Norfolk Island Central and Eastern Sydney PHN

Norfolk Island Central and Eastern Sydney PHN Activity Work Plan 2016-2018: Norfolk Island Coordinated and Integrated Primary Health Care Services Mental Health and Suicide Prevention Drug and Alcohol Treatment Central and Eastern Sydney 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 Margaret Como via email Margaret.Como@health.gov.au on or before 30 Nov 2016. 1

Introduction Overview The key objectives of Primary Health Networks (PHN) are: Increasing the efficiency and effectiveness of medical services for patients, particularly those 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. Each PHN must make informed choices about how best to use its resources to achieve these objectives. 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. Activity Planning The PHN Needs Assessment will identify local priorities which in turn will inform and guide the activities nominated for action in the 2016-2018 Activity Work Plan. PHNs need to ensure the activities identified in the annual plan also correspond with the PHN Objectives; the actions identified in Section 1.2 of the PHN Programme Guidelines (p. 7); the PHN key priorities; and/or the national headline performance indicators. PHNs are encouraged to consider opportunities for new models of care within the primary care system, such as the patient-centred care models and acute care collaborations. Consideration should be given to how the PHN plans to work together and potentially combine resources, with other private and public organisations to implement innovative service delivery and models of care. Development of care pathways will be paramount to streamlining patient care and improving the quality of care and health outcomes. 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. Please contact your Grants Officer if you are having any difficulties completing this document. 2

Strategic Vision CESPHN is committed to building a comprehensive, person-centred integrated system of care for the people of Norfolk Island. This will be achieved through strong collaboration with the Norfolk Island Health and Residential Aged Care Service (NIHRACS), South Eastern Sydney LHD (SESLHD), local service providers and most importantly the local community. There will be a strong focus on promotion, prevention and early intervention services across primary care, mental health and drug and alcohol services. The primary care sector will work closely with the acute sector to achieve improved health outcomes for the community of Norfolk Island, as reflected in the NIHRACS Clinical Services Plan (attached). The strategic vision is founded on key planning principles that have been defined in consultation with local stakeholders, as part of the joint Norfolk Island Health and Residential Aged Care clinical planning process. These are: A focus on wellness, protective factors and community resilience, identifying the contributions and assets (experiences, resources, strengths) of individuals and communities to support community health and mental and social wellbeing. Integration of service providers wherever possible to reduce duplication of services and space and to produce a seamless continuum of care and team-focused approach to care delivery. This includes involvement of health and aged care related service providers in codesigning and co-producing services with community members, staff and key partners. Strengthened partnerships with service providers on Norfolk Island and off Island formal networked providers to maximise the use of resources, reduce community confusion, and build local capacity to deliver care and improve service outcomes. To better utilise resources (including funding, staff and equipment) in respect to the provision of appropriate health services that meet the needs of the Norfolk Island community - both resident and visitors - asset management and support services in the provision of health services. The vision for the integrated system of care is a multidisciplinary team approach to providing health and social care services, coordinated with other services. There will be a broad approach to improve family and community wellbeing that extends beyond care coordination. There is the potential to develop a community-focused integrated care hub in which health and wellbeing and social service providers are physically co-located to facilitate this system of care. 3

Description of the process undertaken in developing the Activity Work Plan Carramar Consulting were engaged to develop the Clinical Services Plan for NIHRACS in mid-2016. Subsequently, Carramar Consulting were engaged by CESPHN to assist in the development of the Needs Assessment and this Activity Work Plan for Norfolk Island. As part of this broader process, Carramar Consulting undertook on-site consultation alongside SESLHD and the Commonwealth Department of Infrastructure and Regional Development. This included consultations with the local health service and staff, the Regional Council, community volunteer groups, NGOs, police, school, local leaders and community service providers. This wide ranging consultation process allowed for a broad range of views to be heard and a wide range of local issues to be discussed. This Activity Work Plan has been developed using information obtained during the development of the Needs Assessment and further consultation with CESPHN and SESLHD key stakeholders. A draft Activity Work Plan was developed, and a meeting undertaken between Carramar Consulting, SESLHD and CESPHN to discuss key issues and agree on the way forward. Consensus was achieved as to the priorities for the Activity Work Plan, based on local circumstances on Norfolk Island. The development of the Activity Work Plan has occurred concurrently with concurrent significant changes and further developments in relation to health and social care services on Norfolk Island. The situation on Norfolk Island is dynamic, with new services and workforce roles being created or expanded across NIHRACS and other government and non-government service providers. There will be a need to be flexible in the implementation of this Activity Work Plan, in a way that meets the needs of the community, and fits in with NIHRACS as that organisation continues to adapt to the new and changing legislative and political environment on Norfolk Island. It is likely that this Plan will require some revision in the months ahead. Overview of the Activity Work Plan This activity plan is informed by our needs assessment and reflects the activities to be delivered over the course of 2016-2018. The key activities within this Activity Work Plan are as follows: 1. Norfolk Island Coordinated and Integrated Primary Health Care Services Provide GP practice support on Norfolk Island Enhance approaches to digital health 2. Norfolk Island Mental Health and Suicide Prevention Explore feasibility of a Health and Wellbeing Coordinator / Integrator role with key stakeholders Commission appropriate mental health psychological therapies and/or counselling services for adults, children and young people. 4

Build mental health literacy and community capacity including promoting access to online mental health resources. Increase knowledge and skills of providers to improve capacity of general practice in assessing and managing mild, moderate and severe mental illness. 3. Norfolk Island Drug and Alcohol Treatment Services Improve local access to drug and alcohol treatment services across the continuum of care. Build community literacy about drug and alcohol risk behaviours and harm reduction An important activity within this Activity Work Plan is the exploration of a new on-island role of a (preliminarily named) Health and Wellbeing Coordinator. An on-the-ground, non-clinical and local presence is required to drive a number of the activities outlined in this plan. Their role will be to build community resilience through coordinating health promotion activities, health literacy, be the point of contact in navigating services and facilitating introductions to health professionals. It is important to note that there is a need to ensure that this role is supported, sustainable and does not conflict with existing positions on Norfolk Island, therefore further local consultation will be undertaken with all relevant stakeholders in the first instance. Additionally, there is a key focus on health promotion activities due to the lack of health promoting services and activities currently available on the Island. In order to complement the suite of commissioned mental health and drug and alcohol services, additional resourcing is required at the prevention end of the spectrum to support those people who are at risk of developing a mental illness and/or drug and alcohol disorder. 5

Planned activities for Norfolk Island Norfolk Island Coordinated and Integrated Primary Health Care Services PHC 1.1 Provide GP practice support on Norfolk Island PHC 1.2 Enhance approaches to digital health. Norfolk Island Mental Health and Suicide Prevention NIMHSP 2.1 Commission a Primary and Community Health and Wellbeing Coordinator role NIMHSP 2.2 Commission appropriate mental health psychological therapies and/or counselling services for children and young people. NIMHSP 2.3 Build mental health literacy and community capacity including promoting access to online mental health resources. NIMHSP 2.4 Increase knowledge and skills of providers to improve capacity of general practice in assessing and managing mild, moderate and severe mental illness. Norfolk Island Drug and Alcohol Treatment Services NIDA 3.1 Improve local access to drug and alcohol treatment services across the continuum of care. NIDA 3.2 Build community literacy about drug and alcohol risk behaviours and harm reduction 6

1. Planned activities for Norfolk Island Coordinated and Integrated Primary Health Care Services PHNs must use the table below to outline the activities proposed to be undertaken within the period 2016-18. Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale 2. Develop workforce capability and capacity to support sustainable, quality health services (2.2 GP Practice Support) PHC 1.1 Provide GP practice support on Norfolk Island. CESPHN will support GPs, practice staff, practice nurses to improve quality of care through the following practice support activities: Accreditation Quality improvement (service links, referral pathways, clinical practice) MBS Item numbers and Practice Incentive Payments Digital Health My Health Record, secure messaging, quality improvement activities Referral pathways Immunisation support Clinical software training Provision of education, training and development opportunities, and linking with existing GP training and mentoring programs (e.g. Rural Vocational Training Scheme) Other relevant practice resources. There will be opportunities to support and develop the skills of the Practice Nurse to take pressure off GPs, link services more effectively, and undertake more promotional work. (This is subject to the employment of a Practice Nurse, which is the immediate intention of NIHRACS). CESPHN may consider the Rural Generalist Training Program as an opportunity to enhance general practice sustainability. There will also be exploration of sustainable options for after-hours primary care services. 7

It is noted that there will need to be alignment between CESPHN practice support activities and the work being undertaken by the contracted practice manager (Australian Association of Practice Management, AAPM) at the NIHRACS GP practice. Collaboration Duration Jan 2017-June 2018 Coverage Expected Outcome Commissioning approach (where applicable) Rationale: The GP practice is owned by NIHRACS and employs 2.3 FTE (3 head count) general practitioners. The current permanent 1 FTE GP is transitioning over a 2 year period to a private practice model. Locum arrangements are in place until the recruitment process for an additional 1 FTE GP is finalised. A third GP works part-time from the GP Practice in a private capacity. Two of the three GPs service a 24 hour on-call roster with a 1 in 2 on- call availability. There is no external after hours coverage or telephone support from a deputising service or telephone advice line. There is a high turnover of staff, particularly GPs. This impacts continuity of care particularly for patients with complex and/or chronic disease. Anecdotally, GP services have been stretched as they are required to work across both general practice and within the hospital environment. Consultation indicated that the practice staff require training and development in key areas including mental health and professional practice (e.g. privacy, record keeping). Cost and travel distances have been identified as barriers to professional development opportunities. This is compounded by the small size of the workforce and difficulties backfilling positions. The recent transition to Medicare has necessitated large changes in the way that general practice is managed and services are provided. GP practice staff, AAPM, NIHRACS, SESLHD, SESLHD Public Health Unit Norfolk Island Enhanced general practice management and performance will increase the overall efficiency of the practice, which in turn will enable increased focus on quality patient care and patient outcomes. Operational function 8

Performance Indicator Data source Process: GPs participate in education and training activities CESPHN staff undertake regular site visits to provide practice support Uptake and utilisation rate of MBS items, including Chronic Disease Management and relevant Practice Incentive Payments Outcome: Practice accreditation is achieved Improved general practice capacity to manage chronic disease in line with best practice Medicare Australia statistics CESPHN Client Management System 9

Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale 1. Improve access to health services (1.1 Allied Health Services) 2. Develop workforce capability and capacity to support sustainable, quality health services PHC 1.2 Enhance approaches to digital health. CESPHN will work with general practice, NIHRACS and SESLHD to enhance approaches to digital health in the primary care sector. This will include: promoting the use of telehealth services (subject to the infrastructure being established on the Island) Promoting the use of secure messaging to encourage information sharing and coordination between providers (e.g. Argus, Healthlink), including use of electronic discharge summaries Investigate options to implement HealthPathways locally to support clinical practice and referrals. Promote My Health Record to the community and general practice The implementation of telehealth services will require close collaboration with SESLHD and the Commonwealth Department of Infrastructure to ensure the infrastructure and service models meet the needs of clinicians and the community. Rationale: There is currently very limited use of telehealth services with no formal program or dedicated software and hardware. In addition, there has historically been no integration of information technology systems and no data collection consistent with NSW or Australian guidelines and data standards. Information sharing between services (including between Norfolk Island services and mainland services) is limited due to the previous arrangement of health services and related information systems on Norfolk Island. A range of existing information systems and programs such as HealthPathways have the potential to provide value to the GPs management and referral pathways on Norfolk Island. 10

Collaboration with general practice will be required, along with all providers for whom secure Collaboration messaging is a suitable manner for communicating with patients (e.g. allied health providers and specialists). Duration Jan 2017-June 2018 Coverage Expected Outcome Commissioning approach (where applicable) Performance Indicator Norfolk Island The adoption of enhanced approaches to digital health will facilitate patient-centred models of care, and enable the ability of service providers to monitor and measure a range of indicators around service provision. Operational function. Process: No. of telehealth occasions of service provided at the GP practice Secure messaging between the GP practice and other care providers established CESPHN staff undertake regular site visits to provide practice support in the areas of digital health Uptake and utilisation of my Health record, uploading of shared medical summaries by provider, uploading of discharge summaries. Outcome: Improved uptake of digital health technologies across primary care Data source Secure messaging software providers Department of Health GP feedback 11

2. Planned activities for Norfolk Island Mental Health and Suicide Prevention PHNs must use the table below to outline the activities proposed to be undertaken within the period 2016-18. Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale 1. Improve Access to Health Services 3. Renew the focus on population health, including early intervention and prevention 4. Coordination and effective partnerships for culturally appropriate, patient-centred healthcare NIMHSP 2.1 Commission a Primary and Community Health and Wellbeing Coordinator role Based on community feedback the role of a Primary and Community Health and Wellbeing Coordinator role as a key point of contact to establish coordinate, integrate and build relationships on the Island with SESLHD, NIHRACS, community organisations and community groups, would be welcomed This role will be developed in consultation with SESLHD, NIHRACS and the NI Community and Consultative Committee. In undertaking this activity consideration will be given to best use of current on Island workforce. Planning will be co-ordinated with those groups already outlined. This role will ensure a locally based presence to co-ordinate and integrate PHN, NIHRACS, SESLHD and other activities with all stakeholders. This role would be community focused, using skills and knowledge of the community and ensuring culturally appropriate approaches to community engagement. 12

The co-ordinator role would assist all stakeholders to build community resilience through increasing health literacy, coordinating health promotion activities and coordinating a Communities Matter https://communitiesmatter.suicidepreventionaust.org/ approach to suicide prevention. The role may also serve as a point of contact in navigating services and facilitate introductions to health professionals and identify and refer clients to adequate specialist drug and alcohol treatment services or primary care services where appropriate. The exact role and responsibilities would be subject to consultation NICRACS and the NI Community and Consultative Committee to ensure all relevant stakeholders are supportive and to avoid overlap with existing roles. Rationale: Improving access to mental health and other services is contingent on community health literacy and willingness to access support, and the ability of services both on Norfolk Island and on the mainland to coordinate and integrate effectively. The success and sustainability of newly commissioned services in the future requires a local focus, with a patient centred approach, sensitive to the culture and customs of Norfolk Island. Collaboration Duration Coverage Expected Outcome Performance Indicator NIHRACS, SESLHD, Norfolk Island Community and Consultative Committee, Mental Health Awareness Group (on Island), community groups 2017-2018. Key Milestones Q1 July- Sept 2017: Contract execution, Monitoring and reporting Q2 Oct- Dec 2017: Monitoring and reporting Q3 Jan-March 2018: Monitoring and reporting Q4 April June 2018: Monitoring, reporting and Evaluation Norfolk Island The implementation of the role will lead to better coordination and integration of health services, building community resilience and capacity to support residents health and wellbeing needs. Process: 13

Establishment of a Health and wellbeing Coordinator role, supported by NIHRACS, SESLHD, community organisations and groups Health and Wellbeing coordinator role defined at allocated. Outcome: Increased number of Health promotion, health literacy activities and Primary Mental Health services provided by CESPHN, NIHRACS and other providers are patient centred, coordinated and integrated Establishment of Communities matter community action group Oversee and support groups coordinating activities under the Health Promotion Plan Mandatory Indicators: Indicator Acc-1: Proportion of regional population receiving PHN-commissioned mental health services Low intensity services Data source *Performance Indicators and Targets are currently being reviewed as part of a broader Monitoring and evaluation framework and may be revised prior to 1 July 2017 CESPHN records 14

Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale Collaboration 1. Improve Access to Health Services (1.2 Mental Health Services) NIMHSP 2.2 Commission appropriate mental health psychological therapies and/or counselling services for children and young people. The aim of this activity is to expand the delivery of a range of appropriate psychological therapies and counselling services in line with identified service need for additional community based, school and family therapy services on Norfolk Island. CESPHN will commission additional community focused mental health and suicide prevention services in line with community need and in consultation with SESLHD to ensure we complement services not duplicate services. Due to the dynamic nature of health and social service provision on Norfolk Island, there will be a requirement to undertake further local consultation to define specific services to match the level of needs. Rationale: There is currently only one mental health counsellor working under contract through NIHRACS on Norfolk Island. The existing provider is an experienced Registered Psychologist and is required to provide a broad range of counselling services including relationship counselling, mediation and family dispute resolution. In addition to the above counselling sessions, there are additional home visits, case management of complex mental health clients, training and education of hospital nursing staff, preparation of reports for the court, professional development for Police and the NI School Teachers and coordination of a Community Drum Beat Program. There is no cover for the service when the provider is on leave and there are no alternative service options available. A child and youth counsellor currently visits the school 12 weeks each year which has been reported to be inadequate considering the needs of young people. Family therapy services were also identified as a need. A child welfare officer has recently been appointed to the Council. It is also noted that NIHRACS has recruited a social worker for six months to support the existing counsellor. NIHRACS, SESLHD, Mental Health Awareness Group (Norfolk Island), community groups, NI school 15

Duration Coverage Expected Outcome Performance Indicator Data source 2017-2018. Key Milestones Q1 July- Sept 2017: Procurement, Monitoring and reporting Q2 Oct- Dec 2017: Monitoring and reporting Q3 Jan-March 2018: Monitoring and reporting Q4 April June 2018: Monitoring, reporting and Evaluation Norfolk Island Increased mental health service provision will result in better prevention, early identification and intervention, and management of mental health conditions for adults, children and young people on Norfolk Island. This will lead to better health and social wellbeing outcomes and less reliance on acute services. 2017-18 KPIs Process: Service Commissioned, monitored and evaluated per contractual arrangements Profile of client groups to target population Outcome: Number of referrals (aggregated to gender and age) Numbers of consumers provided a service (aggregated to gender and age) Number of occasions of service (aggregated to gender and age) Improved clinical outcome measures (aggregated to gender and age) Consumer experience of care (aggregated to gender and age) *Performance Indicators and Targets are currently being reviewed as part of a broader Monitoring and evaluation framework and may be revised prior to 1 July 2017 PMHC MDS 16

Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale Collaboration Duration 1. Improve access to health services (1.2 Mental Health Services) 3. Renew the focus on population health, including early intervention and prevention NIMHSP 2.3 Build mental health literacy and community capacity including promoting access to online mental health resources. CESPHN will commission population level activities including mental health and drug and alcohol promotion activities, resources and campaigns on a variety of topics including stigma and discrimination, health literacy, health seeking behaviours, carer and family support, education and harm minimisation. It is noted that the proposed Health and Wellbeing Coordinator position would have an important role to play in delivering health promotion activities, distributing resources and coordinating activities as required. The use of online resources to support low intensity services is also an opportunity (e.g. eheadspace, Beyond Blue, other online programs). Rationale: There is limited mental health literacy in the community with a resulting lack of acknowledgement and recognition of the need for early intervention. There are stress and anxiety issues in both the adult and children s populations. Consultation indicated that the most common mental health presentations to hospital have included depressive disorders and general anxiety / panic disorders. Consultation indicated that some people in the community avoid accessing mental health services due to privacy and confidentiality concerns. There is still a perception of a stigma associated with accessing these services for adults. Consultation also identified a need to improve the knowledge of mental health online resources available to health practitioners including GP s, practice nurse, psychologists and other allied health workers (e.g. emhprac). NIHRACS, SESLHD, Mental Health Awareness Group (on Island), community groups 2017-2018. Key Milestones 17

Coverage Expected Outcome Performance Indicator Data source Q1 July- Sept 2017: Procurement, Monitoring and reporting Q2 Oct- Dec 2017: Monitoring and reporting Q3 Jan-March 2018: Monitoring and reporting Q4 April June 2018: Monitoring, reporting and Evaluation Norfolk Island Investment in the promotion of mental health and drug and alcohol literacy will result in an increased capacity of the people of Norfolk Island to identify health concerns, and take steps to improve their health. Promotion should also address some issues of confidentiality and privacy. Increased use of available online mental health resources will result in improved outcomes for residents, particularly for those with persisting low intensity mental health conditions. 2017-18 KPIs Process: Number of sites on NI where Mental Health resources are available *Performance Indicators and Targets are currently being reviewed as part of a broader Monitoring and evaluation framework and may be revised prior to 1 July 2017 * Further indicators are being developed as part of the Norfolk Island Health Promotion Evaluation Plan CESPHN Commissioned service providers 18

Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale Collaboration Duration 1. Improve access to health services (1.2 Mental Health Services) 2. Develop workforce capability and capacity to support sustainable, quality health services NIMHSP 2.4 Increase knowledge and skills of providers to improve capacity of general practice in assessing and managing mild, moderate and severe mental illness. CESPHN will provide and commission education and training activities to GPs, practice nurses and other staff in the primary care setting in relation to assessment and management of mental illness. This will include case management, the development of mental health treatment plans, screening assessments and therapeutic interventions. Rationale: General practitioners on the Island noted that they require further training and development to ensure they can provide appropriate mental health services to their patients. Some concerns were raised in relation to privacy and confidentiality. There is currently only one mental health counsellor working under contract through NIHRACS on Norfolk Island. Upskilling GPs is required to ensure the sustainability of mental health service provision on the Island. This activity will be linked into the practice support component, see Norfolk Island Coordinated and Integrated Primary Health Care Services activities NIHRACS, SESLHD, Mental Health Awareness Group (on Island), community groups 2017-2018. Key Milestones Q1 July- Sept 2017: Monitoring and reporting Q2 Oct- Dec 2017: Monitoring and reporting Q3 Jan-March 2018: Monitoring and reporting 19

Coverage Expected Outcome Performance Indicator Data source Q4 April June 2018: Monitoring, reporting and Evaluation Norfolk Island The ability of GPs and other staff in primary care to assess and manage patients with mental health illnesses will take pressure of the mental health counsellor and acute mental health services. Increased awareness of general practitioners relating to the identification of, and treatment options for people experience mental health conditions (including options for referral to mainland psychiatric services) will result in better identification and management of mental health conditions for adults, children and young people. 2017-18 KPIs Process: Commission appropriate mental health training services to meet the needs of GPs, Practice Nurses and administrative staff. Outcomes: Number of CPD events held Number of attendees at CPD events (GPs, practice nurses, practice administrative staff, AHPs) Overall participant feedback with education topics. Indication of learning needs met (% of entirely met, % partially met and % not met) *Performance Indicators and Targets are currently being reviewed as part of a broader Monitoring and evaluation framework and may be revised prior to 1 July 2017 CESPHN Commissioned service providers NIHRACS 20

3. Planned activities for Norfolk Island Drug and Alcohol Treatment Services PHNs must use the table below to outline the activities proposed to be undertaken within the period 2016-18. Note 1: Please copy and complete the table as many times as necessary to report on each activity. Note 2: Indicate within the duration section of the table if the activity relates to a two-year period (2016-2018) or a one year period (2016-2017). Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale 1. Improve access to health services (1.3 Drug and Alcohol Treatment) NIDA 3.1 Improve local access to drug and alcohol treatment services across the continuum of care. CESPHN will commission appropriately trained and experienced service providers to provider drug and alcohol treatment services as required. It is noted that these will overlap with commissioned mental health service providers, and the proposed Health and Wellbeing Coordinator will have an important role to play in identifying community need and gaps in service provision at a detailed level. Primary care providers will be educated in relation to early intervention and available referral pathways for drug and alcohol use. Rationale: There is a lack of specific early intervention, counselling and case management services for drug and alcohol issues. Binge drinking is the main alcohol issue on Norfolk Island. 29 per cent of secondary school students indicate that they have tried drugs. Anecdotally, marijuana use is common on the Island. 21

Collaboration Duration Coverage Expected Outcome Performance Indicator Data source NIHRACS, SESLHD, Mental Health Awareness Group (on Island), community groups 2017-2018. Key Milestones Q1 July- Sept 2017: Monitoring and reporting Q2 Oct- Dec 2017: Monitoring and reporting Q3 Jan-March 2018: Monitoring and reporting Q4 April June 2018: Monitoring, reporting and Evaluation Norfolk Island Improved access to early intervention, counselling and case management services for individuals with drug and alcohol issues will result in better patient identification, management and treatment outcomes. 2017-18 KPIs Process: Service Commissioned, monitored and evaluated per contractual arrangements Profile of client groups to target population Outcome: Number of referrals (aggregated to gender and age) Numbers of consumers provided a service (aggregated to gender and age) Number of occasions of service (aggregated to gender and age) Improved clinical outcome measures (aggregated to gender and age) Consumer experience of care (aggregated to gender and age) *Performance Indicators and Targets are currently being reviewed as part of a broader Monitoring and evaluation framework and may be revised prior to 1 July 2017 CESPHN Commissioned service providers 22

Proposed Activities Priority Area (eg. 1, 2, 3) Activity Title / Reference (eg. NP 1.1) Description of Activity and rationale 1. Improve access to health services (1.3 Drug and Alcohol Treatment) 3. Renew the focus on population health, including early intervention and prevention NIDA 3.2 Build community literacy about drug and alcohol risk behaviours and harm reduction CESPHN will work with partners to develop and commission locally relevant health promotion programs for delivery in the general community and in schools in conjunction with broader health literacy activities. This will include the promotion of the uptake of online interventions such as Hello Sunday Morning. The proposed Health and Wellbeing Coordinator will have an important role to play in distributing resources, facilitating and coordinating activities as required. Rationale: Consultations indicated that binge drinking is an issue on the Island. Norfolk Islander teenagers and adolescents report much higher proportions of ever using alcohol (81 per cent) than NSW secondary students (65 per cent) and 34 per cent of residents indicate that they have consumed alcohol every day in the past three months. 29 per cent of secondary school students indicate that they have tried drugs. Collaboration Duration Jan 2017 - June 2018 Coverage Expected Outcome Performance Indicator NIHRACS, SESLHD, Mental Health Awareness Body, community groups, local schools Norfolk Island Enhanced community literacy about drug and alcohol risk behaviours and harm reduction will result in a reduction in drug and alcohol related harms. 2017-18 KPIs Process: Number of sites on NI where Drug and Alcohol resources are available *Performance Indicators and Targets are currently being reviewed as part of a broader Monitoring and evaluation framework and may be revised prior to 1 July 2017 23

* Further indicators are being developed as part of the Norfolk Island Health Promotion Evaluation Plan Data source CESPHN Commissioned service providers 24