6. Resources

A number of resources have been suggested or referenced throughout this resource.

This section refers to those resources specifically designed for the National Outcomes and Casemix Collection (NOCC).

Considerable energy has gone into the development of resources and information primarily for clinicians. This has involved the development of:

• websites and webpages
• protocol documents, including - technical specifications
• training materials - national through AMHOCN, at a jurisdiction and local level.

Training materials including rater and clinical utility

• information sheets and brochures
• frequently asked questions webpages and forum.

The emphasis on mental health information is going to increase not fade away and it has been suggested that to sustain the momentum for consumer outcomes going forward will require two types of resources:

• people who are informed, skilled and provide leadership in both the collection and utilisation of mental health information.
• materials for each target audience - consumers, carers, mental health clinicians, managers/team leaders, trainers, and resource people pitched at relevant levels.

6.1 People

Mental health information is everybody’s business. It involves all stakeholders in mental health services. The barriers experienced in implementing consumer outcomes in mental health services have been considerable. This process is unprecedented or unparalleled in Australian mental health services and the process of routinely measuring consumer outcomes has highlighted many areas for further development.

In order to embed consumer outcomes into clinical practice staff identified as resource people (including trainers) need access to support structures such as mental health information/outcomes working groups, steering committees or implementation groups.

These structures need to ensure that there is co-ordination of activities in line with an overarching vision and aim. The overarching structures should ensure that consumer outcome priorities are identified and managed and activities are targeted.

All people involved in the co-ordination, management and development in the use of, consumer outcomes in clinical practice need to be provided opportunities for networking, mentoring and skill development.

Outcomes Resource People (ORP) and outcomes trainers

Items in italics were taken from additional comments and placed in one of the following five sections and items in square brackets are added to make it general not jurisdiction specific.

“1. What should be the key responsibilities of an ORP? (Some of the points in this section depend on how the position/role is defined or organised for example in/out of the team).

• Person who can provide education and training; provide advice on completing measures and entering data and on interpretation within the team; a model of the use of the [data system] and information; promoting clinical utility.
• A team member well accepted by the team not considered as external.
• Identification of people who are struggling and support and mentor them and delivering a process around this to embed in day-to-day practice.
• Contribute to the development of business rules around the ORP role and expectation and delivery of support for team members; attend meetings and provide feedback to and from state-wide practice and local team practice.
• Continue to develop their own knowledge of information systems and demonstrate use of information in the system using the [funded jurisdictional teams] and other clinical resources.
• Reporting to line management positive and negative information issues; interface with manager and other key players especially [staff that manage mental health information].
• Facilitate development of workplace policies and practices and procedures that facilitate data collection.
• Reference point for accessing resources and skills and motivator for teams.
• Resource in clinical review; assist in the interpretation and meaning of information.
• Show leadership in the use of clinical information to support planning at all levels of service; be a catalyst for change.
• Use information in benchmarking.
• Attend relevant meetings and training sessions.
• Prepare case review lists in advance so staff know when to complete measures.
• ORP should be able to reset passwords.

Activities that promote data quality in terms of validity, reliability, accuracy and timeliness of the consumer outcomes data.

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2. What are realistic expectations of an ORP?

a) From their team

• ORP assists the team to improve skills in clinical utility and facilitate better performance at district level.
• Demonstrate a high degree of knowledge of the system and the ability to articulate this to team members (walk the walk); should be able to inspire clinicians; motivator for participation and learning; clarify problems and challenges within the system.
• Facilitate broad skill development including their own e.g. forums, workshops etc.
• Follow through on [consumer self-assessment] completion issues; willingness to drive consumer involvement.
• Be accessible.
• Work to resolve issues with others.
• Skills in extracting information from the system and demonstrate how to utilise reporting capacities.
• Creates a culture that reflects [data use] as an integral part of the continuum of care.

b) From the service

• Reporting to line management any difficulties or problems regarding implementation.
• Effective communication, commitment and enthusiasm and belief in benefit and value of resource passing information on to the team.
• Running and interpreting reports in discussion with line management.
• ‘Go to’ person with information regarding mental health information and support in use.
• Network with other ORPs; support management in the use of data in service planning/mapping.
• Demonstrate using systems in correlation [non-integrated data systems]
• Time to provide training and support staff and to be up skilled.
• Recognition.
• Improved data collection [and use].
• Manager should have written into position descriptions that they are accountable for collections.
• Routine part of clinical practice.

c) Other

• Liaise with [jurisdictional funded teams] to continue to progress development to reduce barriers including reporting of difficulties/barriers within team.
• Cleansing of data either directly or facilitating.
• Pass information onto the team.
• Leadership from above and within the team.
• Regular feedback/input between [Mental Health Information Managers] and ORPs
• Improvement in consumer participation in mental health service provision.
• Engagement of medical staff.
• [Provide training to consumers and carers in the use and interpretation of OMs.]

3. What qualities and skills make an effective ORP?

• Patience, effective communication, approachable, quick learner, sense of humour, availability and tolerant.
• Able to work out what teams need and to integrate knowledge requirements with type of service.
• Ability to work with other ORP.
• Clinical credibility within a team (not new clinician); good clinical experience.
• Be familiar with able to access, troubleshoot and navigate the system.
• Be proactive and take personal responsibility in regard to access and continuing development of knowledge.
• Innovative and passionate about mental health information.
• Self-motivated and responsible; innovative, thinks outside the square.
• Good computer skills.
• [The ability to communicate with non-clinical people the value and use of the consumer outcomes.]

4. What sustains an ORP?

a) Resources

• Clinicians’ handbook and references.
• Access to trained staff and mentors, support network, training/ ORP Resource days and forums, supervision, clear contact with [jurisdictional funded teams], and steering group.
• Recognition and acknowledgement.
• Benchmarking activities.
• Computer access.
• Time, support of line manager, time to be released from role, and more than one ORP per site.

b) Structures and processes

• Realistic goals and standardised processes.
• Training linked to orientation.
• Clear and concise, systematic and not too cumbersome.
• Linking care plans to outcome measures, flowcharts for forms and data entry points.
• Local outcomes trainer to educate, motivate and drive.
• Admin support, and support from line and upper management.
• Leadership by action and example.
• Dedicated ORP days.
• Clear reporting process for ORP to manage issues with TL’s and line mangers.
• Clear lines of responsibility to [jurisdictional funded teams] etc.

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c) Training

• Regular updates including [data system], time off to attend and backfill, recognition of importance of training, consistent training and training packages and orientation.
• Collaboration with other ORP.

d) Other

• Needs to be able to support other teams that don’t have an ORP.
• ORP email network and online network.
• Tangible recognition/badge/certificate/cash bonus.

5. What barriers impede ORP in their role?

• Culture of organisation, lack of support from management, lack of recognition, relationship with key stakeholders, and support from medical staff.
• Attitudes, reluctance of clinicians to use the [data] system and implications for ORP role.
• Staff who believe they are competent but aren’t, and [who] are unwilling to accept support, and need to have minimum competency requirements.
• Staff skills and high staff turnover.
• Time, workloads, finances/resources, computer access, and lack of computer skills.
• Orientation for new staff.
• Clarity of ORP role, retention of ORP, and team acceptance of role as support to clinicians.
• Fitting specialist teams into the [data collection protocol and data] system”

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

Examples

The principal responsibility of a consumer outcomes resource person is to drive the routine collection and use of mental health information in their Mental Health Service. The role involves a range of responsibilities that will be determined by available resources, skill level and number of resource people in any given area.

Possible roles include:

• Mentoring (individual, group, team based) in practical application such as:
  • offering the self assessment
  • providing feedback on the self-assessment
  • providing feedback on the clinician measures
  • promoting compliance to the collection protocol
  • using consumer outcomes in clinical reviews
  • using consumer outcomes to inform future intervention options
  • data system – entry and/or extraction
  • interpretation of consumer level reports.
• Guidance or expert advice to clinicians/teams on:
  • protocol collection
  • business processes and rules for collection and utilisation of consumer outcomes
  • application and analysis of consumer outcomes.
• Providing guidance or advice to managers by:
  • identifying and communicating current work-practice issues
  • developing and implementing workable solutions to current work-practice issues
  • promoting consumer outcome information to inform service planning and improving models of service delivery.
• Provide guidance and advice to consumer and carer consultants:
  • interpretation of consumer outcome reports at systematic advocacy level such as at quality meetings.
• Reporting:
  • provide recommendations to improve reporting processes
  • provide ad hoc advice or reports to the Executive as requested
  • generating reports to the team/team leader regarding current compliance with collection (where possible).
• Networking:
  • participation in consumer outcomes activities (national conference, statewide forums, local networking meetings)
  • disseminate and actively promote communication tools such as updates, newsletters available locally, from state or territory department, and nationally.
• Progressing mental health information development and use:
  • monitor the quality of the information being entered into the database and addressing problems which may arise
  • liaison with relevant committee/work group or funded positions that oversees consumer outcomes collection and utilisation
  • chairing the local working group
  • problem identification, escalation and resolution in collaboration with key stakeholders, state or territory department, and AMHOCN.
• Training role.

Cairns Mental Health Information: Outcomes Resource Person roles and responsibility document informed this section.

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Consumer and carer consultants (or equivalent)

Consumer and carer consultants are an invaluable resource for mental health services to strengthen consumer and carer engagement. Their potential roles in consumer outcomes should focus at systemic approach to consumer and carer engagement by facilitating clinicians’ capacity and awareness rather than being the primary driver.

Consumer and carer consultants have a range of skills, knowledge and abilities as well as variation in roles, responsibilities and job expectations. There is an ongoing need for training and support to enhance skills of consumer and carer consultants to enable them to effectively and equally participate within Mental Health Services.

Consumer Advisory Groups (CAG) or consumer consultants are resourced to run focus groups to explore the consumer self-assessment measure used in their jurisdiction and provide feedback and/or a protocol to their service about how their consumers would like the self-rated measure offered to them and also how they would like follow up discussions to occur. This would be a good way to increase participation and at the same time perhaps try to promote sensitive and respectful practice in relation to self-rated measures.

Most consumer and carer consultants (or their equivalents) are employed in clinical mental health services. There are however a small number of positions with a dedicated focus either on state-wide activities, an education role or in developer/policy role. This group of staff will have additional workforce development requirements which have not been articulated in this resource.

Depending on position requirements and resources some consumer and carer consultants will be in a position to run groups for consumers and carers regarding the consumer outcomes to increase awareness, provide education and clarify expectations. These groups could be delivered to consumers and carers together or each group separately.

Examples

The role involves a range of responsibilities that will be determined by available resources, skill level and number of other resource people (clinicians or other consumer and carer consultants) in any given area. Possible roles include:

• Promoting the value of consumer self-assessment with:
  • clinical teams
  • consumer and carer groups including how they can get the most out of the consumer self-assessment process.
• Involvement in training/workshop for clinicians on:
  • offering the self assessment
  • providing feedback on the self-assessment
  • providing feedback on the clinician measures.
• Development of materials for consumers and carers about consumer outcomes nationwide plain English version.
• Guidance to clinicians/teams on:
  • consumer self-assessment challenges
  • how consumer outcomes could be used in dialogue with consumer and/or carer and in clinical decision making.
• Providing guidance or advice to managers by:
  • identifying and communicating current work-practice issues
  • promoting consumer outcome information to inform service planning and improving models of service delivery.
• Understanding and using outcome measures to provide leadership in service planning, improving models of service delivery and developing a truly recovery orientated mental health system.
• Reporting:
  • provide recommendations to improve reporting processes
  • involvement in service development for consumer take-home reports.
• Networking:
  • participation in consumer outcomes activities (national conference, statewide forums, local networking meetings and cross jurisdictional meetings)
  • disseminate and actively promote communication tools such as updates, newsletters available locally, from state or territory department, and nationally.
• Progressing mental health information development and use:
  • liaison with relevant committee/work group or funded positions that oversees consumer outcomes collection and utilisation
  • problem identification, escalation and resolution in collaboration with key stakeholders, state or territory department, and AMHOCN
  • participation in activities for the development of a carer measure in adult and older person mental health services
  • role in garnering and recording consumers opinions/perspectives about consumer outcomes.
• Consumer evaluation of service implementation of consumer outcomes, some questions that could be asked are:
  • How well did the service inform all consumers about all the consumer outcome measures?
  • How well did the service inform all consumers about the self rating tools?
  • How well did the service inform all consumers about how consumer outcomes would be used (within the treating team, within the service, within the state, at the national level)?
  • How well did the service engage with consumers in discussing the consumers individual ratings?
  • How well did the service inform all consumers how their own individual ratings (clinician and consumer rated) would be incorporated into care plans?
  • How well did the service use OM for benchmarking service development and quality improvement?
• Co-facilitator training role.

For more information:

David Guthrie, Mishka McIntosh, Tom Callaly, Tom Trauer and Tim Coombs, Barwon Health: Community and Mental Health, Geelong, Victoria, Australia, Consumer attitudes towards the use of routine outcome measures in a public mental health service: A consumer-driven study, International Journal of Mental Health Nursing (2008) 17, 92–97

6.2 Materials

States and territories have developed information brochures for consumers and carers about the consumer outcome agenda. These materials are typically pitched at the general awareness raising level and are not necessarily written in consumer or carer friendly language.

The ‘Whose outcome is it anyway? Consumer Self Assessment in Mental Health’ brochure and poster was developed by consumers and carers for consumers and carers. These materials are general and talk about the consumer self-assessment process.

In developing this resource a gap has been identified for more targeted and detailed materials that clinicians could provide consumers and carers on the measures in the NOCC suite. It has been recommended that these materials should be written in consumer and carer friendly language.

While outside of scope for this particular resource, preliminary discussions have taken place about the value of developing this type of materials.

Each state and territory has an internet address accessible by consumers and carers.

There is significant variation in the extent of information contained on these sites with a number of jurisdictions utilising their intranets for consumer outcomes information which are not accessible by consumers and carers.

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6.2.1 National

Child and adolescent/youth mental health services
Strengths and Difficulties Questionnaires (SDQ)

All Australian Child and Adolescent/Youth Mental Health Services utilise the Strengths and Difficulties Questionnaire (SDQ). This questionnaire is in the public domain and everybody can access the forms at: www.sdqinfo.com/b1.html.

Translations

All translations of the SDQ are undertaken/commissioned by the author of the SDQ Robert

Goodman. The SDQ translations follow the UK English version not the Australian English version.

This means there are some variation in wording of a couple of questions but more importantly there is only one parent version for 4 - 16 year old unlike the NOCC version which splits parents into 4-10 and 11-17. This issue was forwarded by Victorian Department of Human Services, to the CAMHS outcomes expert group November 2007 meeting for advice on possible implications for completion and entry of translated versions. No outcome has been received. The SDQ Vietnamese is in development with finalisation and availability on the SDQ website remains unknown.

The SDQ is translated into the following languages and (D) denotes drafts:

Australian Mental Health Outcomes and Classification Network

Australian Mental Health Outcomes and Classification Network (AMHOCN) provides the authoritative focal point for national leadership in the development of outcomes and casemix concepts in mental health and is currently funded until June 2008. Broadly, AMHOCN performs three roles, including:

• Provide a data bureau function to receive and process the mental health outcomes and casemix data submitted by states and territories. This function will be undertaken by Strategic Data, a Victorian company with expertise in the establishment and management of large data sets.
• Act as a specialist research and development group for the analysis, reporting and ongoing development of mental health outcomes and casemix information at a national level while also providing a resource for such work at state and territory level. This function will be undertaken by the University of Queensland and the University of Melbourne, primarily Dr Philip Burgess and Dr Jane Pirkis.
• Act as a national training and service development resource centre for the ongoing use of outcomes and casemix measures, designed to both inform and improve practice through workforce training, benchmarking and related activities. This function will be undertaken by The New South Wales Institute of Psychiatry, primarily Mr Tim Coombs and Dr Louise Newman.

The Commonwealth Department of Health and Ageing established a website to support the Mental Health National Outcomes and Casemix Collection. It can be found at www.mhnocc.org. This site aims to support the implementation of routine consumer OM Australia’s public mental health sector. The purpose of NOCC is to improve the quality of mental health services through better understanding and use of information about the outcomes for consumers of mental health services.

This site provides key resources on mental health outcomes and case complexity measurement and provides a forum for sharing ideas, views and experience. The site is intended to be used by clinicians, managers, consumers, carers, policymakers, researchers and all other interested stakeholders. Training resources on this site include:

• Rater Training including an extensive range of resources (PowerPoint slides, manuals, vignettes) for CAMHS, Adult and Aged Persons, available from www.mhnocc.org/amhocn/Training_Resources/.
• Clinical Utility Training Resources - ‘Whose Outcome is it Anyway?’ AMHOCN in collaboration with Barwon Health the lead agency of the Victorian Western Cluster Quality through Outcomes Project produced a range of promotional and educational materials including:
• Poster - ‘Whose Outcome is it Anyway?’
• Brochure - ‘Whose Outcome is it Anyway?’
• Flipper Card - ‘Whose Outcome is it Anyway?’
• A DVD of consumers, carers and clinicians that explores the opportunities that routine OM holds in clinical practice.
• Clinical utility training manual, PowerPoint slides and vignettes for CAMHS, Adult and Aged.

Hard copies of the promotional materials including a ”novelty flipper card” along with copies of the DVD and associated training materials are available on request.

Clinicians also have access to the decision support tool which contains clinical reference material generated by AMHOCN from data submitted by each jurisdiction and can be found at http://wdst.mhnocc.org.

For information on outcome measurement undertaken internationally:

• Activities in Ohio - www.mh.state.oh.us/oper/outcomes/outcomes.index.html
• MH Smart in New Zealand - www.huttvalleydhb.org.nz/Article.aspx?ID=623
• Australasian Mental Health Outcomes Conference 2007
  • 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

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6.2.2 State and Territory

States

Victoria

Information is available at: www.health.vic.gov.au/mentalhealth/outcomes/index.htm

This website is accessible to the general public. In addition, a number of Victorian mental health services have placed information on their local Intranet.

Victorian “Outcome Measurement in Clinical Mental Health Services Program Management

Circular” was disseminated in July 2007 and articulates the Department of Human Services expectations. This is available at: www.health.vic.gov.au/mentalhealth/pmc/outcome-measurement.htm.

Information brochures for consumers and carers are available at: www.health.vic.gov.au/mentalhealth/outcomes/concare.htm#info_books.

Measuring consumer outcomes in clinical mental health services: A training manual for services in Victoria 2nd Edition 2003 was developed and distributed. This manual has seven major sections– Introduction, CAMHS, Adult, Aged persons, Training, Glossary, and Resources. The resources section is broken into five sections being General, CAMHS, Adult and Aged Persons. The manual also includes a DVD with vignettes.

Most mental health services in Victoria have developed staff resources/manual that are available in hard copy or on local intranets.

If you need more information contact:

Senior Project Officer
Quality Services
Sector Quality and Workforce Development
Mental Health and Drugs Division
Department of Human Services
GPO Box 4057 Melbourne Victoria 3001

Consumer self-assessment - BASIS-32^® Translations

To strengthen participation and use of outcome measures among consumers from culturally and linguistically diverse backgrounds, the Department of Human Services has commissioned translations of the adult consumer self assessment measure, the BASIS-32^® into a number of community languages: Arabic, Cambodian, Chinese, Filipino (Tagalog), Finnish, French, Greek, Italian, Japanese, Korean, Portuguese, Spanish, Thai and Vietnamese.

Engagement of interpreters should also be considered when discussing and using outcome measures with consumers from culturally and linguistically diverse backgrounds. As the BASIS-32^® is protected by copyright and not in the public domain; the Department of Human Services is unable to make copies of the BASIS-32^® translations available on its website. However they can be posted on local service intranet sites. Translated Versions of the BASIS-32^® are available to consumers of public clinical mental health services from culturally and linguistically diverse backgrounds in Victoria.

South Australia

Information is available at: www.health.sa.gov.au/mentalhealth (website under development).

If you need more information contact:

Central NOCC Coordinator
Mental Health Unit
PO Box 287
Rundle Mall 5001
Adelaide

Consumer self-assessment K-10

There is a reference to the Mental Health National Outcomes Casemix Collection internet site www.mhnocc.org from the SA Health Internet site, where translations of the K10 can be sourced, languages are:

Arabic, Bosnian, Chinese, Croatian, English, Farsi, Greek, Hindi, Italian, Korean, Macedonian, Serbian, Spanish, Tagalog, Turkish, Vietnamese.

Tasmania

Information is available via an intranet site, which cannot be accessed externally.

Coding References are available on the intranet site. This provides the HONOS glossaries.

Our clinicians currently have limited access to the intranet.

If you need more information contact:

Data Management and Reporting Consultant
Department of Health and Human Services
Phone: (03) 6230 7727

Consumer self-assessment - BASIS-32^® Translations – No translations available.

Western Australia

Information is available: www.comhwa.health.wa.gov.au/one/outcome.asp (website is under development).

If you need more information contact:

Senior Program Manager
Mental Health Division
Department of Health
189 Royal Street
East Perth WA 6001
Phone: 08 9222 2349

Consumer self-assessment K-10

Our website links to the MHNOCC.ORG website which provides the translations of the consumer self-assessment in other languages. 

Queensland

Information is available via an intranet site, which cannot be accessed externally. Contents include: self-directed learning package for clinicians, clinician reference manual, outcome measurement forms.

If you need more information contact:

Area Clinical Information Team (ACIT) Co-ordinator can be contacted for more information.

Consumer Self-Assessment - MHI

MHI Translations Online - The Transcultural Mental Health Centre has provided assistance in translating the Mental Health Inventory forms into 13 languages including Arabic, Croatian, Filipino, Khmer, Serbian and Vietnamese. The MHI translations can be accessed through the Information Systems & Management Team intranet site (QHEPS).

New South Wales

Information is available on the NSW Health intranet site, which cannot be accessed externally. Clinicians can download and use as required.

If you need more information contact:

Project Manager MHOAT
InforMH: Building Knowledge, Supporting Services, Improving Care

InforMH
Macquarie Hospital
PO Box 169
North Ryde NSW 1670

Consumer Self-Assessment – Kessler-10 Translations

K10 and consumer brochures have been translated into the following 15 languages:

Arabic, Bosnian, Croatian, Greek, Hindi, Korean, Macedonian, Spanish, Tagalong, Vietnamese, Chinese, Farsi, Italian, Serbian, Turkish.

Territories

Northern Territory

Information is available via an intranet site, which cannot be accessed externally.

Contents include: Self-directed learning package for clinicians, Clinician Reference Manual, K10 forms, with, besides English, translations into 15 languages (taken from NSW Transcultural Mental Health), also SDQ forms and ICP forms for Adults and Older Persons, and Child and Adolescent ICP.

If you need more information contact:

Either:

• Comet Project Officers
• Senior Policy Officer, Workforce Development and Clinical Standards
• Information Officer

Mental Health Program
PO Box 40596
Casuarina
NT 0811
Phone: 08 8999 2553

Consumer Self-Assessment – Kessler-10 Translations

K10 translations available on NT Government Intranet are based on the NSW MHOAT standard suite of translations. Languages are: Arabic, Chinese, Farsi, Hindi, Korean, Serbian, Tagalog, Vietnamese, Bosnian, Croatian, Greek, Italian, Macedonian, Spanish, and Turkish.

Australian Capital Territory

Information is available via an intranet site, which cannot be accessed externally. Resources are available to staff of ACT health.

Information includes outcome measurement resources, information system details (database manual, electronic reporting of outcomes measures including NOCC suite of measures), clinical documentation manuals, outcomes measures glossaries, self assessment forms.

Information available to the public: www.health.act.gov.au/c/health?a=sp&pid=1148966417

(Outcomes resources not yet available via the Internet currently under development pending service reform)

If you need more information contact:
{Interim contact}
Paul Mayers
Mental Health Business Analyst
Mental Health – ACT
PO Box 825
CANBERRA ACT 2601
Ph: (02) 6205 1313

Consumer self assessment – BASIS-32^® (Adult and Older Persons) and SDQ (Child and Adolescent and Parent/Carer)

Self assessment outcomes measures are provided/offered to consumers and potential consumers of mental health services. Availability of translations of these tools into other languages is being pursued based on the work conducted in Victoria with respect to the BASIS-32®. Self assessment measures currently available in English only, this is being reviewed for need and accessibility to those population groups who use other languages that may potentially access public mental health services in the ACT.

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