Co-location of Alcohol and other Drug Services and Area Mental Health Services in a rural setting. How well can it work?

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1 Latrobe Community Health Service Co-location of Alcohol and other Drug Services and Area Mental Health Services in a rural setting. How well can it work? Wayne Atkinson and Ann Hamden

2 Latrobe Community Health Service Latrobe Community Health Service Limited is a major provider of primary health and support services across the Latrobe Valley and Gippsland. Approximately 400 staff. LCHS aims to reduce disease and illness through prevention, health promotion and social, physical and cultural change An integrated and coordinated approach to the delivery of services in community settings at local, sub regional and regional levels.

3 LCHS Drug Treatment Services Drug Treatment Services is the lead agency for service delivery to the Gippsland region in partnership with Bass Coat, Gippsland Southern and East Gippsland. Counselling, C&R NRWN services LCHS DTS employs 21 staff and also provides: Youth Outreach Youth Withdrawal (Closing the Gap -funded until June 30) Mobile Drug Safety Worker-Early Intervention and Needle & Syringe Exchange Program Koori Court Diversion Pharmacotherapy Area Based Network -Lead Agency for Gippsland and Hume region Liverwise Program (regional)

4 LCHS Drug Treatment Services

5 Dual Diagnosis Initiatives AOD clinician attends morning intake meetings in all LGA s-warragul, Traralgon and Sale sites on a weekly basis Sharing of information Updating of progress of shared clients Identifying potential referrals to both MH and AOD Identifying at risk or potential clients Organising/facilitating dual assessment appointment times

6 DD Network Meetings with AMHS and DTS Staff from AMHS and DTS attended sessions inc Psychiatrist, AOD clinicians, Case Managers and Managers May Speed dating and Information sharing about services and models of working together-30 staff August 2013-Case study -25 evaluations completed

7 May 2013 Speed Dating-30 participants Strongly Agree Agree Neutral Disagree Strongly disagree The forum was relevant The forum was well organised The presenters were clear and able to be understood The presenters encouraged participation The information provided has increased my knowledge Overall the session was beneficial to me Do you have any suggestions for improvements to the session? 1. We need to have these forums regularly. 2. Maybe everybody s contact & phone numbers. 3. More regular meetings. 4. Have meetings regularly. 5. Allow time for an open forum. 6. Education sessions could be included. 7. Remember to tell people how they can make a referrals. 8. To come together to more collaboratively as services-new projects. 9. Ongoing collaborative approach. 10. More time, too quick. 11. Regular times\reviews to match staff chosen and service delivery charges.

8 What were the most valuable aspects of the session for you? 1. Networking with staff 2. What is available currently in Mental health. 3. Networking. 4. Everything. 5. Networking. 6. Increased understanding & Child & adolescent service. 7. Information about all services. 8. Understanding the different services & what they offer. 9. Being new to DTS LCHS, It was good to see the people I will be communicating with. 10. Learning about help for children with ASD. 11. Catching up with some of the workers. Name one change you will make to your practice with Dual Diagnosis in the future. 1. Joint case presentation. 2. Case management meetings/updates/working as a team. 3. Ring to work with any child and adolescent issues. 4. I will have a direct line. 5. More education. 6. Contact other agencies direct. 7. Contact for advice about possible drug and alcohol presentations. 8. Increased 2% consults? 9. Joint arrangements. 10. Assist others with DD questions more. 11. The ability to call someone or one number within mental health to brain storm care plans for? DD clients. And everyone have everyone s and phone numbers and title and job role.

9 Case Study August participants Strongly Agree The forum was relevant Agree Neutral Disagree Strongly disagree The forum was well organised I learnt from the case presentation and group work I think the approach used today (17 responses) I met people I didn t already know Overall the session was beneficial to me Do you have any suggestions for improvements to the session? Really good idea, very useful. Wonderful Concept and really meaningful discussions. Action Plan development from key workers at conclusion of session; with follow on and update. No. x 2 More time. Greater education component. The case presentation turned into ideas for the client s treatment not so much what mental health do Vs what AOD do. Collaborative approach.

10 What were the most valuable aspects of the session for you? Listening to mental health perspective and involvement. Discussion. Seeing different views/beliefs of staff. Would be good to repeat. All. Collaboration. Case conference. Case Study. Networking. Working as a team to come up with a better management plan. Discussion. Case presentation Name one change you will make to your practice with Dual Diagnosis in the future. Seek concise history and secondary consult with MH as a matter of course. Close contact. More structure in sessions, not discussions on individual cases.

11 Evaluation of the Colocation of a Drug Treatment clinician Colocation of a Drug Treatment Clinician was undertaken at the West Gippsland Mental Health Service during October The colocation was evaluated by process evaluation methodology to capture quantitative and qualitative data.

12 Background The Victorian Dual Diagnosis Initiative (2007) outlines the key directions and priorities for building improved responses by Mental Health and Drug Treatment Services to people who have concurrent mental health and substance use disorders. Reasons to improve service responses High prevalence

13 Method Pilot Study Participants Data Gathering

14 Data Analysis Service Delivery Outcomes 75% achieved Is dual diagnosis identified and responded to as core business? Are staff in mental health and drug treatment services dual diagnosis capable? Are effective partnerships established? Are outcomes monitored and reviewed? Are consumers and carers involved in the planning and evaluation of service responses?

15 Data Analysis Effective Responses 92% achieved Is collaboration between mental health and drug treatment services effective? Are referrals to drug treatment services timely? Is integrated treatment achieved? Is service capacity increased Is client information shared?

16 Data Analysis Client Interventions 75% achieved Are dual diagnosis clients screened, assessed and treated effectively? Are dual diagnosis clients reviewed regularly? Are dual diagnosis clients monitored between appointments? Is relapse to mental health or drug use disorders prevented? Are dual diagnosis clients provided with high quality information?

17 Data Analysis Professional knowledge 94% achieved Are secondary consultations provided to Mental Health Services staff? Is knowledge freely shared? Does sharing knowledge result in teamwork? Does sharing knowledge result in evidence based interventions? Is a high standard of professional knowledge provided to Mental Health staff?

18 References Australian Healthcare Associates (2011) Evaluation of the Victorian Dual Diagnosis Initiative. Final Report. Croton, G. (2009) Dual Diagnosis Capability Checklist Version 6.0, Northeast Health Wangaratta Davies, R., & Dart, J., (2005) The Most Significant Change (MSC) Technique. A Guide to Its Use. Version 1.00 April Department of Human Services. Victoria. (2007) Dual Diagnosis: Key Directions and Priorities For Service Development. Greenhalgh, T., (2010) How to read a paper: the basics of evidence based medicine. 4 th Edition BMJ Books, Wiley Blackwell. Grinnell, R.M., (1988) Social Work Research and Evaluation. F.E. Peacock. U.S.A. Wadsworth, Y., (2011) Everyday Evaluation On The Run. The user friendly introductory guide to effective evaluation. 3 rd Edition. Allen & Unwin Australia

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