First Step Annual Report FY21

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“Everybody deserves every chance to turn their lives around.”

Annual Report 2020 to 2021


Strategic Plan This report is structured on the progress our goals. The six key goals are from our 2018-2021 strategic plan. Each goal is underpinned by a number of key priorities. This plan has been instrumental in guiding our efforts to help clients reduce drug use, improve their mental health, general wellbeing and lead to richer, more functional lives. In late 2021, we will commence the strategic planning process which will guide our work for the years to come.

Goal 1.

Goal 2.

CONSISTENTLY PROVIDE EXCELLENT CARE

HELP MORE PEOPLE MORE PROFOUNDLY

STRATEGIC PRIORITIES:

STRATEGIC PRIORITIES:

Articulate and embed best practice and continuous improvement.

Build on the 6 Critical Support Elements with optimal services in-house and strategic referral partnerships.

Perform long-term funded evaluation of our unique collaborative model. Continue to remove barriers to vulnerable Victorians accessing all the care they need. Trial, perfect and document innovative treatment modalities and combinations.

Extend ‘Whole-Person Care’ to more of our clients. Look to additional sites and spheres of influence, whilst maintaining a collaborative model. Research and develop a Hub & Spoke model to reach new areas of need.

Embed impact measurement tools.

Goal 6.

EXPAND THE HORIZONS OF FIRST STEP AND THE SECTOR STRATEGIC PRIORITIES: Cover image: Former First Step client Baden Hicks with First Step Principal Lawyer, Michelle Goldberg. Photographer, Nicholas Walton-Healey.

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Overcome mental health vs addiction funding silos.

Explore bringing more stages of recovery and specialisations in-house.


Goal 3.

Goal 4.

Goal 5.

MAINTAIN OPERATIONAL SUSTAINABILITY

DIVERSIFY INCOME & ACHIEVE LONGTERM FINANCIAL SUSTAINABILITY

ADVOCATE FOR COMPASSION FOR ADDICTION

STRATEGIC PRIORITIES:

STRATEGIC PRIORITIES:

Find long-term premises solution encompassing bold vision.

Grow funded treatment income.

Match operational and management resources to growth. Utilise partnerships to achieve vision. Engage external partners and seek funding for ongoing business planning.

Pursue state and federal government funding. Grow financial supporter/ donor base. Strengthen philanthropic relationships. Develop innovative and effective fundraising programs. Fully engage financial supporters to develop longterm, mutually beneficial relationships.

Promote game-changing Housing Health partnerships.

Secure financial support for our boldest ambitions.

STRATEGIC PRIORITIES:

Champion innovative and effective treatments. Be a voice for compassion and tolerance in the community. Fight for a progressive approach to drug policy and other related areas (e.g. Homelessness). Do not accept the status quo. Always lobby for better services for vulnerable people.

Advocate for universal mental health care.

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CEO and Board Report What an enormous year it has been! We have dealt with all the usual challenges, amplified by the threat of COVID-19, the extensive lockdowns in Melbourne, and the strange combination of ‘Groundhog Day’ and unprecedented societal upheaval.

We made it through the year without a single infected staff member or onsite infection of clients – an extraordinary feat as St Kilda became a COVID-19 ‘hotspot’. The organisational skills of Operations Manager Gayle Wood must be recognised as First Step continually adapted to new conditions and regulations, maintaining our capacity to support vulnerable Victorians by phone and telehealth for months on end. Staff working from home remained stoic through the challenges of isolation, simultaneous parenting/ teaching/working and trying to maintain some kind of balance among the tremendous uncertainty. And our clients showed extraordinary resilience as they adapted to lockdown periods where the previous comfort of being face-to-face with their First Step network was replaced with phone calls and video conferencing. Despite the challenges around us, we have continued to evolve as an organisation.

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First Step Legal (FSL) expanded greatly with funding from the Department of Justice adding to ongoing support from major partners and private donors. This enabled the establishment of new Health Justice Partnerships with Star Health and The Alfred. All this while FSL Director Tania Wolff was appointed President of the Law Institute of Victoria! Nelly Katsnelson, our new Philanthropy Manager, funded by Gandel Philanthropy and Wheelton Philanthropy, completed her first full year retelling client stories of amazing resilience and recovery, and creating new initiatives and platforms to fundraise from. With her decades of experience in women’s health and family medicine, we welcomed Dr Caroline Hawkins to the team, who will soon attend Launch Housing in our innovative collaboration: The Road Home Project. In partnership with The Alfred, Dr Basanth Kenchaiah commenced as First Step’s onsite addiction psychiatrist, boosting our clinical mental health expertise and impact on clients living with significant mental illness.


“A warm welcome is where care begins.”

Roslyn Hill, Senior Receptionist

In September, we expanded into our new building at 39 Greeves St, St Kilda, which now houses First Step Legal, ResetLife, and some of the admin team. This backs on to 42 Carlisle St, and in October we celebrated the 20th anniversary of the purchase of that building by Peter and Lyndy White, and the founding of First Step. First Step’s position to advocate for reform of the mental health and alcohol and other drugs sectors is growing rapidly. In February, the Royal Commission into Victoria’s Mental Health System handed down its final report and recommendations for reform. First Step featured extensively and was listed as the example of ‘multi-disciplinary teams’, the most integrated of service delivery models. We partnered with the University of Melbourne School of Population and Global Health to produce a global literature review of co-located services (addiction and mental health). And our CEO now sits on the Alcohol and Other Drug Expert Advisory Group to the Victorian Minister for Mental Health, James Merlino, and also cowrote an article with Professor Ian Hickie for the online magazine of the Medical Journal of Australia: “Who are the Missing Middle of Mental Health Care?”

13,622

consultations by GPs and Mental Health Services for 1,852 people

Our highly skilled and passionate Board members continue to volunteer their time to provide high level organisational, financial and clinical governance. We thank them for their ongoing dedication, support, advice, and vision.

Throughout the year our staff continued to ask that crucial question, “How can we help?” They kept providing all the help, care and support our clients need and want, from one team in one place. They continued to give everybody every chance to turn their lives around.

Patrick Lawrence First Step, CEO

Mark Watt First Step, Board Chair

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1. Consistently provide excellent care

Dr Basanth Kenchaiah, First Step psychiatrist

First Step works with many people at imminent risk of significant injury or death for whom we needed to balance infection control with wellbeing. The challenges arising from the COVID-19 pandemic and repeated lockdowns were two-fold: • Keep the organisation functioning day-to-day. • Maintain a level of excellence in the care and support provided across clinical (GP, mental health nursing, psychiatry) and non-clinical (care coordination, psycho-social supports, legal) care alike. page 6

857

consultations through Psycho-social Services and Care Coordination

During lockdowns, most consultations were by telehealth or video conferencing, but for our most vulnerable clients, for those on the edge, we followed COVID safety protocols, and continued seeing them face to face. The planning and flexibility involved in keeping the organisational wheels turning was immense, tiring and stressful. The team did a remarkable job with First Step not missing a single day of operation. Our team stayed focused and motivated by the stories of survival and recovery against all odds.


Psychiatry First Step was delighted to welcome Dr Basanth Kenchaiah, Addiction Psychiatrist, to the team. Basanth attends First Step through a secondment with The Alfred. He provides clinical support to both clients and staff at a level that is extremely rare in primary care. Our multi-disciplinary team quickly absorbed Basanth into the pool of knowledge, expertise and passion, and he brings an element we now regard as essential to First Step’s belief that everybody deserves every chance to turn their lives around.

“During COVID-19 I have shared my story with clients, that I have lost family members, that it has been hard. It has been a great equaliser.” - Dr Basanth Kenchaiah, psychiatrist

South Eastern Melbourne Primary Health Network The South Eastern Melbourne Primary Health Network (SEMPHN) is funded by the Australian Government to increase access for vulnerable people by commissioning services in primary health care. First Step is commissioned by SEMPHN to deliver four programs: complex mental health, care coordination, psycho-social services and ResetLife. Our relationship with SEMPHN greatly enhances First Step’s ability to provide people with all the help they want and need from one team in one place, and in 2021 included surge funding to grow our staff and care for more clients during the pandemic. First Step and SEMPHN have a shared vision of ensuring people get the health care they need, when and where they need it.

Creating the chance to change - Stacey* *Name has been changed Stacey is a 59 year old woman who started using opiates in her mid-teens and had been on the methadone program for over 20 years. Throughout this time, she still used heroin. In June 2020, Stacey admitted herself into a residential withdrawal unit to transfer from the methadone program to the Long-Acting Injectable Buprenorphine (LAIB) program. When she left the unit, we begun to assister her with the management of LAIB. When we first met Stacey, she was difficult to engage, demanding and at times unreasonable because of her brittle manner. Then something shifted. Slowly, and quite subtly, at first.

Stacey was more patient and understanding. She started to dress differently, as she described, “more appropriate for my age”. And she began planning ahead for things, something she had previously been unable to do. Over the next couple of months, Stacey would excitedly attend appointments, telling us with an enthusiasm we did not believe she had, that she was studying for her Learners, with the hope of getting her license for the first time. Stacey committed a tremendous amount of hard work to achieve change. It is important to note, LAIB is not a ‘miracle cure’. A clever psychiatrist once said, ‘pills don’t teach skills, but they give the brain a chance to learn them’, and this was never clearer than with Stacey.

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2. Help more people more profoundly ResetLife filled my toolbox – Emma* *Name has been changed The first time I drank to black out, I was 14.

Then I found ResetLife at First Step.

As the only child of an emotionally distant single mother who failed to protect me from the men in her life, it was the only way I knew how to lock up the feelings and experiences that were happening to me.

Up until this point, I felt like I was carrying around an empty toolbox. ResetLife filled it up with tools that I could use in daily life. And I learnt that alcoholism is a disease that does not make logical or rational decisions.

I could not wait to escape home at 18 but was not prepared for life on my own. Over the next 25 years, my life spiralled out of control.

If I had not learnt this, had not filled my toolbox, I would still be in the cycle of relapse.

I had looked for help – I went to AA meetings, spent 3.5 months in a rehabilitation facility and three stints in detox. But each time I would relapse. I couldn’t understand – I did everything they asked me to do. What was wrong with me? Why wasn’t it working?

Hayley Pedley, Care Coordinator, Mental Health Services

Now when I am faced with challenges, I allow myself to feel emotions, to experience what is happening to me, with the knowledge that I know how to manage them, to move through them, and to implement practical steps. I use the tools that I learnt at ResetLife.

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people assisted through ResetLife with 32 program graduates

Dr Caroline Hawkins We welcomed Dr Caroline Hawkins as a new GP to the team. Caroline has worked in urban, rural and regional Australia, having her own practice in Wangaratta for many years, and also in hospital emergency wards. She brings great skills and expertise in women’s health and across all areas of general medicine.

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Covid led to a rapid upscaling of vaccinations at First Step

“This is a picture my daughter drew of our family.” - Emma, ResetLife client

National Disability Insurance Scheme First Step has taken the necessary steps to begin incorporating the National Disability Insurance Scheme (NDIS) into our treatment system, to register for therapeutic supports, and to transition eligible clients onto the NDIS. The NDIS is an enormous and complex program, which for First Step means the opportunity for eligible clients to receive the support they need, guaranteed for their lifetime. It also means they can stay with the team they trust, here at First Step, which is so important for continuity of care.

VACCINATIONS On April 12 2021, First Step opened its COVID-19 vaccination clinic. Providing Astra Zeneca vaccines to our clients, our staff vaccinated hundreds of vulnerable people against COVID-19. Sadly, many of our clients have had negative experiences with the mainstream health sector, and with misinformation about the vaccines rife, there was hesitancy. Being able to provide vaccines to our clients by their trusted health care team meant that we could remove some of the barriers to vaccination and provide access to high quality medicines.

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3. Maintain operational sustainability

“Doubling our footprint means we have great spaces for group work. - Patrick Lawrence, First Step CEO

Flexibility was the catchword for 2020-21. In and out of lockdowns and other changing restrictions, staff and clients adapted constantly and maintained a high standard of trust and support.

Greeves Street First Step expanded into a second adjacent building at 39 Greeves St, St Kilda. At first, this building was necessary to accommodate the ResetLife team and their need for a large group room, but then as First Step Legal expanded we quickly came to wonder how we could have coped without it. Once we had renovated the building, we removed the intervening fence, and now the two buildings effectively share a backyard.

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KPMG Since 2018, KPMG has provided thousands of hours in pro bono accounting support in a multi-year partnership with First Step. KPMG partner Zoe Griffiths secured a 3-year extension of this support for which First Step is very grateful. High level accounting advice and support of this nature is invaluable to First Step and something that we simply could not afford outside of this corporate partnership. Financial analysis is particularly important as the sector undergoes reform and fundamental structural change in the wake of the Royal Commission into Victoria’s Mental Health System.

New First Step building 39 Greeves St, St Kilda

20th anniversary First Step celebrated its 20th anniversary in July with a Zoom event attended by current and past staff, board members and volunteers. Guests included Peter and Lyndy White who purchased the building (and volunteered for years), Melissa Hardham who created First Step Legal, and Bryan Ambrosius the former CEO of 16 years.

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4. Diversify income and achieve long-term financial sustainability

Nelly Katsnelson, Philanthropy Manager

Philanthropy Manager With funding from Gandel Philanthropy and Wheelton Philanthropy, First Step has recruited its first ever Philanthropy Manager. Nelly Katsnelson brings a careers-worth of experience, insight and acumen from the not-for-profit sector. The three year position will develop and deliver a strategy that creates sustainable, diversified philanthropic funding streams, and meaningfully engages with our supporters to grow our community of advocacy and support. At the completion of the first full year, we have launched a range of fundraising initiatives, become very active across social media, kept our supporters regularly updated and made sure that our storytelling takes a strength-based approach to reduce stigma and ensure we do not disempower the very people we are trying to lift.

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Long-term financial sustainability is a key goal for every not-for-profit, and no less First Step. To deliver our uniquely wide range of services First Step engage and attract support from state and federal governments, philanthropic trusts and private individuals.


First Step Legal Since 2008, First Step Legal (FSL) has provided pro bono legal services to clients actively engaged in treatment at First Step, assisting some of the most disenfranchised members of our community. Our objective is to ensure that the stress of dealing with a legal matter does not derail our clients’ rehabilitative efforts. As one of the earliest health justice partnerships in Australia, we embed a legal practice within a clinical framework where the legal team forms part of an integrated therapeutic team. Working with our clients’ doctor, therapist, mental health nurse or allied health professional means that our legal staff become part of a triangular therapeutic model of care, facilitating a strong sense of trust with clients.

177

people assisted by First Step Legal with 241 matters

This relationship model promotes client wellbeing. It often involves several court adjournments to allow them to progress in their rehabilitation and recovery prior to their final hearing. FSL has expanded its assistance to clients with criminal law matters, family violence and family law matters, infringements, tenancy issues, and Victims of Crime applications. In 2020-2021, with funding from the Victorian Department of Justice and Community Safety, our service has grown to help clients not only of First Step and Windana Therapeutic Community but also Star Health Family Violence Program and The St Kilda Road Clinic of The Alfred.

Supported decision making - Lauren* *Name has been changed Lauren was dealing with ongoing mental health issues and experiencing elevated Family Violence from her partner. She self-referred to First Step Legal (FSL) for assistance, having had a longstanding (but intermittent) relationship with First Step. We encouraged her to re-engage with the Mental Health nurse she had previously seen at First Step for guided clinical support.

Ongoing engagement with Lauren’s clinical support was encouraged to provide insight and to foster agency. Communication with Lauren was respectful of her choices, aimed at reducing risk and sought to provide all relevant legal and non-legal information about the available options.

Lauren’s primary concerns were safety and housing. Underlying considerations were the legal implications of a Family Violence Intervention Order (FVIO), education about her rights, and the options she had available.

As a result, Lauren was able to make decisions about what she wanted to do and at a pace appropriate to her using the information FSL provided. She was supported by FSL in securing a limited FVIO. This allowed her to live at home in accordance with her wishes. FSL also provided advice on tenancy options in the long-term.

Lauren was assisted by FSL to connect with Safe Steps (Family Violence Response Centre) to obtain crisis accommodation and food vouchers. FSL then provided information and education regarding her rights and options. FSL also made themselves available for regular check-ins throughout.

Lauren’s situation and mental health presentation were both complex. Using a client-centred, time-intensive approach based on trust and agency helped ensure supported decision making. The outcomes we achieved together were practical and personalised.

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5. Advocate for compassion in addiction

Jane Cario credentialled Mental Health Nurse

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World’s Largest Overdose Prevention Training online For International Overdose Awareness Day, First Step ran its fourth annual World’s Largest Overdose Prevention Training in partnership with local agencies and including presenters from Windana Drug and Alcohol Recovery, the Penington Institute and Self-Help Addiction Recovery Centre. Due to the pandemic the event was held online, which allowed interstate participants to attend. Participants included people with a lived experience, family members and those that work in the sector.

Because of First Step’s innovative approach to multi-disciplinary care, we are well placed to capture the insights of our clients and staff, and to translate them into advocacy towards reform. First Step’s voice is heard on a daily basis by its supporters on social media, by the government through a variety of forums and expert advice committees, and by others working in the mental health and alcohol and other drug sectors through collaboration.

Medical Journal of Australia First Step CEO, Patrick Lawrence, had the privilege of co-authoring an article for Insight+, the online magazine of the Medical Journal of Australia, with Professor Ian Hickie (Co-director of the University of Sydney’s Brain and Mind Institute) and Dr Sebastian Rosenberg. The article titled, ‘Who are the Missing Middle of Mental Health Care?’ highlighted the uncertainty of the current reform period in mental health and how First Step leads the way in caring for those who are too complex for primary care, but not complex enough to get support from the tertiary mental health sector.

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6. Expand the horizons of First Step and the sector First Step’s voice has never been heard more prominently than this year, as we published reports, appeared in Royal Commission Reports and staff were sought out by government for their expertise. First Step took its place as an organisation with a unique and important perspective, and an ability to encourage our colleagues to look to a bolder vision where everybody who needs it has every chance to turn their lives around.

Collaboration with the University of Melbourne First Step was proud to commission and contribute to an extensive piece of research by the University of Melbourne School of Population and Global Health. Funded by a grant from the R.E. Ross Trust, this was a systematic global literature review of evidence into the effectiveness of co-located mental health and addiction treatment, otherwise known as dual diagnosis. The evidence from 26 peer reviewed studies points strongly towards the effectiveness of co-location with a great many learnings about when and why it is most effective. This evidence comes at a crucial time in the reform of the mental health and alcohol and other drug sectors, and we hope to have the report published and peer-reviewed.

Elizabeth Frampton, Criminal/Generalist Laywer and Sasie Wijewardana, Legal Case Manager

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Dr John Sherman, Medical Practitioner

Royal Commission into Victoria’s Mental Health System On March 2 2021, the Victorian Government tabled the Final Report of the Royal Commission into Victoria’s Mental Health System at a joint sitting of Parliament. First Step features heavily in the report in a number of sections, including being cited as the example of multi-disciplinary team care (the highest level of integration recommended by the Report), as well as quoting First Step clients and family members interviewed by the Commission. This level of exposure, along with a similar focus from the Productivity Commission’s Review of Mental Health, has created a watershed moment for First Step, validating our model and highlighting our importance to the current reforms.

In FY22, First Step’s CEO Patrick Lawrence, will sit on the State Government’s Expert Advisory Group for mental health and addiction integration, and First Step will lead a broad partnership in the government’s Integrated Care Pilot. We want to ensure that this 10-year period of reform is indeed a game changer, and that people and their families seeking help for mental ill-health and addiction can receive the welcome, empathy and services they deserve.

“Recognition by the Royal Commissioners has enabled First Step to advocate for changes, for compassion and for justice” - Patrick Lawrence, First Step CEO

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Financials STATEMENT OF PROFIT OR LOSS

FOR THE YEAR ENDED 30 JUNE 2021

($) 2021

($) 2020

Revenue

2,678,137

2,671,409

Other income

38,569

67,374

Salaries, wages and employee benefits expense

(2,030,733)

(1,662,875)

Depreciation expense

(91,844)

(76,682)

Interest expense

(4,104)

(411)

Administration expense

(541,433)

(454,038)

Profit before income tax

48,592

544,777

Income tax expense

-

-

Profit for the year

48,592

544,777

Other comprehensive income

-

-

Total comprehensive income for the year

48,592

544,777

($) 2021

($) 2020

Cash and cash equivalents

1,048,705

717,373

Inventories

-

-

Prepayments

14,655

14,194

Trade and other receivables

149,359

355,733

Total current assets

1,212,719

1,087,300

Plant and equipment

121,399

49,349

Right of use asset

59,384

121,943

Other assets

3,207

3,207

Total non-current assets

183,991

174,500

Total assets

1,396,709

1,261,800

Trade and other payables

225,184

145,872

Provisions

210,323

167,747

Lease liabilities

34,042

33,891

Provisions

3,085

7,643

Lease liabilities

33,990

65,154

Total Current liabilities

37,075

72,797

Total liabilities

506,625

420,307

Net assets

890,085

841,493

Retained earnings

890,085

841,493

Total equity

890,085

841,493

STATEMENT OF FINANCIAL POSITION

FOR THE YEAR ENDED 30 JUNE 2021 Current Assets

Non-current assets

Current liabilities

Non-current liabilities

Equity

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We would like to thank the following organisations for their generous support in 2020-21 First Step Staff

FIRST STEP

FIRST STEP LEGAL

• The Spencer Gibson Foundation

• Collier Charitable Fund

• The Jack Brockhoff Foundation

• Gourlay Charitable Trust

• Igniting Change

• Humanity Foundation

• Community Bank Elwood

• Igniting Change

• Community Bank Windsor

• Jagen Nominees

• Wheelton Philanthropy

• Modara Pines

• Helen Macpherson Smith Trust

• Portland House Foundation

• Marian & E. H. Flack Trust

• Spotlight Foundation

• Gandel Philanthropy

• United Health Group

• Lettisier Foundation as Trustees for the Evans Foundations

• Victorian Law Foundation

• StreetSmart Australia

• Virgin Unite

• Victorian Legal Services Board

MAJOR DONORS

• Rob Phillpot • Angela Wheelton • Paul Wheelton CORPORATE

• Price Waterhouse Cooper

We acknowledge the traditional owners of the land on which we work, the Yalukit Willam clan of the Boon Wurrung people and pay our respects to their elders both past and present. We acknowledge and uphold their continuing relationship to this land. First Step are committed to equity irrespective of cultural or linguistic background, sexual orientation, gender identity (LGBTI+), intersex status, religion or spiritual beliefs, socio-economic status, age, or abilities.

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Donations Support our life changing work. We rely on the generosity of our community to provide care to our unfunded clients, fill the funding gaps and support innovation and growth. Your donation to First Step positively impacts our client’s life twice - firstly by sending a powerful message of compassion and support to them, and secondly, by funding us to continue the life changing work we do. Visit firststep.org.au/donate_now to donate, or fill in the form below and return it to 42 Carlisle Street, St Kilda. Name Address Suburb State

Postcode

Phone Email I will donate the following amount: $100

Card type:

$50

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Card No. Expiry date Name on card Signature Date All donations over $2 are tax deductable and we will provide a receipt for tax.

The First Step Program Ltd. 42 Carlisle Street St Kilda, Victoria 3182 Phone: 03 9537 3177 Email: info@firststep.org.au Join our online community: @FirstStepTweets /TheFirstStepProgram First Step Program /First-Step-Program FirstStepStkilda firststep.org.au