Active Service Model Policy context

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Policy context

The Active Service Model is located in the broad policy context set out in A Fairer Victoria (2005) which emphasised early intervention and prevention in all services and for older people, helping them to ‘stay involved in everyday activities to maintain or rebuild their confidence and stay active and healthy’. In Victoria, there are a number of related developments which share the objectives of person centred care, social inclusion, working with people’s strengths and preferences, working collaboratively with the person and the carer, proactively promoting health and capacity building opportunities, recognising and supporting care relationships, providing responsive services and building partnership across organisations and programs.

These developments are located across disability; residential care; community health; the acute and sub-acute sectors as well as across HACC services.

The Victorian HACC Assessment Framework is closely related to the active service model initiative and sets out the revised program policy for Assessment in the HACC context. It details the requirements for the delivery of Living at Home Assessments which include a home-based holistic assessment of need as a key component. The goal of the HACC Assessment Framework is to support and build good practice in delivering Living at Home assessments and to support designated HACC Assessment Services to build alliances with other key providers of assessment such as ACAS, Community Health and agencies providing Supported Access. These alliances will ensure a more coordinated and streamlined approach to Assessment based on a person-centred and active service approach. In 2008, 99 HACC organisations were designated as HACC Assessment Services. The key implementation tasks of the HACC Assessment Framework are integrated into the Victorian HACC ASM Implementation Plan.

Some other examples which share the values of providing person-centred care; supporting care relationships and complement the principles of Active Service Model include:

• HACC Diversity Framework
• Strengthening HACC in Aboriginal Communities (SHAC) strategy
• Access Points Demonstration Project
• the Early Intervention in Chronic Disease (EICD) in Community Health initiative
• the Integrated Chronic Disease Management Strategy
• Make a Move – Falls Prevention
• Count us in! social inclusion for people living in public sector residential aged care services, and
• Well for Life
• Primary Care Partnerships (PCPs)
• the Hospital Admission Risk Program (HARP) and
• the Long Stay of Older Persons Program – Improving Care for Older People in Hospitals Policy Framework.

The policy framework, Recognising and Supporting Care Relationships for older Victorians and planning frameworks such as the Victorian State Disability Plan and the Municipal Health Ageing Plans developed by local councils also apply these values.

The policy landscape underpinning the Active Service Model was sketched out in the first instance during the Ministerial launch of Priorities and Future Directions for the HACC program in Victoria, 11 April 2006.

Principles underpinning the Active Service Model

The principles underpinning the Active Service Model are that:

• people wish to remain autonomous
• people have the potential to improve their capacity
• people’s needs should be viewed in an holistic way
• HACC services should be organised around the person and his or her carer, that is, the person should not be simply slotted into existing services, and
• a person’s needs are best met where there are strong partnerships and collaborative working relationships between the person; their carers and family; support workers and between service providers.

From a service delivery perspective core components are:

• promoting a ‘wellness’ or ‘active ageing’ approach that emphasises optimal physical and mental health of older people and younger people with disabilities
• acknowledging the importance of social connections to maintain wellness
• an holistic and family-centred approach to care
• actively involving clients in setting goals and making decisions about their care, and
• providing timely and flexible services that support people to reach their goals.

What sort of interventions does the Active Service Model involve?

An Active Service Model emphasises the provision of person centred, timely and flexible interventions that prioritise capacity building and restorative care to maintain or promote a client’s capacity to live as independently as possible.

A range of strategies and interventions can be utilised as part of an active service model including:

• strength based assessment
• more timely access to physiotherapy
• retraining in activities of daily living
• timely provision of aids and equipment
• greater utilisation of relationships with community care workers
• encouragement to participate in local health promoting activities, and
• strengthening social support.

The defining characteristic is that the starting points for all clients is their strengths rather than their deficits, and that all clients have some capacity to improve.

This type of service model has underpinned the development of time-limited multi-component programs, now operating in the United Kingdom, New Zealand and Western Australia. A growing body of evidence suggests that these interventions result in substantial functional improvements in frail older adults, and are cost effective in that they reduce for a period of time the need for ongoing health and community services for a substantial proportion of clients – see literature review below.

Activities informing the development of the Active Service Model Initiative

To date the following activities have been undertaken to inform the development of the HACC Active Service Model Initiative.

Literature Review

The Australian Institute for Primary Care were commissioned to undertake a review of the international and national literature in order to provide an evidence base that will inform the development of the ASM within the Victorian system. A comprehensive international review of the literature has been undertaken; this includes a review of conceptual and theoretical underpinnings, current international practice and empirical research utilising an ASM-type approach.
The undertaking has yielded a conceptual overview and synthesis of literature that has identified a limited number of reports that evaluated the efficacy of a more wellness, restorative and reablement approach.

Active service model literature review (534kb, pdf)

HACC Active Service Model Pilot Projects

A range of pilot projects have been undertaken to assist in the conceptual development of the Active Service Model and in exploring associated implementation issues. For more information, refer to HACC Active Service Model Pilot Projects.

HACC National Forum 21 and 22 February 2008

Because of its interest in the ASM approach, DHS organised and hosted the National Home and Community Care Forum on Promoting Independence on behalf of the Commonwealth Government and other States and Territories.

The HACC National Forum brought over 400 key stakeholders together from academics and researchers, service providers, peak bodies and governments to explore the evidence base and implications for more thoroughly adopting a wellness, capacity building and restorative care approach to HACC service provision.

In a stimulating two days, through plenary sessions and workshops a range of issues were covered including: What is the new picture of ageing? What is the financial future for governments and older people? Is there a different paradigm for the provision of HACC services? What international and national models have taken this approach and what have the learnings been? Workshops provided an opportunity to participate in a more detailed exploration of some of the key issues on transforming services; workforce support; demonstrating outcomes; assessment processes; assistive technology and targeting and diversity.

Victorian HACC Active Service Model seminar February 25 2008

The Victorian HACC Active Service Model seminar was a 1-day follow on event to the National Forum, including some of the Forum’s keynote speakers, along with presentations and evaluation findings from a number of HACC Active Service Model Pilot Projects. Nearly 700 people attended the event.

Full details, including program and speakers, and presentations from the day can be found on the following page - Victorian HACC Active Service Model Seminar February 25 2008.

HACC Active Service Model Discussion Paper

The discussion paper provides an overview of the evidence base and trends that have led to the development of the ASM initiative; describes the principles, objectives and key components that underlie the ASM; raises issues for implementation; and outlines possible actions that could be part of an implementation plan.

The discussion document was developed as the basis for a series of consultations with HACC funded service providers and peak bodies through June – July 2008 to feed into the development of the implementation plan. A copy of the discussion paper is provided below:

HACC Active Service Model Discussion document (280kb, pdf)

HACC Active Service Model Consultation on Discussion Paper

A series of consultations with HACC funded and related service occured in June 2008. The aim of these consultations was to have a dialogue with HACC funded and related service providers on:

• barriers and facilitators to the adoption of the Active Service Model and how it will need to be localised to work in particular settings
• identifying examples of current practice that demonstrate this approach
• gaining feedback on implementation strategies already identified
• other ideas about implementation.

The feedback from these consultations was collated and is provided below in the Active Service Model Consultation Report.

Active Service Model Consultation Report March 2009 (251kb, pdf)

A parallel process for consumer consultations was conducted by the Health Issues Centre between September and November 2008.  The report details the methodology used for the consultation stage of the project and findings from the review of the literature and consultations with consumer and carer peak organisations and consumers and carers recipients of HACC services.

Active Service Model: Consumer Consultation Findings June 2009 (164kb, pdf)

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