1. Department of Human Services Multiple and Complex Needs Initiative Responding to Complexity – The Multiple and Complex Needs Initiative Lyndall Grimshaw, Manager MACN Initiative Centre for Public Policy, 31 May 2005

2. Context for change – the drivers History of concerns - raised by service providers, clinicians, carers, Office of Public Advocate, Police, Magistrates and others Poor service outcomes - for a small but significant group with needs that challenge existing policy and legislative frameworks Poor service responses - lacking, inadequate, fragmented and individuals refused services or excluded due to service eligibility requirements Significant public expenditure with limited impact – access to funding has not necessarily led to better outcomes

3. Context for change - Leadership and champions Support from Ministers for Health & Community Services Sponsorship from Secretary of DHS 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

4. Context for change - Sponsors The MACN Initiative involves: Department of Human Services Mental Health Disability Services Drug and Alcohol Services Child Protection Juvenile Justice Housing and Support Department of Justice

5. Research to inform direction Phase 1 Tasks (2002-2003) included: Profiling target population Detailed case studies and annualised costings Consultations – Statewide and regional Literature Review - international Service Model development Business Case with financial modelling and cost benefit analysis Legislative advice

6. Mental Health Drug Treatment Housing & Support Child Protection Juvenile Justice Disability Services Cross Sector Responses 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 247

7. Findings - Characteristics of profiled individuals Relatively young population – 18 to 35 years 2:1 ratio of men to women Combinations of mental health, intellectual disability, acquired brain injury, substance abuse More than half had chronic health problems High volume users of emergency services Significant accommodation issues – 35% homeless, short term or crisis housing 91% were socially isolated, few had regular contact with family High rates of harm and high risk to self, staff and community High rates of contact with criminal justice system

8. Findings – characteristics of service response Responses - often crisis driven, unplanned and unco-ordinated Assessment - fragmented, incomplete or resulted in multiple and/or disputed diagnoses Lack of comprehensive cross sector planning Increasing reliance - on one-off accommodation, intensive support and supervision responses at high cost

9. Model development - considerations Strong external stakeholder pressure to compel individuals to participate Early model development included a residential treatment facility Existence of legislative, policy & program silos Focus on building capacity in the existing service system Supporting a culture of change and active learning

10. Facilitating Change - Core elements of MACN Model Human Services (Complex Needs) Act 2003 - voluntary, provisions for information sharing, unique eligibility criteria eg. intellectual impairment Regional gateway & referral process - new co-ordinator position created in each region, regional cross program mechanisms established, problem solving focus Multiple and Complex Needs Panel - highly experienced & credible membership, external perspective, leverage

11. Facilitating Change - Core elements of Model Multidisciplinary assessment and care planning service - Initiative in microcosm, community development approach of central team Intensive case management service - modelling better practice, mentoring, respite Three year independent Evaluation - influence, impact, contribute to evidence base Central Initiative Team - strategically plan, guide & support the Initiative

12. Multiple and Complex Needs Service Model Existing Service System Department of Human Services Region (Inquiry, Consultation,Referral) MACN Panel (Eligibility, Care Plan, Care Plan Coordinator, Care Pan Review) Care Plan Assessment & Care Planning Service Collaborative service provision with identified lead case manager from either the existing system or the new Intensive Case Management Service 3 2 4 5 1

13. Outcomes Improved individual outcomes stable housing,health and well being, social connectedness & safety a platform for long term engagement Co-ordinated Service Response Effective & efficient expenditure of public monies

14. Initial Achievements Service model is operational Successful prioritisation strategies developed between Depts. of Human Services and Justice Consistent entry point & pathway across the state Effective targeting reflected in high level of appropriate referrals

15. Initial Achievements Value-adding role of regional co-ordinators in facilitating cross program problem solving eg. early data analysis indicates approx. 30% of eligible matters are being resolved at the regional level All regions have introduced (or enhanced) cross program mechanisms to improve service responsiveness & co-ordination Balancing, and at times moderating, the expectations of a diverse range of stakeholders

16. Early Regional Data Analysis – April 2005

17. Of the 21 referrals endorsed by Regional Directors: 10% appear to meet all four conditions 43% appear to meet three conditions 10% mental disorder and ABI 47% appear to meet two conditions 34% mental disorder, ABI and substance abuse 33% mental disorder, ABI and intellectual impairment 11% ABI, intellectual impairment and substance abuse

18. Reflections Complexity? Whose complexity? Local service response – implications re-approx. 30% resolved at regional level Service system divided by categories of conditions & needs Limited knowledge base – re- understanding & responding to impact for an individual of living with multiple conditions & disadvantage Managing change is a sophisticated exercise The Initiative is a step in the right direction

19. To find out more For detailed information about the Initiative: www.dhs.vic.gov.au/complexclients