is envisaged that this function will increase in importance during 1997 by better hardware and software maintenance and installation and staff training. During 1996, sedqa continued its investment in I.T. hardware. In fact LM18000 were invested in information technology during the foregoing year.
 

Finance 

Financial control procedures adopted by the Agency during the past two years were consolidated this year with the implementation of a cost centre financial analysis and monitoring of eventual variances. This has permitted the Agency to adopt a degree of decentralisation, whereby unit coordinators are managing their own budgets resulting in increased efficiency, cost effectiveness and awareness.  

Financial controls have also been strengthened with the commissioning of a report entitled "A Comparative Report on Service Costs and Utilisation". Although some reference to the salient aspects of this report has been made elsewhere, it is worth re-emphasising that Komunita’ Sta. Marija, Dar Impenn and - have all registered a considerable drop in unit cost as compared to 1993. This encourages management even further to continue to strive for more cost awareness across the Agency and will update the report commissioned this year annually.  

The Agency’s main source of funding takes the form of a government grant, which in 1996 amounted to Lm 720,000. The recurrent expenditure for 1996, totalling Lm700,000 was apportioned in the following manner:
 

Staff Development  

During 1996 sedqa continued with its recruitment programme putting emphasis on qualified personnel. Out of a total compliment of 92 full and part timers, 53 have at least a diploma or first degree, and 6 have at least a Master’s degree. All the other staff have been trained for the role that they fulfill. The limiting factor remains the shortage of qualified personnel, particularly, social workers. However in a space of two and a half years, sedqa managed to put together a professional, multi-disciplinary team that ensures that our clients are provided with a holistic service. The following pie chart denotes the diverse qualifications of sedqa’s staff.