Primary Health Networks

Primary Health Networks Drug and Alcohol Treatment Activity Work Plan 2016-17 to 2018-19 Western Victoria PHN When submitting this Activity Work Plan 2016-2018 to the Department of Health, the PHN must ensure that all internal clearances have been obtained and has been endorsed by the CEO. The Activity Work Plan must be lodged to <name of Grant Officer> via email <email address> on or before 6 May 2016. 1

Introduction Overview The activities under the Drug and Alcohol Treatment Services Annexure to the Primary Health Networks Programme Guidelines will contribute to the key objectives of PHN by: Increasing the service delivery capacity of the drug and alcohol treatment sector through improved regional coordination and by targeting areas of need, and Improving the effectiveness of drug and alcohol treatment services for individuals requiring support and treatment by increasing coordination between various sectors, and improving sector efficiency. Each PHN, in accordance with the guidance provided by the Department, must make informed choices about how best to use its resources to achieve these drug and alcohol treatment objectives, contributing to the PHN s key objectives more broadly. Together with the PHN Needs Assessment and the PHN Performance Framework, PHNs will outline activities and describe measurable performance indicators to provide the Australian Government and the Australian public with visibility as to the activities of each PHN. This document, the Activity Work Plan template, captures those activities. This Drug and Alcohol Treatment Activity Work Plan covers the period from 1 July 2016 to 30 June 2019. To assist with PHN planning, each activity nominated in this work plan can be proposed for a period of between 12 months and 36 months. Regardless of the proposed duration for each activity, the Department of Health will require PHNs to submit updates to the Activity Work Plan on an annual basis. This Drug and Alcohol Treatment Activity Work Plan template has the following parts: 1. The Strategic Vision of each PHN, specific to drug and alcohol treatment. 2. The Drug and Alcohol Treatment Services Annual Plan 2016-17 to 2018-2019 which will provide: a) A description of planned activities funded under the Schedule: Drug and Alcohol Treatment Activities, Item B.3 Drug and Alcohol Treatment Services Operational and Flexible Funding b) A description of planned activities funded under the Schedule: Drug and Alcohol Treatment Activities, Item B.4 Drug and Alcohol Treatment Services for Aboriginal and Torres Strait Islander people Flexible Funding 2

Annual Plan 2016-17 to 2018-2019 Annual plans for 2016-17 to 2018-2019 must: Provide a coherent guide for PHNs to demonstrate to their communities, general practices, health service organisations, state and territory health services and the Commonwealth Government, what the PHN is going to achieve (through performance indicator targets) and how the PHN plans to achieve these targets; Be developed in consultation with local communities, Clinical Councils, Community Advisory Committees, state/territory governments and Local Hospital Networks as appropriate; and Articulate a set of activities that each PHN will undertake, using the PHN Needs Assessment as evidence, and measuring performance against Local Performance Indicators (where appropriate) and targets to demonstrate improvements. Activity Planning The PHN Needs Assessment will identify local priorities which in turn will inform and guide the activities nominated for action in the 2016-17 to 2018-19 Annual Plan. PHNs need to ensure the activities identified in the annual plan also correspond with the Activity Objectives and Actions eligible for grant funding identified in Annexure A2 Drug and Alcohol Treatment Services. The Drug and Alcohol Treatment Annual Plan will also need to take into consideration the PHN Objectives and the PHN key priorities. Drug and Alcohol Treatment Services Funding From 2016-17, PHNs will undertake drug and alcohol treatment planning, commissioning and contribution to coordination of services at a regional level, to improve sector efficiency and support better patient management across the continuum of care. Having completed needs assessments for their regions, PHNs will now identify the appropriate service mix and evidence based treatment types suitable to meet the regional need. The Drug and Alcohol Annual Plan will complement the information in the Needs Assessments, and should be used to record the activities you intend to fund. The Commissioning of Drug and Alcohol Treatment Services guidance document will assist you in understanding the Department s expectations in relation to activities that are in scope for funding, and will assist you in translating drug and alcohol treatment evidence into a practical approach. Measuring Improvements to the Health System National headline performance indicators, as outlined in the PHN Performance Framework, represent the Australian Government s national health priorities. PHNs will identify local performance indicators to demonstrate improvements resulting from the activities they undertake in relation to the commissioning of Drug and Alcohol Treatment Services. These will be reported through the Six Month and Twelve Month Performance reports and published as outlined in the PHN Performance Framework. Activity Work Plan Reporting Period and Public Accessibility The Drug and Alcohol Treatment Activity Work Plan will cover the period 1 July 2016 to 30 June 2019. A review of the Drug and Alcohol Treatment Activity Work Plan will be undertaken on an annual basis (in 3

both 2017 and 2018) and resubmitted as required in accordance with Item F of the Schedule: Drug and Alcohol Treatment Activities. Once approved by the Department, the Annual Plan component must be made available by the PHN on their website as soon as practicable. The Annual Plan component will also be made available on the Department of Health s website (under the PHN webpage). Sensitive content identified by the PHN will be excluded, subject to the agreement of the Department. It is important to note that while planning may continue following submission of the Activity Work Plan, PHNs can plan but must not execute contracts for any part of the funding related to this Activity Work Plan until it is approved by the Department. Further information The following may assist in the preparation of your Activity Work Plan: PHN Grant Programme Guidelines: Annexure A2 Drug and Alcohol Treatment Services; Guidance for PHNs: Commissioning of Drug and Alcohol Treatment Services; Drug and Alcohol Treatment Services Needs Assessment Toolkit; PHN Needs Assessment Guide; PHN Performance Framework; Primary Health Networks Grant Programme Guidelines. Clause 3, Financial Provisions of the Standard Funding Agreement; Please contact your Grants Officer if you are having any difficulties completing this document. 4

1. Strategic Vision Vision: Individuals, communities and service providers have access to coordinated, evidence based alcohol and other drug services in Western Victoria. Governance Arrangements: Good governance of the commissioning process will ensure that public money is spent in an efficient and effective way and that Western Victoria PHN is held accountable for the decisions made and the impact on our local health population. We understand that governance for a commissioning organisation requires a structure which recognises the importance of delivering clinically safe and effective services and which holds service providers accountable for the way in which services are delivered on behalf of the organisation. Western Victoria PHN is underpinned by a governance structure which successfully enables commissioning as a series of interrelated organisational processes and which supports cross organisational decision making and support. The governance framework incorporates: Committee structures with the necessary clinical expertise and decision making authority. Business planning in line with our commissioning intentions and strategic plan. Procedural guidance for staff. A mechanism to provide the most stable financial solutions to commissioning requirements that align with our performance management objectives. A risk management approach to ensure that risks associated with commissioning activity are documented and managed as part of the overarching organisational risk management framework. A quality management system to ensure commissioning activities are developed, delivered and monitored in a clinically safe and appropriate manner. Contract and performance reporting and evaluation. Conflicts of interest management, probity, transparency and fair handling of our procurement and tendering processes. Flexibility to adapt to changing commissioning responsibilities and environment. Western Victoria PHN will develop a stepped care approach to Alcohol and Other Drug services in the region, underpinned by the above vision and governance structure. We are committed to collaboration, consumer involvement and co-design in the development of an integrated, coordinated platform of care 5

2. (a) Planned activities: Drug and Alcohol Treatment The activities in this workplan outline the PHN s approach to facilitating a coordinated approach to delivering AOD services within the region. This will consist of implementing a stepped care approach through offering new services that provide early intervention/support for people demonstrating risky substance use before dependency. This addition of services is important, as currently the main type of support focuses on treatment once people meet a specific assessment criteria. The proposed activities will provide a more comprehensive system that addresses all levels of AOD support. The activities that are proposed within this workplan are interlinked and each activity will build upon the one listed before it. Therefore each activity needs to be completed in the listed order or concurrently to inform or support the following activity. These activities will establish a foundation to build on in the continuous development of coordinated and integrated approaches in the delivery of evidence based AOD services to meet AOD needs within the community. Proposed Activities Drug and Alcohol Treatment Priority Area / Reference (e.g. Priority Reference 1, 2, 3) Activity Title / Reference (e.g. Activity 1.1, 2.1, etc.) P-13 Communication. Formation of working group to support AOD service provider networking and collaboration - AOD -1 To increase limited engagement between AOD treatment services and the broader health system, integrated planning will aim to respond to changing drug treatment needs. By engaging broader health services this should assist in building extensive knowledge of the AOD treatment service and system gaps. Workforce development will also be a critical component in the development of AOD services within a stepped care approach and a focus on awareness and education of heath care providers will be incorporated into this activity. Training programs for health professionals, including GPs and other primary care health professionals will continue to be delivered and/or facilitated by Western Victoria PHN. Description of Drug and Alcohol Treatment Activity These linkages will be achieve through the coordination and integration of AOD services through the formation of a working group (consisting of managers/coordinators of AOD services and those providing direct delivery). Key activities will inform commissioning and include: Formation of terms of reference, communication plan, and working plan Networking and relationship building The opportunity for service providers to work together Identify AOD service providers levels of health literacy Contribute and inform detailed AOD service and workforce mapping (and linkages with mental health services), including place-based gaps Identify potential quantitative and qualitative data sources Identify AOD system barriers (particularly for the most at risk groups) Identify and contribute to areas of improvement for service delivery Identify AOD workforce shortages 6

Collaboration Indigenous Specific Duration Coverage Commissioning approach Performance Indicator Local Performance Indicator target Data source The working group will include but is not limited to: AOD service providers (including faith based, state-funded, residential, and private organisations) Pharmacotherapy Networks Mental health service providers Aboriginal Community Controlled Health Organisations (ACCHOs) General practices Culturally and Linguistically Diverse (CALD) peak bodies Employment and housing organisations AOD clients and carers Local Hospital Networks State Government AOD providers. The working group will provide advice and information to Western Victoria PHN s clinical and community councils and operational processes within Western Victoria PHN. No. July 1 2016 September 2016 Formation of this group and identification of initial goals. September 2016 June 2017 Implementation of goals. July 2017-30 June 2019 Constant referral to working group to obtain local input. Entire Western Victoria PHN region This activity will be directly delivered by Western Victoria PHN. Outcomes Commissioning will be underpinned by the outcomes of this working group. Improved relationships and knowledge of the members of the working group. Pre and post surveys of working group. Creation of Terms of reference, communication plan and work plan for group. Working group attendance rate of 70%. Production of agendas and meeting minutes. Project reports. Education and training for AOD workforce. Minutes and recording of information from networking meetings. Comprehensive AOD service mapping. Surveys to collect evaluation data. 7

Proposed Activities Drug and Alcohol Treatment Priority Area / Reference (e.g. Priority Reference 1, 2, 3) Activity Title / Reference (e.g. Activity 1.1, 2.1, etc.) P-14 System integration and coordination. P-10 Access to AOD treatment services. Upskilling and supporting general practices to provide AOD support and referrals AOD-2 Description of Drug and Alcohol Treent Activity The limited early intervention services available within Western Victoria PHN region became evident after completing AOD service mapping. This will be addressed by promoting quality improvement approaches by supporting general practitioners through education and training. This will consist of support for the use of low intensity interventions within general practice to avoid problems related to dependency, particularly for methamphetamines and prescription overuse (this includes AOD support for users and carers, family and friends). General practices are an ideal platform to provide AOD support, as 84% of the population in the Western Victoria PHN region attended general practices in 2013-14 (NHPA, 2013-14). General practices will deliver AOD interventions and/or provide appropriate referrals in the context of a stepped care model. This activity will identify AOD strategies and supports available for general practices and their patients, and appropriate pathways in the event of escalating need through: The development of an evidence based risk stratification framework for risk assessment and appropriate referral. Supporting general practice to identify and claim MBS item numbers for the delivery of AOD support to patients/carers. The development of HealthPathways 1 to provide general practitioners with patient AOD support and referral pathways. The development of data collection, monitoring and analysis tools by Western Victoria PHN. Through leveraging Pharmacotherapy Networks 2 and Primary Care Consultants 3 existing relationships with general practices. These knowledgeable and skilled staff will provide support, information and tools for general practices to provide opportunities for low level intervention or appropriate referrals to treatment. A general practitioner champion/s will be assisted to support other general practitioners in implementing this activity. General practices will also be upskilled to administer motivational interviewing for family, friends and carers of people requiring AOD support to identify their goals (and support their wellbeing 1 HealthPathways is a web based information portal of locally-agreed, condition based guidelines that support general practitioners and other primary health care providers in the assessment, management and referral of their patients. HealthPathways aims to build a stronger primary care sector through improving communication between all health care providers, supporting and empowering general practitioners and ultimately delivering quality care to our community. 2 There are two Pharmacotherapy Networks within the Western Victoria PHN region. These networks provide a community-based model where medical professionals and pharmacists work together to make pharmacotherapy available to clients in the community. Aiming for pharmacotherapy providers to implement a more integrated and cohesive service focused on improving client outcomes. 3 Primary Care Consultants are the project officers at Western Victoria PHN that have existing relationships with General Practices, therefore are in a good position to support the implementation of this activity. 8

Collaboration Indigenous Specific Duration Coverage Commissioning approach Performance Indicator Local Performance Indicator target Data source Pharmacotherapy Networks Drug and Alcohol Clinical Advisory Service (DACAS) Education and training providers General practitioner champion/s Collaboration with these organisations will provide training and support to general practitioners (and general practices), so general practices can deliver AOD support to their patients. No. 2016-2017 Pharmacotherapy Networks, Primary Care Consultants and general practitioner champions will engage general practices to provide low intensity AOD interventions with those who have demonstrated a willingness to provide AOD support to patients. Western Victoria PHN will evaluate and identify enablers and barriers before expanding to other general practices. 2017-2019 Expansion of the program through the promotion of the success of practices involved in year one and improvements through constant evaluation. Entire Western Victoria PHN region. Direct delivery. Outcome Delivery of AOD early interventions by general practitioners with a particular focus on methamphetamines and prescription overuse. Evidence based risk stratification framework, including validated screening tools. Identification of MBS item numbers for the delivery of AOD support to patients/carers. Pre and Post data on number of MBS items claimed. Capturing the number of AOD engagements with general practice. Consultations with participating general practitioners. Development of AOD specific HealthPathways 1 (that includes Activity 5 around referrals for brief interventions). Number of AOD specific education/training events. Quantitative and qualitative data recorded within internal databases. Google analytics of HealthPathways. MBS data. Pre and post screening of clients. Consultations to identify barriers and enablers of general practitioners implementing this activity. 1 HealthPathways is a web based information portal of locally-agreed condition based guidelines that support general practitioners and other primary health care providers in the assessment, management and referral of their patients. HealthPathways aims to build a stronger primary care sector through improving communication between all health care providers, supporting and empowering general practitioners and ultimately delivering quality care to our community. 9

Proposed Activities Drug and Alcohol Treatment Priority Area / Reference (e.g. Priority Reference 1, 2, 3) Activity Title / Reference (e.g. Activity 1.1, 2.1, etc.) Description of Drug and Alcohol Treatment Activity Collaboration P-14 System integration and coordination. P-10 Access to AOD treatment services. The identification and implementation of brief interventions - AOD-3 The majority of AOD support is provided for clients that meet intake and assessment thresholds, therefore mainly targeting people with higher AOD needs. This can be addressed by providing locally appropriate, evidence based, brief interventions for people using AOD. Western Victoria PHN will work with the AOD working group (formed as part of AOD-1) to identify needs and an appropriate service model to support evidence based brief interventions, whilst ensuring clearly articulated pathways (e.g. step up and step down). This activity will require close engagement and information sharing with other AOD stakeholders not within the working group (including potential service users/carers). Services beyond the AOD sector will also be engaged to identify people at risk and provide information regarding entry points for brief interventions. The assessment of evidence based models will include; peer support in rural areas, and stepped up and stepped down approaches around brief interventions. A stepped care model will assist in identifying the most appropriate AOD support for the individual. Specific place-based models will be designed and implemented based on evidence based frameworks and consultations. It is envisaged that this will enable early intervention to minimise the transition to addiction and the requirement for withdrawal services for people in this vulnerable group. The brief intervention services will interface between general practice, emergency departments and the state funded services providing more intensive treatment options. Western Victoria PHN is currently a member on two of three consortiums of service providers delivering the more intensive services. They are a significant stakeholder in the development and implementation of an integrated AOD service continuum and these existing relationships will be very valuable.. In the other part of the region, Western Victoria PHN has a strong relationship with the consortium lead with whom we liaise around population planning data and service system issues. These brief interventions will differ from general practice support, as it will provide AOD support beyond the capability of general practices. Current AOD service providers Intake and assessment teams, to Those listed as part of Activity 1. Carers, family and friends At risk populations including: young people, women, Aboriginal and Torres Strait Islander people, unemployed, Lesbian, Gay, Bisexual, Trans and/or Intersex (LGBTI), Culturally and Linguistically Diverse people (CALD), and those in rural areas. This collaboration will ensure those providing AOD treatment are informed of the stepped care model. 10

Indigenous Specific No Duration Coverage Commissioning approach Performance Indicator Local Performance Indicator target Data source July 2016 - September 2016 Undertake scoping, and place-based needs assessment. September 2016 January 2017 Undertake commissioning process January 2017 June 2017 Implement commissioned brief interventions. Regular monitoring, review, and refinement of service delivery. 2017-2019 Constant evaluation of brief intervention models to inform future planning. Locations to be identified through place-based needs assessment. Commissioning process will be dependent on market capacity. Outcome Clients receiving brief interventions for substance use, including methamphetamines and prescription misuse. Number of consultations with stakeholders (including clients/carers). Identification of evidence based models for brief intervention. Demographic information on the clients receiving brief interventions e.g. number, location of delivery, service type. Consultations with stakeholders. Service provider reports in accordance with contract. 11

Proposed Activities Drug and Alcohol Treatment Priority Area / Reference (e.g. Priority Reference 1, 2, 3) Activity Title / Reference (e.g. Activity 1.1, 2.1, etc.) Description of Drug and Alcohol Treatment Activity Collaboration Indigenous Specific Duration Coverage Commissioning approach Performance Indicator Local Performance Indicator target Data source P-14 System integration and coordination. Identify existing referral processes to leverage in order to coordinate and integrate AOD services- AOD-4 This activity will identify appropriate models and/or leverage off existing referral platforms to provide coordination and integration of services. This will assist in facilitating and supporting access to appropriate evidence based AOD treatment through a flexible model tailored to individual need. The Western Victoria PHN will use the AOD working group (as described in AOD-1) to guide and provide input into the research of evidence based methods of ensuring coordination of care within a stepped care model. Coordination of referrals will require building relationships and working with current AOD service providers (and broader health services) to ensure consistency and clarity of client pathways and referrals. This activity will identify existing platforms that could be leveraged to ensure brief intervention referrals are integrated into existing referral coordination processes. This activity will also assist in referring people to the appropriate services to support their holistic care when there are comorbid conditions (e.g. mental health, chronic disease). This activity will explore the range of options available and their evidence base including online, telephone and face to face. Collaborate with a range of stakeholders including the working group (AOD-1) to ensure the development of an integrated referral process for brief intervention services is implemented and communicated. No. January 2016- June 2017 Identification and trial an integrated referral pathway. July 2017 June 2019 Review and implement integrated referral pathway to broader Western Victoria PHN region. Region to be determined based on data analysis. The commissioning approach will be dependent on the identification of appropriate referral management processes, and could be direct engagement or another approach. Outcome Successful implementation of the coordination of referrals for brief interventions which provide service users with timely and appropriate access to services based on need. Use of specific AOD HealthPathways. Documentation and communication of referral pathway. Number of referrals for brief interventions. Consultations with stakeholders (including clients/carers). Reports measuring number of brief intervention referrals. 12

2. (b) Planned activities: Drug and Alcohol Treatment Refer to PHN Grant Programme Guidelines: Annexure A2 Drug and Alcohol Treatment Services and Guidance for PHNs: Commissioning of Drug and Alcohol Treatment Services for the list of inscope activities. It is emphasised that PHNs are to consider strategies to support the workforce in delivering the proposed activities through promoting joined up assessment processes and referral pathways, and supporting continuous quality improvement, evidence based treatment and service integration. Proposed Activities Drug and Alcohol Treatment Priority Area / Reference (e.g. Priority Reference 1, 2, 3) Activity Title / Reference (e.g. Activity 1.1, 2.1, etc.) Description of Drug and Alcohol Treatment Activity P-12 Aboriginal And Torres Strait Islander access to AOD treatment AOD-5 Co-design AOD support with Aboriginal And Torres Strait Islander communities to implement culturally appropriate place-based activities. There are limited AOD treatments targeting Aboriginal and Torres Strait Islander people within Western Victoria PHN. Therefore Western Victoria PHN will develop the context to enable co-design of services with Aboriginal and Torres Strait Islander populations with a focus on coordinated, joined up approaches. This activity will consist of building relationships with ACCHOs and Aboriginal and Torres Strait Islander populations through co-designing Aboriginal and Torres Strait Islander specific AOD services. This will be a staged approach due to: The commitment of resources from ACCHOs to participate in this process. The need to understand the cultural context and how this impacts on the holistic approaches to health care. To build mutual understandings of funding guidelines. Agreements on the way engagement will occur. Creating a shared understanding of the engagement process. Consultations regarding appropriate project workers to facilitate this activity. Western Victoria PHN is proposing to commission the delivery of brief interventions. A number of ACCHOs have yet to participate in the consultation phase so will need to be included in further discussions prior to final confirmation of allocation of dollars per health service. The staffing resource to deliver brief interventions are envisaged to be co-located within the respective ACCHOs. In essence ACCHOs will be commissioned to deliver the services. The brief interventions will be based on cognitive behavioural therapy. Due to the limited funding, Aboriginals and Torres Strait Islander AOD Brief Interventions funding, will be used in conjunction with Aboriginal and Torres Strait Islander Mental Health funding and will be commissioned as a combined bundle of services. A clear governance process will be in place to ensure 13

respective reporting and data collection is compliant with the two separate funding streams. Collaboration Aboriginal Controlled Community Health Organisations (ACCHOs) Victorian Aboriginal Controlled Community Health Organisation (VACCHO) Victorian Alcohol and Drug Association (VAADA) Local Aboriginal And Torres Strait Islander communities Indigenous Specific Duration Coverage Commissioning approach Performance Indicator Local Performance Indicator target Data source This collaboration will ensure the activity is accepted for local and cultural relevance. Yes July 2016- December2016 Develop and complete the commissioning process for culturally appropriate services co-designed with Aboriginal and Torres Strait Islander communities. January 2017-June 2017. Implement the delivery of culturally appropriate services Regular monitoring, review, and refinement of service delivery. 2017-2019 Constant evaluation of models to inform future planning. All eight ACCHOs within Western Victoria PHN region will be included within this activity. The commissioning method will be decided upon once co-design with Aboriginal and Torres Strait Islander communities has occurred, it is envisaged that this will involve direct engagement. Implementation of culturally appropriate AOD support for Aboriginal And Torres Strait Islander communities that provide improved access to treatment. Number of engagement activities with ACCHOs and Aboriginal And Torres Strait Islander communities Documentation of co-design process and outcomes. Commissioning of services. Process evaluation. Stakeholder consultations Documentation of processes and outcomes. 14