5. Workforce development

Expectations

Routine outcome measurement (consumer outcomes) was introduced in Australian clinical mental health services in 2003 as a key strategy of the national agenda to strengthen evidence based culture and practice. As collection of outcome measures is mandatory in all public (and private hospital) mental health services (with nationally agreed exceptions), ongoing training for clinical staff in accurately completing and using the measures is essential. Implementation of routine consumer outcomes is also reliant on effective leadership at all levels and building the capacity of information technology systems to produce meaningful reports. Increasing the knowledge and confidence in consumer outcomes among consumer and carer consultants will enhance collaborative practice and service improvement initiatives.

Action to consolidate systems for workforce development, consumer and carer involvement, improved reporting capability, and providing effective leadership have been developing in or across states and territories through Quality Through Outcomes funded activities and initiatives.

Consequently a range of resources have been developed to support consumer outcomes.

Establishment of sustainable and enduring systems for training will be a vital step for consolidation of a workforce capable of collecting and meaningfully using consumer outcomes in the future.

As an example, the Victorian Department of Health, Draft Victorian Outcome

Measurement Training Framework has been incorporated into the following sections detailing the competencies, minimum requirements and timeframe for the five types of training:

• orientation
• managers/leaders
• clinicians
• consumer and carer consultants (or their equivalents)
• trainers.

Linking to key policies and strategies

• The routine measurement of clinical outcomes is an initiative under the National Mental Health Strategy that was introduced across all clinical public mental health services in Australia in 2003-2004 and is now part of the third National Mental Health Plan 2003-2008.
• Key Performance Indicators for Australian Public Mental Health Services (2005) report proposes a set of key performance indicators for use in Australia’s public sector mental health services that is based on the National Health Performance Framework and linked to the strategic directions of the National Mental Health Plan 2003-2008.
• The measurement of consumer outcomes in mental health is compatible with the emphasis placed on high quality health services, consumer and carer participation and improving outcomes articulated in jurisdictional plans.

Roles and responsibilities

The roles and responsibilities related to training and workforce development should be articulated for each of the following key stakeholders:

• Australian Mental Health Outcomes and Casemix Network (AMHOCN)
• jurisdictional departments
• funded consumer outcome positions/programs
• mental health services
• funded training, education and workforce development programs
• trainers – funded and portfolio holders
• consumer and carer consultants (or their equivalents)
• participants of consumer outcomes training.

In addition to formalised training sessions the full potential for consumer outcomes in clinical practice and in ensuring data integrity will require a commitment by mental health clinicians and services to the development of ‘learning environments’ where consumer outcomes are routinely used and applications are further developed. Examples of these would include clinical review meetings, clinical/operational supervision, peer mentoring etc. There is also a role for other development activities such as annual Australasian Mental Health Outcomes Conference, statewide forums and research activities. For more information visit: http://amhoc2008.com.au

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Training delivery

Initial materials were developed in 2002. The Australian Mental Health Outcomes and Casemix Classification Network (AMHOCN) developed and distributed basic training materials in 2005 and clinical utility materials in 2006.

In the absence of a nationally articulated outcome measurement framework, the following competency areas, minimum requirements and recommendation duration were taken from a Draft Victorian Outcome Measurement Training Framework.

The Australian Mental Health Outcomes and Casemix Classification Network (AMHOCN) have carriage for NOCC training accreditation. A national training framework, including NOCC rater certification and trainer accreditation and e-learning for NOCC, will in part be developed through AMHOC 2008 pre-conference workshop November 2008. Following this workshop a discussion paper will be developed and contribution sought from the mental health sector.

Each state and territory has developed and implemented different training models. Despite this difference there is a shared recognition that training is required at different levels dependent on target audience. Generally there are three tiers of training requirements from orientation, basic or rater training and utility. Experience suggests that inclusion of clinical utility training with the rater training is beneficial. In addition to the types or tiers of training required it has also been identified that training needs differ dependent on the target audience with three key groups identified, managers/leaders, mental health clinicians as well as consumer and carer consultants.

Bearing in mind the specific training requirements and models utilised in each state and territory the following proposed training components are included in an attempt to differentiate between the training requirements as a guide only.

Example orientation components

5.1 Managers

Example managers/leaders training components

This training is designed for staff employed in leadership/supervisory/management roles involved in the use but not the completion of the measures.

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5.2 Clinicians

Mental health clinicians have considerable skills, knowledge and expertise having undertaken discipline specific undergraduate degrees and for some postgraduate qualifications. Professional development opportunities and access to supervision varies considerably across mental health services.

Participation in the consumer outcomes initiative affects nearly all aspects of clinical service delivery and most clinicians will have areas where their skills and knowledge excel and also areas that require further skill development.

Child and adolescent mental health clinicians require specific training in CAMHS consumer outcomes while adult and older person measures can be trained either in combination or separately.

Consumer and carer involvement in consumer outcomes training for clinicians is a powerful way of promoting:

• The value of collecting and using measurement tools.
• That clinician rated and self-rated measures provide opportunities to elicit multiple perspectives.
• Measurement tools can assist in prioritising and negotiating goals.
• Utilisation of existing programs/training strategies would provide an avenue for sustainable consumer outcome training, such as:
• Identification and integration of consumer outcome training into broader discipline based activities, for example graduate nurse programs and psychiatric registrar rotations, would ensure that consumer outcomes are understood and integrated as a mandatory clinical activity.
• Mental health training providers.
• Universities, particularly postgraduate degrees.

Generic skill requirements

Ongoing skill development in the following areas will enable active participation in consumer outcomes:

• knowledge and understanding of consumer outcomes - rationale, how to rate the measures and use of consumer outcomes ratings
• ability to interpret consumer ratings and engage in dialogue with consumer
• ability to offer the self-assessment including a rationale, instilling value in the process and ensuring time to explore issues/fears
• understanding clinical information systems
• ability to provide support and possibly assistance to consumers in the completion of the self-assessment
• ability to facilitate meaningful dialogue on consumer outcomes with consumers and carers
• skills in clinical review preparation, presentation and documentation
• skills in incorporating consumer outcomes into care planning.

Example

Rate an existing consumer as a group

This activity is perhaps more useful in teams where there are more than one clinician involved in the consumer care. Rating as a group is an opportunity to share perspectives, developing an understanding, and confidence of the measures and engaging collaborative information exchange, development of the use of a consistent terminology and language.

Subsequently this technique can improve inter-rater reliability.

All services hold regular staff meetings that discuss clinical issues, business information (service changes, new policies/procedures etc) and provide a space for staff development (external and internal presentations). Some services have embedded consumer outcomes into these meetings in the staff development component. For example one staff member leads the discussion by utilising one of the examples from this resource:

• case-manager describing how they introduced and talked about consumer outcomes with a consumer.
• Consultant psychiatrist presenting information about discrepancies between clinical perception (HoNOS and LSP-16 ratings) and consumer perception (for example, BASIS-32® ratings) for discussion by all staff.

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Example clinician training components

5.3 Consumer and carer consultants (or equivalent)

Consumer and carer consultants as discussed here refer to roles employed by mental health services.

Consumer and carer consultant/advisor roles vary across states and territories but it is suffice to say that these roles are fundamentally designed to support and assist in improving outcomes for people receiving mental health services. While consumer and carers bring a wealth of personal experience and knowledge to these roles, they also require opportunities for professional development and training. Currently, skill building for consumer and carer consultants has not been prioritised.

Consumer and carer consultants or advisors have the potential to play a pivotal role in consumer outcomes providing that they are:

• Not expected to be the primary engager of consumers and carers in consumer outcomes, this is a service wide responsibility with clinicians taking the primary role.
• Provided with key materials and resources related to consumer outcomes.
• Provided opportunities to develop skills to interpret consumer outcome information to use it for service quality.
• Offered professional development opportunities to enhance general skills as well as focused sessions on consumer outcomes including creative ways for managing resistance.

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Example consumer and carer consultant training components

5.4 Trainers

There is considerable variation across jurisdictions regarding the appointment, capacity (formalised training role), qualifications (Cert IV in workplace assessment and training etc) and requirements for trainers in consumer outcomes. Jurisdictions have also implemented quite different training programs including:

• train-the-trainer model
• small pool of appointed staff
• accredited trainers.

The provision of training in a number of jurisdictions is undertaken by trainers as an add-on to their primary role. The sustainability for training and trainer requirements continues to be an area for development.

There have been a number of identified benefits from involving consumers and carer consultants in training clinicians in consumer outcomes:

• positive response from clinicians
• felt their involvement made a difference
• more confident about being involved in training
• raised profile within service.

Example trainers training components

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