Primary Health Network Needs Assessment Reporting Template

Primary Health Network Needs Assessment Reporting Template This template must be used to submit the Primary Health Network s (PHN s) Needs Assessment report to the Department of Health (the Department) by 30 March 2016 as required under Item E.5 of the PHN Core Funding Schedule under the Standard Funding Agreement with the Commonwealth. This template should include the needs assessment of primary health care after hours services. To streamline reporting requirements, the Initial Drug and Alcohol Treatment Needs Assessment Report and Initial Mental Health and Suicide Prevention Needs Assessment Report can be included in this template as long as they are discretely identified with clear headings. Name of Primary Health Network Murrumbidgee Primary Health Network When submitting this Needs Assessment Report to the Department of Health, the PHN must ensure that all internal clearances have been obtained and the Report has been endorsed by the CEO. Page 1

Instructions for using this template Overview This template is provided to assist Primary Health Networks (PHNs) to fulfil their reporting requirements for Needs Assessment. Further information for PHNs on the development of needs assessments is provided on the Department s website (www.health.gov.au/phn), including the PHN Needs Assessment Guide, the Mental Health and Drug and Alcohol PHN Circulars, and the Drug and Alcohol Needs Assessment Tool and Checklist (via PHN secure site). The information provided by PHNs in this report may be used by the Department to inform programme and policy development. Reporting The Needs Assessment report template consists of the following: Section 1 Narrative Section 2 Outcomes of the health needs analysis Section 3 Outcomes of the service needs analysis Section 4 Opportunities, priorities and options Section 5 Checklist PHN reports must be in a Word document and provide the information as specified in Sections 1-5. Limited supplementary information may be provided in separate attachments if necessary. Attachments should not be used as a substitute for completing the necessary information as required in Sections 1-5. While the PHN may include a range of material on their website, for the purposes of public reporting the PHN is required to make the tables in Section 2 and Section 3 publicly available on their website. Submission Process The Needs Assessment report must be lodged to the Grant Officer, Margaret Como via email Margaret.Como@health.gov.au on or before 30 March 2016. Reporting Period This Needs Assessment report will cover the period of 1 July 2016 to 30 June 2018 and will be reviewed and updated as needed by 30 March 2017. Page 2

Section 1 Narrative This section provides PHNs with the opportunity to provide brief narratives on the process and key issues relating to the Needs Assessment. Needs Assessment process and issues (500-1000 words) in this section the PHN can provide a summary of the process undertaken; expand on any issues that may not be fully captured in the reporting tables; and identify areas where further developmental work may be required (expand this field as necessary) Murrumbidgee PHN (MPHN) has presented the Primary Health Needs Assessment and the Mental Health, Suicide Prevention, and Alcohol and Other Drugs (MHSPAOD) Needs Assessment as separate documents, however the findings from these two processes have been collated and presented together in this report. MPHN has undertaken an epidemiological approach(1, 2) as the foundation of the priamry health needs assessment; whilst building upon the previous knowledge attained by Murrumbidgee, Hume and Lodden Mallee Murray Medicare Locals. This approach has has been complemented with stakeholder and community feedback to inform strategies to ensure the MPHN meets the objectives of; increasing efficiency and effectiveness of medical services for patients at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time. MPHN has established Clinical Councils, the Community Advisory Committee and a Stakeholder Reference Group to ensure a broad and balanced view of health needs and potential solutions across a large georgaphic region. To support this undertsanding, the PHN has been divided into four sectors and data has been grouped and analysed by sector, LGA and community levels (where available) to assist our understanding of the health and service needs of local communities. The needs assessment also involves mapping and profiling of current services across the region. Where possible this is done at the level of local government areas or at the individual communitiy level. Comparative analysis has also been undertaken to provide an understanding of how Murrumbidgee PHN health and service needs might be similar or diferrent to identified peers. Formalised and opportunistic stakeholder consultations have also been a feature of this needs assessment, with particular focus on Aboriginal health, Child and Youth Health, Mental Health, Suicide Prevention, and Alcohol and Other Drugs (MHSPAOD). More intensive indivudal consultations with clinicians (e.g., psychiatrists and respiratory physicians) has also occurred to support deeper understanding of a particular issue or need. The existing consortiums established by the PHN (such as the Child Health Consortium and the Aged Care Consortium), have provided a valuable source of stakeholder and community feedback. Page 3

In addition to the above processes, for the MHSPAOD needs assessment, MPHN also established a Mental Health Working Party, considered results of previous or conducted consumer consultations (e.g., PIR clients and Youth Reference Groups), conducted spotlight consultations on specific areas of need (e.g., Education Providers) and surveyed community members- a process that elicited more than 800 responses. MPHN completed the first draft of the MHSPAOD needs assessment and engaged ConNetivca to assist with further analysis and prioritisation. Determining the pimary care after-hours needs of residents of the Murrumbidgee commenced with a review of the 2012 after-hours needs assessments of the relevant former Medicare Locals and subsequent after-hours intitatives implemented in the regions. Updated health service provider mapping information and hospital emergncy department triage and presentation time was used to inform current availability of primary care in the after-hours period to provide a baseline. A primary health care provider think-tank was held in October to discuss baseline data, and identify significant gaps in access, and prioritise approaches to improving access. Local communities were provided with an opportunity to contribute to the afterhours needs assessment via on on-line survey. This was promoted through the (then) 30 operational Local Health Advisory Committees and via the MPHN website and social media. The following areas have not been fully explored in this edition of the needs assessment and may be subject to further developmental work: Primary Health 1. High rates of hospitalisations for urinary tract infection (UTI) 2. Variations in the management of chronic kidney conditions 3. Any associations between 1 and 2 4. Rising incidence of rare cancers with poor prognosis (such as digestive and respiratory neoplasm, multiple myeloma, cancer unknown primary) and whether these cancers bear any association with the prevalent chronic conditions in this region 5. High rates of hospitalisations associated with chronic renal disease, digestive system conditions and the underlying reasons for high volumes of other factors influencing health. 6. Notifiable diseases and other infectious diseases prevalent in this region 7. Primary health service utilisation across the NSW and Victorian border as well as across PHN borders by service related groups and volume of patient flow 8. National cancer screening program participation rates across the Victorian border Page 4

9. Workforce development issues Murrumbidgee PHN have a preliminary indication of workforce shortages and the narrow scope of practice in some registered disciplines (such as physiotherapy based on RA category comparisons). Further analysis is required using the Modified Monash Model categories along with systematic consultation across both registered and unregistered disciplines to fully understand workforce capacity and development needs 10. Analysis of ED triage data relating to times, days and categories of presentations Mental Health, Suicide Prevention and AOD 1. Analysis of why there are significantly higher levels of psychological distress in some communities (e.g., Boorowa LGA) or higher rates of self-harm related hospitalisations (e.g., Young and Cootamundra LGA) or suicide (Wagga Wagga LGA). 2. Some specific issues or conditions were raised during the consultations with community (e.g., impact of Trauma/Family Violence, local prevalence of eating disorders and service response, and behavioural issues in children). 3. Understanding the experiences of LGBTIQ community members and targeting services effectively and appropriately. 4. In depth analysis of workforce related issues for improved design and capacity building initiatives. 5. Mental Health needs of Older People Additional Data Needs and Gaps (approximately 400 words) in this section the PHN can outline any issues experienced in obtaining and using data for the needs assessment. In particular, the PHN can outline any gaps in the data available on the PHN website, and identify any additional data required. The PHN may also provide comment on data accessibility on the PHN website, including the secure access areas. (Expand field as necessary). In this iteration of the needs assessment, the MPHN have elected to use LGA as the lowest level of demographic analysis. This is because majority of the regional epidemiological sources have use these units. In future years, a transition to the ASGS units will be systematically performed as part of the collaborative needs assessment process with the Murrumbidgee Local Health District. Multiple sets of local service delivery data have been obtained; however, without data linkages between services and sectors, there has been a challenge in gaining a comprehensive understanding of service utilisation and provider capacity across the region. Emergency Department (ED) data is critical for the MPHN to understand the reasons for ED presentations and peak periods. MPHN obtained local ED data for triage Page 5

category 4 and 5, however less than 10% of total presentations have a SNOMED description which renders the data of limited use. There is limited understanding of patient flow data for primary health services across the Victorian border. Ideally data sets that match a residential location with service utilisation patterns between states would provide a better understanding of service usage and in particular cancer screening activities. (ie flowinfo data set from NSW Health). There is limited data regarding AOD use during pregnancy and early parenthood, however anecdotally, consultations have indicated major community concerns surrounding alcohol and illicit drug use during pregnancy and early parenthood. In particular, the Clinical Councils have expressed concern related to the use of alcohol in pregnancy, but there appears to be no formal data source. Future expansion of knowledge in this area may be gained through auditing of records or targeted service provider and stakeholder feedback. There has been a great deal of emphasis on Clinical Council, Community Advisory Committee, Stakeholder Reference Group and consortium engagement, to support and inform this needs assessment. Stakeholder and community feedback is highly valued, however the vast geography of MPHN, combined with a large variety of demographics means that important themes or issues may have been missed in this iteration of the needs assessment. Ongoing stakeholder and community feedback will be an important part of MPHN activities over the next 12 months to ensure a broader and increasingly accurate perspective across all areas of primary health. There are major issues associated with accessing current and accurate information about suicide attempts and completed suicides. More time will enable MPHN to effectively consult with police, ambulance, and health and determine a more appropriate strategy for local data collection. This also must be addressed as a priority at a state and national level. There is a lack of outcome and experience data associated with a number of programs (e.g., MHNIP, Better Access) and this has limited our ability to understand the efficacy and utility of these programs to plan improvements and understand gaps. MPHN has been able to access data regarding service use, however local, state and federal data has frequently excluded an Indigeneity classification- this has restricted our ability to determine treatment rates for Aboriginal people. MPHN approached most helplines (e.g., the Suicide Call Back Service and Lifeline) for information about service use by Murrumbidgee residents. Future editions of the needs assessment will include this data and analysis. Additional comments or feedback (approximately 500 words) Page 6

in this section the PHN can provide any other comments or feedback on the needs assessment process, including any suggestions that may improve the needs assessment process, outputs, or outcomes in future (expand field as necessary). The accuracy and quality of future needs assessments could be markedly improved with a data linkage system between primary and acute services. A service data portal combining hospital, community health, GP, other private practice and community pharmacy service data would greatly enhance the analysis informing the health needs assessment. A central repository of primary health and population health data would ideally have linkage to a data visualisation tool or platform to improve efficiency of the needs assessment and planning process. Collaboration with local academic institutions would greatly enhance the MPHN s capacity to conduct a more thorough and rigorous needs assessment. There is an opportunity for mutually beneficial arrangements that could potentially form part of future workforce development and research opportunities. Page 7

Section 2 Outcomes of the health needs analysis This section summarises the findings of the health needs analysis in the table below. For more information refer to Table 1 in 5. Summarising the Findings in the Needs Assessment Guide on www.health.gov.au/phn. Additional rows may be added as required. Outcomes of the health needs analysis Identified Need Key Issue Description of Evidence Potentially preventable hospitalisations Management of exacerbation of chronic conditions High-rates of unplanned hospitalisations for the following conditions: Chronic Obstructive Pulmonary Disease (COPD) Chronic Heart Disease (CHD) Urinary Tract Infections in 0-9 and over 60 years of aged (Murrumbidgee has the highest rates nationally for unplanned hospital admissions associated with UTIs); Cellulitis and ENT infections Data also indicates that Murrumbidgee residents are accessing hospital services for mental healthcare when the care could be provided by community and primary care providers High rates of hospitalisations for COPD attributed to poor management of infective exacerbation of COPD despite a high rate of preventive medication prescribing. CHF hospitalisation admissions over 40 years of age for Wagga Hospitalisation rates, MLHD data, health care variation, clinical council consultations, clinician consultations (e.g., respiratory physician, respiratory CNC), community and stakeholder consultations and service mapping. Highest rate of smoking-attributable hospitalisations in NSW, Hospitalisation rates, Australian Atlas of Health Care Variation, clinical council consultations. Page 8

Outcomes of the health needs analysis Management of multimorbid conditions (including general and mental health diagnoses) Self-management skills and adequate health literacy Ageing population Cancer screening rates Wagga and Griffith-Murrumbidgee is among the top 10% in the nation. Clinical council feedback points to delayed presentation to services. Current programs tend to cater for single conditions and treatment is provided by clinicians working in silos, rather than by providers connected across agencies as one team. This is further compounded through lack of information sharing capabilities (e.g., shared care planning tool). Lack access to information/resources to management chronic or acute conditions, lack knowledge on health conditions, how treatment works and having a strategy / action plan in place when conditions worsen (e.g., exacerbation) High volume of hospital separations and prolonged length of stay in hospitals due to delayed transition to aged care facility. Co-morbidity, issues associated with service access and timely access, limited uptake of advance care planning, confusion surrounding pathways to care (including issues related to My Aged Care Service). Lower than state average cervical cancer screening rates and suboptimal screening rate for breast and bowel cancers. Low rates of breast screening amongst Aboriginal and CALD females, and some rural communities (particularly in the Border sector; however data may be influenced by cross Service needs analysis, clinical council feedback, clinician experience, and hospitalisation data. Demographic and population characteristics, evidence of inappropriate service utilisation- low use of primary healthcare services, and high hospitalisation rates associated with people from low socio-economic backgrounds and at risk of poor health outcomes. High levels of triage 3 and 4 ED presentations with steep upward trend in triage 3. Ageing demography, increasing over-representation of over 65 year age groups in health services particularly in respiratory and cardiac failure. High volumes other factors influencing health and rehabilitation hospitalisations with extended hospital stays of 17 to 25 average bed days. Clinical council consultations, feedback from Aged Care Consortium, consultation regarding My Aged Care service. National cancer screening data. Page 9

Outcomes of the health needs analysis border flow). Health outcomes for special needs or vulnerable groups Lifestyle risk factors Maternal and child health Growing demand and pressure on carers Compounding factors of socioeconomic disadvantage and unemployment. These factors are more pronounced in Aboriginal and Torres Strait Islander people and people with severe mental illness. (Links with high rates of lifestyle risk factors) People from CALD background may experience access barrier due to low levels of English proficiency. High smoking rates, high rates of risky alcohol consumption, less than optimal fruit and vegetable intake and sedentary lifestyle, high rates of obesity Women are less likely to attend antenatal care early in pregnancy and less than half of Aboriginal woman attend primary care before 14 weeks gestation. Aboriginal women are 3 times more likely to smoke during pregnancy. Carers are significant in the delivery of physical, social and emotional support for vulnerable members of the community, however many carers are ageing themselves. There are growing pressures on; Carers of the aged Carers of people with severe mental illness Carers of people with chronic and terminal disease Carers of people with a disability Mortality, hospitalisation rates, demographic trends and disease prevalence, expected growth in Aboriginal population in the younger population also in the over 65 year old population. Stakeholder consultations. Highest age adjusted BMI attributable hospitalisations in NSW, life expectancy in Murrumbidgee lower than NSW average, leading cause of death is circulatory disease, high rates of lung cancer, increasing trend in digestive system malignancy. MLHD data, Aboriginal Health Consortium feedback, Aboriginal consultation, Aboriginal health worker feedback Demographic trends the proportion of 15-44 year olds to 65+ year olds is decreasing, meaning less young people in the community to care for older persons. Community survey, consultations with clinical councils, National Carers Report Page 10

Outcomes of the health needs analysis High incidence of cancer Immunisation rates Increasing cancer incidence with limited changes to mortality indicates a rise in prevalence in the community. Cancer incidence is higher in rural and remote areas and areas of socio-economic disadvantage. While childhood immunisation rates are relatively high in the Murrumbidgee, rates remain below the 95% national target. Cancer Institute NSW statistics module, Australian Commission of Safety and Quality in Health Australian Atlas of Healthcare Variation, hospitalisation data. National performance authority data Mental Health and Suicide Prevention Outcomes of the health needs analysis Identified Need Key Issue Description of Evidence Psycho-social and developmental risk factors for children and young people Levels of psychological distress in children and young people Poor general health of people with severe and persistent mental illness Risk factors such as housing and homelessness, education completion rates, employment and income, and safety (bullying, family violence) is contributing to higher prevalence of distress and mental illness Most LGAs in the Murrumbidgee have high or very high rates of psychological distress Increasing prevalence of multi-morbidities and chronic disease resulting in limited quality of life, poorer functioning and premature mortality AEDI data (10% of children in Murrumbidgee are vulnerable on 2 or more domains), specialist homelessness service data, risk of significant harm reports, Murrumbidgee FACS data, feedback from consultations with Youth Reference Groups, consultation with Education providers ABS National Report Children and Youth, 2015 Department of Health report, consultation with Clinical Councils, community survey, service activity data (e.g., PIR) Page 11

Outcomes of the health needs analysis Low levels of help seeking behaviour for vulnerable groups Unresolved trauma contributing to high levels of psycho-social distress and mental illness Increasing rates of selfharm for women in MPHN High rates of self-harm in particular LGAs Increasing incidence of suicide risk and suicide in the MPHN Aboriginal and Torres Strait Islander People Young People CALD Men People living in Rural and Remote communities No region-wide trauma counselling service for adult survivors of child abuse, survivors of family violence and limited confidence/competence of existing workforce (e.g., Better Access providers) Rates of self-harm are increasing and at a 14 year high across all age groups for women, and Young women (aged 15-24) are particularly at risk The LGAs of Young, Cootamundra, Tumut and Cowra have very high rates of self-harm related hospitalisations when compared with NSW average Local and national data indicates that suicide attempts and suicides are increasing for: Men Aboriginal and Torres Strait Islanders Young People Women People with disability People with chronic disease LGBTIQ community members Treatment rates, service access by LGA, service activity data (e.g., MBS), consultations Literature, provider feedback, community consultation, service reports (WWHC) Hospital data at LGA level, consultations, Health Stats NSW longitudinal and comparative data NSW Health Stats 2014 ABS Cause of Death Data, local data (police, hospital) Page 12

Alcohol and Other Drugs Outcomes of the health needs analysis Identified Need Key Issue Description of Evidence High rates of AOD use (including risky consumption and addiction) amongst vulnerable groups Impacts of AOD use on others Increasing rates of risky alcohol consumption by males Binge alcohol consumption and drug taking and poly substance High rates observed across vulnerable groups including: Young People Aboriginal and Torres Strait Islander People Men Pregnant Women and New Mothers People with mental illness People from low-socio-economic backgrounds Psychological distress associated with the AOD use of a loved one or parent: Family members Dependent Children Murrumbidgee has significantly higher rates of risky alcohol consumption across NSW LHDs Age adjusted alcohol attributable hospitalisations for males in Murrumbidgee are significantly higher than NSW rates Risky levels of drug consumption for at risk groups (in particular young people, and men) Service activity, hospital data (significantly higher alcohol attributable hospitalisations for males), clinical council consultations, education sector consultations, youth reference group consultations, community survey Service activity, hospital data, clinical council consultations, education sector consultations, youth reference group consultations, community survey MLHD admission data Youth Reference Group consultations, national data, local hospital data (DRG by age group and sex) Page 13

Outcomes of the health needs analysis use among young people Section 3 Outcomes of the service needs analysis This section summarises the findings of the service needs analysis in the table below. For more information refer to Table 2 in 5. Summarising the Findings in the Needs Assessment Guide on www.health.gov.au/phn. Additional rows may be added as required. Outcomes of the service needs analysis Identified Need Key Issue Description of Evidence Increasing rates of hospital admissions unrelated to PPH Antimicrobial prescribing Health workforce development The bulk of the increase in hospitalisations relates to procedural reasons. For example, health care variations indicate higher rates of hospital admissions for tonsillectomy for people aged 17 years and younger, prostate biopsies 40 years and over, and radical prostectomy hospital admissions 40 years and over. Significant variation in compliance with prescribing guidelines and appropriateness of antimicrobial prescribed. Potential for clinicians to work to the top of their current scope and opportunity to extend their scope (e.g., Physiotherapists in Murrumbidgee currently have limited involvement in cardiopulmonary care and Australian Atlas of Healthcare Variation, hospitalisation rates, burden of disease measures. Wagga GP After-Hours Survey audits, Hospital National Antimicrobial Prescribing Survey, Australian Atlas of Healthcare Variation Health workforce analysis, hospitalisation by condition and stakeholder consultation. Page 14

Outcomes of the service needs analysis treatment, despite professional capabilities) Access to allied health services Clinical variation across multiple conditions Geographic mal-distribution of allied health services across the region. Evidence of duplication and gaps in services, and poor coordination of services, particularly with outreach to rural communities. Fragmented care due to current multiple funding streams and lack of shared care planning and information sharing. Shortage of credentialed diabetes education across the region. Lack of information about evidence, best practice, treatment, and referral options/pathways for optimal management Under-utilisation of allied health related MBS items in the region. Clinical council feedback. Service mapping / feedback from clinicians and local service providers. Australian Atlas of Health Care Variation, clinical council consultations, clinician feedback Service Coordination and knowledge of available services Access to specialist palliative care services in regional, rural and remote communities. Lack of coordination between providers across acute, primary and community managed sectors, limited transfer of information owing to no shared care planning tool, limited awareness of services and limitations of access to some services. Lack of specialist palliative care services for regional, rural and remote areas. Need to ensure GPs are well connected to specialist palliative care services for continuity of care. Stakeholder and community consultation, clinical council consultation Service mapping, community and provider consultation Page 15

Mental Health and Suicide Prevention Outcomes of the service needs analysis Identified Need Key Issue Description of Evidence Access to mental health services Programs and Services not suitably targeted and tailored to meet varied and changeable needs of consumers Inadequate communication and engagement with family members and carers Poor access to services at time of need/ crisis Geographic mal-distribution of allied mental health services across the region. Limited or no access to mental health services in a number of communities throughout the MPHN- including MHNIP, Better Access, and psycho-social supports One size fits all approach with a lack of options and services that meet the varied and changing needs of people at risk of or experiencing mental illness. In Murrumbidgee there are very few non-digital low intensity service options, and a lack of therapeutic options for people with severe and persistent mental illness Providers are not effectively communicating with and involving carers and family members in service provision, care planning and decision-making. A large number of communities in the MPHN region have no access to primary mental health care (e.g., Better Access, MHNIP), whilst the vast majority have limited access with few or solo providers working in isolation and not able to meet community demand at existing workforce levels. MBS: Provider ratios, underutilisation of allied health related MBS items in the region, clinical council feedback, service mapping / feedback from clinicians and local service providers. National Mental Health Commission Review of Services, service mapping, local consultation, community survey Community survey, stakeholder consultations Service mapping, community survey, stakeholder consultation, emergency department data Page 16

Outcomes of the service needs analysis Community members encounter delayed access to services in times of crisis, particularly if not requiring acute and specialist response provided by MLHD and in the absence of a suitable community based service are presenting to emergency departments. Complicated referral pathways Limited integration and opportunities for team care led by the consumer Under-developed frontline responses to psychological distress, mental illness and suicide risk More specifically, timely services in response to psycho social and environmental stressors was emphasised Poorly articulated referral pathways, eligibility, suitability, capacity, and target groups despite previous attempts to communicate more clearly. Multiple and complicated entry points, which are a barrier to access, delay timely access or contribute to people falling through the gaps. Current programs tend to cater for a single need and services are provided in silos, rather than by providers connected across agencies as one team. Particularly where the individual has complex needs requiring a multi-agency response (including mental health, general health, but also housing, education, employment). This is further compounded through lack of information sharing capabilities (e.g., shared care planning tool). An interest in, and willingness to provide better responses to mental health issues and suicide risk in mainstream services (e.g., General Practice) or other health facilities (e.g., Aboriginal Medical Services) is not resourced (e.g., clinical co-consultation, training) or Expressed need- Consumers, carers and stakeholders consultations, service mapping, community survey Expressed need- Consumers, carers and stakeholders consultations, service mapping, community survey, PIR data BEACH survey, clinical council consultations, community survey Page 17

Outcomes of the service needs analysis Inappropriate use of Hospital based services Lack of ongoing therapeutic follow up post-discharge Stigma and discrimination supported by clear information about pathways in to care Lack of services in the community, limited capacity of community based services to respond to worsening condition, and a lack of knowledge about alternative pathways to care are contributing to a local reliance on hospital and emergency services Limited therapeutic intervention and care coordination for consumers post-discharge for mental health or suicide related admission Stigma and discrimination towards people with severe and enduring mental illness, people who self-harm, and individuals who have personality disorders by health professionals, social care providers, and mainstream services MLHD hospital data indicates that 41.3% of all mental health related hospital emergency presentations are deemed as being more suitable for management in the community and primary care Community survey, PIR data, Clinical Council Consultations Community survey, clinical council consultations, PIR needs assessment and evaluation, feedback from PIR Consumer Advisory Committee Alcohol and Other Drugs Outcomes of the health needs analysis Identified Need Key Issue Description of Evidence No available AOD counselling or rehabilitation targeting young people in the region Absence of youth specific community based AOD services contributing to proportionately lower treatment rates for Young People in Murrumbidgee despite increasing problem AOD use and expressed needs for safe and youth-friendly services Service activity data Calvary Healthcare and MLHD, hospital data, stakeholder consultation, community survey, Youth Reference Group consultations, community survey Page 18

Outcomes of the health needs analysis Limited AOD counselling or rehabilitation targeting Aboriginal and Torres People No AOD counselling or rehabilitation specifically for Pregnant Women and New Mothers Inequitable geographic distribution of existing AOD services Rapid post-crisis responses Supports for children whose parents(s) have AOD issues/addiction Continued issues associated with ineligibility and dual Lack of targeted and culturally appropriate services contributing to proportionately lower treatment rates for Aboriginal People in the Murrumbidgee Prevalence of AOD use in pregnancy, and continued use in early childhood was identified as a major issue for stakeholders. Providers and consumers identified a need for a service that combines family and parenting support/education/skill development and AOD support/treatment. Non-Government AOD Services in the MPHN are all based in Wagga however community consultations indicate a preference for an out of town option due to stigma and discrimination Opportunity to intervene and break the cycle for those whose AOD use has led to hospital admission, overdose, crime, or family breakdown through brief intervention and supported access to longer-term therapeutic options and support to alleviate psycho-social stressors. Children and young people who are experiencing difficulty coping with parental substance abuse (particularly alcohol) Consumers being turned away from service, or offered a disjointed service due to substance use or mental health issues Service activity data Calvary Healthcare and MLHD, hospital data, Aboriginal Health Consortium Consultation, Consultation with MHSPAOD Working party, community survey AIHW data, stakeholder consultation, consultation with Aboriginal Health Consortium, community survey, Aboriginal Health Community Consultation Service mapping indicates no non-government services outside of Wagga. Data indicates a need for additional services in Young and Griffith to provide greater geographic coverage. Best practice evidence, Stakeholder consultation, community survey National evidence, Stakeholder consultation, community survey, consultation with Kids and Families Consortium, Consultation with Youth Reference Group Community survey, Clinical Council consultations Page 19

Outcomes of the health needs analysis diagnosis (mental illness and addiction) Primary Care and Community Managed Organisations Capacity Lack of guidance and support for primary care professionals and community managed organisations managing AOD use and addiction in primary care settings and community settings Clinical Council consultations, stakeholder consultations 1. Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. International journal of epidemiology. 2002;31(2):285-93. 2. Coster G. Health needs assessment for New Zealand: background paper and literature review: Ministry of Health; 2000. 3. Government A. PHN Background 2015 [updated 2015 December 8; cited 2016 Feb 3]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/content/phn-background. Page 20