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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. Multiple and Complex Needs Initiative. Context for change – the drivers.

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Multiple and Complex Needs Initiative

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

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

  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 1 Department of Human Services Region (Inquiry, Consultation,Referral) 2 3 MACN Panel (Eligibility,Care Plan, Care Plan Coordinator, Care Pan Review) 5 4 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

  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. Early Regional Data Analysis – April 2005 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

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