Opportunities in practice         

Outcome measurement in mental health

Published by the Mental Health and Drugs Division, Victorian Government,
Department of Human Services, Melbourne, Victoria
Authorised by the State Government of Victoria, 50 Lonsdale Street, Melbourne.
August 2008 (080708)

© Copyright, State of Victoria, Department of Human Services, 2008
© Copyright, Commonwealth of Australia 2008

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth or Victorian Governments. Requests and inquiries concerning reproduction and rights should be addressed to Mental Health and Drugs Division, Victorian Government.

For electronic copies (including future revisions) visit:
www.health.vic.gov.au/mentalhealth/outcomes

Disclaimer
Opinions expressed in this publication are those of the authors and do not necessarily represent any official Government position or view. The authors hold final editorial responsibility for the document and any errors that remain herein.

Contents

1 Getting started…
1.1 Foreword
1.2 Acknowledgements
1.3 Your invitation
1.4 Navigation

2. Engaging
2.1 Clinician
2.2 Consumer
2.2.1 Offering
2.2.2 Dialogue
2.3 Carer
2.4 Manager
2.5 Partnerships
2.6 Endorsements

3. Practice
3.1 Assessment
3.2 Care plans
3.3 Review
3.4 Discharge
3.5 Supervision

4. Supporting functions
4.1 Documentation
4.2 Policies/procedures
4.3 Tips and suggestions
4.4 Service quality

5. Workforce development
5.1 Managers
5.2 Clinicians
5.3 Consumer and carer consultants (or equivalent)
5.4 Trainers

6. Resources
6.1 People
6.2 Materials
6.2.1 National
6.2.2 State and Territory

References

Websites
Published journals, reports, books, presentations, promotional materials

Appendices

Appendix 1 - Phase one – project overview and consultation processes
Appendix 2 - Glossary

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 1.1 Foreword

The routine measurement of consumer outcomes has been a priority of the National Mental

Health Strategy since it was first adopted by Australian Health Ministers in 1992 and is articulated in all subsequent National Mental Health Plans. The measurement of consumer outcomes is also compatible with each jurisdiction’s emphasis on high quality health services and increased consumer and carer participation as articulated in relevant policy documents. Work undertaken during the period of the Second National Mental Health Plan (1998-2003) targeted the development of information infrastructure and workforce skills to support the use of outcome measurement and other quality improvement activities. All states and territories prepared comprehensive Information Development Plans (IDP) to guide their implementation activities.

The National Outcomes and Casemix Collection (NOCC) involves clinicians and consumers measuring changes over time in the health status of a consumer and include both clinician and consumer rated measures. It was introduced across all clinical public mental health services in Australia in 2003-2004 and is reported as a Key Performance Indicator, based on the National Health Performance Framework and linked to the strategic directions of the National Mental Health Plan 2003-2008.

Recognising the complexity of the work required and its national significance, the Australian Government contributed Commonwealth Own Purpose Outlays (COPO) funding under the Australian Health Care Agreements to assist jurisdictions in implementing their Information Development Plans (IDP) to support a range of quality and safety initiatives in specialist mental health care. States and territories have also received additional funding (2005-2008) under Quality Through Outcomes (QTO) agreements (Australian Health Care Agreements) to implement and enhance consumer outcomes in routine clinical practice.

The implementation of routine measurement of consumer outcomes was unprecedented and resulted in significant challenges for mental health services to embed the collection and utilisation of consumer outcomes in clinical practice. Consistent with funding and governance processes of mental health services across Australia, and the different models of service delivery, each state and territory has faced unique challenges in this implementation. Despite the differences, many similarities have been identified, including:

• workforce capacity to routinely collect and utilise consumer outcomes
• workforce development including general training in IT, assessment and documentation and in consumer outcome rating and application
• attitudinal challenges in developing mental health services with a focus on mental health
• information and a culture of enquiry
• data system accessibility and reporting capabilities
• consumer and carer awareness of, and participation in, the consumer outcome agenda.

The development of this resource was undertaken by the Mental Health and Drugs Division of the Department of Human Services, Victoria through QTO funding (Appendix 1) and draws together the collective experience of each jurisdiction on how consumer outcomes can be used in practice. It has been a challenge to use sufficiently generic and inclusive language to ensure that the content is applicable across age groups (child and adolescent, adult and older person), service settings (inpatient, ambulatory and community residential) and jurisdictions (states and territories). This resource has captured current practice opportunities for focussing on consumer outcomes.

Given that the utilisation of consumer outcomes is evolving, this resource will undergo routine review and revision in the future.

Refer to: 1.3 Your invitation

1.2  Acknowledgements

This project was developed by the Mental Health and Drugs Division, Department of Human Services Victoria with funding from the Commonwealth Department of Health and Ageing. The resource was developed by Angie Hunter, Project Manager, with extensive input from jurisdictional colleagues. Collectively the following individuals have had extensive experience with public mental health services either in clinical practice and/or expertise in consumer outcomes. This collective experience has been invaluable in the development of this resource.

There have been two distinct phases:

March – July 2008 involved the original content development
July – November 2008 involved the refinement of the content.

Phase one - Resource content contributors

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Phase two - Resource refinement

 1.3 Your invitation

This resource was an initial attempt to pull together a wide variety of largely unwritten materials related to outcome measurement in mental health practice. It was also an opportunity to visually represent the opportunities and complexities to facilitate an ongoing dialogue between all involved in this activity.

To ensure relevance, currency and usefulness of the material it will need to be routinely reviewed and updated. It is an ambitious endeavour to create a living, organic and developmental resource to capture dynamic and changing aspects of clinical practice.

To provide input into the resource please visit: www.mhnocc.org/forum/

Or speak with Outcome Measurement nominated staff in your service and/or jurisdiction.

1.4  How to use this resource

Layout

This resource has been developed to allow the user to utilise areas of interest. It could also be utilised as part of a local implementation plan using small time-limited projects around a part of a specific section, and reviewed sequentially. This would break it down into smaller ‘do-able sections’ with an end result that the total resource would be covered (eventually) over time.

Content

The content of this resource is current at November 2008. For clarification of terms refer to the Glossary (Appendix 2).

The content was developed predominantly by staff with a clinical mental health background, and drew on the collective experience of staff involved in the implementation and utilisation of consumer outcomes across Australian states and territories.

In addition to the collaborators consulted, the review of a number of intranet/internet sites informed the development of this resource including:

• Mental Health National Outcomes and Casemix Collection www.mhnocc.org

• Queensland Health intranet

• Victorian Department of Human Services internet www.health.vic.gov.au/mentalhealth/

• New Zealand’s National Centre of Mental Health Research - Te Pou internet (specifically the Australasian Mental Health Outcomes Conference 2007 pages) www.tepou.co.nz/page/23-Welcome

The National Outcomes and Casemix Collection (NOCC) involves clinicians and consumers measuring the health status of the consumer and noting change over time. Therefore, a decision was made to refer to the NOCC suite of measures as consumer outcomes rather than routine outcome measurement, ROM or outcome measurement. Consumer outcomes include all NOCC measures, clinician and consumer-rated.

The material contained in this resource is written for mental health clinicians but may also be useful for consumer and carer consultants employed in mental health services. It outlines strategies, principles and techniques for using consumer outcomes in clinical practice. With a few exceptions individuals are not specifically showcased.

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Considerations

Making this resource accessible and relevant for mental health clinicians across Australia is challenging as names/labelling vary considerably within services and across jurisdictions. Language used is consciously generic and inclusive to ensure that the content is applicable across age groups, service settings and jurisdictions.

The examples included in this resource are suggestions rather than an exhaustive list. It is critical that mental health clinicians refer to local and jurisdictional requirements related to protocol, policies and procedures and documentation before using any of these examples.

This resource is designed for clinicians and for use in clinical practice. As clinical practice is dynamic and changing, and as consumer outcomes become more embedded into practice, this resource offers a starting point for practice opportunities and continued development.

Ideally it will be reviewed regularly by jurisdictional representatives to revise existing content and capture new material. Consumers and carers are directly involved in consumer outcomes through a process facilitated by a clinician. It is the clinician’s responsibility to offer, explain and discuss completed self-assessment measures.

References

Websites

Australian Federal Government’s Department of Health and Ageing
www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-workstds
www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/doha-plan-1

Australian Association of Social Workers
www.aasw.asn.au/
www.aasw.asn.au/adobe/publications/Practice%20Standards_Supervision.pdf

Better Access to Mental Health Care Initiative
www.primarymentalhealth.com.au/site/index.cfm?display=15129

Mental Health Carers ARAFMI Australia
www.arafmiaustralia.asn.au

Mental Health Coalition
https://owa.sagems.sa.gov.au/exchweb/bin/redir.asp?URL=http://www.mhca.org.au/donate.html

Mental Health Council of Australia
www.mhca.org.au/AboutUs/ListMemberOrgs.html

Mental Health National Outcomes and Casemix Collection
www.mhnocc.org
www.mhnocc.org/Benchmarking
www.mhnocc.org/amhocn/Training_Resources

Mental Health Nurse Association
www.amicus-mhna.org

Mental Health Nurse Incentive Program
www.medicareaustralia.gov.au/provider/incentives/mental-health.jsp
www.medicareaustralia.gov.au/provider/incentives/files/2111-mental-health-nurse-incentive-programprogram-guidelines.pdf

MH Smart in New Zealand
www.huttvalleydhb.org.nz/Article.aspx?ID=623

Mentoring Works
www.mentoringworks.com.au/notice.html

Ohio Department of Mental Health
www.mh.state.oh.us/oper/outcomes/outcomes.index.html

New Zealand’s National Centre of Mental Health Research – Te Pou
www.tepou.co.nz/page/23-Welcome
www.tepou.co.nz/page/420-Information-Utility
www.tepou.co.nz/page/323-Speakers-039-Presentations-Day-One
www.tepou.co.nz/page/324-Speakers-039-Presentations-Day-Two
www.tepou.co.nz/page/325-Speakers-039-Presentations-Key-Notes

SANE
www.sane.org

South Australian Department of Health
www.health.sa.gov.au/mentalhealth/Default.aspx?tabid=99

The Australian Psychological Society Ltd
www.psychology.org.au

Victorian Department of Human Services
www.health.vic.gov.au/mentalhealth/
www.health.vic.gov.au/mentalhealth/outcomes
www.health.vic.gov.au/mentalhealth/cpg/families.htm
www.health.vic.gov.au/mentalhealth/outcomes/concare.htm#info_books
www.health.vic.gov.au/mentalhealth/outcomes/index.htm

Victorian Mental Health Carers Network
www.carersnetwork.org

Victorian Mental Illness Awareness Council
www.vmiac.com.au

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Published journals, reports, books, presentations, promotional materials

Australian Health Ministers Advisory Council (AMHAC) - National Mental Health Working Group, Information Strategy Committee, Commonwealth of Australia:

• National Standards for Mental Health Services, December 1996 – currently under review

• National Practice Standards for the Mental Health Workforce, September 2002

Jones A and May J, Working in Human Service Organisations A critical introduction, Longman, Australia, 1992.

Mental Health National Outcomes and Casemix Collection: Technical specification of State and Territory reporting requirements for the outcomes and casemix components of ‘Agreed Data’, Version 1.50, Department of Health and Ageing, Canberra, 2003.

NMHWG Information Strategy Committee Performance Indicator Drafting Group, Key Performance Indicators for Australian Public Mental Health Services, ISC Discussion Paper No.6 Australian Government, Department of Health and Ageing, Canberra, 2005.

Pirkis J, Burgess P, Kirk P, Dodson S & Coombs T, ‘Review of standardised measures used in the National Outcomes and Casemix Collection (NOCC) Version 1.2’ Australian Mental Health Outcomes and Classification Network ‘Sharing

Information to Improve Outcomes’ An Australian Government funded initiative, May 2005.

Published by Queensland Health:

• Outcomes Initiative Updates 7, 8, 9

• Cairns Mental Health Information: Outcomes Resource Person roles and responsibility document

• Outcomes Resource Person Development Activity Summary – Queensland Northern Area Outcomes Forum 16 May 2008, 2008, Queensland.

Published by the Australian Association of Social Workers:

• National Practice Standards of the Australian Association of Social Workers: Supervision,

July 2000

Published by the Australian Mental Health Outcomes Classification Network:

• Clinical Utility Materials, 2006

• ’Whose outcome is it anyway? Consumer Self Assessment in Mental Health’ brochure, 2006

• PowerPoint presentation, December 2006

Published by the Department of Human Services Victoria:

• Mental Health and Drugs Division, Department of Human Services, Draft Victorian Outcome Measurement (OM) Training Framework, Victoria, 2008.

• Victorian Western Cluster QUATRO Project, Policies and Procedures Template, 2006

Published by Tony Buzan iMindMapTM

• Help Manual

Appendices

Appendix 1

Phase one – project overview and consultation processes

Victoria secured Quality Through Outcomes funding provided by Department of Health and Ageing through Commonwealth Own Purpose Outlay, to undertake a national initiative focusing on enhancing the utility of consumer outcome measures for collaborative planning.

This project included targeted consultation with jurisdictional representatives/funded teams in adult and aged services in Queensland, who use the Mental Health Inventory, Victoria (BASIS-32®) and NSW (K-10), and the Strengths and Difficulties Questionnaire (SDQ) used nationally in CAMHS ensuring that all of the consumer self-assessment measures are covered. In addition, broader liaison with other states and territories was undertaken.

This phase of resource development was overseen by Veronica Spillane, Manager,

Office of the Chief Psychiatrist, Mental Health and Drugs Division, Department of Human Services Victoria.

The project objectives were:

• To explore options to assist clinicians in engaging with consumers in OM in a way that contributes to collaborative care planning.

• To identify barriers and/or difficulties experienced by clinicians in engaging with consumers, with a view to identifying resources and strategies to overcome these.

Anticipated project deliverables:

• Summary of general lessons from Jurisdictional templates completed by states and territories for May 2008 NOCC Trainers Meeting.

• General strategies and techniques resource.

• Preliminary exploration for information sheets/brochures for consumers and carers.

This project was developed and delivered in collaboration with the Australian Mental Health

Outcomes Classification Network and finished in June 2008.

A facilitated discussion regarding the concept\ and usability of this resource was undertaken with 70 mental health clinicians attending the Northern Forum in Cairns.

Phase one - consultation process

Consultation for the development of a draft general resource for clinicians

Consultation on the draft general resource for clinicians

Phase one - consultation forums attendee list

Appendix 2

Glossary

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