Perspectives on addiction training in Finland Kauma Development of substance abuse work modules in vocational secondary education: from training psychiatric nurses to training practical

Perspectives onaddiction training in Finland

by the transdrug project

Perspectives on

addiction training in Finlandby the transdrug project

EditorMarjatta Montonen

CopyrightA-Clinic Foundation and the authors 2003

PublisherA-Clinic Foundation 2003

Graphic Designer Mary Woolley

A-Clinic Foundation Report Series no. 49ISSN 1459-3939

ISBN 952-9894-85-6 (on line)

The Transdrug project has been carried out with the support of the European Community Leonardo da Vinciprogramme.

The content of this project does not necessarily reflect the position of the European Community or the NationalAgency, nor does it involve any responsibility on their part.

Foreword

Recent developments in training for substance abuse work • 6

Tiina Sutinen

Competence-based qualification at the interface of teaching and work in the substance

abuse field • 9

Leila Märkjärvi

Challenges and developmental needs of substance abuse work as seen by students

preparing for the competence-based qualification • 14

Tiina Kauma

Development of substance abuse work modules in vocational secondary education: from

training psychiatric nurses to training practical nurses • 23

Riitta Heikkinen-Peltonen and Marjut Virta

Pirkanmaa Polytechnic’s specialisation programme in substance abuse work: student-centred

training for health care and social work professionals • 28

Tuija Salo and Marja-Liisa Torikka

Substance abuse work competence through postgraduate studies at a social services

polytechnic • 33

Terhi Laine and Antti Weckroth

The A-Clinic Foundation’s training activities • 37

Tuula Annala

The Huuko project: a national and regional effort to develop continuing training in the

treatment of drug problems • 42

Maria Inkinen

Development of addiction training for professionals in the Turku region • 45

Marja Niskasaari and Arja Tikka

Local decision-makers’ information and training needs relating to substance use issues • 48

Anitta Tähti-Niemi

Contributors • 52

Annex: General features of substance use related training in Finland • 53

Contents

1Transdrug project: A

Trainer’s Tool Kit—advancing

quality & relevance in

addiction training. A-Clinic

Foundation 2003.

The Transdrug project (2001-2003) focussed on the development of training offered to

professionals working with substance abuse problems. The project approached the topic

through the assessment of training needs: project partners based in four European

countries tested in their own field the applicability of various needs assessment methods.

The experiences were published in A Trainer’s Tool Kit1, intended as a handbook and a

source of inspiration in the design and implementation of training in substance use related

issues.

In A Trainer’s Tool Kit, sub-projects carried out by Finnish partners were described in

concise case reports focussed on methodology. Somewhat more extensive reports can be

found in the present publication. The present collection of articles also includes additional

texts by experts involved in the development of addiction training within the A-Clinic

Foundation or in other organisations. The collection of articles sheds light on Finnish

addiction training from different angles. The aim is not to give an exhaustive account of

the field but to highlight some of the current issues and trends.

The introductory article by Tiina Sutinen gives an overview of the main challenges in the

development of training in the addictions field in Finland today. The next two articles,

by Leila Märkjärvi and Tiina Kauma, focus on the newly introduced competence-based

qualification in substance abuse work, designed for people who have acquired competence

through work but who lack a formal degree. The article by Riitta Heikkinen-Peltonen and

Marjut Virta traces the development of substance use components in vocational secondary

education, from psychiatric nurse training of the early 1900s through to current practical

nurse training, introduced in 2001. The next two articles shed light on the opportunities

for substance abuse specialisation offered by polytechnics. Established in the 1990s to

create a non-university sector in higher education, the Finnish polytechnic system is still

in a development phase. The article by Tuija Salo and Marja-Liisa Torikka describes a

specialisation programme offered as further training to persons who already have a

diploma or degree in health care or social work. The article by Terhi Laine and Antti

Weckroth looks at the still experimental postgraduate degree system. The last four articles

deal with the A-Clinic Foundation’s training activities. Tuula Annala describes the training

offered by the Foundation’s central office and the regional service units. Maria Inkinen

outlines a joint training project of the A-Clinic Foundation and of other organisations in

the field. The article by Marja Niskasaari and Arja Tikka describes a local implementation

of the same project. Anitta Tähti-Niemi takes a look at the information and training

needs among persons involved in municipal decision-making about substance use-related

issues.

The Transdrug project wishes to express warmest thanks to the developers of addiction

training who contributed to this collection of articles.

transdrug project 2003

www.a-klinikka.fi/transdrug

Foreword

Perspectives on addiction training6

RECENT DEVELOPMENTS INTRAINING FOR SUBSTANCE ABUSE WORK

Tiina Sutinen

A lot has been written about substance abuse, the growing harm caused by alcohol anddrug abuse as well as the developments in the treatments available, but little has beenpublished about training in the field of substance abuse work. It has been proven thatinvestment in treatment and rehabilitation for substance abuse is worthwhile andproductive. Such commitment presupposes that social services and health care workershave the knowledge and expertise necessary, as well as the opportunity to intervene atthe right time. A flexible and seamless system for treatment and rehabilitation also has tobe in place.

In Finland, there is a national need for basic training in substance abuse work, as well asa need for continuing training and further qualification in the subject. This is clearly shownin the fact that three national policies – the National Health Care Programme, theDevelopment Programme on Social Services, and the Alcohol Programme – all mention theimprovement of substance abuse care as an important target area. These policies particularlyemphasise the need for basic health care and social services personnel to be able to identifysubstance abuse in its early stages. Furthermore, the Recommendations concerning thequality of services for substance abusers from the Ministry of Social Affairs and Health andthe Association of Finnish Local and Regional Authorities state that everybody workingwithin the general social and health services, as well as those who are particularly involvedwith substance abuse problems, must have the necessary expertise, acquired through basicand continuing training, to identify substance abusers at an early stage, to assess theirneed for treatment and to offer them high-quality professional treatment and rehabilitation.According to a report about the Development Programme on Social Services the adequatelevel of service defined in the Recommendations concerning the quality of services forsubstance abusers should be reached by the year 2007.

Currently, several different organisations offer training in substance abuse work. In additionto training traditionally offered by substance abuse services, courses are provided byvocational training institutions in the health and social services field, as well as by professionalgroups such as addiction nurses and doctors, and a number of organisations. The variety oftraining on offer is both a valuable resource and a challenge. There is tough competition forboth entry-level study places and for students. This creates a number of challenges: incoordinating the training on offer; for the horizontal and vertical structure of knowledge;for planning the training; for assessing the need for training; for the content of courses; forthe methods used; and to assure the quality of all the training. Many vocational traininginstitutions offer a sprinkling of lectures in substance abuse work within a variety of subjectson a pass/fail principle, or offer substance abuse study programmes of different sizes eitheras part of their basic studies programme or as an elective subject. Several polytechnics nowoffer specialisation studies in substance abuse work and in substance abuse prevention. Infuture, so-called post-graduate studies in the subject will be more important than they areat present. Increasingly, there will be more experience available in substance abuse workand training, as professionals gain more experience in running the further training courses,and more professional health workers graduate from them.

Central Areas of Development

In terms of vocational training, some of the main areas of development are the improvementof teachers’ knowledge of substance abuse work, securing the availability of experts andlecturers from outside through financial arrangements and a clear structuring of the contentsof substance abuse training into basic studies and specialist knowledge. At present,substance abuse training is not tied closely enough into the basic study plans of Finnisheducational institutions, excluding secondary level vocational training. This means thereis a danger that substance abuse work as a subject in its own right, as well as the integrationof this study with other subjects, is dependent upon individual teachers’ interest andknowledge. Another problem is that, in order to give teachers the knowledge they need toteach, active cooperation is needed between schools and the substance abuse services, as

Central areas of development• teachers’ competence insubstance abuse work

• use of expert trainers• clarification of contents• inclusion of substance abusework in basic study plans

• co-operation betweentraining institutions andsubstance abuse services

7Perspectives on addiction training

field work is the only way to learn the practical side of the work. This is particularlyimportant as it is not only students who need practical experience as part of their studies,but the teachers themselves must also be guaranteed long-term work experience. Onlythrough such cooperation can the teachers continually update their knowledge of thesituation in the field, while the social services and health care workers reciprocally get toknow what is going on in the training field. Such an arrangement has the added benefitof enabling comparisons to be made between the needs arising in a training situation andthose of the work environment.

The content of training in substance abuse work has grown more diverse. Teaching in thefield has moved away from traditional pharmacology and substance-centred information,as well as from descriptions of how the substance abuse services function, and is now nearerto an approach that concentrates on identifying the user and learning how to approachthe subject of their abuse, and how to assess need for treatment. In future, it will bereasonable to make a clearer distinction between basic skills and specialist knowledge.This also presupposes a clearer division of labour between educational institutions andother organisations offering courses in substance abuse work.

Basis of knowledge in substance abuse work

What then is the basis of knowledge in substance abuse work? Is such a definition neededand, if so, for what? What is the basis of knowledge that is common to people who workin different professions? What knowledge and know-how is needed in substance abuse workwhen you work with the basics, and what is needed in specialist services? Can we assumethat institutions which provide social services and health care training without a singlecourse in substance abuse work, will produce knowledgeable professionals able to handlethe demands of a society plagued in varying degrees by substance abuse problems? Or canwe assume that all employees ought to have some basic skills in understanding the processesbehind motivation and change, or know how to conduct a motivational interview? Whatmethods are used in caring for people with substance abuse problems: in our health caresystem, in the social services, in youth work, in the substance abuse services? Case managersclearly exemplify a new kind of know-how and professionals in substance abuse work whomove flexibly and seamlessly between different service providers. However, we may wellask how the know-how of these case managers is structured and how we can furtherstrengthen it with training?

Integral to training are the methods and materials used. What methods of teaching areneeded to refresh and strengthen basic knowledge and raise further the level of knowledgeof substance abuse work? It seems to be time to move on from big, isolated training eventsto long term training processes in which theoretical studies and practical work alternateover a longer period. Clearly, there is a need for training that focuses on particular methodsand procedures. Web-based learning should also be developed further.

More and more, the training providers are expected to be able to offer students regionalknowledge and the ability to make use of inter-administrative and network-based methods.The educational and other needs in a certain area or economic region form the basis ofplanning the training. In future it will be increasingly important to ask what will be theplace of traditional substance abuse work in the basic and special services offered by themunicipalities and how can the training needs of professionals employed by themunicipalities be guaranteed, so that the clients of the substance abuse services and theirfamilies can have the type of service they need. One alternative solution has been suggested:having more regional cooperation and co-production of services across municipality bordersmight enable the service providers to offer the specialist knowledge needed to treat clientswith less frequently-occurring problems.

Other areas for future development include improving coordination of substance abusetraining and making use of the experiences gained in this training. Also, there is thequestion whether substance abuse work needs a clearer frame of reference of its own? Thebasic and specialised services for substance abusers also need to be clarified andstrengthened. Mindful of future training needs, it is important that people who have workedlong in the field are able to pass on the knowledge they have accumulated to new employees.

Both long term trainingprocesses and shorttailored courses areneeded.

Recent developments intraining for substance abusework


Another challenge is that new substances are being misused and consideration must begiven to how this affects current approaches and methods. We are also forced to reviewexisting approaches and methods in relation to special groups of substance abusers, suchas patients with double diagnosis and disabled people. There are great regional differencesin substance abuse and in the availability of treatment. How can we guarantee training,consultation and in-work guidance for people in the substance abuse services who workin sparsely-populated areas?

It is important to build on information and experience from all the aspects mentionedabove. In future, the Centres of excellence on social welfare will function as a commonregional forum to further substance abuse training. Hopefully, this will make it easier todisseminate innovations in methods and work throughout the country. At the same time,it is very important to create appropriate networks between national, regional and localoperations.

Last but not least, substance abuse work training and its teachers must raise their ownprofiles, taking their place in society and putting forward their views as representatives ofsubstance abuse work and training. They must speak for substance abuse work both indifferent forums and within their own institutions.

Recent developments intraining for substance abuse

work


COMPETENCE-BASED QUALIFICATION AT THE INTERFACE OF TEACHINGAND WORK IN THE SUBSTANCE ABUSE FIELD

Leila Märkjärvi

Since the autumn of 2000, competence-based further qualification in substance abuse welfarework has made it possible for people working in the substance abuse services to demonstratetheir vocational competence. 1

According to the Vocational Adult Education Act (631/1998), competence-basedqualifications take into account the vocational qualification and competence that adultshave acquired in a variety of ways. Further qualification in substance abuse welfare workis among these competence-based qualifications that do not depend on the way you haveacquired the necessary competence, but are based on a demonstration of the vocationalskills needed to achieve the qualification for professional work.

The purpose of the qualification is:• to improve and maintain the vocational skills of people working in the substance abuseservices, and

• to offer people who have worked in the field for a long time without vocational trainingthe opportunity to acquire further qualification.

In competence-based qualifications, the vocational skills required have been defined insuch a way that it is not possible to attain them without previous work experience in thefield or without having in some other way achieved a competence that is equal to threeyears of work experience.

The work experience required for competence-based further qualification in substance abusewelfare work can be acquired through work within the substance abuse services after adegree in some area of social or health care work, through long-term volunteer work orwork as a support person, or from working within the substance abuse services withoutvocational qualifications, inspired by one’s own rehabilitation and recovery. In order toachieve competence-based qualification, a person must pass the required competence testsin genuine work situations of substance abuse prevention, treatment and rehabilitation,as defined in the Requirements of the further qualification in substance abuse welfare work2000 (Päihdetyön ammattitutkinnon perusteet 2000).

Requirements of further qualification and work practice

The vocational skills requirement of the further qualification in substance abuse welfarework together with the targets and criteria of assessment were defined by experts. Thedefinitions were based on the different work processes in substance abuse work, as well asthe basic and specialist skills those processes required, as they had been experienced bythe specialists who took part in defining them.

As a result, the requirements of further qualification were set with three compulsorymodules: Legislation and the service system; People-centred professionalism; and Basics andmethods of Substance abuse work. Two elective modules are also required, one of whichmust be chosen from: Psychosocial approach towards substance abuse work; Christian workwith substance abusers; or the Myllyhoito™ model 1. The remaining electives are Voluntarywork and work in non-profit organisations in the substance abuse field; Preventive substanceabuse work and Independent self-employment.

The further qualification in substance abuse welfare work has been tested in practice fornearly three years. A total of 22 educational institutions are now authorised to providepreparatory training for the qualification, and nearly 300 people have achieved the furtherqualification. Increasingly, therefore, more people have experienced how well or otherwisethe requirements of the qualification match up to actual work practice. Their experienceand impressions have made it possible to review the vocational skills requirements andthe targets and criteria of assessment.

Vocational skills aredemonstrated throughcompetence-basedqualifications

The work process and the

demonstration

1) Finnish: Päihdetyön ammattitutkinto;

Swedish: Yrkesexamen i arbete bland

missbrukare;

English: Further Qualification in

Substance Abuse Welfare Work - National

Board of Education: English translations

of the titles of Finnish vocational

qualifications

http://www.oph.fi/english


There is a sense that the requirements of the further qualification have managed to catchthe real-time processes of substance abuse work rather well, even though there was noempirical study on substance abuse work available for the experts to turn to in definingthe requirements. The work to define the requirements was supported by general processmodels of treatment, rehabilitation and problem-solving.

Preparatory training and work practice

The further qualification emphasises its close relationship to work practice and thechallenges of the changes inherent in such work. A person seeking qualification shouldmeet this challenge by demonstrating the vocational skills needed in the different stagesof substance abuse work. This presupposes that they have already acquired most of theskills necessary through working in the field. So far, very few people have demonstratedthat they have the vocational skills required to achieve the qualification with only workexperience behind them. More often, the qualification has been gained in conjunction withpreparatory training.

Central to the provision of preparatory training by educational institutions offering thequalification is that, in cooperation with a work environment, they arrange competencetests in such a way that the vocational skills of each student are demonstrated. At thesame time, it is important to ensure that each student has the means to demonstrate thenecessary skills; in other words, that he or she is ready for the competence tests. For itspart, the preparatory training should strive to rectify any shortfall in a student’s readiness.

In the early days of further qualification in substance abuse welfare work, many educationalinstitutions offered training that was very education-centred and offered preparatorytraining immediately. In these institutions, plans for the competence tests were oftensketchy or incomplete, and their contact with work environments loose. Some institutionseven began to offer preparatory training without having the authority to grant competence-based qualifications. This resulted in a lot of problems, such as pressure to rushauthorisations through the Qualification Committee as the deadlines for preparatory trainingand competence tests were looming. It also meant that some students, while doing theirpreparatory training, did not know whether or not they would have the opportunity totake the required tests.

A basic problem of vocational education and the demands of work practice, as reported byeducationalists, has raised its ugly head in connection with the preparatory training forfurther qualification in substance abuse welfare work (see Tuomi-Gröhn & Engeström, 2001).Because educational institutions have lacked current information about the real-timepractices in substance abuse welfare work preparatory training has not always correspondedto actual needs, and information has been out-of-date.

To some extent, concentrating on preparatory training that is not up to date with real-time work practices and the requirements of the qualification has distanced the organiserof the competence tests from the original idea of competence-based qualifications. Thecontents and points of view selected to be part of training courses may in part have beenborrowed from further education in substance abuse work previously on offer, and maytherefore have been structured around the views of the people who set that curriculum.

The competence-based qualification for adults is transforming the traditional practice ofgaining further vocational qualifications, in which the assessment of skills is concentratedon learning through work, on mastering the factual information within the qualification,and on professional growth. The vocational skills are then expected to stabilise over timein the transition to work practice. Gaining the competence-based qualification is independentof the method of acquiring the vocational skills – and is therefore not dependent on allstudents taking the same route through the system of education. What information passesthrough to the work environment from the education, or what kind of learning processthe person taking the competence test has undergone to acquire his or her skills in substanceabuse work is not what is relevant.

Competence-basedqualification at the

interface of teachingand work in the substance

abuse field


In competence-based qualifications, the emphasis is put on making visible the real-timevocational skills a person already possesses as a result of working in the substance abuse services,possibly supplemented by preparatory training. The person taking a competence test must beable to show in a genuine work situation that their skills meet the requirements of thecompetence-based qualifications. Such competence tests are graded as either pass or fail.

Central to the individual competence test plan is that the person seeking qualificationorganises opportunities for exhibiting their vocational skills in substance abuse work, anddoes so in cooperation with the place/s where their competence is to be assessed. It iscrucial that the person acquaints him- or herself with the work processes in advance, andequally essential that they are able to realistically assess their own readiness for thecompetence tests in relation to the vocational skills requirement of the different modules.The preparatory training and contact between the educational institutions and the workenvironment should specifically aim to strengthen these prerequisites for gaining thecompetence-based qualification.

The qualification requirements as a basis

The requirements of the further qualification define what should be considered basicinformation in substance abuse work. For many social work and health care professionalsand teachers, this has created an opportunity – in Finland perhaps for the first time – tostop and thoroughly review, on a larger scale, what competence in substance abuse workreally is and what its demands are.

Substance abuse work has rarely been studied as a profession-specific field of expertise.Previously, studies have been done from the point of view of the substance abuse worker’sprimary profession (doctor, psychologist, nurse, church social worker, social worker, etc.)or even those without any basic training background. The common multidisciplinarycompetence in substance abuse and addiction treatment that is expected of the helpingprofessionals is inadequate. In such a situation, the introduction of competence-basedfurther qualification in substance abuse welfare work has also significantly clarified andpromoted the vocational skills necessary in the field.

Therefore, improving competence in the vocational skills specified in the requirements offurther qualification in substance abuse welfare work is desirable in the social servicesand health care sector in general, as well as within other people-centred and help-orientedprofessions and organisations. As is well known, the relevance of one’s observations andactions can be confused in a situation of interaction that is connected to an addiction.Substance abuse work that suffers from the bias of the helper (Lindqvist, 1990) and ‘savioursyndrome’ (Märkjärvi, 1995; A Trainer’s Tool Kit, 2003, 48) does not meet the criteria of aprofessional approach. Working through the module on People-centred professionalism inthe further qualification in substance abuse welfare work helps sort out an individual’sapproach and attitudes.

On the challenges of further education in substance abuse welfare work

From mapping the views of students and teachers on the needs in substance abuse trainingwe proceed to the definition and choice of the contents and methods taught (A Trainer’sTool Kit, 2003). Are these needs really relevant to the practical demands of work in reallife? Do they produce more developed or newer practices in the work environment? Mostlythey do not, as it is a truism that professionals prefer to keep using the methods they areused to, even when those methods are not relevant and are often influenced by unconsciousmotives and attitudes (Schön, 1983).

Conflicts and problems arising from the reality of work situations are not easy to pinpointand face without some form of objective observation that reveals how work practices areactually performed. So, it seems to me that one demanding aspect of the development ofsubstance abuse training is the need for some more general theory and tools to use insubstance abuse work. From a theoretical point of view, no fruitful work can be expectedunless the worker can clearly identify and interpret the object of their work, theenvironment in which it is done, and understands how to make best use of their existing

Competence-basedqualification at theinterface of teachingand work in the substanceabuse field


tools. An imprecise image and a distancing from the object of the work, combined with ahaphazard testing of tools cannot lead to wholly organised and fruitful work, as for instancewas shown in a study on the substance abuse services offered by nurses in health carework places (Märkjärvi, 1995). (See also Engeström,1995, 42–48).

A theoretical diagnostic image of the processes involved in substance abuse work shouldbe created so that the training can focus on areas that would lead to more effective toolsfor preventing the harm caused by substance abuse, as well as to support substance abusers,and their next of kin, through their rehabilitation. On a practical level, this wouldpresuppose an actual examination of work practices and identification of conflicts withinthe processes throughout the substance abuse service system (Engeström, 1995). Anotherthing that might help clarify the current situation is real-time reflection on work practices(Ruohotie et al,1998, 77–82).

A systematic presentation of the training needs based on a study of the current situationof the work, including feedback from clients and patients as well as studies of theeffectiveness of the work being done, would naturally demand a great deal of work. Theresources won’t allow such an extensive study, which means it is easier to offer trainingthat relies on mapping of needs and hopes of employees and such-like superficial statements,or follow the trends when choosing the contents of the training.

From the perspective of the preparatory training for the competence-based qualification insubstance abuse welfare work, it would be essential to observe and interpret the processes andeveryday reality of substance abuse work. What tools the teachers and people who have plannedthe training have used to do this remain mostly unrecorded. I would assume that the teachers’previous work experiences in substance abuse services as well as the information passed onthrough the work environment group will get the training over the first hurdles, assumingthat work contacts in the field have been good and actually covered all the different workenvironments described in the requirements of the qualification. One must assume that thework experience of the students recruited into the preparatory training will significantly influencethe future content of the training and the methods used.

At the interface of working life and training

Further qualification in substance abuse welfare work has both raised and maintained theprofessional competence of people working in the field. Each person participating in thepreparatory training has brought to it their own views and experience and added to thecommon pool of knowledge. Various competence-testing environments have enriched people’simage of the substance abuse services and given the workers an opportunity to use thenew tools and views they have learned.

Competence-based qualifications, then, have become an important source of cooperationbetween educational institutions and places of work in the substance abuse services. Thego-between in this interactive process is the person seeking qualification – he or shebecomes the one who crosses the boundary and with whom information passes via preparatorytraining from the educational institution into work practice, and via competence-test plansand the tests themselves from the work environment to the world of education. Operatingat this interface is an interesting phenomenon from the point of view of developing trainingand the work environment (see Tuomi-Gröhn, 2001).

Opportunity for renewal within substance abuse work and preparatory training

In addition to demonstrating vocational skills and competence, the further qualificationin substance abuse welfare work appears to challenge people working in the field to observeand develop the quality of work within the substance abuse services. One sign of this istraining employees. By allowing competence tests to be performed at their units, theemployers and test participants meet new people who are competent in substance abusework and who might in future be available for jobs within the substance abuse services, asthat work becomes progressively more demanding.

Competence-basedqualification at the

interface of teachingand work in the substance

abuse field


The competence-based qualification challenges the educational institution offering thepreparatory training and competence tests, the person seeking qualification, and the workenvironment to look for the work processes that demonstrate the vocational skills requiredin the work practices of the substance abuse services, and to define them together. This,in turn, provides an opportunity to renew work processes. Together, the parties learn tostudy the target phenomena of substance abuse work and to question old approaches andtools. The competence-based process does not work only through intervention into thecompetence of the person seeking qualification, but also into the practices of the workenvironment and the preparatory training.

Further qualification in substance abuse welfare work has offered many people with longexperience of working in the field the chance to re-evaluate their own work. Sharing awider view of the work helps open up an ingrained work environment and the individual’sown role in it. At best, through the preparatory training an individual can connect theirwork motivation in preventive work, treatment, rehabilitation and recovery support to alarger societal context. Finding a common work motivation is known to boost personalenergy for work. In substance abuse work – traditionally not a very highly respected orattractive field – strengthening the work motivation and professional identity of theemployees will be particularly important in the future.

The fact that the qualification is independent of the method of acquiring the vocationalskills has also enriched the qualification process. It has recognised the skills of many peoplewho have worked in the substance abuse field for a long time without professionalqualification, often with their own recovery at the core of their work and on a voluntarybasis. These people have been able to impart their experience of having recovered fromsubstance abuse and of being a client and patient at different stages of substance abuse topeople in the substance abuse services who have worked solely on a professional basis,and to the planners and teachers of the preparatory training.

The further qualification in substance abuse welfare work has, with preparatory trainingand all, for its part improved the quality of substance abuse work and its ability to competefor competent professional personnel in the future. Also, it has made it harder to ignorethe need for competence in substance abuse work in multidisciplinary work. The futurebelongs to unprejudiced, innovative and competent substance abuse workers who are opento re-evaluating and updating their work practices.

Literature

Engeström, Y. 1995. Kehittävä työntutkimus – perusteita, tuloksia, haasteita. PainatuskeskusOy. HelsinkiLindqvist, M. 1990. Auttajan varjo – pahuuden ja haavoittuvuuden ongelma ihmistyönetiikassa. Otava. Helsinki.Märkjärvi, L. 1995. Työterveyshoitajat päihdetyöverkoston kehittäjinä. SHKS. Gummerus.Jyväskylä (Aikuiskasvatustieteellinen väitöskirja/Helsingin yliopisto kasvatustieteiden laitos).National Board of Education. Päihdetyön ammattitutkinnon perusteet 2000.(Opetushallituksen määräys 011/2000). [Requirements of the further qualification insubstance abuse welfare work 2000. Regulation 011/2000.]Ruohotie, P., Kulmala, J., Siikaniemi, L. 1998. Työssä oppiminen. Oppilaitosten ja työelämänroolimuutos – esteitä ja edistäjiä. Opetushallitus. Kehittyvä koulutus 3.Schön, D.A. 1983. The Reflective Practitioner. How Professionals Think in Action. Basic Books.New York.Tuomi-Gröhn, T. ja Engeström, Y. (toim.) 2001. Koulun ja työn rajavyöhykkeellä. Uusiatyössä oppimisen mahdollisuuksia. Yliopistopaino. Helsinki.Tuomi-Gröhn, T. 2001. Kehittävä siirtovaikutus koulun ja työpaikan yhteistyön tavoitteena– tapaustutkimus lähihoitajan lisäkoulutuksesta. Teoksessa Tuomi-Gröhn, T. ja EngeströmY. (toim.) 2001. Koulun ja työn rajavyöhykkeellä. Uusia työssä oppimisen mahdollisuuksia.Yliopistopaino. Helsinki.A Trainer’s Tool Kit by the Transdrug Project - advancing quality & relevance in addictiontraining. 2003. Edited by M. Montonen & T. Powers-Erkkilä. A-Clinic Foundation.Vocational Adult Education Act (631/1998)

Competence-basedqualification at theinterface of teachingand work in the substanceabuse field


CHALLENGES AND DEVELOPMENTAL NEEDS OF SUBSTANCE ABUSE WORK ASSEEN BY STUDENTS PREPARING FOR THE COMPETENCE-BASEDQUALIFICATIONTiina Kauma

Tampere Institute for social and health care studies offers an educational programme thatleads to the competence-based further qualification in substance abuse welfare work.1 Bydeepening the vocational preparedness of professionals who work with substance abusersespecially in community care, the programme aims to respond to the changing needs ofsubstance abuse services. The first 15 students who participated in preparatory trainingin our institute were awarded their competence-based qualifications in June 2001. Theywere the first substance abuse workers in Finland to achieve this qualification

Some of the persons seeking qualification have already completed a vocational instituteprogramme or college education in social and health care (they may be practical nursesfor social and health care or registered nurses, for example), while some others may havesimilar qualifications from other fields. Many have several years’ experience of professionalwork in substance abuse services. Alternatively, they may have been involved in voluntarywork, or they have acted as support persons in services for substance abusers or in mentalhealth work. Some may be recovered substance abusers themselves who have gone throughthe process of recovery and rehabilitation.

A further qualification involves the demonstration of the competence required from aprofessional working in the field. The required vocational skills have been defined in sucha way that it is not possible to attain them without additional studies after a basicqualification and without minimum three-year work experience. The purpose of thequalification is to improve and maintain vocational skills after the basic qualification andto offer people who have worked in the field for a long time without formal training theopportunity to acquire a qualification. (Requirements of the qualification 2000)

The further qualification in substance abuse work is taken in competence-basedexaminations in authentic settings. According to the Vocational Adult Education Act (631/1998), competence-based qualifications take into account the competence that adults haveacquired in a variety of ways. Competence acquired in education and training, work lifeand interests shall be dealt with as a whole in such a way that it can be utilised in thedemonstration tests required for achieving the qualification. The competence-basedqualifications are thus independent of the acquisition method of vocational skills.Nevertheless, the qualifications are mainly completed in connection with different formsof preparatory training. (Requirements of the qualification 2000)

Further qualifications are arranged based on a contract between an educational institutionand the national Qualification Committee (nominated for the period 1.12.2000-30.11.2003).Competence-based tests can be arranged by training institutions, by providers of vocationaleducation and by institutions run by registered associations or foundations that possessthe required expertise. The organisations are required to have solid experience ofimplementing substance abuse work training for adults and a National Board of Educationquality assessment focussed on the resources necessary for arranging competence tests.The authorised institutions are required to offer the possibility to take a further qualificationalso without preparatory training. (Requirements of the qualification 2000)

Those who have completed the competence-based qualification master the knowledge basisand the skills required in the particular occupation (in addiction to the knowledge andskills of their basic qualification) and are able to function as experts in their own work inmultidisciplinary work environments and in co-operation with different parties. Those whohave completed the further qualification in substance abuse work may work in differentpositions requiring competence in substance abuse work. Substance abuse work is carriedout within different general and specialised services, such as day activity centres, outpatientunits, health centres, housing services, rehabilitation units, hospitals, within home careservices, mental health work, youth work, child protection, deaconal work, public healthorganisations and voluntary activities. (Requirements of the qualification 2000)

1 Finnish: Päihdetyön

ammattitutkinto

Swedish: Yrkesexamen i arbete bland

missbrukare

English: Further Qualification in

Substance Abuse Welfare Work -

National Board of Education

English translations of the titles of

Finnish vocational qualifications:

http://www.oph.fi/english


Challenges anddevelopmental needs ofsubstance abuse work asseen by students preparingfor the competence-basedqualification

The further qualification in substance abuse work is composed of three compulsory modulesand two elective modules. The qualification is completed when a total of five modules havebeen completed to an acceptable standard. The compulsory modules need to be completedbefore demonstration tests relating to the elective modules can take place.

Preparatory training

The preparatory training offered by Tampere Institute for social and health care studiesconsists of multi-mode studies, of on-the-job learning and of the competence tests. Thecourse outline is the basis for a personal qualification and learning plan that allows tailoringthe training to the student’s previous training and work experience. If a student has alreadyacquired knowledge and skills that can be recognised as preparatory training, s/he cantake a competence-based test immediately. The study goals and the amount of preparatorytraining needed are defined together with the person seeking qualification, based onassessment of existing competence.

The preparatory training comprises three compulsory modules of the qualification(18 credits + competence tests equalling 2 credits):

1 Legislation and the service system —4 credits• Health care and social services system, regulations and ethical principles• Substance abuse services, regulations and programmes• Familiarity with substance abuse work projects• Planning and assessing one’s own learning process

2 People-centred professionalism —6 credits• Professionalism in substance abuse work• Group work and management of groups in substance abuse work• Professional development and growth

3 Basics and methods of substance abuse work —8 credits• Information and communication technology• Individual, societal and cultural aspects of substance use• The treatment and rehabilitation of a substance abuser• Professional substance abuse work within health care and social services The compulsory modules include 6 credits’ worth on-the-job learning.

In addition, the person seeking qualification can choose two elective modules:one from modules 4-6 and another one from modules 4-9(18 credits + competence tests equalling 2 credits):

4 Psychosocial approach in substance abuse work —9 credits5 Christian work with substance abusers —9 credits6 Myllyhoito© Model —9 credits7 Voluntary and non-profit substance abuse work —9 credits8 Preventive substance abuse work —9 credits9 Independent self-employment —9 credits The compulsory modules include 10 credits of on-the-job learning.

On-the-job learning is goal oriented learning based on the course outline, supervised andassessed jointly by the training institution and by a representative of the workplace. Theperson who seeks qualification acquires part of the professional competence throughsubstance abuse work done in an authentic work environment. Institution-based learningand on-the-job learning are complementary. On-the-job learning can take place in 1-5separate periods.

At the beginning of the preparatory training the student is introduced to the skillsdemonstration tests that will be taken during the training and a preliminary personal studyplan is drawn up that includes both a learning plan and a competence test plan. At thebeginning of each module, the students learn about the vocational skill requirements ofthat particular module, about the competence test and about the targets and criteria forassessment.

1 credit = 40 hours of work

Myllyhoito© is a Finnishapplication of theMinnesota Model.


In the competence-based qualification, professional skills are demonstrated in authenticsettings in accordance with the modules of the qualification. The tests are assessed (pass/fail) jointly by an expert coming from work life and the teacher responsible fordemonstration tests. The teacher is required to have taken a course (15 credits) designedto train for this particular task. The competence tests are not separate work tasks but aprocess in which the person seeking qualification demonstrates the achievement of theobjectives central to occupational proficiency. The work organisations (multi-professionalwork group; work based on treatment/ service/ rehabilitation plan) that function ascompetence-testing environments nominate an assessor who is required to have taken atraining course for assessors (1 credit), who is familiar with the requirements of thequalification and who has a diploma or degree in social or health care or other appropriatefield as well as minimum three-year experience of mental health/substance abuse work.(Course outline 2001)

Taking a competence-based qualification costs around 50 euros. When all five modules ofthe qualification have been completed to an acceptable standard, the person seekingqualification is awarded a Certificate of the Further vocational qualification in substanceabuse welfare work. The national Qualification Committee confirms that the requirementsfor the qualification are fulfilled and issues the Certificate. Instead of aiming at thequalification, a person may seek to take a competence test in just one or in a few of themodules. (Requirements of the qualification 2000)

Substance abuse work as seen by students participating in preparatory training

The students preparing for the competence-based qualification are genuinely interestedin developing their professional skills in substance abuse work. They have been selectedinto a demanding 1.5-year-long programme at the end of which work life experts will assesstheir professional competence. As part of the Transdrug project, we conducted a small-scale study to explore how the students perceive the professional competence required insubstance abuse work as well as the related developmental needs. We gave the students,at the start of their studies and again at the end, a SWOT analysis-based learning assignmentfocussed on substance abuse work and professional competence.

SWOT analysis (Strengths, Weaknesses, Opportunities, Threats) is a method the results ofwhich can be used to identify, assess and develop selected aspects of a topic or phenomenon.SWOT applications are commonly used at the beginning of planning and developmentprojects. (Siirilä, Haveri & Linnamaa 1997)

SWOT analysis based on participants’ perceptions of the strengths, weaknesses, opportunitiesand threats pertinent to a topic can be repeated periodically to monitor change over alonger period of time. The results can be presented in the form of a 2 * 2 table, pointingout conclusions regarding areas where improvement is needed and areas where the currentsituation is satisfactory. The conclusions serve as a basis for a strategy for development inthe near future. When resources are limited, choices have to be made as to what will bedone, when and how. Strategic choices aim at putting existing strengths to the best possibleuse. (Sotarauta 1997)

The learning assignment focussed on substance abuse work and professional competencewas completed by 13 students of study group 3 whose education lasted from 3.9.2001 to31.10.2002. The group comprised four men and nine women, their age ranging from 26 to56. The students came from different parts of the country. Ten of them already had a diplomaor degree suitable for the field. Four were recovered substance abusers. All had previousexperience of substance abuse work, mental health work or other work in the health careor social service sector.

The students were given at the start and again at the end of their studies a learningassignment on the development of substance abuse work and professional growth, alongwith a SWOT analysis chart. The students had one month to complete the assignment thatwas submitted in the form of an essay. Instructions for completing the assignment weregiven during class. The students were meant to work on the assignment both individuallyand in study groups of four persons.

Challenges anddevelopmental needs of

substance abuse work asseen by students preparingfor the competence-based

qualification


While all students completed the first essay assignment, the second one was completedby 10 out of 13. The essays varied in length from one page to 10 pages, attachmentsincluded. The completed SWOT analysis charts were turned in along with the essays.

Analysing the essays written by the students, we examined how they clarified theirconceptions of substance abuse work and regarded the trends and challenges arising fromtheir societal context, in relation to their life history, cultural background and the changingsocietal context. At the end of their studies, the students also assessed their own learningprocess and professional growth, identified their strengths and designed a plan for theirown professional development after the qualification.

Perceptions of substance abuse work

At the beginning of the studies the students regarded substance abuse work as somethingstrongly based on specific laws such as the law on the status and rights of patients andthe law on the status and rights of social service clients. The students thought that aperson’s own physiology sets limits to one’s substance abuse. The students felt that ingeneral people’s attitudes towards alcohol were positive and accepting but the use of drugscaused a lot of anxiety and fear among citizens. Nevertheless, they felt that attitudes arebeginning to change, with drugs becoming a part of everyday life and people seekingsensations from drug use at different stages of their life. Attitudes were seen to play acrucial role in substance abuse work, since substance use is a phenomenon with implicationsfor affects and values.

According to the students’ descriptions, substance abuse was no longer what it used tobe, traditionally controlled by strict norms. In fact, patterns of behaviour are today quitemixed and simultaneous use of alcohol and drugs, for example, has increased. Psychiatricproblems related to abuse appear to be more and more common and, at the start of theirstudies, the students pondered the connection between depression and substance abuse.It seemed to them that problems related to substance abuse were not generally understoodin society, even though drugs are now a part of everyday life. Decision-makers faired poorly,regarded by the students as people who live happily in ignorance, failing to see the realconcerns of the overall population.

As to the various models and theories explaining the problems caused by substance abuse,the students focused on aspects related to dependency problems, pointing out thatexperiences of anger, bitterness and frustration, shame and rejection have an impact onthe emergence of substance use-related problems.

The students saw voluntary workers and people who do substance abuse work as a vocationas a major resource that was more in need of support on various levels. They believed thatcontacts with substance abusers can best be made in places that are easily accessible tothem. The students described the recovery process only to a limited degree, some sayingthat the significance of daily routines and chores in the recovery should not beunderestimated. Alternative methods, such as interaction with pets, field trips, gamesand camp environments were viewed to be also therapeutic to one’s recovery process.

At the end of the studies, nearly all students started their essay by noting that “comparedto last fall, my view about substance abuse work has changed”. They described the contentof substance abuse work in a well-argumented manner based on their own changedexperience and in accordance with the professional competence requirements of the modulesof the qualification. Most mention on-the-job learning, places of on-the-job learning andfellow students as factors contributing to the change.

Some students present the content of substance abuse work by examining the service system,forms of substance abuse work, levels of substance use, approaches or development trendsof substance abuse work. Some do not make an attempt to give structure to their essay butproduce text as if following the free flow of thoughts (to get their last assignment done?).

The students no longer see substance abuse work simply as treatment of problems: they stressthat the work should be directed to intervening in the client’s life as a whole. Changed views





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of substance use by the young are a case in point: at the start of the studies, students expressedconcern about the phenomenon; at the end, they saw illbeing of children and the young assomething that should be taken into account in work with substance-abusing families. Manycall on adults to act in a more responsible manner and to make explicit their own values.

On the whole, the students at the end of their studies were not interested in describingthe content of substance abuse work. “I won’t describe in length the content of substanceabuse work here because there is a lot of material/information available, literature isabundant and in this era of technology, the computer/internet is a good place to find theinformation you need.”

Perceptions of challenges and developmental needs

At the beginning of the studies the biggest challenge of substance abuse work the studentsnoted was the multiple problems caused by changes in today’s society. The studentsmentioned mental health problems, social marginalisation, as well as a person’sdisadvantaged social and/or economical status as the main causes. The fragmented systemof substance abuse work should endeavour to develop its services into a seamless care systemto better tackle these multiple problems.

According to the students, increasing poly-drug use presents a challenge and calls for furtherdevelopment and adoption of assisting strategies such as low-threshold services, substitutiontreatment and outreach work. Developing current helping strategies requires more trainingopportunities in the field so that knowledge and experience gained in other countries canbe applied to the Finnish context. Enhanced research into the effectiveness of the differentforms of care was also thought to be necessary to ensure an effective allocation of resources.

Although substance abuse work is by law a shared responsibility of the social and healthcare sectors, co-operation in this field was seen to still be in its infancy. The students blamedorganisations that, despite the requirements of the new legislation, are only slowly changingfrom bureaucracy-orientation to client-focus. According to the students, developing preventivework and a system of community care is an important task for the future.

At the end of the studies all students mention a worrying increase in the use of all sortsof substances and stress the need for early intervention. While trying to pinpoint effectivemethods for early intervention, they stress that the greatest challenge is how to reach intime the people who would benefit the most.

The students think that the demand for addiction services within the general health serviceswill increase, because they find it unlikely that specialist addiction services could beexpanded. In addition, general health services should prepare for an increase in substanceuse-related somatic diseases.

Many wrote that professional substance abuse work in Finland still rests on an anecdotalbase as opposed to evidence-based practice. Specific challenges mentioned by the studentsinclude the organisation of substitution treatment for opiate addicts in health centres:the centres may be eager to dispense the substitute drug but may not pay enough attentionto planning psycho-social rehabilitation. They also note that the media tend to give aone-sided picture of the issue - as if all addicts were addicted to opiates and as medicationassisted treatment was the only option.

Another great challenge is presented by the increase in mental health problems amongthe clients coming to addiction services. The growing number of dual diagnosis clientstend to fall in a gap between the services and are left without proper treatment. The studentsalso felt that preventive substance abuse work does not reach the most important targetgroup: “Can placement in a group home for 20 youngsters really be considered as preventivesubstance abuse work or does it just learn the child to live in an institution?”

The students are concerned about the risk of burn-out: “More attention should be paid toensuring sufficient staff coverage and support for the staff, because the work becomes evermore demanding as the problems increase in number and severity.”



Important aspects of substance abuse work in the future include the development of newmethods of work, such as outreach work and approaches based on peer support. Observanceof the newly established recommendations for quality in addiction services is also seen asa challenge in the future.

What kind of substance abuse worker am I?

At the start of the studies all those who were recovered substance abusers stated thattheir own recovery process is of value in professional work. Some described themselves aneducator, a messenger or a drug worker. Many expressed concern especially for young people.

As central values many mentioned respect for life, maintenance of health, and human dignity.Putting into practice the principles of individuality and self-determination involves aconfrontation of the worker’s personal values and those arising from their professional roleand, on the other hand, the client’s values based on which they make decisions about theirown treatment. Still, many felt: “I don’t see myself as substance abuse welfare worker yet.”

At the end of the studies many students considered their values and attitudes unchanged.Nevertheless, some also noted that: “I may have become more tolerant, more open-mindedand I am able to look at issues from different angles.” Someone’s strict attitude towardsmedication assisted treatment had mellowed and the person now saw medication assistedtreatment as one part of a substance abuser’s rehabilitation process. “I’m glad about mystudies that I have thought about with mixed feelings, my ability to deal with emotions hasdeveloped in many ways; I’m no longer afraid of everything.”

All students considered themselves skilled and knowledgeable substance abuse workers.“I am a good worker, I know how to listen and refer clients. In know where to find theinformation the client needs and I know how to plan a suitable treatment path togetherwith the client, taking into consideration different options.” “I know I have knowledge andskills thanks to my own recovery process, my studies and also my personality.”

The importance of taking care of oneself was emphasised in several essays: “I wonder if Iam now capable to do substance abuse work in a professional manner, not at the expense ofmy own feelings, burning out myself? That’s what I am asking myself and the answer is:yes.” “I have also noticed that in this type of work one has to have a chance to expressone’s feelings and ‘therapise’, to deal with experiences of loss and death.”

What kind of substance abuse worker would I like to be?

At the beginning of the studies the student’s ideas of themselves as a substance abuseworker were connected with the attitudes of the surrounding society. The students wantedto influence those attitudes and to provide support especially to children, young peopleand families. The essays also stress the importance of knowledge and learning new things.“I would like to answer the question ‘How on earth can someone work with substance abusers?’and at the same time to challenge people’s attitude problems regarding substance abusers.”“I want to be open-minded, interested in new things and ready to accept new challenges.”

At the end of the studies the students provided a nuanced picture of their future assubstance abuse workers. They want to respect each person as a unique individual, theywant to be professionally correct and take into account the limits of their own resources.Many mentioned the importance of work supervision and of self-development. “I wouldlike to be the kind of substance abuse worker that clients can turn to easily and withoutembarrassment, that they would trust, that would be easy to approach.” “Continuous self-development, mental and professional growth is important. Growth will be possible throughtherapy, training, and by keeping one’s ears open”.

Clients’ commitment to treatment was seen as a challenge: how does one motivate for andguide towards a health-promoting life if the client’s life history has provided no experienceor idea of such a life, if the client enters the path towards sobriety just to please others orhalf willingly. “I want to develop motivational skills so that all clients see the light andunderstand that they have to do something about their life.”




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Self-assessment of learning

At the beginning of the studies the students wrote that they had gained new information,although the learning process had not always been smooth, but that the information hadnot turned into knowledge yet. The interest in substance abuse work arose from one’sown anxiety. “My head is full of all kinds of new things, concepts and opinions which havechanged and have been remoulded.”

At the end of the studies some noted that when doing the assignment they noticed forthe first time what a broad and varied field substance abuse work actually is. Their previousviews had been limited to what they had learned through their own work or through theirown experiences of substance abuse work. The students examined the training and theirown competence as a whole: few students made any distinctions between on-the-joblearning, study groups, learning assignments and classroom teaching. Competence testswere not mentioned at all. Most analysed their own learning in relation to their pre-trainingmode of action or attitudes.

“This year of study has clarified my view of substance abuse work, albeit it is still fragmented.My interest has focussed more and more on the content of the work, especially the contentof my own work; what we are aiming at and with what means?”

“My professional competence has developed so that I learned to protect myself from thekind of work that exhausts my resources. My personality is good as it is. My life experiencehelps me understand different fates in life, but too much sympathy can be fateful. That’swhat I have learned.”

“I have grown professionally, I have gained more self-knowledge, self-confidence and self-appreciation. I have learned how to recognise people’s behaviour as well as better co-operationskills.”

“Now I notice that this training has been useful, since at least my own attitudes have changedand I have grown as a person.”

Discussion

The purpose of the learning assignment was to examine how students preparing for professionalsubstance abuse work saw the content and the developmental challenges of such work.

SWOT analysis forces the students to focus on what is essential in the content of substanceabuse work and in their own professional development. It also helps the students plantheir professional career. The SWOT table is an efficient tool for comparison of differentperspectives, especially since the results can be presented on a single sheet of paper. Onthe other hand, making distinctions between strengths, opportunities, weaknesses, andthreats can be quite a demanding task.

During the work process, the students discussed in groups how the SWOT analysis shouldbe done and how they could find out what substance abuse work actually is about. Topicsfor discussion also included the trouble of gathering material and the time needed forindividual thinking.

SWOT analysis worked well as a learning assignment, helping both the student and theteacher assess current knowledge and skills while identifying training needs. The analysiscould easily be repeated with new student groups to chart training needs over a longerperiod of time. SWOT analysis is a useful method for vocational training offered to adultsin the health and social service sector. Life and field experiences provide a fruitful basisfor reflection and self-assessment. Nevertheless, self-assessment may be quite demandingfor students. Interest in one’s own professional development may not be evenly distributedamong the group.

The analysis of extensive text material such as the essays written by the students requiresa considerable amount of work and specific analytical skills. It is not easy to fully grasp



the meaning of the text. The text material has been analysed at group-level only so it isnot possible to follow possible changes in individual students’ views or compare the viewspresented at the end of the studies with those presented at the beginning. Use of thematerial for further development of training requires familiarity with the national corecurriculum and the requirements for the competence-based qualification, as well as anunderstanding of the societal context, change processes and prospects for development.

Only few of the students categorised the content of substance abuse work in the sameway as the modular qualification requirements. Although the emphasis in the trainingwas on preparing the students for the competence tests, the tests were not given prominenceat the end of the studies - students’ views of substance abuse work had been amalgamatedinto a whole. The challenge for the preparatory training for the further qualification insubstance abuse work lies in helping adults whose background is formed by different lifeexperiences, training, degrees and learning resources to identify existing knowledge andskills in substance abuse work and how they fit with the professional skills descriptionsgiven in the modules of the further qualification.

References

Horelli, L. & Roininen, J. 1998. Rakennepolitiikan tasa-arvoarviointi. Helsinki:Työministeriön ESR-julkaisut No 32.

Kauma, T.& Heikkinen-Peltonen, R. 2002. Päihdetyön koulutus sosiaalipalveluissa: päihdetyönammattitutkinto tutuksi, IX Valtakunnalliset Päihdepäivät 10.-11.9.2002, Helsinki.

Krause, K. & Kiikkala, I. 1996. Hoitotieteellisen tutkimuksen peruskysymyksiä. Helsinki:Kirjayhtymä Oy.

Lehtovaara, M. 1992. Subjektiivinen maailmankuva kasvatustieteellisen tutkimuksenkohteena. Tampere: Tampereen yliopisto.

Märkjärvi, L. 2002. Päihdetyön tutkintotoimikunnan kannanotto tutkintotoimikuntatyöryhmänmuistioon 12/2002.

Niiniluoto, I. 1985. Tiede, filosofia ja maailmankatsomus. Filosofisia esseitä tiedosta ja senarvosta. Keuruu: Otava.

Näyttötutkinto-opas (luonnos) 2003. Opetushallitus.

Perttula, J. 1995. Fenomenologisen psykologian metodi – kohti käsitteellistä selkeyttä.Hoitotiede 1/1995. Vol. 7.

Päihdetyön ammattitutkinto, näyttötutkinnon perusteet 2000. Opetushallituksen määräys 55/011/2000. [Further qualification in substance abuse welfare work. Requirements of thecompetence-based qualification 2000. National Board of Education Regulation 55/011/2000.]

Siirilä, S. & Haveri, A. & Linnamaa, R. (toim.) 1999. Puheenvuoroja aluekehityksestä.Tampere: Tampereen yliopisto, aluetieteen laitoksen julkaisuja sarja A 18.

Sotarauta, M. 1997. Alueellisten strategioiden kahdet kasvot: Klassinen suunnittelukone jakommunikaatioprosessi. Kuntalehti, No 2.

Hakkarainen, R. 2002. Tutkintotoimikuntatyöryhmän muistio, Opetusministeriö. Tampereensosiaali- ja terveysalan opisto, Aikuiskoulutus, 14.6.2001.

Päihdetyön ammattitutkintoon valmistavan koulutuksen opetussuunnitelma 2001.Tampereen sosiaali- ja terveysalan opisto, Aikuiskoulutus, 14.6.2001.

Varto, J.1992. Laadullisen tutkimuksen metodologia. Tampere: Kirjayhtymä, Tammer-Paino Oy.

National Board of Education web site http://www.oph.fi/english


LEARNING assignment:Development of substance abuse work and professional growth

Objective

• The learners clarify and analyse their conceptions of the content of substance abuse work, itsdevelopment trends and challenges arising from the society and examine their role andprofessionalism in relation to their life history, cultural background and the changing societalcontext.

Assignment

• Study the content, challenges and development trends of substance abuse work using as sourcesat least two professional publications, television, radio, internet, journals, different forms ofart, interviews, your personal learning diary, dreams, experiences, thoughts etc.

• Monitor and collect from newspapers, magazines and professional journals articles related tosubstance use: What kind of a picture do they give on the attitudes and views prevalent inour society regarding substances and substance use?

• Discuss and justify: Which of the issues above do you consider the most important?• Which aspects in attitudes, knowledge and skills are the most important in the topics youchose? What is your role regarding those topics? What do you plan to do and how do youplan to achieve progress in those topics?

• What kind of a substance abuse worker are you? What kind of a worker would you like to be?What kind of targets do you set for yourself and your action in substance abuse work? Whatkind of targets do your employer, your work community, the society set? What kind of targetsdo the clients set and their next-of-kin? At what stage of your professional growth will you bein the fall of 2001? How have your values, attitudes, professional skills changed during thepreparatory training?

Result

• Write a structured, presentable essay that is true to yourself and that includes self-assessment.Make a list of the sources you have used. Use the SWOT chart to give structure to your essay.

• Assess your understanding of substance abuse work: How did the assignment help you seeconnections with your previous knowledge and experience? How can you make use in yourfuture work of the knowledge gained during training?

• Assess your own work: How did you make use of your own creativity and innovativeness,your ability to systematic work, of discussions and other sources? How do you rate your socialskills in study group work: how did the division of labour work, and how did you function asa member of the group? To round up, you can rate your learning achievements on a scale of1 to 5.

Fill out the following SWOT chart:

Name: My internal strengths: My internal weaknesses:

Date:

Opportunities offered Success plan: Development plan:by society:

Threats posed by society: Deterrance plan: Avoidance plan:



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DEVELOPMENT OF SUBSTANCE ABUSE WORK MODULES IN VOCATIONALSECONDARY EDUCATION: FROM TRAINING PSYCHIATRIC NURSES TOTRAINING PRACTICAL NURSESRiitta Heikkinen-Peltonen and Marjut Virta

The development of secondary education occupations in the health and social servicessector clearly shows the general development of occupations from externally directed,repetitive, narrow-competence work to occupations based on professional expertise. Thischange is also seen in the transformation of the occupation of psychiatric nurse to that ofpractical nurse.

In the early years of Finnish education for psychiatric nursing, training in the field wasdeveloped mostly by hospital schools. In 1913, the first ever course to train psychiatric nurseswas started at Pitkäniemi Hospital in Pirkanmaa. Almost simultaneously, another course beganat Lapinlahti Hospital in Helsinki. At first, courses were six months long, but in 1917 theywere extended to a full year. The course contents touched upon substance abuse treatmentin the context of toxaemia patients suffering from alcoholic poisoning. The actual substanceabuse work and any treatments were handled by the church and social services, which meantthat they were not emphasised in the training for psychiatric nurses. The Finnish Prohibition(1919–1932) resulted in a socially difficult substance abuse situation, and in 1936 a newlaw was passed: the Alcoholics Care Act. The Act put care for alcoholics on a par with carefor the poor. Neither had any place in the training of psychiatric nurses.

In 1948, Pitkäniemi Hospital began offering alcoholics the new Antabus treatment, andso addiction treatment became part of the training offered at the hospital. The teachinghad a very practical bias and emphasised psychiatric care. Questions of substance abusetreatment were mostly raised as needed on a patient to patient basis. The last of the hospitalschool courses at Pitkäniemi Hospital ended in 1969.

Nationally, a lot of thought had been given to transferring the training of nursing staff to acentralised administration. This change was realised in 1968, when the National Board ofVocational Education took over responsibility for the training from the National Board of Health.At this time, the basis for a national curriculum for mental health care training was created.

Substance abuse treatment came up within the psychiatry modules of medical courses asthe students learnt the basics of alcoholism, alcohol-related illnesses and medication-basedtreatment. Treatment of drug users was touched upon mainly in the form of misuse ofmorphine and medicinal heroin. Substance abuse-related themes also came up in the seminarpapers and final essays of some of the students.

In addition, students participated in longer periods of guided practical studies in substanceabuse treatment, for example in the substance abuse welfare services of the cities and thedetoxification units of the A-Clinic Foundation. However, substance abuse work andaddiction treatment did not become a separate subject in the curriculum, but was seen asbeing part of psychiatric care.

Secondary education reform helps develop vocational training throughout the country

From 1985 through 1987, basic secondary education, i.e. general upper secondary andbasic vocational education, was reformed throughout Finland. The aim of the reform wasto make vocational training more competitive with the general upper secondary educationschools. The official term used for nurses in mental health care in Finland changed frompsychiatric nurse (mielisairaanhoitaja) to mental health nurse (mielenterveyshoitaja). Thelength of the training for nurses varied according to their earlier education. For peoplewho had completed only their lower secondary education, the training took three years,in which the first year (general studies) consisted of mathematics, languages and othercore subjects from the general upper secondary education courses. The last two years focusedon vocational subjects, including themes touching on substance abuse treatment. Forstudents who had completed their general upper secondary studies with an upper secondaryschool matriculation exam, training to be a nurse took two years.

Substance abuse work aspart of psychiatric care


The curriculum did not contain any separate modules in substance abuse work or treatment,but some areas of substance abuse work were nevertheless touched upon:

• The course in Psychiatric Care (3 credits; 1 credit = 40 hours) contained substance abuse-related topics, such as the definition of addiction; alcohol and health; alcohol-relatedillnesses; the basics of detoxification treatment; pregnancy and alcohol; children withfetal alcohol syndrome (FAS); drugs; seniors and alcohol; mixed use of alcohol and drugs.

• In Mental Health nursing (0.5 credits) the students were acquainted with the substanceabuse service units and their work.

• In the Advanced Studies module (10 credits) a seminar essay was written. Each studentcould choose the subject of their essay, so at least some of them focused on substanceabuse work and addiction treatment.

Practical studies in mental health work (13 credits) were done in two parts. The studentscould choose where to do their practical studies: either at a psychiatric care unit or at asubstance abuse service unit. Among the places on offer were the detoxification units andyouth clinics of the A-Clinic Foundation, the substance abuse units of the cities and theProbation Association, as well as rehabilitation institutions and the then existing substanceabuse treatment centres.

Although most mental health nurses who gained their qualification worked within themental health service, a small percentage did work in the addiction services.

The latest reform in vocational training:Practical nurse training in secondary education

In the early 1990s, it was again decided to reform vocational training. Generally speaking,the aims of the previous reform of upper secondary education had not produced the resultsthe authorities had hoped for. Esteem for vocational training had not increased; studentswere still aiming for the upper secondary school matriculation examination and highereducation; and, some 20 per cent of the pupils completing their lower secondary educationdid not go on to do any vocational training.

A far-reaching reform was implemented throughout the health and social services sector,which led to the fusion of ten former professions. This resulted in a broad-based basicqualification in health care, namely that of practical nurse. In 1993, the training of thefirst practical nurses began. Early on, the training course was two and a half years forstudents who had a background of only lower secondary education, which meant therewas a full term less of studies in each student’s specialist subject (mental health care)compared to the earlier three-year model. The reform met with opposition both from theeducational institutions and those involved with practical nursing work. Despite protestsfrom the schools and people working in the health care sector, the reform was implementeddue to educational and employment-political concerns.

However, time has bypassed the need for quickly-trained personnel. Negative feedback onthe newly qualified practical nurses resulted in the study programme being extended: since2001, the training has been three years for students with a background of lower secondaryeducation and two years for students who have passed the upper secondary schoolmatriculation exam. The practical nurse qualification has been confirmed as the basicqualification in the health and social services sector, with 120 study credits leading toqualification. In mental health care and substance abuse work, many professions requirevocational skills that 20 credits of training could not provide. The advanced studies modulespecialising in these subjects was defined as 40 credits in length, and so a practical nurse/mental health care and substance abuse work qualification study programme was created.

On 1 August 2001, a new Act and Decree redefined the form of training offered as beingcurriculum-based upper secondary level education and vocational adult education that ispart of the competence-based further qualifications system, which can be realised in theform of apprenticeship training and as employment-political education. From the point ofview of educational institutions, the reform means that both social services institutes andhealth care institutes train practical nurses according to a common national curriculum.

Practical nurse - a broad-based basic qualification in

health care

Development of substanceabuse work modules in

vocational secondaryeducation: From training

psychiatric nurses totraining practical nurses


Substance abuse work within practical nurse training

In the national curriculum for practical nurse training, substance abuse work has its placeas a defined area of study. The basics of addiction training are also included in the generalmodules (80 credits) to a significant extent compared to previous training. Building up abasis of knowledge in substance abuse work is something that begins with the patient orclient. The early stages of training focus on preventive aspects, factors that affect thedevelopment of self-esteem at different stages of life, the influence of intoxicants on health,and risk factors such as addiction-related behaviour.

The study programme for mental health and substance abuse work (40 credits) delves deeperinto the basis of knowledge and value of substance abuse work, including topics such aslegislation and the service system as well as ethical professional decision-making. Differentmethods used in substance abuse work and rehabilitation – for example, the principles ofindividual work, group work and networking – are studied both in theory and throughwork practice. The courses take an in-depth look at changes in society and culture andthe influence of prevalent attitudes on substance abuse work. Students also learn how toinvolve next of kin and peer groups in the treatment of addiction. Resources central tosubstance abuse work, such as work guidance and consultation as well as health and safetyat work, are topics running through the entire training.

The training for mental health and substance abuse welfare work (40 credits) consists of thefollowing modules:• Mental health and substance abuse work, 4 credits• Interacting with the mental health patient and the substance abuser, 4 credits• Individual mental health work, 20 credits• Individual substance abuse work, 10 credits• Free-choice studies, 2 credits

The training contains 16 credits of on-the-job training. The students can choose a serviceprovider within the mental health services and/or the substance abuse services in accordancewith their own interests or career plans.

The vocational competence of a practical nurse specialised in mental health care andsubstance abuse work is visible in smooth operations, practical skills and an ability tosolve problems in the work situation. Professional development, reforming work practicesand the changing demands of work today presuppose self-assessment and learning skillsas well as willingness to keep learning new things.

More and more, vocational competence is becoming multidisciplinary. Training gives a wide,yet strongly specialised competence to be a substance abuse worker. A person working inthe field must be able to keep abreast of current issues in mental health and substanceabuse work as well as future needs in the work of a practical nurse. The ability to manageeveryday work efficiently and with regard to quality is essential. Among the currentrequirements of competence are also familiarity with the principles of sustainabledevelopment and the internalising of those principles as part of a common globalresponsibility.

In the mental health and substance abuse field, a practical nurse can work in the home;in child-protection services; in mental health hospitals and in substance abuse serviceunits such as day wards, day activity centres, community work, rehabilitation homes,outpatient clinics, detoxification and rehabilitation centres, in-patient rehabilitation, orlow-threshold services for drug users.

Study programmes 40 credits• Emergency care• Children’s and youthcare and education

• Mental health andsubstance abuse work

• Nursing and care• Oral and dental care• Care for the elderly

Basic studies50 creditsSupport and guidance fordevelopment —16 creditsNursing and care —22 creditsRehabilitation support—12 credits

Core subjects20 credits

Free-choice studies10 credits

Health and social servicessectorBasic vocationalqualification,practical nurse

Development of substanceabuse work modules invocational secondaryeducation: From trainingpsychiatric nurses totraining practical nurses


The need for substance abuse work training among practical nurse students

One of the institutes of Tampere College, the Tampere Institute of Health Care, offers basicand vocational qualification for the health and social services sector as well as furthereducation according to needs in the field. In the spring of 2002, a survey was conductedas part of the Transdrug Project to find out what practical nurse students thought theirneeds were for training in substance abuse topics in relation to their future jobs.

A questionnaire was presented to students who were at different stages of their practicalnurse training. Some 83 of the students were doing basic studies and 43 were at the studyprogramme stage. The survey was conducted during class. Students were asked toindependently assess their own training needs and were given half an hour to completethe questionnaire, after which the forms were handed back to the teacher. The studentsparticipated in the survey with interest and enthusiasm. A majority (90%) of the 126respondents were women. The average age of the respondents was 20.

The survey utilised a short version of the training needs questionnaire developed in theA-Clinic Foundation’s Transdrug and Monikko Projects1). The questionnaire comprised 13questions, two of which were open-ended. The structured questions asked the participantsto assess their training needs on a scale from 1 to 6. The open-ended questions were designedto elicit further information.

Because of limited source material (N=126) and the small numbers in each class of answers,the alternatives training need great and considerable as well as some and very slight werecombined and a four-tier scale was used to denote the level of interest in a particulartraining topic.

The practical nurse students felt they most needed training in the treatment of drug users(75%), in controlling violent situations (75%), and in when and how to address a substance-abuse problem (61%). Information about testing for drugs at work (35%) and aboutlegislation (36%) was perceived as the least necessary. Open-ended questions were answeredby only one respondent who expressed a wish for training in how to handle the situationof a colleague being a substance-abuser.

Most of the respondents were in the fourth and final term of their basic studies, in manycases young students of 17–18 years. To them, the world of drug users may seem remote,a frightening and confusing experience, to which an image of violent behaviour as portrayedby the media is connected. At the same time, their caring about the treatment of drugusers illustrates the general consciousness that the situation for most drug users is adesperate one. The young age and lack of experience set limits for professional interactionwith clients or patients, even though in training the students have already learnt aboutthese things. In accordance with the curriculum, these questions are dealt with in moredepth in the study programme stage of the studies, at which point the ability of the studentsto deal with difficult situations is already more developed. (Cf. only 43 of the surveyrespondents were at the study programme stage.)

On the basis of the survey, there should be more training in the treatment of drug usersand in controlling violent situations included at the basic training level, and the study ofthese topics should be deepened in all study programmes. Since at least a third of theparticipants felt their need for training to be great or considerable in each topic mentionedin the questionnaire, the training in all these areas should be reviewed.

1 A Trainer’s Tool Kit by the Transdrug

Project. A-Clinic Foundation 2003.

(p. 126–136).

Development of substanceabuse work modules in

vocational secondaryeducation: From training

psychiatric nurses totraining practical nurses


0 10 20 30 40 50 60 70 80 90 100

Prevention of substance-abuse problems

Recongnising substance-abuse problems

Testing for drugs

When and how to address a substance- abuseproblems

Information on detox programmes

Information on the treatment and rehabilitationof substance abusers

Information on poly drug use ( mixing oralternating between the use of alcohol,

prescription drugs and illegal drugs)

Information on drugs and their effects

Law and orders

Treating substance -abuse

Controlling violent situations

pieni ja melko pieni kohtalainen suuri ja melko suuri yhteensä

Väkivaltatilanteiden hallinta

Päihdeongelman hoito

Lait ja asetukset

Päihteet ja niiden vaikutukset

Monipäihteisyys

Päihdeongelmaisen hoito ja kuntoutus

Katkaisuhoito

Milloin ja miiten ottaa puheeksi päihdeongelma

Huumetestaukset

Päihdeongelmien tunnistaminen

Päihdeongelmien ennaltaehkäisy

Controlling violent situations

Treatment of addiction

Legislation

Intoxicants and their use

Poly-drug use

Treatment and rehabilitation ofsubstance abusers

Detoxification treatment

When and how to addressa substance abuse problem

Testing for drugs

Recognising substance abuse problems

Prevention of substance abuse problems

some and very slight moderate great and considerable

Development of substanceabuse work modules invocational secondaryeducation: From trainingpsychiatric nurses totraining practical nurses

Survey on the need for training in substance abuse topics :Practical nurse students, Tampere College / Tampere Institute of Health Care,Spring 2002


PIRKANMAA POLYTECHNIC ’S SPECIALISATION PROGRAMME IN SUBSTANCEABUSE WORK: STUDENT-CENTRED TRAINING FOR HEALTH CARE AND SOCIALWORK PROFESSIONALSTuija Salo and Marja-Liisa Torikka

Pirkanmaa Polytechnic is one of the most recently established polytechnics in Finland.Founded in 1997, it was granted a permanent status in 2000. A specialisation programmein substance abuse work was started in September 2001. Specialisation programmes are aform of long-term further training offered to professionals who have already completed adiploma or degree programme in the field in question. The studies are intended to strengthenboth theoretical knowledge and practical skills. The extent of specialisation programmesvaries between 20 and 40 Finnish credits (30-60 ECTS credits).

The need to continually upgrade knowledge and skills in substance abuse work amongsocial and health care personnel arises from an increase of and diversification in substanceabuse problems among the clients. Professionals working in the field feel that they arenot well equipped to recognise problems or to intervene. They also lack knowledge abouttreatment methods and about options for receiving treatment. When we set out to developthe new study programme, we wanted to take account of both students’ needs and theneeds of today’s work life. We wanted to draw up the course outline together with thestudents and identify and develop the central themes based on their experiences. Thespecialisation programme can be linked to one’s work activities and completed alongsidework.

Pirkanmaa Polytechnic’s participation in the Transdrug project gave momentum to thedevelopment of the new specialisation programme: the programme was started sooner thanexpected and a link with the project was evident in the training right from the start. Theproject provided an excellent tool and opportunity for the design and implementation ofthe training. Participation in the project motivated our work and brought an internationalperspective to it as well as information about partner countries’ work and research practices.The project functioned as a forum for discussion, placing our work in a wider context andcontributing to a more varied approach to substance abuse work. The project also encouragedus to apply more student-centred working methods.

The planning phase

In the Transdrug project’s first transnational work meeting, in February 2001, we heard apresentation about the use of the Delphi technique to chart future training needs in healthcare and social services (Metsämuuronen 2001). The presentation inspired us to explorethe potential of the Delphi technique in designing a course outline for the new specialisationprogramme. We wanted to take account of students’ needs as well as their views and opinionsof substance abuse work today and in the near future.

The Delphi technique counts among the methods of future research that rely on expertopinion. The approach is based on the assumption that an expert who possesses cutting-edge knowledge in the field in question is better able to forecast the future than a personwho does not possess the same amount of knowledge. Basically, the Delphi techniqueinvolves gathering information about experts’ views. When the expert views have beengathered, they are sent back to the same experts for re-evaluation. The procedure is repeateduntil the experts have agreed on one common view. (Metsämuuronen, 1997)

The students applying for the specialisation programme were professionals already workingin health care or social services, with a diploma or a degree in the field. All had workrelated experience of clients or patients with substance abuse problems. We chose theapplicants as the panel of experts from whom we gathered information about trainingneeds related to substance abuse work, thereby involving them in the development of thecourse outline for the specialisation programme.

It should be stressed that our application of the Delphi technique was unorthodox andour approach to its methodology pragmatic rather than academic. The Delphi techniqueserved as a tool and as a motivator for both the teachers and the students. The main purpose

Training needs as seen bythe students applying forthe training programme.


was to develop the practice of planning substance abuse work training. We wanted tomake use of the applicants’ solid, long-term experience of work in health care and socialservices. We also anticipated involvement in the development of their own trainingprogramme to foster commitment and to encourage the students to acquire further skillsand knowledge. A broader base of expertise would have been available if the panel hadbeen formed of experts of substance abuse work and substance abuse training. Contactinga larger panel of experts was, however, not feasible due to the tight planning schedule.

Student recruitment and development of the course outline

We started work on the course outline in spring 2001, at the same time as the studentrecruitment process. Three Delphi rounds were conducted to outline the contents for thespecialisation programme.

For the first round, a questionnaire was designed in which the applicants were asked todescribe in short essays their views of the basic qualifications required in substance abusework and about the qualifications required in the future. Basic qualifications refer to skillsand competencies that are needed already now. Future qualifications are skills andcompetencies that will be needed more in the future than today. (Metsämuuronen 2000).The questionnaire was sent to the applicants along with the application form, to be returnedtogether. Essays were handed in by 16 applicants. The essays were analysed and thequalifications mentioned were grouped according to similarity.

For the second round, a Likert-style questionnaire was designed listing the qualificationcategories identified in the first round. Respondents were asked to indicate on a five-pointscale the importance of each of the categories (1= the least important, 5= the mostimportant). The questionnaire was returned when the applicants came to the school for aselection interview. Questionnaires were returned by all interviewed applicants (n=25),although some of them did not participate in the first round. The Likert-style questionnaireused in the second round resulted in a quantitative weighing of the qualifications.

The third round was conducted in the form of group interviews with the applicants in May2001. The applicants discussed among themselves in groups of 3-5 persons and wereinstructed to reach agreement about the three most important qualifications in substanceabuse work. The second-round questionnaire was used as a checklist. We observed thediscussion and decision-making process and assessed the applicants’ interest in studyingsubstance abuse work. The number of students for the specialisation programme was limitedto 18, which was also the number of students admitted.

We conducted an analysis of the responses given in the second round and of the results ofthe group discussions. The most important qualifications in substance abuse work as seenby the students were thereby identified, and subsequently used as central themes in thespecialisation programme. The course outline was formulated in August 2001.

The Delphi technique suited well to be used as a tool for training programme development.The approach resulted in a dialogic relationship between the applicants and the teachersand provided the applicants with an opportunity to exchange ideas about the qualificationsrequired in substance abuse work.

Content and implementation of the specialisation programme

The study programme was structured around broad themes, each with several study sections.The study sections ranged from one credit to five credits (1 credit = 40 hours of work).The methods used included work in classroom setting, assignments and individual study.

The first theme consisted of introductory studies and covered general aspects of polytechnicstudies, use of information technology, strategies for information seeking and differentlearning strategies. A personal learning plan was drawn up for each student. The processof drawing up such a plan involves discussion about the student’s background and interests,their goals in training, options for internship, and possible subjects for the developmentproject to be done during the training. During the introductory studies, as well as later

Training needs analysis asthe basis for developingtraining contents.

Pirkanmaa Polytechnic’sspecialisation programme insubstance abuse work:student-centred training forhealth care and social workprofessionals


on, we stressed the importance of the personal learning process and of linking the acquiredknowledge and skills to one’s own experiences and one’s own professional identity. Attitudesplay a central role in substance abuse work and the examination of one’s own attitudes isessential to developing professionalism and quality in the services provided to clients.

Especially at the start of the training programme, there were strong expectations from thestudents that we as “teachers” provide them with state-of-the-art knowledge. The studentsexpected to hear facts about phenomena, effects and treatments. Many students seemedstuck to a passive view of learning where knowledge is simply received. The teacher toocan easily fall in the trap of simply lecturing the information to the students. Addictiontraining needs to move beyond the view that “all work falls to the teacher” and encouragestudents to process their own attitudes, emotions and work practices. Each student mustbe guided to being an active producer and processor of knowledge. We as teachers faced asimilar challenge: the need for a continuing examination of own attitudes and competenciesand of the contents of the training.

Interaction and co-operation skills formed an important theme in the training: we learnfrom each other. At the start of the training, special emphasis was given to group formationso as to foster an atmosphere of security and confidentiality. Some assignments were donein small groups in order to foster co-operative learning. Feedback from the students waspositive although group work also involved problems with timetables, logistics, family life,and shift work. In any case, solving problems related to co-operation is something thestudents will need to do in work life.

The largest component of the training was devoted to basics of substance abuse work,including information about substance use, legislation, preventive work, treatment andrehabilitation as well as issues related to co-operation and coping at work. These topicswere approached through lectures, joint discussions, lectures by experts, role-play anddistance assignments. Study visits were done in groups or individually. An important aimwas to encourage the students to reflect on their own work and competencies and to usetheir own work and experience as a context for applying the new information. An importanttask for us as teachers was to question issues and interpretations.

The specialisation programme included a four-week internship, involving supervised workin the student’s own workplace or in substance abuse services in the public sector or inthe 3rd sector, for example in non-profit associations or projects. Internship places werechosen as far as possible according to the students’ objectives and wishes. It was also possibleto do an internship abroad—this was arranged thanks to contacts with Transdrug partners.When the internship took place in the student’s familiar work setting, the aim was to finda new angle for developing work practices.

In most cases the internship was linked with the development project done during training.The development project equalled five credits and focussed on developing substance workpractices in the student’s own work community or some other topic that fosters competencein substance abuse work. The aim was to combine theoretical and practical knowledge andto recognise linkages between the different topics encountered during training.

Effectiveness of training

At the end of each term we gathered feedback from the students and used it to adjusttraining contents and methods of study. In the final evaluation in the fall of 2002 thestudents were presented with the same questions about basic and future qualificationsthat were used in the application phase. The essays written at the end of the studies showedprofessional development: the answers regarding substance abuse work were moreknowledgeable and more concrete. The students showed a more in-depth view of the contentof substance abuse work; they had gained new knowledge and had learned to understandcomplex wholes. The students felt more prepared for substance abuse work and for addressingsubstance use with clients and families. Students’ views of basic qualifications centred oninteraction and communication skills and on a broad competence in substance abuse work.Future qualifications, in their view, included above all skills to influence attitudes, especiallyregarding alcohol use, preventive work, treatment of young drug users and child protection.

• Self-reflection• Active learning• Interaction• Co-operation• Linkages betweentheory and practice

Pirkanmaa Polytechnic’sspecialisation programme in

substance abuse work:student-centred training forhealth care and social work

professionals


Sharing experiences among the student group was considered a good learning method.Experiences stemming from different work contexts contributed to an in-depthunderstanding of substance abuse work. Real-life experiences were brought into play injoint work on assignments. A reflective relationship between work and studies wasconsidered fruitful. The students ceased to ask for expert lectures as they realised thatthey are able to find information by themselves and learn from peers in a group. Skills forfinding information on the Internet improved and the threshold for making use ofinternational web sources was lowered.

The specialisation programme contributed to students’ career development. Several studentswere nominated as the person in charge of developing substance abuse work in theirworkplace. Three students who were unemployed at the start found jobs in addictionorganisations. Some students’ status was changed from contract worker to employee. Onestudent was assigned to set up a new addiction clinic for families with children. Theprogramme was thus effective in terms of improved employment opportunities and increasedresponsibility. This may also indicate that there is a severe lack of substance abuse expertsin health care and social services.

Experience from the specialisation programme convinced us that it does make sense toimplement substance abuse work training in the form of joint courses for health care andsocial work professionals. Substance abuse work is multi professional in nature and involvesnetworking with other actors in the field—working alone is not a good option. Co-operationis a source of richness also in training. It is important to make use in training of students’expertise and experiences.

Participation in the Transdrug project was a motivating factor for us as teachers. The projectprovided a vantage point on substance abuse work in partner countries: it broughtinformation about substance use and about the contexts and approaches of substance abusework. We were able to make use of project related materials in the development of trainingcontents. The project contributed to increased awareness of sources of information on theInternet and of the possibilities of e-learning, and lowered the threshold for using materialsin English. Contacts with Transdrug partners will be useful also in the future in organisinginternships for students or study visits for teachers.

References

Metsämuuronen, J. 1997. Delfi-tekniikka sosiaali- ja terveydenhuollon osaamistarpeidentutkimisessa. http://www.mol.fi/esf/ennakointi/metodit/jmdelfi.htm

Metsämuuronen, J. 1997. Documentation of the Anticipation Practice/Method.http://www.mol.fi/esf/ennakointi/metodit/SOTEMETO.htm

Metsämuuronen, J. 2000. Maailma muuttuu - miten muuttuu sosiaali- ja terveysala? Sosiaali-ja terveysalan muuttuva toimintaympäristö ja tulevaisuuden osaamistarpeet. 2. tarkistettupainos. Sosiaali- ja terveysministeriön, Opetushallituksen, Stakesin ja Suomen kuntaliitonyhteisjulkaisu, Oy Edita Ab, Helsinki.

Metsämuuronen, J. 2001. The Delphi technique. Lecture in Transdrug Work Meeting inHelsinki, February 2001.

Pirkanmaa Polytechnic’sspecialisation programme insubstance abuse work:student-centred training forhealth care and social workprofessionals


Increased understanding of aspects of substance abuse work

• the diversity in substance use• recognising a substance abuse problem• approaches and forms of treatment• preventive and rehabilitative work• drug use and work with drug users• child protection

Enhanced skills

• encountering and interaction with the client has become easier• giving attention to the client’s next-of-kin• finding information on the Internet, finding research-based information• guiding and motivating the client has become easier• responsibility for and development of substance abuse work in one’s own workplace• a broader view of the treatment of a substance abuser• more confidence in one’s work• courage to address the issue• learning to express feelings more directly• applying substance abuse work in one’s own line of work• enhanced professional network

Change in attitudes

• more deep-going reflection on own attitudes• interest in and motivation for substance abuse work• one notices more things than before• accepting the drug user “as is”• understanding the subtle nature of substance abuse work• professional development as a joint effect of studies and work experience• more courage to embrace what’s new• growing as a person

Especially appreciated

• learning from other students’ experiences• “peer group” discussions• more structured view of substance abuse work• the societal aspects of substance abuse work• getting a job / changing jobs thanks to the training• being nominated as the person in charge of substance abuse issues in the workplace

Students’ views of their professional development during the trainingPirkanmaa Polytechnic’sspecialisation programme in

substance abuse work:student-centred training forhealth care and social work

professionals


SUBSTANCE ABUSE WORK COMPETENCE THROUGH POSTGRADUATE STUDIESAT A SOCIAL SERVICES POLYTECHNIC

Terhi Laine and Antti Weckroth

In our society, substance abusers in particular live under the threat of social marginalisation.Of this group of people, the majority are heavy drinkers, but the relative share of drugusers and poly substance abusers has been on the increase until the late 1990s(Päihdetilastollinen vuosikirja, 2001; Partanen, 2002). Consumption of alcohol and drugshas increased since the mid 1990s, as have the various harms caused by substance abuseand the number of substance abusers needing services. At the same time, the life situationsand needs of the people needing substance abuse services have changed. The life and socio-economic situation of drug users in particular are even more difficult today, compared tosubstance abusers in general (Hakkarainen, 2002). Estonia’s EU membership and a possiblenew taxation policy may cause an increase in substance use and thereby in the need forservices in the near future (Heikkilä, Kaakinen, Korpelainen, 2003).

This situation challenges Finnish society to develop the entire service system in such away as to prevent social marginalisation. In the social services sector, this means that inaddition to working with clients, substance abuse workers must critically monitor andinfluence decision-making in society. Through policies aiming to influence substance useand regulate the substance abuse services, the government attempts to maintain the welfareof the citizens and prevent risks inherent in intoxicant use. Since the increase in drug usein the 90s, there has been a shift in government policy from a client-based provision ofservices towards a more control-centred approach (Kaukonen, 2000). Part of this policychange is the redefinition of substance abusers, and drug users in particular, as peoplewho are socially marginalised in a particular way. This social exclusion is the explanationgiven for the need for support and stronger control (Helne 2002).

A report on the national Development Programme on Social Services states that theimplementation of the substance abuse services clients’ right to service can be influencedthrough developing the premises for and principles of the services offered, and that theneed for specialist medical care can be decreased through an increase in social servicesassistance (Heikkilä & al., 2003). Despite this, in the past few years the services offeredto drug users in particular have centred on providing psychiatric care (Kaukonen, 2002).

However, in the long run there are other ways of creating substance-abuse policy andpreventing social marginalisation. One way is through building a society of learning andtraining (Filppa, 2002; Heiskanen, 1999). In a situation such as described above, we findthe main reasons for offering a polytechnic postgraduate degree that specialises in substanceabuse work in the social services sector. According to the Postgraduate Polytechnic DegreesAct (645/2001), the aim of a postgraduate degree is “to offer the student the necessarycompetence to handle duties involving development as well as other jobs that demandspecial expertise, and to do this in accordance with the demands posed by the developmentof polytechnics and of the work life”. In the postgraduate degree course Intoxicants andSocial Marginalisation at the Diaconia Polytechnic (Diak), an attempt has been made tomeet this challenge through looking at intoxicants and the concept of marginalisation toan extent that a basic degree course would not allow, by linking these themes with an in-depth approach to the development of work life and by requiring the students to presenta thesis in the form of a development project of their own.

Diaconia Polytechnic represents the non-university sector of higher education. With some2,800 students, it is Finland’s largest polytechnic for social services studies. One of itscore values is siding with those who, in one way or another, are weak in society. The aimof the social services postgraduate degree course focussed on intoxicants and socialmarginalisation is to give students the competence to develop work practices in the fieldand in the long term, to help them find their place in the field of substance abuse servicesand use their influence and develop the services.

The first group of postgraduate degree students in social services began their studies inthe autumn of 2002. The group is made up of 17 social and health care services professionals,

Diaconia Polytechnichttp://www.diak.fi/english/index.html


combining a wide range of orientation in substance abuse issues. The students are requiredto have a polytechnic-level of competence in social services. In the case of the firstmultidisciplinary group this has meant that the participants include a nurse with apolytechnic degree and a Bachelor of Business Administration who have worked in socialservices. The other participants all have degrees in social services, either from a polytechnicor a university. Two have worked with specialist services for substance abusers, but mostwork in other parts of the social services system, where they constantly and increasinglycome into contact with addiction-related problems. The students want more informationand improved skills; they think about their own professional growth as well as developingtheir own work practices and workplace. The students will finish the course at the end of2004. The next postgraduate group will begin its studies in the autumn of 2004.

Contents of postgraduate degree on Intoxicants and Social Marginalisation

The degree programme is realised as multiform studies that link various learning methods,such as distance education and independent study. Between the intensive study periodswith the whole group, the students work on their development projects or other assignmentsrelated to their studies. A virtual learning room has been created for communicationbetween the responsible teachers and the students. The virtual learning room works as anotice board and the students can use it to discuss their study tasks. The site also hoststhe reference literature central to the postgraduate course as well as links to pertinentInternet sites and library reference services. Furthermore, part of the training is realisedin the form of video sessions, in which Diak’s units in Helsinki, Pori, Lahti and Pieksämäkiparticipate.

The degree course consists of four study modules: professional challenges of marginalisationprevention and care for intoxicant abusers (20 credits); professional challenges of drugwork (12 credits); methods for development projects (8 credits); and the thesis project(20 credits).

Diak’s Research and Development Unit, under the Research Manager, is responsible for themethods training that encompasses various methods of research and development work.An agreement is made with particular workplaces where a thesis project is to be undertaken.The idea is that the development task in a work environment defines the research.

Here we see the difference between a university thesis and a polytechnic basic degreethesis project. The university thesis is defined by the student’s chosen branch of study,whereas the postgraduate study thesis project is clearly practice-oriented andmultidisciplinary. The polytechnic basic degree thesis is not as clearly linked to thedevelopment of work as is the postgraduate degree thesis project, where the developmentof work is also emphasised in the assessment, which evaluates how strongly the developmentwork is part of the thesis project and what has really been accomplished in the workplace.

Developing work in real life

Subjects for the thesis projects include: school; intoxicants and social marginalisation;community service and substance abuse work; persons taken into custody and developmentof substance abuse work; intergenerational linkages in child protection work; social workamong HIV-positive clients. Some of the students have begun their studies with theintention of developing work practices in their own workplace, which makes theirpostgraduate studies a clearly defined workplace project. Others have seen their professionalcareer as an individual project, using the postgraduate studies to move on to new areas ofwork. In those cases, the students do their development project within the polytechnic’swork life development project.

The competence and expertise developed in the postgraduate degree comes close to theconcept of socially shared, collective expertise described by Forsberg (1998), linked to co-operative learning and development within a work organisation. This is especially truewhen the development work is done within the student’s own workplace, which enablesthem to learn together with their colleagues. If postgraduate students do their developmentproject within the polytechnic’s work life development project, they have the role of an

The degree programme aimsat an expertise that is• self-reflective• shared• network-based

Substance abuse workcompetence throughpostgraduate studies

at a social servicespolytechnic


outside innovator in the workplace, and the community in which the student learns isthat of the development team of the polytechnic.

In the social services sector, there is a lot of discussion about self-reflective expertise,which unites research- and experience-based knowledge in the self-assessment of work.Narrow expertise based on a single area of social services work is felt to be insufficient.What is important is an active process of research and discovery, on which a social servicesworker and their colleagues embark together with the client (Mutka, 1988; Satka, 1999).In the polytechnic postgraduate degree, particularly in the thesis project, there is constantinteraction between research- and experience-based knowledge. Producing such mutuallyinformed knowledge can be seen as a move away from obtaining and transferring informationtowards creating knowledge, thereby towards a deliberating and network-based expertise(Saaristo, 2000). In this expertise, experience-based knowledge is united with explicit,scientific information and as a result a new kind of knowledge is created. The thesis projectsof the postgraduate degrees are also a means of conceptualising and externalising knowledgethat is born out of work practice.

Follow-up and assessment of the postgraduate degree

An external follow-up group has been appointed to monitor the still experimentalpostgraduate degree. The chair for the group is Jorma Niemelä, Managing Director of theFinnish Blue Ribbon. Other members are representatives of the Ministry of Social Affairsand Health; the Church Council; STAKES, the National Research and Development Centrefor Welfare and Health; the National Research Institute of Legal Policy; the HelsinkiDeaconess Institute; the Jyväskylä Area Substance Abuse Services; and the youth workcompany Nuorten Palvelu Oy.

The responsibility for planning and implementing the postgraduate degree has resided withthe polytechnic’s Head of Department in Social Services Studies and a researcher/trainingplanner from the Järvenpää Addiction Hospital. The planning and implementation has beendone in close cooperation with representatives of the work life. The students have theirown representation in the committee responsible for the administration aspects of thedegree.

The postgraduate degree is assessed according to the benchmarking principle. Benchmarkingis used to compare similar components against an agreed standard of merit (Tuomainen &Tuomainen, 2003, 168). The benchmarking is done in cooperation with the social servicespostgraduate degree programmes at the Kemi-Tornio Polytechnic and the SeinäjokiPolytechnic. The areas of assessment will be decided in June 2003, and a common assessmentday will be held in the autumn of 2003.

References

Forsberg, H. 1998. Perheen ja lapsen tähden. Etnografia Kahdesta lastensuojelunasiantuntijakulttuurista. Lastensuojelun keskusliitto. Tampereen yliopisto.Yhteiskuntatieteellinen tiedekunta. Gummerus Kirjapaino Oy. Saarijärvi.

Filppa, V. 2002. Kansalaisten tarpeista sosiaalialan erityisosaamiseen. Osaamisenmonimuotoisuutta etsimässä. Sosiaali- ja terveysministeriön selvityksiä 2002:9. STM.Helsinki.

Hakkarainen, P. 2002. Huumekulttuurin muutos ja huumekuolemat. In: Kaukonen, O.,Hakkarainen, P.: Huumeidenkäyttäjä hyvinvointivaltiossa, 110–136. Gaudeamus.Yliopistopaino. Helsinki.

Heikkilä, M.; Kaakinen, J.; Korpelainen, N. 2003. Kansallinen sosiaalialan kehittämisprojekti.Selvityshenkilöiden loppuraportti. Sosiaali- ja terveysministeriön työryhmämuistioita2003:11. STM. Helsinki.

Substance abuse workcompetence throughpostgraduate studiesat a social servicespolytechnic

Järvenpää AddictionHospitalwww.a-klinikka.fi/jss/english/index.html


Heiskanen, T. 1999. Informaatioyhteiskunnasta oppimisyhteiskunnaksi? Työelämännäkökulma keskusteluun. In: Eteläpelto, A.; Tynjälä, P. (eds.): Oppiminen ja asiantuntijuus.Työelämän ja koulutuksen näkökulmia 25–47. Juva.

Helne, T. 2002. Syrjäytymisen yhteiskunta. STAKES, Tutkimuksia 123, Helsinki.

Kaukonen, O. 2000. Päihdepalvelut jakautuneessa hyvinvointivaltiossa. Helsinki: STAKES,Tutkimuksia 107. Gummerus Kirjapaino Oy.

Kaukonen, O. 2002. Päihdepalvelupolitiikka ja hyvinvointivaltion muutos. In: Kaukonen,O., Hakkarainen, P. Huumeidenkäyttäjä hyvinvointivaltiossa, 137–166. Gaudeamus.Yliopistopaino. Helsinki.

Murto, L. 2002. Päihdehuollon suomalainen malli kansainvälistyvässä ympäristössä. In:Kaukonen, O., Hakkarainen, P. Huumeidenkäyttäjä hyvinvointivaltiossa, 167–192.Gaudeamus. Yliopistopaino. Helsinki.

Mutka, U. 1998. Sosiaalityön neljäs käänne. Asiantuntijuuden mahdollisuudet vahvanhyvinvointivaltion jälkeen. SoPhi. Jyväskylän yliopisto. Jyväskylän yliopistopaino.Jyväskylä.

Päihdetilastollinen vuosikirja. 2001. Alkoholi ja huumeet. STAKES, Helsinki.

Partanen, J. 2002. Huumeet maailmalla ja Suomessa. In: Kaukonen, O., Hakkarainen, P.:Huumeidenkäyttäjä hyvinvointivaltiossa, 13–37. Gaudeamus. Yliopistopaino. Helsinki.

Postgraduate Polytechnic Degrees Act (645/2001)

Saaristo, K. 2000. Avoin asiantuntijuus. Nykykulttuurin tutkimuskeskuksen julkaisuja 66.Jyväskylän Yliopisto. Gummerus Kirjapaino OY.

Satka, M. 1999. Tasavertaistuvaa tiedontuotantoa kohti? JANUS. Sosiaalipolitiikan jasosiaalityön tutkimuksen aikakauslehti. No. 4/99. Vol. 7, 273–278.

Tuomainen, R; Tuomainen, M. 2003. Benchmarking-arviointi ja erikoissairaanhoidonalueelliset erot. Yhteiskuntapolitiikka, 2/2003, Vol. 68, 166–278.

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at a social servicespolytechnic


THE A-CLINIC FOUNDATION ’S TRAINING ACTIVITIES

Tuula Annala

The A-Clinic Foundation’s core mission is to improve the situation for those who sufferfrom substance abuse problems, and for their next of kin and significant others, by offeringa varied range of substance abuse services. A-Clinic Foundation is also among the foremostdevelopers of addiction work and providers of training in addiction issues. The Foundationhas a long history and a central role in providing training courses in addiction work methodsand other specialised skills for health care and social work professionals. In the last years,the emphasis has been on developing training in the treatment of drug users.

The aim of the training activities is to foster the renewal of work methods, the disseminationof innovations developed in projects and in day-to-day work and the development ofcompetencies among addiction service personnel. Core activities consist in:• provision of training services (by regional units, central office, projects)• development of training in the treatment of problems related to drug use or poly-druguse (development through projects)

• staff training and development.

Training anchored in practice-based experience of addiction work

The A-Clinic Foundation has around twenty regional units in different parts of the country,half of which participate in the provision of training, co-ordinated by the central office.The regional units are operated independently and are free to offer training servicesaccording to their resources. Demand for courses designed for specific agencies or groupsincreases steadily and, in fact, surpasses the Foundation’s capacity to deliver training.

The Foundation’s network of trainers includes 50 persons. Most work as trainers part-time,along with their chief occupation. Full-time trainers are the exception rather than therule. The central office’s training unit has two full-time employees and one part-timeassistant. The trainers’ solid expertise is based in hands-on experience of addiction work.The link between training and work helps anchor training contents in real-life experiencesthat can be processed and structured through training and development activities. Differenttypes of projects have played a central role in the development of the Foundation’s trainingprogramme.

A varied training programme

The A-Clinic Foundation’s training has a long tradition of a multi-professional approach inmethods training. The emphasised topics include family-centred and network-centred workmethods, cognitive therapies as well as solution-oriented and resource-mobilisinginterventions. In 2003 the topics ranged from addiction therapy training to training indrug use and poly-drug use issues, to training in the use of specific methods, and to worksupervision training. Training activities also include development days and work conferencesfor different categories of professionals. The national training programme published bythe Foundation has offered 70-80 training events yearly. In addition, a range of tailoredtraining courses have been delivered by regional units, the central office or projects.

Target groups for the Foundation’s training include personnel in specialised addictionservices and, in an increasing number, professionals working in health care and socialservices or in other positions where professional substance abuse work is demanded. Thetraining often attracts also voluntary substance abuse workers. The target groups for tailoredtraining are even more varied since substance abuse training is commissioned by a widerange of workplaces.

Day-to-day work experiencesinteract with training


The A-Clinic Foundation’s training (2004) is grouped in five main categories:• Training in addiction work (formerly addiction therapy training)• Training in drug use and poly-drug use issues• Methods training• Development days and work conferences for professionals• Tailored training

Renewed training: A-Clinic Foundation’s training programme in addiction work

The A-Clinic Foundation has offered training in addiction therapy for some 10 years. InMay 2003, this training programme was renewed and a new continuing training programmein addiction work (240 hours) is to be launched in 2004 by several regional units. Thetraining programme comprises two main parts: basic training and training in specialisedskills. The basic training is intended for professionals who encounter problem substanceusers and for students in the health and social services field. Completion of the basictraining, or demonstration of similar competence acquired elsewhere, is required beforeone can take a course in specialised skills. The modes of training include classroom daysand distance learning, possibly also web-based study.

The training programme in addiction work covers the following areas:

Part 1. The knowledge basis and ethics• Substance use, history, legislation• Encountering and interaction with the client• Values and ethics• The processual nature of substance use problems• One-day study visit to a specialised addiction service unit

Part 2. Specialised skills• Managing the process of change and crisis work• Family-centred work methods• The group as a resource• Network-centred work methods

Linkages between training and development projects

The development of A-Clinic Foundation’s training activities has for more than 15 yearsrelied on the input of competent trainers on the one hand and of training-related projectson the other. The projects carried out by the A-Clinic Foundation nearly always involvesome form of training. Recent, specifically training related projects co-ordinated by thecentral office have included the Huuko project (a project to develop continuing trainingin the treatment of drug problems), the Monikko project (a training and development projectfocussed on the prevention and treatment of poly-drug use related problems), the Transdrug-project and the development of e-learning approaches within the Virtual Clinic project.

The national Huuko network was created in co-operation with other organisations in theaddictions field, with support from the Ministry of Health and Social Affairs. The networkis formed by trainers and training planners who work at the regional level to promotetraining in the treatment of drug problems. Members of the network have received trainingand support from the Huuko project (2001-2003). Around 100 persons - experts in addictionwork - have participated in the training for trainers organised by the project. Regionalwork groups have been set up to plan and organise regional training courses tailored tothe professionals’ needs. In most cases, the training organised at regional level has aimedat enhancing basic knowledge and skills. The number of participants is more than 1200,mainly professionals in health care and social services and teachers in this field.

The Monikko project (1999-2002) involved local and regional training and consultation inpoly-drug use related topics. Supported by Finland’s Slot Machine Association, the projectwas implemented by the A-Clinic Foundation’s regional/local units in five municipalities.The project also sought to promote regional level networking of professionals and agencies.

The A-Clinic Foundation’straining activities

RAY -Finland’s Slot Machine

Associationhttp://www.ray.fi/


The Monikko project was instrumental to more than 100 training or development eventsthat attracted a total of more than 4000 participants. The project’s products include amanual for the treatment of drug problems (forthcoming in fall 2003) especially intendedfor outpatient services.

Poly-drug use was touched upon also in the Transdrug project (2001-2003), supported bythe EC Leonardo da Vinci programme. The project joined together 18 organisations fromfour countries who all have a stake in the development for high quality training forprofessionals working with substance use-related issues. The project focussed on developingtraining needs assessment methods. The methods as such were not new: they were standardresearch and group work methods, familiar from a variety of contexts. What was new wasthat the methods were used for a systematic assessment of training needs in the addictionsfield. In Finland the target groups included addiction professionals as well as professionalsin health care and social services.

Development of e-learning approaches within the Virtual Clinic project aims at testing outand applying web-based techniques in the A-Clinic Foundation’s training activities. TheFoundation’s virtual learning environment has been created using the WebCT software.Training in the use of the WebCT software and in the development of online course materialhas been organised for the Foundation’s trainers and other interested persons. Pros andcons of combining a virtual classroom with face-to-face teaching have been explored inthe context of the Foundation’s addiction therapy training, of training offered by projectsand of training implemented in co-operation with vocational training institutions, includinga substance abuse work course delivered in English. An entirely web-based training coursedesigned for the health care and social services personnel of a small municipality servedas a preliminary phase in the development of a drug action programme for the municipality.

The WebCT platform has also been used to create shared virtual workspaces for specificpersonnel groups such as addiction nurses, social workers or cooks and cleaners. Theworkspaces are meant to support staff training, communication and exchange betweenthe professionals, and individual study.

Challenges for the training

The strengths in A-Clinic Foundation’s training include multiple expertise, practicalexperience, a client-centred approach, teamwork, tradition and core values. Nationalnetworks and international contacts have an important supporting function. A flexibleorganisation and a minimum of bureaucracy have also contributed to the development ofa varied training programme.

The process of training planning is often quite slow. Quicker reactions to changes in thefield and more flexibility are needed: the pace of change in substance use and in clients’needs has been rapid in Finland over the past years. Opportunities for the development ofA-Clinic Foundation’s training activities arise from an immense demand, co-operation withvocational training institutions, projects, networks and a focus on specialised expertise.

Challenges in the near future include:• Securing a pool of trainers and a new generation of trainers.• Developing methods training (long term training processes, on-the-job learning, e-learning).

• Strengthening multi-professional work.• Developing co-operation with other training organisations and non-profit organisationsin the addictions field.

• Developing ICT skills• Developing more efficient marketing strategies.

A series of new work groups have been set up, including a visions group and an e-learninggroup, to outline common strategies and lines of action for the training activities. The e-learning group focuses on the potential of web-based techniques in A-Clinic Foundation’straining activities. The group includes trainers already familiar with e-learning approaches,trainers interested in the new techniques as well as representatives of regional units and


Keys to success:continuous developmentand networking


the central office. The visions group is similarly formed by representatives of regional units,the central office and projects. The future-oriented visions group focuses on the prioritiesin training activities and on co-ordination. In addition, the trainers convene a few timesa year to plan future activities. The planning group and the trainers involved in the trainingprogramme in addiction work also convene in yearly meetings.

Increased emphasis on networking

A wide range of professionals need skills for substance abuse work. Professionals workingin specialised addiction services are counted in thousands. Substance abuse related problemsare encountered also in general health care and social services, in child protection andyouth work, in probation services, in training institutions and in workplaces.

The basics of substance abuse work have remained unchanged for a long time and areunlikely to change much in the future: the professional should be motivated to work withclients and should possess an adequate amount of knowledge and an adequately variedrepertoire of skills. The professional should be able to relate sympathetically to the client,to listen to the client’s needs, to assess the client’s ability to change, to strengthen theclient’s own resources and to motivate the client to work towards goals that curb the harmfrom substance use. Strengthening this type of abilities will remain the goal in A-ClinicFoundation’s training activities also in the future.

The importance of co-operation between addiction services and the vocational trainingsector has been brought to the fore by the Transdrug project among others. Addictionservices need well-trained and motivated staff. Training institutions, for their part, needup-to-date information on clients’ needs, on professionals’ needs for training and onprofessionals’ views regarding substance abuse work. This calls for increased co-operationbetween services and the training sector also in the future. In the field of professionaltraining the A-Clinic Foundation has co-operated, among others, with universities, summeruniversities, polytechnics, vocational institutes for health care and social work, folk highschools, Local Government Training Ltd, the Finnish Society for Addiction Medicine, theAddiction Nursing Network and other non-profit organisations in the addictions field.


Local Government TrainingLtd specialises in training

for staff working at alllevels and in all sectors in

local and regionalgovernment and their

services.

http://www.kuntakoulutus.fi/


A-Clinic Foundation’s training programme in addiction work

Part I: The knowledge basis and ethics, 10 days of training in classroom (70 hours),assignments and literature (10 hours)

Part II: Specialised skills, 13 days of training in classroom (91 hours), distance work (33hours) and work supervision (36 hours)

Part I constitutes basic training and is intended for professionals who encounter problemsubstance users and for students in the health and social services field. Completion of thebasic training, or demonstration of similar competence acquired elsewhere, is requiredbefore one can take a specialised skills course from Part II. The modes of training includeclassroom days and distance learning, possibly also web-based study. The extent of theprogramme is 240 hours. The courses start in 2004.

1 The knowledge basis and ethics

1.1 Substance use, history, legislation (2 days)

Objective: To increase knowledge about substances and their effects and aboutdetoxification methods. To introduce the students to the history of substance useand substance abuse work and to the pertinent legislation.

1.2 Encountering and interaction with the client (2 days)

Objective: To explore interaction and pertinent theories at individual and group level.

1.3 Values and ethics (2 days)

Objective: To introduce the students to the ethical principles of substance abusework.

1.4 The processual nature of substance use problems (3 days)

Objective: To examine perceptions of and attitudes towards substance users and toincrease understanding of the processual nature of substance use problems.

1.5 One-day study visit to a specialised addiction service unit (1 day)

2 Specialised skills

2.1 Managing the process of change and crisis work (3 days)

Objective: To understand the role of the professional in the process of change and incrisis work.

2.2 Family-centred work methods (4 days)

Objective: To encourage the student to encounter the family and to work with them.

2.3 The group as a resource (3 days)

Objective: To give an overall view of the structure and methods of interaction in agroup and develop skills to manage groups.

2.4 Network-centred work methods (3 days)

Objective: To increase skills for network-centred work methods.



THE HUUKO PROJECT: A NATIONAL AND REGIONAL EFFORT TO DEVELOPCONTINUING TRAINING IN THE TREATMENT OF DRUG PROBLEMS

Maria Inkinen

The Huuko project (2000-2003), a broad-based effort to develop continuing training inthe treatment of drug problems, was started in October 2000 with support from the Ministryof Health and Social Affairs. The funding is connected to the national plan for thedevelopment of health care and social services 2000-2003. The national plan sets thedevelopment objectives and indicates the required actions as well as the actors. ObjectiveNo. 12 involves enhancement of the competence of health care and social services personnel.Action recommendation No. 63 focuses on the need to develop continuing training in thetreatment of drug addiction. Non-profit organisations in the addictions field were invitedto present, under the leadership of the A-Clinic Foundation, a proposal for a training projecton this topic.

A range of addiction organisations (A-Clinic Foundation, Helsinki Deaconess Institute,Tyynelä Development Centre/Finnish Blue Ribbon, Myllykallio Development Centre/Myllyhoito Association and Irti Huumeista, a voluntary drug prevention organisation) andseveral training organisations joined in. The project’s advisory board includes alsorepresentatives of the Ministry of Health and Social Affairs, of the National Research andDevelopment Centre for Welfare and Health (STAKES), and of the Association of FinnishLocal and Regional Authorities.

The broad-based partnership convened in a brainstorming seminar to draw up plans foraction. The Huuko project was seen to involve three intersecting areas of action:• Training and support for key persons in addiction work.• Support for regional training and co-operation.• Information service for training and development related to drug problems.

The Huuko project has offered key persons training and other support to promote regionalco-operation and the development of regional training that meets the needs of the professionalcommunity. The national Huuko network of key persons and multi-professional regional workgroups, formed on key persons’ initiative, have been instrumental in the development oftraining. The core idea has been to mobilise regional resources to enhance the competencein the treatment of drug problems in a way that best meets the regional needs.

The planning for a training programme offered to the key persons started in 2000 in co-operation with the training team of A-Clinic Foundation’s Therapeutic CommunityHietalinna. The publication of a WANTED notice for professionals interested in trainingand development related to drug problems gave as a result a list of some 200 interestedpersons. In the spring of 2001, the two first groups received training in the planning ofregional training. The first regional work groups were also started in spring 2001.

Training for key persons to develop training skills and to increase understanding ofdrug problem treatment

The development of key persons’ training skills was given emphasis especially at the startof the project in order to strengthen national and regional training resources by increasingthe number of experts who are also able to provide training.

In 2001 the training programme for key persons consisted of two 5-day seminars organisedfor three separate groups. In 2002, similar seminars were offered also separately. The contentof training has been regularly evaluated and modified based on the feedback fromparticipants. The “opening seminar”, which at the start consisted in introducing theparticipants to the training offered by addiction organisations, was gradually transformedinto a few days’ course in the range of approaches available for the treatment of drugproblems. A need for training that gives or updates an overall view of drug problemtreatment was evident both among specialised addiction services personnel and amongprofessionals working in general health care and social services. In all some 180 personshave taken the course The spectrum of drug problem treatment methods.

A-Clinic Foundationwww.a-klinikka.fi/english/

index.html

Helsinki Deaconess Institutewww.hdl.fi/english/

index.html

Finnish Blue Ribbonwww.sininauhaliitto.fi

Myllyhoito Associationwww.myllyhoito.fi

Irti Huumeistawww.irtihuumeista.fi

Ministry of Health andSocial Affairs

www.stm.fi/Resource.phx/eng/index.htx

National Research andDevelopment Centre for

Welfare and Health STAKESwww.stakes.fi/english/

index.html

Association of Finnish Localand Regional Authorities

www.kunnat.net


The content of the training in the Planning and implementation of training was also modifiedto better meet participants’ needs. The latest version, a three-day seminar on Training skills (3days) has been considered highly successful in this respect. The course covers models of in-depth and goal-oriented learning, the planning and delivery of a lecture on a specific theme,teaching methods, the use of illustrative examples and materials, ethical issues in training,the assessment of training and the trainer’s personality as a tool in the teaching process. Inall, some 110 people have participated in the training skills seminars so far. The feedback hasbeen positive and the demand shows no signs of weakening. The Therapeutic CommunityHietalinna’s team has been responsible for organising the training in training skills.

The majority of those who have participated in the training offered by the Huuko projecthave been social therapists or nurses working in specialised addiction services. The resthave mainly been nurses working in psychiatric departments of hospitals or in prisons, orprofessionals working in social services, in specialised youth work, in drug prevention orin various projects. The participants also include several teachers from vocational traininginstitutions in the health and social services field. In sum, the participants are experts indrug problem treatment or in training, who possess the competence and the motivationfor training or for developing training programmes for other professionals in the field.

Twice a year (2 days in spring, 2 days in fall) a Huuko seminar has been organised for thosewho have participated in the training. The seminars have attracted some 40 participantsfrom around the country. The seminars have proven to be an important forum for exchange,discussion and further training that spurs the motivation to develop regional training.

A separate two-day seminar was organised in January 2003 for those teachers from thevocational training sector who have joined the Huuko network or who have been involvedin the training organised at regional level. Organised in co-operation with the Preventionof substance abuse group of STAKES, the seminar attracted around 40 teachers. Theprogramme comprised presentations on courses and training programmes, discussion andgroup work. The aim was to form an overall view of the status of training in substanceabuse work in vocational training institutions and polytechnics.

In formal vocational training, training in substance abuse work may be offered in thecontext of basic, specialist, post-degree or continuing training for occupations in the healthand social sector. The overall picture is fragmented and teachers are poorly informed aboutthe training and development going on in other schools and in other regions. The teachersparticipating in the seminar expressed a need for networking and for opportunities toupdate their knowledge and to get further training. In response to a call from theparticipants, a second seminar will be organised for the same target group in January 2004.

Regional training enhances competence and advances networking

The regional work groups set up in the framework of the Huuko project have includedrepresentatives from specialised addiction services, from general health and social services,from specialised health services and from vocational training institutions. A large part ofwork group members have participated in the training offered by the Huuko project. Aregional work group has been set up in 13 of the 20 regions in which members of theHuuko network are operating. In the rest of the regions, responsibility for the developmentof regional training rests on an active contact person, or a pair of resource persons, or ona regional network. In some cases regional training is developed in co-operation with otherlocal or regional projects. Detailed information about the forms of regional organisationwill be gathered in the fall of 2003.

Since fall 2001, the extent of the regional training in the treatment of drug problems organisedby regional groups or resource persons has increased rapidly. By April 2003, the total numberof training days was 87,5 and the total number of participants more than 3 500.

Nearly all training events have been designed for a multi-professional group. Some eventshave aimed specifically at enhancing networking and co-operation between professionalsworking in local/regional services. Other events have been designed for specific target groupssuch as personnel in somatic departments of hospitals, professionals working in psychiatric

The Huuko project: anational and regional effortto develop continuingtraining in the treatment ofdrug problems


care or in addiction services, or social workers and physicians in generalist services. Sometraining events have focussed on a particular subgroup of drug users or on a particulartreatment method. Core topics in the training events organised by the Huuko people haveincluded basics of interaction with the drug-using client, of early intervention and of thetreatment process. In some regions training days supported by the Prevention of death fromdrug overdose project have been integrated in the Huuko programme. Members of the Huukonetwork have been involved also in a number of training events organised by other agencies.

Based on the feedback received, the training organised so far has offered new informationfor some participants and an opportunity to update knowledge for others. Besides enhancingknowledge and skills, the training has strengthened motivation and provided an opportunityto get to know other professionals and services in the locality/region.

The Huuko ”headquarters” at the service of the training and development network

The Huuko network and the support functions developed during the project are meant toserve as more permanent structures for the development of drug problem treatment and relatedtraining.1 The resource persons representing expertise in drug problem treatment/ substanceabuse work, in health and social services or in training in the field have joined the networkout of their own interest and are motivated to develop drug problem treatment and relatedtraining. Professionals working in specialised addiction services tend to be among the mostactive members of the network. The core group is formed by 20 regional contact persons.

Exchange of information and mutual support are central to a professional network of experts,trainers and local/regional actors. The Huuko support services have been developed torespond to the needs and interests of the network. The support services essentially consistin gathering information and relaying it to network members and in providing consultationand motivation for their work.

An e-mail list ([email protected]) was established in March 2003 to servethe participants of Huuko training and others involved in local/regional Huuko activitiesas an information exchange channel.

In response to a call from the participants of Huuko training, a virtual Huuko workshop wascreated in November 2001 using the A-Clinic Foundation’s Internet-based e-learning platform(www.a-klinikka.fi > Nettipaja). A range of documents can be downloaded or printed outfrom the workshop: Huuko newsletters, project plans, a list of network members and theircontact information and a variety of forms, instructions, outlines of model training eventsetc. The number of network members visiting the workshop has been around 20 per month.

In April 2002, a web site (www.a-klinikka.fi/huuko) was launched to serve all professionalsin health and social services who have an interest in the development of drug problemtreatment and related training. The contents of the pilot web pages have been expandedgradually by adding information about current events and developments and other newmaterial. In the month of February 2003 the web site was visited 206 times, by 155individual visitors. Based on a survey of needs for web-based information among theparticipants of Huuko training, the most requested topics include current issues in drugproblem treatment, official documents, available treatment services, training and trainers,pertinent projects and literature. Of the 35 respondents, 60% worked in specialised addictionservices and 40% in other services.

The combination of training for trainers and support services organised at the nationallevel, of a nation-wide network of resource persons and of training organised at the local/regional level has worked well in the Huuko project. The project has contributed todiminishing the differences between regions in the availability of and funding for substanceabuse training. The provision of support for key groups in substance abuse work and furtherdevelopment of working methods will be important also in the future. An equally importanttask consists in strengthening a long-term approach in the assistance offered to drug usersin general health and social services and in enhancing competence and co-operation amongprofessionals.

1 A somewhat similar national

network and support functions are

run by STAKES in the field of drug

prevention -

www.stakes.fi/hyvinvointi/english/

pade/index.html

See also: Warpenius K: From project

chaos to flexible networking – a

utopia?

The establishment of a national

network of municipal substance abuse

prevention professionals. Nordic

Studies on Alcohol and Drugs, English

Supplement Vol. 20, 2003.

”Regional training, at itsbest, is one form of co-operation within the local/regional network of services,the ultimate aim of which isto enhance the functioningof the services and thequality of the treatmentprovided.”

www.a-klinikka.fi/huuko

The Huuko project: anational and regional effort

to develop continuingtraining in the treatment of

drug problems


DEVELOPMENT OF ADDICTION TRAINING FOR PROFESSIONALS IN THETURKU REGION

Marja Niskasaari and Arja Tikka

The regional work group Halko for the development of addiction training in the Turkuregion was formed in April 2001. The members are professionals involved in substanceabuse work, based in Turku or in the neighbouring cities. The work group has representativesfrom the Turku A-Clinic Services, the Turku Polytechnic, the addiction department of theTurku City Hospital, the University Hospital of Turku, the ambulance services of the TurkuFire Department, the Turku Social Services Centre, the Salo Health Centre, the KaarinaHealth Centre and the Raina Foundation based in Raisio. A substance abuse worker employedby the parishes of Turku and Kaarina has also participated in the work. In administrativeterms, the activities of the Halko group cover the entire Hospital District of the Varsinais-Suomi region.

The Halko group was established as part of the Huuko project (2000-2003), a nationalproject for the development of continuing training in drug problem treatment, co-ordinatedby the A-Clinic Foundation. The tasks of the Halko group consist in planning and organisingregional training events that respond to needs arising from day-to-day work with substanceusers. While the Huuko project ends in 2003, the Halko group is meant to serve as apermanent structure for co-operation in this field. This despite the fact that the Halkogroup is entirely unofficial: the members participate out of their own interest but evidentlywith their employer’s consent.

The tasks

The tasks of the Halko group have been modified along with the work. To give structureto the activities and to ensure continuity, a planning seminar was organised in the fall of2002. Based on the seminar the core tasks were defined as follows:

• Assessment of professionals’ training needs regarding substance abuse issues.• Informing training providers about training needs.• Dissemination of information about available training.• Organising training events in co-operation with agencies and organisations in the field.• Creating a list of trainers specialised in substance abuse issues.• Offering consultation in the planning of training.

The activities

The Halko group has convened monthly or at two-month intervals. The members haveexplored training needs for example by carrying out surveys in their own workplaces. Smallerplanning groups have been formed to organise specific training events.

Participants of the first training event organised by Halko were asked to fill in a formdesigned in the Transdrug project for the mapping of substance use-related training needs.1

Based on the information gathered, two half-day training seminars were organised in thefall of 2001 by the training unit of the Turku A-Clinic Services. The objectives of the seminarsincluded:

• Building in-depth knowledge of poly-drug use related problems.• Learning about work practices in different fields.• Building networks and clarifying needs for co-operation.• Identifying gaps and problematic areas in substance abuse work practices.• Envisioning future substance abuse work practices.• Finding channels for influencing the development in the field.• Uncovering emerging training needs.

In the Transdrug project, the tasks of the Turku A-Clinic involved uncovering emergingtraining needs. Therefore an application of the future workshop method was used in thehalf-day seminars to explore participants’ views of substance use related training needs in



(p. 126–136).


the future.2 The future workshop method was chosen because it is a flexible and easilyapplicable way to encourage participants to think about future challenges.

The half-day seminars were advertised as discussion meetings between professionals whowork with substance users. 70 invitation letters along with brochures about the programmewere sent to social and health services and to departments of education. E-mail was alsoused to advertise the seminars. The seminars attracted a total of 60 professionalsrepresenting social, health and education services in Turku or in the neighbouring cities.

The seminars began with a pair of half-hour opening lectures given by invited experts,each examining the seminar’s theme from their perspective. The themes were chosen withregard to their topicality and ability to incite discussion about addiction treatment. Thechosen themes were: 1. Medication-assisted versus medication-free treatment of drugaddiction and 2. Drug testing: To do it or not? After the lectures the participants discussedthe theme in small groups, identifying future challenges and future training needs.

Experiences from the half-day seminars were encouraging. The participants liked the workingmethod and appreciated the seminar not taking more than an afternoon’s worth of time.The discussion contributed to a fuller understanding of other professionals’ work and gavea chance to get to know new people. The ideas presented in the seminars led to two trainingdays organised in the spring of 2002.

Besides mapping training needs and organising training, the Halko group disseminatesinformation about other training on offer. The group has set up a web site (http://members.surfeu.fi/halkoryhma) that offers information about upcoming training coursesand events. Visitors of the web site can contact the Halko group, send information abouttraining events, give feedback and ask questions, or register for an e-mail list. The e-maillist has proved an effective way to disseminate information about current events in theaddiction treatment field. People on the e-mail distribution list are mainly substance abuseworkers in social and health services but also include people working in parishes, ineducation, in the police force or in voluntary organisations.

Training organised so far

Based on the information gathered about training needs, the first training day was organisedin May 2001. Four training events were organised in 2002 and two during the first half-year of 2003 The training has focussed on issues of current interest, such as:

• Death from drug overdose can be prevented (4.5.2001)• Comprehensive treatment of drug users in out-patient services (22.3.2002)• Understanding and controlling violence in work with clients (13.5.2002)• Basic training in medication-assisted treatment for opioid users, combined with a workshop(21.5.2002)

• Low-threshold services for drug users (14.11.2002)• Treatment for amphetamine users and for users of other stimulants (13.2.2003)• A seminar on cannabis (10.6.2003)

These training events, as well as the half-day seminars, have been popular due to a modestattendance fee and to a broad-based interest in the chosen themes. Financial support fororganising training has been provided by the Huuko project or by the A-Clinic Foundation’sMonikko project. For some training events, the parishes of Turku and Kaarina or the Cityof Turku have provided the facilities free of charge. The training events have attracted atotal of 250 participants, representing broadly health and social services but also includingpersonnel from schools, parishes and ambulance services as well as voluntary workers.

Challenges and opportunities

Members of the Halko group participate in the development of addiction training on avoluntary basis and out of their own interest. Halko is a self-nominated work group.Securing the employer’s consent for such an unofficial co-operation has not always beeneasy. Nevertheless, most of the founding members are still with the group. Some members

2A Trainer’s Tool Kit by the Transdrug


(p. 76–79).

Development of addictiontraining for professionals in

the Turku region


Ideas fortraining

Training events(one day or longer)

TurkuA-Clinic Services

The parishes ofTurku

The addictiondept. of TurkuCity Hospital

TurkuSocial Services

Centre

Training needs

Afternoon seminars

HALKOwork group

Turku Fire Dept.

▼

▼

▼

▼

▼

▼

Future workshops

▼

SaloHealthCentre

UniversityHospital of

Turku

The RainaFoundation

KaarinaHealthCentre

TurkuPolytechnic

▼

Futurechallenges and

projects

have quit because they changed jobs or their job tasks changed. The Halko group’s self-imposed rules say, however, that if you quit, you find first a replacement member fromyour organisation.

The Halko group’s unofficial status means that it has no budget to carry out the plannedactivities. This is why a free web site host—and a clumsy Internet address—is used to runthe Halko web pages. Maintenance of the web pages depends on the interest and motivationof a single member of the group. There are plans to integrate the Halko pages in the website of the City of Turku but so far these are just plans.

Despite the unofficial status—or maybe because of it—the work group has been activeand the work has been rewarding for those involved. The members’ interest shows no signsof withering. The training organised so far has mainly dealt with the treatment of drugproblems, which is understandable in the current situation. The rapid increase in drug useover the 1990s and the fast pace of change in drug use patterns took the professionals bysurprise. There is a need to get the most up-to-date information.

Halko plans to continue organising half-day seminars since the experiences have so farbeen positive. Afternoon seminars are quick to organise and an easy way to respond tocurrent challenges. The idea of organising a yearly regional training event that would servean even larger geographical area is also tempting. The problem is that, while afternoonseminars can be organised with a shoestring budget and relying on voluntary work, a trulyregional training event requires proper funding.

The model for planningtraining in substance useissues in the Turkuregion

Development of addictiontraining for professionals inthe Turku region

Structured surveysof training needs


LOCAL DECISION-MAKERS ’ INFORMATION AND TRAINING NEEDSRELATING TO SUBSTANCE USE ISSUES

Anitta Tähti-Niemi

Kuusankoski is a medium-sized industrial city in the region of North Kymenlaakso, witha population of 20 000. Together with six neighbouring municipalities, Kuusankoski hasset up a joint authority, which gives a good basis for networking in various fields, such ascommercial activities or vocational training. The City of Kuusankoski has its own healthcentre and social services. There are plans to form a joint public health authority fororganising health centre services together with two neighbouring municipalities.

Municipalities in Finland are quite independent in decision-making, which means that theyhave both considerable power and considerable responsibility. Responsible decision-makingrequires a thorough understanding of the issues at hand. Since the local situation regardingsubstance abuse/drug problems has deteriorated rapidly in Kuusankoski, it seemed timelyto take a look at local decision-makers’ information and training needs relating to substanceuse issues.

In the past few years, Kuusankoski has witnessed a rapid increase in drug problems amongyoung people. While the A-Clinic of Kuusankoski treated six drug users in 1997, in 1999the number was 21 and in 2003 close to 40. Two clients receive substitution treatment(buprenorphine). Clients turn to the A-Clinic on their own initiative or, in some cases,are referred by the police based on the EC directive on driving licences in DUI cases (91/439/EEC). Compared with the number of clients treated in the A-Clinic, the real numberof problem drug users is estimated to be at least tenfold, let alone the number of recreationaldrug users. Jatta Tyllinen, a case manager based in Kouvola, a neighbouring city, estimatesthat the Police Department of Kouvola interviews daily several young drug users, anincreasing number of which are young women. The reason for arrest is usually possessionof drugs, or car thefts or burglaries committed to get money for buying drugs. Worryingtrends include young people’s attitudes towards drugs. A case in point is cannabis use,considered by the young far less harmful than smoking tobacco. Besides illicit drugs, manyof the young use alcoholic beverages and medicinal drugs to get high. Seeking treatmentis not common because substance use is not considered problematic or because of areluctance to give up the chosen life-style and the company of friends.

The first municipal Action plan on alcohol and drug policies was drawn up in Kuusankoskiin 2001 with support from the A-Clinic Foundation’s Monikko project. Director PekkaTurunen and the supervisor of halfway housing Veikko Tanska from Kuusankoski A-Clinicwere instrumental in formulating the plan. The action plan started with an overview ofalcohol and drug use, and of related problems and services in Kuusankoski. Therecommendations for action and development presented in the plan received, unfortunately,little public attention. The Recommendations concerning the quality of services for substanceabusers, issued by the Ministry of Social Affairs and Health in 2002, has brought a need toupdate the plan. A motion to provide funding to employ a person to update the plan hasbeen submitted to the City’s Health Committee. To take into account the recommendationsconcerning the quality of services, the current action plan needs to be thoroughly modified,new information needs to be gathered and a new approach needs to be taken regardingfuture development.

Focussed on the prevention of poly-drug use related problems and on the development oftreatment, the Monikko project (1999-2002) sought to enhance knowledge by offeringtraining for professionals and experts in health and social services. Training coursesorganised in Kuusankoski with support from the Monikko project covered topics such as:• EuropASI—assessment of the severity of addiction problems• Detoxification from benzodiazepines and other psychotherapeutic medications• Medication-assisted detoxification, substitution and maintenance treatment for opioiddependent persons

• Alcohol and drugs in the workplace.

Further information aboutmunicipal self-governmentand municipal services in

www.kunnat.net.


Mapping the training needs of municipal decision-makers

Municipal decision-makers are elected on a political basis. Members of the council, of themunicipal board and of municipal committees are elected representatives of the residents.They are a heterogeneous group in terms of professional and education background. Thecouncil is elected directly by the residents. The chair and the members of the municipalboard and of the committees are nominated by the council. The council is the highestdecision-making authority although it has delegated part of the decision-making powerto the municipal board. Municipal committees are subject to the board and are involvedboth in the preparation of issues and in decision-making. The committees handle localaffairs related to education, health and social services, the environment or other communityconcerns. A municipal employee representing the sector in question acts as the committee’ssecretary and prepares the issues brought before the committee. The composition of thecommittees, of the board and of the council reflects the relative strength of political partiesin the municipality. The gender quota system of the Finnish public administration prescribesa minimum 40/60% balance between male and female members in all decision-makingbodies. The municipal committees of Kuusankoski typically comprise eight members plusthe chair. The male/female balance is typically 5/4.

I contacted the chairs of the council, of the municipal board and of four committees tofind out about these bodies’ willingness to participate in training needs assessment to beorganised in the frame of the Transdrug project. The committees were chosen on the basisof a decision-making role in drug-related issues and active involvement in drug prevention,as evidenced in their yearly plan of activities. The chosen committees were the Sports/Youth Committee, the Social Services Committee, the Health Committee and the EducationCommittee.

The Social Services Committee deals with social welfare and temperance work, both statutoryduties of the local government. In the preparatory phase of the Action plan on alcohol anddrug policies, the Social Services Committee issued an opinion statement on the draft.Main tasks of the Committee include ensuring subsistence for individuals and families,organising pre-school education and promoting community well-being.

The Health Committee is responsible for organising work to promote public health. Theobjective is to provide primary health care for the residents in a manner that ensures equalaccess and cost-effectiveness. The Committee works in co-operation with municipalauthorities, private service providers, and non-profit organisations. At the time of theMonikko project, the Health Committee gave its consent for the involvement of KuusankoskiHealth Centre in the project that, besides training, also included gathering informationon drug related problems. The Committee had a supportive role in the development of theAction plan on alcohol and drug policies

The Education Committee defines the goals for and monitors the performance of theeducation department. The Committee approves the curricula for comprehensive schoolsand upper secondary education and is in charge of the non-formal education offered inthe Adult Education Centre.

The Sports/Youth Committee was established in 2001 to replace the former Leisure/CultureCommittee. The Sports/Youth Committee is responsible for providing for the residents sportsservices and health promoting youth services. The Committee’s tasks also include theprovision of cultural services and the promotion of social well-being for the community.

As part of the Transdrug project, information about committee members’ substance userelated knowledge and training needs was gathered in three stages: preliminary informationwas gathered with a questionnaire, the OPERA method was used to get more in-depthinsights, and a second questionnaire was used to gather additional information.

The chairs of the council, of the municipal board and of the four committees enquiredabout members’ interest in co-operation with the Transdrug project. I contacted the chairsfirst by phone, then sent them a letter with an official invitation to co-operate. I wasquite surprised to learn that the council and the board declined to participate, but delighted

Local decision-makers’information and trainingneeds relating to substanceuse issues


to see that the committees were eager to co-operate. Information about information andtraining needs was thus gathered from committee members only.

The preliminary questionnaire1 was distributed through the committee secretaries. Despitereminders the response rate remained poor. The questionnaire asked each respondent torate their subjective need for training in a range of topics, including the prevalence ofdrug use, alcohol and drug policies, recognition of substance abuse problems, treatmentand rehabilitation services and work methods. Respondents were asked to think abouttheir role as committee members, rather than their professional role or educationbackground, when filling in the form.

The priority topic for the Social Services Committee was drugs and their effects, withprevalence of drug use among the under-18s in second place. The Health Committee wasinterested in information about addiction services and about options for referral and inprimary prevention of substance use problems. The highest-ranking topic on the EducationCommittee’s list was intoxicants and overdosing. The Sports/Youth Committee was primarilyinterested in cognitive therapy in the treatment of substance abusers and in addiction servicesas a whole. Other topics of interest to committee members included substance usedependence and withdrawal symptoms. Committee members’ professional or educationbackground reflects to some extent in the expressed needs for information/training: severalmembers of the Social Services Committee were employed in social services; members ofthe Health Committee included a doctor and a nurse, who may possess information aboutdrugs but not the kind of expertise characteristic of specialised addiction services. TheEducation Committee and the Sports/Youth Committee had fewer members with work-related knowledge of drug related issues, so the need for basic information was more marked.

Another type of method was needed to get a closer view of Committee members’ needs forinformation/training. Together with Marja Nevalainen, a social work student doing herinternship in the A-Clinic, we planned the process and chose the OPERA method as thetool for gathering information.2 Based on previous experience, we both considered OPERAan effective, democratic and creativity enhancing method for group work. The committeechairs were contacted to get a permission for organising an OPERA session. A separatesession was organised for each committee. Due to time constraints, there were only 50minutes allotted per session. Two of the committees reserved enough time and the sessionwas completed as planned. The Education Committee placed the OPERA session after theofficial meeting, which led to some members leaving before we started. The Social ServicesCommittee reserved too little time, which proved detrimental to overall success.

Participants of the OPERA session were asked: What kinds of information do you need to beable to make decisions on drug related issues? The question also specified further by askingeach participant to think of the topic in relation to their post on the committee. Eachparticipant worked individually writing down their ideas. Next, participants broke off intopairs to discuss the ideas and to agree on the top five topics. Each proposal was thenpresented to the rest of the group, without any commentary or discussion. The facilitatorgrouped the proposals according to similarity. The next step consisted in a vote in whicheach pair had five votes to give to the proposals they considered the best or the mostimportant. The results of the vote brought to the fore the committee members’ sharedview of their needs for information/training. The session ended with joint discussion aboutthe results.

Most participants enjoyed using a work group method that was new to them. Two of thecommittees worked with motivation, producing proposals with substantial backing. Theworking of one committee was disturbed slightly by the school boyish behaviour of twomembers. They apparently had trouble taking the matter seriously, which at times disturbedothers in the group. Partly due to time constraints, the final proposals from all groupswere somewhat general in nature.

The most urgent need for information related to the prevalence of drug use among youngpeople in Kuusankoski and in the wider region. The ability to recognise a drug user andgeneral knowledge about drugs were also among priority topics. More time would have beenneeded to formulate more specific ideas for training. An important result was, however,



(p. 80–85).



(p. 126–136).

Local decision-makers’information and training

needs relating to substanceuse issues

Decision makers lackinformation on the local

situation regardingsubstance use problems.


that the members of the four committees became aware of gaps in their knowledge and oftheir needs for further training in drug related issues.

Since the results were still on a fairly general level, an additional questionnaire was usedto get more precise information. The questions focused first on current knowledge levels,then on subjectively experienced training needs (open-ended question), and finally onthe appeal of different modes of training. Questionnaire forms were distributed at a meeting,along with a summary of the results of the previous phases.

The responses regarding training needs mirrored those indicated on the earlierquestionnaire. Drug use among young people was again an issue of priority, includingtopics such as prevalence, treatment and rehabilitation, and primary prevention.Respondents’ current knowledge, as estimated by themselves on a scale from 0 to 3, variedgreatly. Some claimed themselves pretty knowledgeable about youth cultures and variousdrugs, whereas others fell into the category of no knowledge at all.

The responses regarding modes of organising training varied too. The majority would prefertraining to be organised during their leisure time. All but three respondents were interestedin ICT-supported training.

During the whole process, co-operation was hampered by committee members’ tightschedules. It was hard to fit in any extra issues on the agenda. The lay decision-makerselected on a political basis are a heterogeneous group. Their willingness and motivationto participate in this type of work varied a lot. One would have expected a bit moreenthusiasm and curiosity. Now the overall impression is one of superficiality due to busyschedules.

The information gathered on local decision-makers’ training needs has been conveyed toorganisations that provide continuing training in the region and that are in the positionto offer training in drug related issues either to the committees as a group or to committeemembers individually. The gathered information gives a good basis for designing shortcourses tailored to the target group’s needs, but the success of such course cannot beguaranteed unless tested in practice.

Local decision-makers’information and trainingneeds relating to substanceuse issues


Annala Tuula Human Resources Development Manager

A-Clinic Foundation

www.a-klinikka.fi

Heikkinen-Peltonen Riitta Lecturer

Institute of Health Care, Tampere College

www.tao.tampere.fi

Inkinen Maria Project Coordinator

Huuko project—Continuing training in the treatment of drug problems 2000-2003

A-Clinic Foundation

www.a-klinikka.fi/huuko

Kauma Tiina Teacher in Health Care

Secretary of the Qualification committee for substance abuse work

Institute for Social and Health Care Studies, Tampere

http://tasto.piramk.fi/

Laine Terhi Head of Department in Social Services Studies, Lic.Soc.Sc.

Diaconia Polytechnic

www.diak.fi

Märkjärvi Leila Doctor of Education, Specialist Nurse, Acting Director, Chair of the Qualification committee for

substance abuse work, Vice-chair of the National Co-operation Committee for Substance Abuse Care

Myllyhoito Association

www.myllyhoito.fi

Niskasaari Marja Social Therapist, Trainer

Turku A-Clinic

www.a-klinikka.fi

http://members.surfeu.fi/halkoryhma

Salo Tuija Lecturer

Pirkanmaa Polytechnic

www.piramk.fi

Sutinen Tiina MNSc., Project Cooordinator for substance abuse work

From drug routes to the treatment chain - Interreg III A

Mikkeli Polytechnic

www.mikkeliamk.fi

Tikka Arja Senior Social Therapist, Trainer

Turku A-Clinic

www.a-klinikka.fi

http://members.surfeu.fi/halkoryhma

Torikka Marja-Liisa Lecturer

Pirkanmaa Polytechnic

www.piramk.fi

Tähti-Niemi Anitta Project Coordinator

More sober pregnancy 2002-2004

Kuusankoski A-Clinic

www.a-klinikka.fi/kuusankoski

Virta Marjut Lecturer

Institute of Health Care, Tampere College

www.tao.tampere.fi

Weckroth Antti Researcher, Training planner, MNSc.

Järvenpää Addiction Hospital

www.a-klinikka.fi/jss/

Contributors


ANNEXGENERAL FEATURES OF SUBSTANCE USE RELATED TRAINING IN FINLAND

Substance use related training offered to professionals in Finland has undergone a lot ofchanges over the past decades, gaining in depth and breadth. The range of organisationsoffering training has also grown in scope and diversity. Therefore it is no longer easy toform an overall view. 1

The chart on page 60 is meant to give an idea of the types of organisations involved intraining aimed at professionals who deal with substance use problems or the preventionof such problems. Training aimed at voluntary workers, school-based alcohol and drugeducation, and training offered by recovery groups are excluded here. Substance use relatedtraining aimed at professionals and at non-professionals may overlap: for example, coursesoffered by Open University/Polytechnic attract professionals who wish to enhance job skills,voluntary workers and “lay people” interested in the topic. A training provider - for example,an addiction treatment organisation or a local police department - may be involved bothin training activities targeted to professionals and in activities targeted to subgroups ofthe general public. Courses, seminars and training events are often organised jointly bydifferent types of organisations. 2

The information on substance use related training presented here is not exhaustive. It ismeant to give an overall view and some illustrative examples. There is a lot of variationamong the included training providers in terms of scope, form and continuity of trainingor the emphasis placed on substance use issues. Besides the organisations included, manyothers touch upon substance use issues in their training, at least from time to time.Organisations that offer addiction training and consultation mainly on a commercial basisare excluded here.

The chart looks at the addiction training field from the training providers’ perspective.From the perspective of the professionals who make use of the training, the field mightlook different. It seems that people typically use a number of sources to get work-relatedtraining, picking different courses at different times from different training organisations’curricula. Most of the major annual training events are explicitly targeted to a multi-professional or multi-sectoral audience.

Vocational education

After the nine year comprehensive school, young Finns can choose between general andvocational upper secondary education. With regard to performance in work life, thecompletion of upper secondary education is regarded as the minimum requirement. Roughlyhalf of each age group continue to the general upper secondary school. The curriculum hasbeen designed to extend over three years, but in practice the studies can take a longer orshorter time. A minimum of 75 courses needs to be completed. The upper secondary schoolends with the matriculation examination. The matriculation certificate provides eligibilityfor all forms of higher education.

Roughly half of each age group opt for vocational education. Initial vocational educationis arranged in vocational institutions and in the form of apprenticeship training. The initialvocational qualification takes three years to complete and yields eligibility for all formsof higher education. Matriculated students can also move on to vocational training; theirstudies are shorter owing to credit transfer. The total number of entrants in vocationaltraining in 2001 was around 49 000.

Vocational education is co-financed by the government and the local authorities. Thereare over 200 vocational institutions, licensed by the Ministry of Education; roughly halfare operated by municipalities, half are private. There is no tuition fee for the student.

The Government decides on the general structure of the study programmes, whereas theMinistry of Education decides on their scope and details. The National Board of Educationissues the national core curricula determining the objectives and core contents of the

1 Sutinen, p. 6.

2 Inkinen, p. 40;

Niskasaari & Tikka, p. 43

Ministry of Education:Education in Finlandwww.minedu.fi/minedu/education/index.html

National Board of Educationportalwww.edu.fi/english

Vocational education inFinlandwww.ammatillinenkoulutus.com/eng/index.htm

Education in Finland,Statistics Finland 1999www.stat.fi/tk/he/edufinland/

Opportunities forinternational studentswww.cimo.fi


studies. Vocational institutions have tripartite consultative bodies, representing the viewsof employers, employees and training providers, which participate in the planning oftraining. Within the framework of the confirmed structure of the study programmes, theinstitutions may focus their education as they see fit, allowing for local/regional business,industry and service needs.

There are currently 52 initial vocational qualifications, of which five in social and healthservices. The qualification yields basic skills for various positions in the field and morespecialised expertise in one sector of the study programme. The scope of the qualificationprogramme is 120 credits (1 credit = 40 hours), including at least 20 credits’ worth of on-the-job learning. On-the-job learning is guided and target-oriented training given at theworkplace. The qualification also includes a diploma project. Specialisation in mental healthcare and substance abuse work is possible in practical nurse qualification studies.3

Adults already working in a given field can demonstrate their knowledge and skills incompetence-based tests and thereby gain an initial, further or specialist vocationalqualification. A person seeking a qualification can take a competence-based test withoutspecific preparation. In practice, however, the tests are taken in conjunction with preparatorytraining, available in the form of courses arranged by vocational institutions or in the formof apprenticeship training. The number of competence-based further qualifications is closeto 100 (9 in social and health services) and the number of competence-based specialistqualifications around 70 (9 in social and health services). The substance use-specific FurtherQualification in Substance Abuse Welfare Work was introduced in 2000.4 Substance use issuesoccupy an important place also in the Specialist Qualification in Psychiatric Care, introducedin 2002.

Substance abuse issues are touched upon also in a number of other study programmes,typically in optional studies. The scope and content of substance use related studies variesbetween the study programmes and between the institutions. Besides qualification studyprogrammes, vocational institutions offer continuing education for those who wish toupgrade, update or diversify professional knowledge and skills. Substance use related coursesare offered also in continuing training.

Polytechnics

The Finnish education system comprises two parallel higher education sectors: universitiesand polytechnics. The higher education as a whole offers a place for 68% of the age group(universities 31%, polytechnics 37%).

Polytechnics were formed in the 1990s by upgrading and merging former post-secondaryvocational institutions. Polytechnics are more practically oriented than universities andemphasise close contacts with business, industry and services, especially at the regionallevel.

Polytechnics are either municipal or private, and are co-financed by the government andthe local authorities. There is no tuition fee for degree students. The Ministry of Educationconcludes a three-year agreement with each polytechnic on the general objectives, intakeand funding. The Ministry confirms the degree programmes but, within this framework,the polytechnics decide on the content and structure of the studies and on their annualcurricula. In 2001, there were 29 polytechnics in Finland. Most of them are multidisciplinaryinstitutions and operate in several localities. The number of students registered inpolytechnics is currently around 120 000.

The polytechnic entry requirement is: upper secondary school matriculation examinationor equivalent/ vocational qualification, further vocational qualification or equivalent /post-secondary or higher vocational diploma. The polytechnic degree is a Bachelor-leveldegree. Being 140-180 credits in extent depending on the field of study, the degree takes3,5 to 4,5 years to complete. The study programme comprises basic and professional studies,optional studies, on-the-job training and a thesis project. The study programmes includeoptions for specialisation.

4 Märkjärvi, p. 8, anb Kauma, p. 13.

3 Heikkinen-Peltonen & Virta, p. 22.


Polytechnic education is provided in several fields, of which social and health services isthe 3rd largest, measured by the number of students (21% of the intake in 2001). Substanceuse related issues are covered to a varying extent in degree programmes in Nursing, PublicHealth Nursing, Midwifery, Emergency Care Paramedics and Social Sciences.

Postgraduate polytechnic degrees were introduced on an experimental basis for the period2002-2005. The experiment will be evaluated and the results will be used to formulate adefinitive policy on the position of the postgraduate polytechnic degree in the overalleducation system. Permission to offer a postgraduate degree is granted by the Ministry ofEducation. The Ministry confirms the name and the extent of the postgraduate degree.The entry requirement is a first degree from a polytechnic or an applicable university degreeplus a minimum of three years’ work experience. The extent of the postgraduate degree is40-60 credits. Substance use issues are in focus in the postgraduate degree programme insocial sciences Intoxicants and Social Marginalisation (60 credits) 5 and in the postgraduatedegree programme in health promotion and disease prevention Family-Centred Work in HealthPromotion for Mental Health and Substance Abuse clients (60 credits).

Polytechnics also offer continuing education for those who wish to upgrade, update ordiversify professional knowledge and skills. Specialisation programmes, varying between20 and 40 credits, are one type of continuing training. The usual entry requirement is apost-secondary diploma or degree and work experience. Substance use issues are in focusin specialisation programmes such as Substance Abuse Work (Pirkanmaa Polytechnic) 6,Mental Health, Crisis and Substance Abuse Work (Laurea Polytechnic) and Young Peopleand Marginalisation (Lahti Polytechnic).

Universities

There are 20 universities in Finland, the University of Helsinki being the largest. Alluniversities are state-run, with the government providing some 65 % of their funding.The Ministry of Education concludes a three-year agreement with each university on theoperational principles. The extent and overall structure of university degrees are definedin field-specific national decrees. Universities decide independently on the detailed contentsand structure of the degrees, and on their curricula. There is no tuition fee for degreestudents.

Universities offer a place to roughly one third of the age group. Competition for entry isintense. All fields apply numerus clausus, in which entry examinations are a key element.In 2002, universities received a total of 109 500 applications; 67 700 of the applicantstook entrance examinations; 28 400 were accepted. The total university enrolment iscurrently around 163 000 students.

Universities provide lower (Bachelor’s) and higher (Master’s) academic degrees and scientificpostgraduate degrees (licenciate and doctorate). A Bachelor’s degree (120 credits) can inprinciple be completed in three years and a Master’s degree in five years (160-180 credits,or Bachelor’s degree plus 40-60 credits). Studies tend to take longer, the average completiontime of the Master’s degree being around 6 years in 2002; efforts have been made to pushstudents to speed up their studies. After the Master’s degree students can apply for doctoralstudies. In most fields a pre-doctoral degree called Licenciate may be taken before theDoctor’s degree. Full-time studies for a doctorate take in principle four years after theMaster’s degree, in practice often longer than that. During the year 2002, a total of 17500 university degrees were awarded; the number of Master’s degrees was nearly 12 100and the number of doctorates over 1 200.

Degree studies can be taken in some 20 fields. The Bachelor’s degree consists of basic andintermediate studies in the major subject, including a thesis, plus studies in one or moreminor subjects and language studies. The Master’s degree includes advanced studies and aMaster’s thesis. The studies consist variously of lectures and other instruction, exercises,essays or other independent work, textbook examinations, seminars etc. The studies are amix of compulsory and optional components and it is also possible to take extra coursesin addition to what is required for the degree.

5 Laine & Weckroth, p. 31.

6 Salo & Torikka, p. 27


Substance use related issues may be touched upon in various subjects (medicine, healthscience, social work, social psychology…) or in study modules (e.g. youth work modulewithin social work at the University of Tampere). Since the detailed content of degreeprogrammes is designed independently by each university, there is a lot of variation inthe extent and nature of the training offered.

In medicine the higher degree is called Licenciate. The studies are more extensive than inother fields (250 credits) and include internship as an integral part. The Licenciate’s degreecan be completed in six years. Substance use is touched upon most commonly in courseson psychiatry, neurology or forensic medicine. The Faculty of Medicine of the Universityof Helsinki places special emphasis on substance use issues. A short course in addictionmedicine (1,2 credits) is compulsory for all students. The course includes expert lecturesand group work on patient case examples. The aim is to provide future physicians with abasic level of competence in identifying and treating substance use related problems anddiseases. The course is arranged by the University’s Research Unit of Addiction Medicine,the only of its kind in Finland.

Universities also offer adult education in Open University or in their Centres for continuingeducation.

Continuing education

The importance of adult education as a component of the Finnish education system hasbecome more and more evident over the past decades. The 1980s and the 1990s were aperiod of rapid development in continuing vocational education. The concept of lifelongeducation was introduced as a response to structural and qualitative change in industry,business and services.

There is a wide range of adult education providers: vocational institutions, Open Universityand Open Polytechnic, centres for continuing education, summer universities, adulteducation centres, folk high schools etc. Continuing training geared to update, upgradeor diversify professional competence is an important part of adult education. There is alsoa wide range of skills-oriented, arts or social studies available that can be pursued merelyfor self-enhancement. About one million students participate annually in institution-basedadult education, which amounts to some 10 million classroom hours. Certificate-orientedadult education involves no tuition fees for the student. For other courses, students payeither a subsidised fee or the market price.

Universities provide adult education in their Centres for Continuing Education. Continuingeducation is aimed at persons with university degree, who wish to update or expand theirprofessional skills, and at persons who need university level knowledge in their job. Theforms of continuing education range from courses and programmes to seminars andconferences. For example the Centre for Continuing Education of the University of Tampereoffers a 4-year training programme in cognitive therapy, aimed at persons with a degreeand work experience in health care. Those who complete the programme can submit anapplication to the National Authority of Medicolegal Affairs for the right to work as aregistered psychotherapist. (Psychotherapy training in Finland will be overhauled in thenext few years).

Open University courses, provided by 19 universities, are open to everyone, regardless ofage or educational background. For the study year 2003/2004, The Open University inOulu offered half a dozen courses on substance use, ranging from a 2-credit introductoryclass to a full-fledged course in substance abuse work, worth 15 credits.

Open Polytechnic courses are similarly open to anyone regardless of educational background.Students can choose separate courses from the polytechnic curricula and may ask for credittransfer should they later enter a degree programme. For example the Diaconia Polytechnicoffers in the spring of 2004 a five-day course on work with drug users and a five-day courseon mental health and substance use. The Open Polytechnic Learning Network AVERKO offerscourses based on e-learning. The basic course in substance abuse work covers the natureof substance abuse problems and of addiction, key concepts, user groups, treatment options

Universities’ Centres forContinuing Educationwww.uta.fi/council/

index2.html

Open Universitywww.avoinyliopisto.fi/

english/

Open Polytechnic LearningNetwork AVERKO

www.averko.fi/english/index.htm

Summer universitieswww.kesayliopistot.fi/

Folk high schoolswww.kansanopistot.fi/


and substance abuse work methods. The scope of the e-learning course is three creditsand it is meant to be completed over a 3-month period.

There are 21 summer universities in Finland, operating in more than 130 localitiesthroughout the country. For instance the Summer University of Vaasa offers a two-daycourse on parenting, drug problems and treatment options for professionals in health andsocial services.

Folk high schools provide liberal or professional adult education typically in the form ofone-year courses. Short one week-courses and weekend courses are also offered. Substanceuse-related courses can be found among both types. In adult education centres the rangeof topics is very broad and may include substance use related issues.

The third sector

A very large part of substance use-related training happens outside the formal educationsystem. In fact, substance use issues were introduced in formal training fairly recently.Non-profit organisations such as the A-Clinic Foundation that are primarily treatmentservice providers also provide training for professionals.7

Training in specific substance use topics is also offered by a range of organisations involvedin primary or secondary prevention or in health promotion. For example, the Federationof Mother and Child Homes and Shelters and the Association on Mental Retardation haveoffered training dealing with FAS and the support needs of pregnant women, mothers andfamilies. The Finnish Red Cross has offered training for instance on how to intervene indrug use by young people. The Association for Healthy Lifestyles offers a five-day coursefor health and social services professionals who encounter problem drinkers; the courseprovides professionals with skills and tools to support change in drinking habits and self-control of drinking.

The Central Association for Mental Health organises yearly a two-day training event (MentalHealth Fair) in which also drug abuse and double diagnosis-related problems have beendealt with. The foremost training event in the addictions field (Addiction Days) is organisedyearly by the Centre for Health Promotion in co-operation with other actors in the field.The two-day event is targeted to a multi-professional and multi-sectoral audience andcomprises a range of seminars on specific topics. The event attracts around 500 participantseach year.

Training for professionals may also be offered by recovery groups such as A-guilds andtheir national federation, although their training activities are mainly targeted to membersand volunteer workers.

The Evangelical Lutheran Church of Finland, which counts as members around 85% of Finns,provides substance use related training for its employees. A 20-credit specialisation coursein substance abuse work, organised by Diaconia Polytechnic, is targeted to theologists,deacons and youth workers employed by the Church.

Professional associations and trade unions

Professional associations play an important role in organising substance use-related trainingand in promoting the development of such training within the formal education system.

The Society for Addiction Medicine organises, in collaboration with the A-Clinic Foundation,a series of monthly lectures on addiction medicine, relayed by means of video-conferencingto 3-5 locations around the country. The Society was instrumental in the introduction ofthe Special Competence in Addiction Medicine, granted by the Finnish Medical Association.The special competence system was introduced in the 1990s as a supplement to the officialsystem of specialisation, in which options for specialisation have been reduced over thepast decade. The Special Competence in Addiction Medicine consists of full-time residencyin more than one addiction unit under the supervision of a senior addiction specialist(unsupervised work in the addiction field may also be acceptable), of 260 hours additional

7 Annala, p. 35.


study and of a textbook examination. The special competence can be completed in 2-3years. By January 2003, 54 physicians had been granted the special competence.

Enhancing professional competence is in the interest of trade unions, too. Substance useissues have been dealt with in training days and seminars organised for example by theUnion of Practical Nurses, the Union of Health Care and Social Professionals, the Union ofProfessional Social Workers and the Trade Union for the Municipal Sector.

The Centre for Occupational Safety is a joint body of employers’ and employees’ organisations.The centre provides training for personnel involved in occupational safety. A one-dayseminar is targeted to anyone interested in the development of workplace programmes onsubstance use problem prevention and management.

Public government institutions

A range of public government institutions provide training for specific groups ofprofessionals or on specific topics. Some institutions that are mainly involved in researchor development work have a guiding or supporting role in the addictions training field.

Substance use issues are, of necessity, dealt with in training of the police force and ofprison administration and probation services personnel. Police force training is providedin Police School (upper secondary level) and in Police College (polytechnic level).Supplementary training is mainly provided by police departments. Besides training theirown employees, police departments may be involved in providing training on substanceabuse issues to other kinds of professionals or to subgroups of the general public.

Prison personnel training is provided in the Prison Personnel Training Centre. Persons whohave obtained a matriculation certificate or an initial vocational qualification can applyfor basic training in prison administration. The extent of the study programme is 53 credits,of which 22 credits’ worth on-the-job training in a prison. The basic examination of prisonadministration qualifies for supervision and guarding duties. In 2002, a polytechnic levelstudy programme was started, organised in co-operation with the Laurea Polytechnic. Thecriminal sanctions branch study programme qualifies for management and expert dutiesin prison and probation administration. Supplementary training is provided by the PrisonPersonnel Training Centre, the Criminal Sanctions Agency, the Probation Services and byprisons.

The State Provincial Offices (altogether six offices) are joint regional authorities for sevenministries and have a range of administrative, supervisory, monitoring, evaluation anddevelopment duties a.o. in education and culture, health care and social services, policeand judicial administration. The State Provincial Offices may organise training for variousgroups of professionals relating to specific topics, including substance use related issues.The education department monitors municipal education services and provides grants forvocational adult education. The education department is also responsible for providingfurther education for personnel in education services.

The National Centre for Professional Development in Education Opeko, an expert organisationunder the National Board of Education, offers courses for teachers, managers and otherschool personnel. For instance under the theme student guidance and counselling, a one-week course on substance use prevention and early intervention in comprehensive schoolsis available free of charge.

Due to its research and development activities and steering though information, the NationalResearch and Development Centre for Welfare and Health STAKES plays a central role in thesector. The Prevention of substance abuse group co-ordinates a national network of personsresponsible for the prevention of substance abuse in municipalities and provides the networkwith support in the form of information services and training. Major training eventsorganised by STAKES in co-operation with other actors in the field include the annualSchool Health Event and the annual Training Event in Social Welfare and Health Care (TERVE-SOS), both of which usually deal with substance use related issues.


The National Public Health Institute’s tasks consist in research, monitoring health behavioursand health promotion. The Department for mental health and alcohol research disseminatesinformation to professionals through publications, lectures and seminars.

The Institute of Occupational Health FIOH is a research and expert organisation in the fieldof occupational health and safety. The FIOH and its regional institutes carry out extensivetraining activities targeted to persons involved in labour protection and personneladministration. The FIOH offers a two-day course on drugs in the workplace, targeted tooccupational health and safety personnel, personnel administration and to student healthpersonnel in vocational and higher education institutions.

Municipalities are the main providers of social services and health care in Finland. 8 Morethan half of the municipal sector employees work in these services and 48 percent ofmunicipalities’ expenditure is incurred from these services. Within the Social servicesdepartments and Health departments various kinds of training, including training onsubstance use related issues, is organised for the personnel. Many of the municipalitieshave a Substance abuse prevention unit that may provide information services and trainingfor both professionals and the general public.

The Association of Finnish Local and Regional Authorities is made up of all rural and urbanmunicipalities. The Association promotes the interests of local and joint authorities, actsas an expert organisation in municipal issues and provides the members with guidance,information and other services. Substance use issues are given attention in the annualHealthy Cities event (Terve Kunta -päivät) organised jointly by the Association of Localand Regional Authorities and STAKES. Offering a broad range of seminars on research anddevelopment projects and on current issues, the event attracts around 600 municipalemployees and elected officials representing municipal administration, social and healthservices vocational institutions run by municipalities. Local Government Training Ltd., atraining company established by the Association, provides training on a variety of topics,including substance use related issues, for both municipal employees and elected officials.

Substance use related training for hospital staff and other health care personnel is organisedby hospitals, hospital districts (joint authorities set up by two or more municipalities),and central hospitals and university hospitals (operated by hospital districts). Especiallywell equipped to transfer knowledge in this area are the addiction units in some of thecentral hospitals.

Social and welfare centres of expertise are a recent development in Finland. The nine centresof expertise (eight regional centres and one for the Swedish speaking population) startedtheir operation on a permanent basis in 2002. The centres are limited companies,associations or corporations funded by a government grant and by the municipalities.Besides municipalities, the main co-operative organisations include universities,polytechnics, vocational institutions, State Provincial Offices, provincial associations andsocial and health care organisations. The main co-operation partner for all centres is STAKES.The centres of expertise are meant to serve as permanent co-operative structures betweenresearch and training activities and the practical work of local authorities. The task of thecentres include research and development covering both general and specialised socialservices, development and dissemination of the expertise needed in social services, andenhancement of co-operation and exchange between vocational training and practical workin the sector. The centres of expertise are also hoped to function as a common regionalforum to further substance abuse related training.

8 Tähti-Niemi, p. 46

Social and welfare centresof expertisehttp://pre20031103.stm.fi/osaamiskeskukset/


Organisations offering addiction training services in Finland

University hospitals

Central hospitals

Hospital districts

qualification/degree programmes

postgraduate and continuing training

compulsory substance use related studies

options for specialisation

continuing/further/specialisation

training

personnel training

lectures, seminars, courses

co-operation between training

providers

Addiction treatment organisationsA-Clinic Foundation

Järvenpää Addiction Hospital

Myllyhoito Association - Rehabilitation

based on a Finnish application of the

Minnesota Model

Finnish Blue Ribbon - Christian prevention

and rehabilitation

Kran - Christian substance abuse work for

the Swedish speaking population

A-guilds

Health and social sector organisationsIrti huumeista - Voluntary drug prevention

organisation

Youth Against Drugs

Association for Healthy Lifestyles

Federation of Mother and Child Homes and

Shelters

Association on Mental Retardation

Central Association for Mental Health

Finnish Red Cross

Centre for Health Promotion

Training Centres of theEvangelical Lutheran Church

Dioceses and parishes

State Provincial Offices

National Centre forProfessional Development inEducation Opeko

Open University

Open Polytechnic

Summer universities

Centres for continuingeducation

Vocational adult educationcentres

Folk high schools

Adult education centres

National Research andDevelopment Centre forWelfare and Health STAKESPrevention of substance

abuse group

National Public HealthInstituteDept. for mental health and

alcohol research

Institute of OccupationalHealth

Social and welfare centresof expertise

Professional associationsMedical Association/Society for Addiction

Medicine

Federation of Nurses/Addiction Nursing

Network

Society for Alcohol and Drug Research

Trade unionspractical nurses, health care workers, social

workers, municipal employees

Centre for Occupational Safety

MunicipalitiesHealth and social services

Substance abuse prevention units

Association of Local andRegional Authorities

Local Government Training Ltd.

Universities• Medicine, Health Science

• Research Unit of Addiction

Medicine/University of Helsinki

• Fields: Social Work, Psychology…

• Study modules: Youth Work…

Social and health sectorPolytechnics• Degree programmes: Social

Sciences, Nursing, Public Health

Nursing…

• Postgraduate degree programmes

• Specialisation programmes

Social and health sectorVocational institutions• Practical Nurse/Mental Health Care

and Substance Abuse Work

• Further Qualification in Substance

Abuse Welfare Work

• Specialist Qualification in

Psychiatric Care

Police force training

Police departments

Prison Personnel TrainingCentre

Probation Service

Prisons

Perspectives on addiction training in Finland Kauma Development of substance abuse work modules in vocational secondary education: from training psychiatric nurses to training practical

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