Department of Human Services Responding to People with Multiple and Complex Needs MULTIPLE AND COMPLEX NEEDS INITIATIVE Lyndall Grimshaw, Manager - MACN Initiative project team 30 April 2004

Background Established in early 2002 History of concerns raised by service providers, clinicians, carers, OPA, Police, Magistrates and others Poor service outcomes for a small but significant group with complex needs that challenge existing policy and legislative frameworks Service responses lacking, inadequate and clients refused services or excluded due to service eligibility requirements Strong stakeholder support for Project

Program Areas Mental Health Disability Services, Drug and Alcohol Services Child Protection Juvenile Justice Housing and Support Department of Justice (Office of Corrections, Court Services, Police)

Leadership for change Strong support by Ministers for Health & Community Services Sponsorship from Secretary of DHS and Executive Director, Operations Steering Committee – senior departmental executives with ability to determine future cross program policy Reference Group – external and internal stakeholders to provide expert opinion and advice eg. OPA, IDRP,HSC, Regions, NGOs

Phase 1: research & model development Tasks included: Profiling target population Detailed case studies and annualised costings Consultations – Statewide and regional Literature Review Service Model development Business Case with financial modelling and cost benefit analysis Legislative advice

Client Profile A total of 247 clients identified 208 DHS directly provided or funded services 39 Corrections custodial and community based services 226 are 16 years and above and are eligible to be referred to new service model

Characteristics of Client Group Relatively young population – 44% are 18 to 35 years. 2:1 ratio of men to women. Major presenting problems – combinations of mental disorders, intellectual impairment, acquired brain injury, substance abuse. Behaviours present significant levels of risk to community, staff and self. 90% - at least one incidence of harm to self, staff and community, 47% harm for all three. 71% - current or past contact with criminal justice system High volume users of emergency services. Significant accommodation issues – 35% homeless, short term or crisis accommodation. 91% are socially isolated, few have regular contact with family. 55% have chronic health problems.

Mental Health Drug Treatment Housing & Support Child Protection Juvenile Justice Disability Services Cross Sector Responses 247 Majority of client service activity – specialist service system Cross program activity – including collaborative partnerships and jointly funded initiatives Attempts to meet multiple and complex needs across program boundaries DHS Client Service Activity

Findings - costs On average, each client costs around $248,000 per annum – total cost of $56m(69% funded by DHS) Increasing reliance on ad hoc non-recurrent service responses 20% receiving tailored funding packages - $5.6m in 2001/02 Highest cost package in 2002/03 was $643,000 Ad hoc expenditure is not sustainable for the future

Outcomes to be Achieved Improved client outcomes While many clients will continue to have long term and high level needs Model will assist in stabilising client and improving health and well being Co-ordinated service response Sustainable cost savings Require alternative to escalating, high cost, ad hoc responses A targeted, new solution will reduce costs

Service Model Objectives A time limited intervention that: enables stable housing,health and well being,safety,social connectedness provides a platform for long term engagement in the service system pursues planned and consistent therapeutic goals for each client

Core Elements of Model Regional gateway & referral process Multiple and Complex Needs Panel Multidisciplinary Assessment Service Intensive case management services Underpinned by legislation Evaluation

Multiple and Complex Needs Service Model Existing Service System Department of Human Services Region (Referral) Panel Care Plan Assessment Service Collaborative service provision with identified lead case manager from either the existing system or the new Intensive Case Management agencies 1 2 3

1. Regional Gateway Referrals can be initiated by DHS and funded agencies, Courts, Police and Correctional services Provides a single point of entry / gateway Preliminary eligibility assessment Check existing local service system responses insufficient Facilitate case co-ordination if Panel referral unnecessary Endorsement by DHS Regional Director for referral to proceed to Panel

2. Multiple and Complex Needs Panel Direct a multidisciplinary assessment and a Care Plan Body with status and authority Accepts referrals from Regional Directors for individuals 16 years and above Panel quorum -chairperson and 2 others Members with significant mental health, drug and alcohol, disability and welfare experience Capacity to co-opt other expertise as advisors Client, family and carers to participate in consideration of Care Plan

3. Multidisciplinary Assessment Service Recognises difficulty for people with multiple and/or disputed diagnoses All clients will receive multidisciplinary assessment – community, bed based, prison Complexity and duration of assessment may vary - up to 3 months Assessment informs development of draft Care Plan Assessment Service to report back to Panel

4. Intensive Case Management Build on existing expertise To implement 12 month Care Plan when existing services unable to implement and oversight Care Plan To address client needs in relation to: Stable housing Health and well being Safety Social connectedness Therapeutic, clinical and treatment functions to be provided by existing services

Care Plan Coordinator The Panel appoints a Care Plan Coordinator The Act specifies responsibilities to –monitor care plan and clients progress –coordinate services in accordance with care plan –provide review reports to Panel May be located in any part of existing human services (incl. public or community housing), or in new intensive case management service Expectation that will undertake role within existing funding arrangements

Human Services (Complex Needs) Act 2003 To facilitate and coordinate services for eligible people with multiple and complex care needs Provide for a referral process Establish eligibility criteria Establish panel and its functions Provide for establishment of assessment service Outline the assessment and care plan development process

The Act cont. Provides express authority for disclosure of relevant personal and health information Provides for clients to be notified of information disclosure and procedures of the Panel Establishes a process for clients to communicate refusal to participate Provides appropriate safeguards and penalties for privacy of client information

Eligibility criteria A person who has attained 16 years of age; and Appears to have 2 or more of the following: –A mental disorder –An intellectual impairment –An acquired brain injury –Is an alcoholic or drug–dependent person; and has exhibited violent or dangerous behaviour that caused serious harm to himself or herself or some other person, or is exhibiting behaviour which is reasonably likely to place himself or herself or some other person at risk of serious harm; and is in need of intensive supervision and support and would derive benefit from receiving coordinated services.

Building Capacity in Existing Service System Existing Services will continue to be primary service providers Assessment Service will facilitate and Panel will determine a planned and co-ordinated response Specialist agencies will supplement existing service options Specific initiatives to support client group being negotiated with each program area

Phase 2: Implementation Regional gateway & referral process –Regional coordinators appointed –Operational guidelines and processes developed –Regional visits underway Multiple and Complex Needs Panel –Executive officer appointed since December 2003 –Awaiting Cabinet & Governor-In-Council approval of Chair and members –The Act to be proclaimed when members appointed Multidisciplinary Assessment Service –Consortium appointed –Staff selection underway

Phase 2: Implementation Intensive Case Management Response –Consortium appointed –Staff selection underway Evaluation –Evaluators appointed