SUBMISSION GUIDELINES: Innovative non-residential rehabilitation

SUBMISSION GUIDELINES: Innovative non-residential rehabilitation Department of Health and Human Services Victoria SUBMISSION DUE DATE: 12 NOON THURSDAY 18 JUNE 2015 CONTACT: Email: icetreatmentgrowth@dhhs.vic.gov.au

CONTENTS 1. INTRODUCTION... 3 2. PROGRAM REQUIREMENTS... 3 2.1 WHAT WILL BE FUNDED?... 3 2.2 SCOPE AND CLIENT GROUP... 4 2.3 POTENTIAL LOCATIONS FOR INVESTMENT... 4 2.4 KEY COMPONENTS OF PROGRAM... 5 3. ACTIVITY LEVELS AND FUNDING... 7 3.1 COMMENCEMENT... 7 3.2 PERFORMANCE, MONITORING AND ACCOUNTABILITY... 7 3.3 PRICING... 7 4. SUBMISSION & ASSESSMENT... 8 4.1 WHO CAN MAKE A SUBMISSION?... 8 4.2 SUBMISSION REQUIREMENTS... 8 KEY DATES... 9 APPENDIX 1: STATEMENT OF OUTCOMES... 10 APPENDIX 2: ALCOHOL AND DRUG TREATMENT PRINCIPLES... 14 APPENDIX 3: OVERVIEW NON-RESIDENTIAL DRUG REHABILITATION PROGRAMS... 15 APPENDIX 4: KEY DOCUMENTS AND REFERENCES... 17 KEY DOCUMENTS:... 17 REFERENCES:... 17 2

1. INTRODUCTION In March 2015 the Victorian Government released a $45.5 million Ice Action Plan. The Plan was developed to tackle the growing use of methamphetamines in the Victorian community and the harms associated with use. Alcohol and drug treatment services are an essential part of responding to these problems, and the Plan includes $18 million over a 4 year period to expand non-residential drug rehabilitation services. It is expected that this funding will deliver services for at least 500 clients per annum when fully operational. This investment will focus on establishing innovative non-residential rehabilitation services in rural and regional communities. Suitably qualified providers of funded alcohol and drug and community health services are invited to submit proposals to develop and deliver drug treatment programs that deliver a range of outcomes (Appendix 1) consistent with the alcohol and drug treatment principles that underpin all state funded drug treatment services in this State (Appendix 2). 2. PROGRAM REQUIREMENTS 2.1 WHAT WILL BE FUNDED? This funding will be utilised to establish non-residential rehabilitation programs for people recovering from methamphetamine and other substance misuse. It will fund programs of intensive, structured interventions to address psychosocial causes of drug dependence though evidence-based treatment, They should provide client-centred rehabilitation services addressing the psychosocial causes of drug dependence. This typically includes motivational enhancement, cognitive behavioural therapies and individual and group counselling, self-help and peer support, and supported reintegration into the community and re-engagement with recreation and activities. Non-residential rehabilitation programs provide an alternative to residential rehabilitation. Participants do not live on site, while completing the programs, so that connections with family, friends and community can be maintained throughout the rehabilitation period. Emerging international and local evidence is showing that intensive non-residential rehabilitation models are demonstrating effective outcomes for some alcohol and drug clients, including those for whom methamphetamine is their primary drug of concern. 3

In addition, it shows that moderately intensive programs over a longer period are showing positive outcomes, particularly for methamphetamine users. A brief overview of some of the available evidence to date is provided at Appendix 3, with an additional list of relevant evidence and literature at Appendix 4. 2.2 SCOPE AND CLIENT GROUP Consistent with the Ice Action Plan, the funding is for non-residential service delivery only. Funding will be allocated to proposed non-residential rehabilitation programs that are able to meet the needs of methamphetamine clients, while recognising that many clients are polydrug users and may be using other drugs and alcohol. The service provided therefore needs to be suitable for a wide range of drug types, while ensuring the particular needs associated with recovering from methamphetamines are catered for. While non-residential programs in Victoria have, to date, tended to operate five days a week over a period of 4-6 weeks, other models may be proposed which structure programs in a different way. Non-residential rehabilitation aims to provide an alternative for clients requiring a rehabilitation program, rather than providing a step-up step-down option. Non- residential rehabilitation will not be a suitable option for all clients. Clients who have access to family support and stable housing, or who have dependent children may be more suitable for a community based rehabilitation option rather than a bed-based option. However, care planning should always be flexible to reflect the clinical assessment of a client s needs. 2.3 POTENTIAL LOCATIONS FOR INVESTMENT The Premier s Ice Action Taskforce identified ice as a particular concern in rural communities. This initiative aims to maximise access for clients in non-metropolitan areas, including regional towns, rural areas and outer-metropolitan locations where access to existing rehabilitation services may be difficult. A range of Local Government Areas have been identified as potential priorities for additional services based on a range of data (Table One), although proposals targeting communities in other locations will be considered where the submission demonstrates a compelling case for investment. Funded alcohol and drug services in Victoria may accept clients from any area or catchment. Successful proposals will be expected to be available to all clients and may, as part of this, suggest strategies that directly target people from the identified areas. 4

Table One: In scope Local Government Areas identified as potential priorities for investment Ballarat Campaspe Cardinia Casey Glenelg Greater Bendigo Greater Geelong Greater Shepparton Horsham Hume Latrobe Maribyrnong Melton Mildura Mitchell Warrnambool Whittlesea Wyndham 2.4 KEY COMPONENTS OF PROGRAM In order to be considered for funding, the non-residential rehabilitation program proposal should include: 1. An outline of the proposed structure and mode of delivery of the program, and the key considerations (including evidence base) which have led to the recommended approach. Where a specific cohort or client group is proposed, evidence to illustrate why that approach is recommended and how those clients will benefit should also be provided. 2. How the program would respond flexibility to client needs, including those related to methamphetamine and other drug use. 3. How the proposed program will provide culturally safe services to clients, including Aboriginal people. 4. A description of proposed governance and other risk management/quality assurance mechanisms, including clinical governance arrangements. 5. A description of how services will be tailored to reflect individual s care plan, including consideration of care needs before and after involvement in the nonresidential rehabilitation program (e.g. withdrawal, community-based counselling, care and recovery coordination). 5

6. A description of how the proposed service model will deliver client-focussed, holistic support which addresses substance issues and strengthens the life skills that support sustainable recovery. 7. Key referral pathways and linkages to other services such as alcohol and drug treatment service providers, intake and assessment providers, Aboriginal community based organisations and the Australian Community Support Organisation (ACSO) Community Offenders Advice and Treatment Services (COATS) program. 8. A description of how consumers, families and other supporters will be actively involved in the program s development, implementation and continuous improvement. 9. A brief description of the proposed staffing structure, including how the proposed skills and qualifications mix aligns to the proposed service model, treatment principles and client group. 10. Confirmation that the program will be consistent with current government policies, standards and requirements for funded alcohol and drug service delivery, which can be accessed at http://www.health.vic.gov.au/pfg/. 11. A brief summary of the proposed budget for the program, which demonstrates sustainable cost structure that delivers value for money. 12. A brief summary of the proposed implementation plan to deliver the required services in the designated timeframes, should the proposal be successful. 13. A description of the physical infrastructure that will support the model, including access to appropriate space/s for group based activities; access to kitchen and dining facilities; access to office facilities for permanent and contracted staff; and information technology resources. 6

3. ACTIVITY LEVELS AND FUNDING 3.1 COMMENCEMENT Funded programs must commence operation no later than 1 October 2015. 3.2 PERFORMANCE, MONITORING AND ACCOUNTABILITY Successful providers will be required to report activity to the Department on a regular basis. Service requirements will be monitored through agreed performance indicators and supported by an analysis of issues impacting on the performance achieved. Service providers are accountable for the use of the funding for the delivery of the programs specified in the department s service agreement. The monitoring and review processes that apply to funded services are outlined in the department Policy and Funding Plan. The Victorian Health Policy and Funding Guidelines can be accessed on the department s Funded Agency Channel website (http://www.dhs.vic.gov.au/funded-agency-channel). As part of this accountability, service providers are required to comply with data collection and other reporting requirements. Successful providers and their partner agencies will be required to actively participate in the evaluation of this project which will be undertaken by the department. This includes the collection of data required to support program monitoring, evaluation and review. 3.3 PRICING Operational funding will be provided through an allocation of Drug Treatment Activity Units (DTAU) for courses of non-residential rehabilitation. Non-residential rehabilitation is equivalent to a DTAU weighting of 11.0. This equates to $7,358 (2014-15 prices) for a course of treatment for each client. This must include all associated costs, among these program costs, on costs, consumables and related accommodation and administration costs. The total funding available per program will depend on the model proposed and the anticipated number of clients participating and completing the program. It is therefore important that proposals include accurate program costings to ensure the viability of the service and assist in identifying which proposals offer the best value for money. Please note that the department will be seeking to maximise client access as well as effectiveness, so any opportunities to increase the number of clients who can be supported while maintaining the quality and integrity of the program should be identified in proposals. The standard loadings will apply for forensic and Aboriginal clients. Aboriginal clients attract a price loading of 30 per cent, and forensic clients attract a price loading of 15 per cent. If a 7

client is both Aboriginal and a forensic client, only the 30% Aboriginal loading will apply. Services should therefore make allowances for the likely representation of these clients group in programs, when calculating the anticipated cost per client. In the initial year, funding may include a small component for establishment costs. This should be specified in submissions. However, establishment costs should not exceed the equivalent of three month s annual funding, as services are expected to be commencing no later than 1 October 2015. 4. SUBMISSION & ASSESSMENT 4.1 WHO CAN MAKE A SUBMISSION? Proposals will be accepted from all agencies that: currently deliver drug treatment services and/or are funded community health services. In addition, proposed providers must: Demonstrate capacity and experience in delivering effective, evidence based alcohol and drug treatment services. Have an existing contractual arrangement with the Department of Health and Human Services, and an established record in complying with its terms and conditions. Have current accreditation within existing accreditation frameworks by an entity that is certified by the International Society for Quality Health Care or the Joint Accreditation System of Australia and New Zealand. Have capacity and willingness to report on service delivery, and participate in program evaluation and review. 4.2 SUBMISSION REQUIREMENTS Proposals should provide a clear description of how the proposed non-residential rehabilitation program will be structured and delivered including addressing the key program components identified in section 2.4 of this document. All submissions must be Submitted via email to icetreatmentgrowth@dhhs.vic.gov.au and received no later than 12 noon Thursday 18 June 2015. Be submitted on the attached template. Be no more than 20 pages in length (excluding any supporting attachments that may be included). Late submissions will not be accepted. 8

You should receive an email confirming receipt of your submission within 1 business day. If you do not receive a confirmation email, please contact us via icetreatmentgrowth@dhhs.vic.gov.au. Copies of the submission template, these submission guidelines and other relevant documents will also be available on the Departmental website at www.ice.vic.gov.au. Please submit any queries or questions to icetreatmentgrowth@dhhs.vic.gov.au. 4.3 ASSESSMENT Proposals will be assessed on the basis of the written proposal, according to a range of submission criteria described in the template, including: Alignment with the stated requirements and scope of the program, as outlined in this document. Demonstrated capacity to deliver program outcomes across the domains outlined in Appendix 1. Alignment with Victorian alcohol and drug treatment principles as outlined in Appendix 2. Evidence of unmet need or identified service gap, drawing on both evidence provided in the proposal and external sources (e.g. service data, information on existing services). KEY DATES Date Deliverable 29 May 2015 Call for submissions released 18 June 2015, 12 noon Closing date and time for submissions 18 June - 22 June 2015 Review, assessment and selection of proposals 26 June 2015 Outcomes of submission process announced July September 2015 No later than 1 October 2015 Establishment Non-residential services commence operation 9

APPENDIX 1: STATEMENT OF OUTCOMES Please note this information is illustrative only. The Department reserves the right to amend any aspect of this statement of outcomes. Table 1: Indicative outcomes and benefits to client to which alcohol and drug treatment services are expected to contribute: Outcome domains Effectiveness Indicative Outcome Alcohol and drug taking behaviours of clients stabilised, improved or ceased Improved quality of life status Improved social connectedness/reduced social isolation Health outcomes Clients capacity for engagement in alcohol and drug treatment services and decision making about their own treatment planning improved Ways benefit might be measured Reduced frequency and/or level of alcohol and/or drug use Increased protective behaviours associated with alcohol and/or drug use Client reports better/greater satisfaction with living conditions Family or significant other are positively engaged with the client and are part of the support system provided to the client Improved quality of personal relationships Improved safety and wellbeing of dependent children Client participates in mainstream social and recreational activities that are meaningful to them Client reports fewer or less severe physical health symptoms Improved engagement with primary health for prevention and/or management of chronic health problems Reduction in preventable illness, key health risks and chronic disease (for example obesity, diabetes, smoking) Reduction in co-occurring health problems (including mental health issues) Clients have the skills, knowledge and confidence they need to make informed choices about the type of treatment and ongoing support they need Clients articulate recovery oriented treatment goals Self-management capacity 10

Outcome domains Efficiency & sustainability Responsiveness Indicative Outcome Contribution to improved long-term housing security Contribution to improved economic participation Client engagement with health, human services and other key social supports Reduced involvement with the justice system Improved involvement of families in support provided to the client Services are cost efficient Responsiveness to population diversity Improved responsiveness to family members including children and significant others Improved responsiveness to dependent children of Ways benefit might be measured Reduction in number of clients experiencing repeated or chronic homelessness Timely access to appropriate and affordable stable housing Maintenance of stable tenancy Engagement by clients in schooling/ vocational training opportunities of their choosing Improved employment participation Improved engagement with primary health for prevention and/or management of chronic health problems Improved engagement with human services and social supports (e.g. housing, community services). Reduction in the number of clients that come into contact with the justice system and the frequency of contact by individual clients Families have the skills, knowledge and confidence they need to support the person they care for Active, respectful involvement of family in decisions related to the provision of support Services delivered at minimum cost. Services are culturally safe Services effectively engage and respond to diversity Services effectively engage and respond to individuals/groups known to experience significant disadvantage, particularly: Aboriginal people, their families and the community People experiencing or at risk of homelessness People with a dual diagnosis/disability People with criminal justice involvement People from culturally and linguistically diverse backgrounds Family members provided with timely information, referral and advice to support Dependent children identified and needs recognised in client care and support Dependent vulnerable children referred to appropriate 11

Outcome domains Accessibility Indicative Outcome clients Alcohol and drug treatment services are easy to find and access People who are most in need are prioritised for access Ways benefit might be measured supports Clients more confident in managing parenting responsibilities Referral agencies, clients, and family members find it easy to locate alcohol and drug treatment services Services are able to accept new clients on referral within a timely manner People with high-level alcohol and drug problems receive priority access and support in a timely manner The alcohol and drug treatment services system is easy to navigate Clients do not have to retell their full histories multiple times. Complex clients are actively supported through their treatment Continuity People have reasonable access to alcohol and drug treatment services no matter where they live Pathways between alcohol and drug treatment streams, including intake and assessment, are well established and support continuity of care Pathways to and from local human services and other social support services are well established and support continuity of care People living in rural Victoria have reasonable access to alcohol and drug treatment services More people and services are accessing treatment via centralised screening and catchment based intake units More people are accessing online screening and selfdirected treatment options through the centralised screening and referral service No gaps exist in the alcohol and drug treatment pathway for clients because: Coordination at the statewide, catchment based, service and client level is effective and supports continuity of care for clients Coordination and referral pathways between intake and assessment and alcohol and drug treatment services, are effective and support continuity of care for clients Alcohol and drug treatment services and human services/social support services collaborate and plan together to achieve improved outcomes and continuity of care for shared clients. Well established and effective referral pathways exist between alcohol and drug treatment services and human services/social support services e.g. no gaps exist between elements of the treatment and support pathway 12

Outcome domains Indicative Outcome Ways benefit might be measured Safety Client safety Number of critical incidents involving clients Family safety Worker safety Number of critical incidents involving families and dependent children Number of critical incidents involving workers 13

APPENDIX 2: ALCOHOL AND DRUG TREATMENT PRINCIPLES The delivery of Victorian alcohol and drug treatment services is underpinned by treatment principles that inform practice and service delivery. Substance dependence is a complex but treatable condition that affects brain function and influences behaviour Treatment is accessible Treatment is person-centred Treatment involves people who are significant to the consumer Policy and practice is evidence informed Treatment involves integrated and holistic care responses The treatment system provides for continuity of care Treatment includes a variety of biopsychosocial approaches, interventions and modalities oriented towards people s recovery The lived experience of alcohol and drug consumers and their families is embedded at all levels of the alcohol and drug treatment system The treatment system is responsive to diversity Treatment is delivered by a suitably qualified and experienced workforce. In addition to delivering services in ways that align to the treatment principles, funded alcohol and drug treatment providers will be expected to: Provide a friendly, welcoming and culturally safe environment for all clients, including Aboriginal and Torres Strait Islander people and people from culturally and linguistically diverse backgrounds, and their families. Deliver services in ways that are also consistent with the Victorian alcohol and other drug client charter. Ensure clients have the right to privacy and should provide informed consent for any information regarding their care to be exchanged between workers within an alcohol or drug treatment service or with other agencies. There is a need to balance the client s right to privacy with the needs of significant others involved in the person s informal day to day support for information essential to this role. Service providers must have clear policies and processes regarding this that are consistent with the Victorian Information Privacy Act and associated Information Privacy Principles. 14

APPENDIX 3: OVERVIEW NON-RESIDENTIAL DRUG REHABILITATION PROGRAMS Rehabilitation is client-centred recovery designed to address the psychosocial causes of drug dependence. The Victorian Government funds rehabilitation programs delivered through residential or day program settings, counselling or care and recovery approaches. Non-residential rehabilitation programs are intensive, structured interventions to address psychosocial causes of drug dependence though evidence-based treatment, with the aim of sustainable recovery. These interventions include a variety of individual and group cognitive behavioural therapies and additional educational and therapeutic elements designed to promote client mental health and wellbeing. This typically includes motivational enhancement, cognitive behavioural therapies and individual and group counselling, self-help and peer support, and supported reintegration into the community and re-engagement with recreation and activities. The key difference between this and traditional bed based rehabilitation services is that people do not live on site, but return home for evenings and weekends, so that connections with family, friends and community can be maintained throughout the rehabilitation period. While residential rehabilitation plays an important role, there is evidence in Victoria and other jurisdictions that demonstrates that there can be other ways of delivering effective, community-based, rehabilitation services. Emerging international and local evidence is showing that intensive non-residential rehabilitation models are demonstrating effective outcomes for alcohol and drug clients, including methamphetamine clients. In addition, it shows that moderately intensive programs over a longer period are showing positive outcomes, particularly for methamphetamine users. These programs identified that transition into treatment may be affected by ongoing experience of withdrawal, however, treatment strategies such as motivational enhancement, cognitive behavioural therapies and ongoing family support, can improve treatment outcomes, in conjunction with the provision of ongoing support after treatment completion. Clients have achieved good outcomes from attending non-residential rehabilitation programs that use a mix of evidence-based group work and individual psychosocial approaches such as Cognitive Behavioural Therapy (CBT), mood and management therapies, and Motivational Enhancement Therapy (MET). While day programs are generally designed around a full program of therapeutic interventions, some services provide a combination of compulsory and optional units that allow clients to choose which sessions to attend. Optional units 15

typically include holistic support sessions designed to increase overall health and wellbeing, treatment retention, and client satisfaction. These units could include life skills training, such as financial or employment counselling, nutrition, exercise, and art therapy classes. Existing models of day programs are generally provided for a minimum of 4-6 weeks. The program promotes daily attendance at the initial stages, with levels of intensity tapering off towards the end of the program to promote community integration. Scheduled free time enables clients to develop coping mechanisms and promote family and social interaction. Some programs offer drop-in aftercare support sessions to allow clients to remain linked in with treatment, and allow for rapid re-entry in the event of relapse. Discharge support and aftercare are critical elements of day programs. Comprehensive post-program care can include access to refresher or extension programs, or repeating the program when needed. Similar to residential rehabilitation, services provide clients with clear and structured connections with a range of appropriate continuing treatment interventions, such as counselling and mutual aid groups. Aftercare models such as ongoing group work, which continue to apply cognitive behavioural and motivational enhancement strategies, can help clients maintain their goals by coping with urges, solving problems related to their substance use and working to establish lifestyle balance. Evidence shows that intensive, non-residential alcohol and drug rehabilitation options may be suitable for clients who require more intensive support than individual counselling but who are not suitable for, or cannot access, residential rehabilitation. Eligibility criteria for existing programs suggests that clients need to be self-motivated, capable of self-management, have a moderate level of social and intellectual functioning, and be of reasonably stable mental health and life circumstances. Clients who have not undergone withdrawal, a confirmed period of abstinence, or stabilisation of use of drugs of dependence are generally not considered suitable for community rehabilitation programs.however, clients who have withdrawn from methamphetamine can experience agitation, disturbed sleep and poor concentration for longer periods after withdrawal treatment. This means methamphetamine clients require a flexible approach early in the program to maximise treatment retention and positive treatment outcomes. 16

APPENDIX 4: KEY DOCUMENTS AND REFERENCES KEY DOCUMENTS: 1. Department of Premier and Cabinet, Ice Action Plan, State Government of Victoria, 2015. https://4a5b508b5f92124e39ff- ccd8d0b92a93a9c1ab1bc91ad6c9bfdb.ssl.cf4.rackcdn.com/2015/03/ice-action-plan-final- Summary-Document-Web-Version.pdf. 2. Department of Health and Human Services, Catchment based intake and assessment guide, State Government of Victoria, 2015. http://docs.health.vic.gov.au/docs/doc/catchmentbased-intake-and-assessment-guide-april-2015 3. Department of Health and Human Services, Victorian AOD Client Charter, State Government of Victoria, 2011. http://docs.health.vic.gov.au/docs/doc/english---victorian-aod-client-charter- Brochure-(2011) 4. Department of Health and Human Services, Victorian alcohol and drug treatment principles, State Government of Victoria, 2013. http://docs.health.vic.gov.au/docs/doc/victorian-alcoholand-drug-treatment-principles 5. Department of Health and Human Services, Information for health and human service providers, State Government of Victoria, 2015. http://docs.health.vic.gov.au/docs/doc/factsheet-alcohol-and-other-drug-treatment-in-victoria-april-2015 6. Department of Health and Human Services, Service specification for the delivery of selected non-residential alcohol and drug treatment services in Victoria, State Government of Victoria, 2014. http://docs.health.vic.gov.au/docs/doc/service-specification-for-the-delivery-ofselected-non-residential-alcohol-and-drug-treatment-services-in-victoria 7. Department of Health and Human Services, Victorian policy and funding guidelines 2014-15 http://docs.health.vic.gov.au/docs/doc/victorian-health-policy-and-funding-guidelines-2014-15 REFERENCES: 1. Substance Abuse and Mental Health Services Administration (US). Services in Intensive Outpatient Treatment Programs. [book auth.] Center for Substance Abuse Treatment. Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. s.l. : Treatment Improvement Protocol (TIP) Series, 2006. 2. Harney A, Lee N. Evaluation of Torque a catalyst non-residential program: Interim Report 2, 12th Jan 2015. s.l. : Available online at: http://www.regen.org.au/images/programs/torque/torque%20interim%20report%202_1201 15_Web.pdf, 2015 3. Kiehne M, Berry M. Evaluation of UnitingCare ReGen Catalyst program, July 2009-June 2012, Final report. s.l. : Accessed online: http://www.regen.org.au/catalyst/catalyst_final_evaluation_report_2009-2012.pdf, 2012. 17

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