asm prepare 3 year revie · final report march 2015 this project was supported with funding under...

ASM PREPARE 3 Year Review

Final Report

March 2015

This project was supported with funding under the HACC Program by the Commonwealth and Victorian Governments

Table of Contents

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1 EXECUTIVE SUMMARY ................................................................................................................. 10 1.1 Background ............................................................................................................................ 10 1.2 Project requirements .............................................................................................................. 10 1.3 Online tool development ......................................................................................................... 11 1.4 Targeted follow-up focus groups and consultations ................................................................ 11 1.5 Summary of findings ............................................................................................................... 11 1.6 Opportunities to continue to support ASM .............................................................................. 13

2 INTRODUCTION ............................................................................................................................. 16 2.1 Review background ................................................................................................................ 16 2.2 The HACC Active Service Model ............................................................................................ 16 2.3 ASM PREPARE ...................................................................................................................... 18 2.4 Transition of HACC to the Commonwealth ............................................................................. 16 2.5 Project requirements .............................................................................................................. 19

3 METHODS ....................................................................................................................................... 20 3.1 Overview of project process ................................................................................................... 20 3.2 Online tool development ......................................................................................................... 20 3.3 Maximising participation ......................................................................................................... 21 3.4 Targeted focus groups and follow up phone consultations ..................................................... 21

4 ONLINE TOOL DATA ANALYSIS – OVERVIEW ........................................................................... 23 4.1 Overall response rate ............................................................................................................. 23 4.2 Response rate by organisation type ....................................................................................... 23 4.3 Self-rating scale and evidence ................................................................................................ 25

5 ASM PREPARE – DATA ANALYSIS .............................................................................................. 28 5.1 Type of organisation ............................................................................................................... 28 5.2 Service coordination elements ................................................................................................ 28 5.3 Practice areas ......................................................................................................................... 30 5.4 Service delivery ...................................................................................................................... 35

6 ASM PREPARE – ENABLERS AND BARRIERS TO ASM IMPLEMENTATION ........................... 46 6.1 Resource enablers ................................................................................................................. 46 6.2 Workforce development and commitment enablers ................................................................ 48 6.3 Systems change and support enablers .................................................................................. 49 6.4 Barriers to ASM Implementation ............................................................................................. 50

7 ASM PREPARE – MOST SIGNIFICANT CHANGES ...................................................................... 52 7.1 Overarching most significant changes .................................................................................... 52 7.2 Most significant changes: Initial Contact/Initial Needs Identification ....................................... 53 7.3 Most significant changes: Assessment ................................................................................... 55 7.4 Most significant changes: Care Planning and Review ............................................................ 57 7.5 Most significant changes: Service Delivery ............................................................................. 57 7.6 Most significant changes: Service Closure and/or Transition ................................................. 59

8 ASM PREPARE–EXPRESS – DATA ANALYSIS ........................................................................... 61 8.1 Type of organisation ............................................................................................................... 61 8.2 Service coordination elements ................................................................................................ 61 8.3 Practice areas ......................................................................................................................... 63 8.4 Service Delivery ...................................................................................................................... 67

Table of Contents

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9 ASM PREPARE–EXPRESS – ENABLERS AND BARRIERS ........................................................ 79 9.1 Resource enablers ................................................................................................................. 79 9.2 Workforce development and commitment enablers ................................................................ 81 9.3 Systems change and support enablers .................................................................................. 82 9.4 Barriers to ASM implementation ............................................................................................. 84

10 ASM PREPARE–EXPRESS – MOST SIGNIFICANT CHANGE ..................................................... 86 10.1 Overarching most significant changes .................................................................................... 86 10.2 Most Significant Change: Service Commencement ................................................................ 87 10.3 Most Significant Change: Service Delivery ............................................................................. 88 10.4 Most Significant Change: Service Closure and/or Transition .................................................. 88

11 TARGETED FOCUS GROUPS AND PHONE CONSULTATIONS ................................................. 91 11.1 Purpose of the follow up consultations ................................................................................... 91 11.2 Enablers for ASM implementation .......................................................................................... 91 11.3 Barriers to ASM Implementation ............................................................................................. 94 11.4 What has changed? ................................................................................................................ 96

12 SYNTHESIS OF KEY FINDINGS AND OPPORTUNITIES ............................................................. 99 12.1 ASM review online tool response rate .................................................................................... 99 12.2 Stages of ASM implementation .............................................................................................. 99 12.3 Barriers and enablers to ASM implementation ..................................................................... 100 12.4 Most Significant Change ....................................................................................................... 102 12.5 Areas for improvement ......................................................................................................... 102 12.6 Conclusions .......................................................................................................................... 104

Table of Contents

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List of Tables

Table 2-1: ASM Practice areas ............................................................................................................ 18

Table 3-1: Agency participation rates in targeted focus groups and phone calls ................................. 22

Table 4-1: State-wide response rate to ASM PREPARE and ASM PREPARE–Express online tools ......................................................................................................................... 23

Table 4-2: Comparison of organisation types selecting either ASM PREPARE or ASM PREPARE—Express ................................................................................................. 24

Table 4-3: Self-rating scale for the ASM online tool ............................................................................. 25

Table 5-1: ASM PREPARE state-wide summary of self-ratings for service coordination elements ..... 28

Table 5-2: ASM PREPARE state-wide summary of practice area self-ratings ..................................... 32

Table 5-3: ASM PREPARE state-wide summary of self-ratings for Person-centred approach by funded activity type ........................................................................................................ 37

Table 5-4: ASM PREPARE State-wide summary of self-ratings for Diversity planning and practice by funded activity type .......................................................................................... 40

Table 5-5: ASM PREPARE State-wide summary of self-ratings for Capacity Building by funded activity type ........................................................................................................ 42

Table 8-1: ASM PREPARE–Express state-wide summary of self-ratings for service coordination elements ............................................................................................ 62

Table 8-2: ASM PREPARE–Express state-wide summary of practice area self-ratings ...................... 64

Table 8-3: ASM PREPARE–Express State-wide summary of self-ratings for Person-centred approach by funded activity type ........................................................................................ 69

Table 8-4: ASM PREPARE–Express state-wide summary of self-ratings for Diversity planning and practice by funded activity type .................................................................................... 73

Table 8-5: ASM PREPARE–Express state-wide summary of self-ratings for Capacity Building by funded activity type ........................................................................................................ 75

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List of Figures

Figure 4-1: ASM PREPARE state-wide responses by region (n = 171) ................................................ 24

Figure 4-2: ASM PREPARE–Express state-wide responses by region (n = 191) ................................. 25

Figure 5-1: ASM PREPARE state-wide average self-ratings for service coordination elements (n = 173) ............................................................................................................................. 29

Figure 5-2: ASM PREPARE state-wide proportions of organisations self-rating at each level (n = 173) ............................................................................................................................. 30

Figure 5-3: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Initial Contact and Initial Needs Identification (N=173) ............................ 33

Figure 5-4: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Assessment (n = 173) ......................................................................... 33

Figure 5-5: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Care Planning and Review (n = 173*) ................................................. 34

Figure 5-6: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Service Closure and Transition (n = 173) ............................................ 34

Figure 5-7: ASM PREPARE state-wide Service Delivery self-ratings for practice areas by funded activity types (n = 173) ....................................................................................... 36

Figure 5-8: ASM PREPARE State-wide proportions of organisations self-rating their Person-centred approaches at each level for each funded activity type (n = 173) .......................... 38

Figure 5-9: ASM PREPARE State-wide proportions of organisations self-rating their Diversity planning and practice for each funded activity type (n = 173) ............................................. 41

Figure 5-10: ASM PREPARE State-wide proportion of organisations self-rating of their Capacity building for each funded activity type (n = 173) .................................................................. 43

Figure 6-1: ASM PREPARE resource enablers (n = 173) ..................................................................... 47

Figure 6-2: ASM PREPARE State-wide workforce development and commitment enablers (n = 173) ............................................................................................................................. 49

Figure 6-3: ASM PREPARE State-wide Systems Change and Support enablers (n = 173) ................. 50

Figure 6-4: ASM PREPARE State-wide barriers to ASM implementation (n = 173) ............................. 51

Figure 8-1: ASM PREPARE–Express state-wide responses by type of organisation (n = 191) ............ 61

Figure 8-2: ASM PREPARE–Express state-wide average self-ratings for service coordination elements (n = 191) ............................................................................. 62

Figure 8-3: ASM PREPARE–Express state-wide proportions of organisations self-rating at each level (n = 191) ........................................................................................................ 63

Figure 8-4: ASM PREPARE–Express state-wide proportion of organisations self-rating for each practice area (n = 191) ......................................................................................... 65

Figure 8-5: ASM PREPARE–Express State-wide Service Delivery self-ratings for practice areas by funded activity types (n = 191) ....................................................................................... 68

Figure 8-6: ASM PREPARE–Express State-wide self-ratings for Person-centred approach to Service Delivery by funded activity type (n = 191) .............................................................. 71

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Figure 8-7: ASM PREPARE–Express State-wide self-ratings for Diversity planning and practice in Service Delivery by funded activity type (n = 191) .............................................................. 74

Figure 8-8: ASM PREPARE–Express state-wide self-ratings for Capacity Building in Service Delivery by funded activity type (n = 191) ........................................................................... 76

Figure 9-1: ASM PREPARE–Express resource enablers (n = 191) ...................................................... 80

Figure 9-2: ASM PREPARE–Express workforce enablers (n = 191) .................................................... 82

Figure 9-3: ASM PREPARE–Express Systems Change and Support enablers (n = 191) .................... 83

Figure 9-4: ASM PREPARE–Express Barriers to ASM implementation (n = 191) ................................ 85

Glossary

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Abbreviation Definition

ACCHO Aboriginal Community Controlled Health Organisation

ACCO Aboriginal Community Controlled Organisation

AHA Australian Healthcare Associates

ASM Active Service Model

BSW Barwon South West region

CALD Culturally and Linguistically Diverse

CHC Community Health Centre

CHS Community Health Service

CCCS The Community Care Common Standards

CHSP Commonwealth Home Support Program

CQI Continuous Quality Improvement

CSO Community Service Organisation

DHHS Department of Health and Human Services (Victoria)

EMR Eastern Metropolitan Region

FSR Flexible Service Response

CSS Café style support

CCP Community Connections Program

HACC Home and Community Care

IC Industry Consultant (ASM)

INI Initial Needs Identification

LGA Local Government Authority

LM Loddon Mallee Region

MOU Memorandum of Understanding

NGO Non-Government Organisation

NWMR North West Metropolitan Region

OT Occupational Therapist

PAG Planned activity group

PCP Primary Care Partnership

PRG Project Reference Group

NDIS National Disability Insurance Scheme

SMR Southern Metropolitan Region

Glossary

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Organisation type definitions

Organisation type Definition

LGA Refers to HACC-funded local councils or shires.

Other NGO Refers to all other HACC-funded non-government organisations (i.e. those NGOs who are not identified as ACCO or CALD specific).

CHC Refers to HACC-funded public sector health services, generally referred to as integrated organisations, and HACC-funded registered or stand-alone community health centres.

Health/Nursing Refers to all other HACC-funded health services (i.e. those health services that are not funded as an integrated CHC) and all HACC-funded nursing services (i.e. district nursing, bush nursing services).

ACCO Refers to all HACC-funded Aboriginal Community Controlled Organisations.

CALD Refers to all HACC-funded Culturally and Linguistically Diverse organisations.

Glossary

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A note on capitalisation The following table lists the Service Coordination Elements, Practice areas, and Funded activity types which are analysed in this report. Throughout the report, title case has been used for the Service Coordination Elements, while sentence case has been used for Practice areas and Funded activity types. Note that service closure and/or transition is both a Service Coordination Element and a Practice area. The meaning will be apparent from the context, as well as being distinguished through capitalisation.

Service Coordination Elements

Title Case (every word is capitalised)

Practice areas

Sentence case (only the first word is

capitalised)

Funded activity types

Sentence case (only the first word is

capitalised)

1. Initial Contact/Initial Needs Identification (IC/INI)

2. Assessment

3. Care Planning and Review

4. Service Delivery

5. Service Closure and/or Transition

1. Care planning

2. Diversity planning and practice

3. Gathering information on client outcomes

4. Health promotion and early intervention

5. Information collection

6. Information provision

7. Inter-agency care plans

8. Marketing materials

9. Person-centred approach

10. Referral action plans

11. Restorative approach

12. Review

13. Seamless intake/assessment systems

14. Service closure and/or transition

15. Solution-based approaches

16. Strengths-based and goal setting approaches

17. Working in partnership

1. Access and support

2. Allied health

3. Café style support (CSS)

4. Community connections program (CCP)

5. Delivered meals

6. Domestic assistance

7. Flexible service response (FSR)

8. Linkages

9. Nursing

10. Personal care

11. Planned activity group (PAG)

12. Property maintenance

13. Respite

14. Volunteer coordination

1. Executive Summary

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1 EXECUTIVE SUMMARY

1.1 Background

Australian Healthcare Associates (AHA) was engaged by the Victorian Department of Health to conduct a review of the first three years of the implementation of the Active Service Model (ASM) by Home and Community Care (HACC) funded organisations in Victoria. 1.1.1 The Home and Community Care Program

The Home and Community Care (HACC) program has been a central plank of suite of aged and community care services for frail older people and younger people with disabilities since it was introduced in 1985. It is jointly funded by the Commonwealth and State governments and administered by the Victorian Department of Health and Human Services (DHHS). The HACC program provides basic support and maintenance services for those whose capacity for independent living is at risk, or who are at risk of premature or inappropriate admission to residential aged care, as well as carers of these individuals.1 1.1.2 The HACC Active Service Model

The Victorian Department of Health and Human Services began implementing the HACC ASM in 2009. The ASM is a quality improvement initiative that focuses on restorative care and on promoting capacity building in community care service delivery. The ASM is focused on assisting people in the HACC target group to live in the community as independently and autonomously as possible; however, it is recognised that not all HACC clients will be able to live independently and autonomously. To this end, the ASM is based on the principle of working collaboratively with clients to assist them in gaining the greatest level of independence they can and wish to achieve. ASM PREPARE and ASM PREPARE–Express were developed in 2010 as audit tools and guidance for agencies to assess their current practices and identify priorities for planning ASM implementation strategies. In 2010, HACC-funded agencies completed a review of their practices using the ASM PREPARE or ASM PREPARE–Express tool. This review was completed in paper format and not submitted to the Department. Funded agencies have, however, been required to submit annual ASM implementation plans detailing their progress and identifying priorities for action. 1.2 Project requirements

This project required the development of an online tool to support the collection and analysis of ASM PREPARE and ASM PREPARE–Express review information. The objectives of the project were to:

Implement an online survey of ASM PREPARE and ASM PREPARE–Express 3-Year Review

1 Department of Health, Victorian Home and Community Care Manual 2013. Victorian Government, 50 Lonsdale Street, Melbourne. November 2013


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Generate individual agency, state-wide and regional results in order to identify agency progress towards implementing ASM based on self-assessment. Progress was identified using the same practice areas and self-rating scale as the 2010 ASM PREPARE. Agencies were able to compare their own progress to their self-rating in 2010 but this comparison was not part of the state-wide data collection

Feed results back to individual agencies and the department

For the service coordination element Service Delivery, capture a self-rating by service type in three areas of practice

Identify the enablers and barriers to implementing an ASM approach in specific areas

Identify the most significant changes that agencies have made in their practice in order to implement ASM

Enable HACC-funded organisations to identify their individual priority areas and develop their agency ASM implementation plans for 2014-15

Enable the department to identify priority areas for ASM implementation in 2014-15 (state-wide and regional).

1.3 Online tool development

The online tool was developed in consultation with the Project Reference Group (PRG) and the Department, including the ASM Industry Consultants (ICs). A series of worksheets were developed in parallel with the online tool, and distributed to agencies to assist them in reviewing their organisational practices in relation to the ASM. The online tool was released to HACC-funded organisations on 6 March 2014, and organisations had until the 30 May 2014 to complete and submit their review. 1.4 Targeted follow-up focus groups and consultations

In collaboration with the department and ICs, a sample of HACC-funded agencies were identified to participate in targeted focus groups in order to develop a richer and more detailed understanding of the barriers and enablers to implementation of the ASM approach. Two focus groups were conducted in the metropolitan area (NWMR and SMR/EMR).Follow-up phone calls were conducted with a sample of organisations across all the remaining HACC regions. Organisations were selected to participate based on their stage of ASM implementation. 1.5 Summary of findings

A response rate of 97.6% was achieved with 364 of a possible 373 agencies completing the ASM online tool. Approximately half of the HACC agencies completed the full ASM PREPARE (47.5%) and the remaining completed the ASM PREPARE–Express (52.2%). At a state-wide level, some variance was noticeable in the level of ASM implementation across the different service coordination elements. The most progress towards implementing an ASM approach was reported in the service coordination element of Assessment for ASM PREPARE agencies and Service Commencement for ASM PREPARE–Express agencies. The least-progressed service coordination element for both ASM PREPARE and ASM PREPARE–Express agencies was Service Closure and/or Transition.


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Across the 20 practice areas, Person-centred approach had the highest average self-rating for agencies completing either version of the review tool. The practice area with the lowest average self-rating for both ASM PREPARE and ASM PREPARE–Express was Gathering information on client outcomes. Some differences were apparent between the regions; however, the regional findings were largely consistent with the state-wide findings. 1.5.1 Enablers

A range of enablers for implementing ASM were identified by HACC-funded organisations in three areas: resources, workforce and system change. For resource enablers, organisations completing either version of the review tool identified similar enablers, but provided slightly different weightings for each enabler. For example, organisations completing the ASM PREPARE–Express tool placed greater importance on local and regional networks when compared to organisations completing the ASM PREPARE review tool. For ASM PREPARE agencies, the Strengthening Assessment and Care planning Toolkit, closely followed by the Goal Directed Care planning Toolkit were identified as the most useful resources to support ASM implementation. Follow-up phone calls and focus groups highlighted the important role played by Industry Consultants in facilitating ASM implementation in their region. Regional networks and alliances were also identified by most organisations as a central plank to driving and supporting the ASM approach. ASM training, staff commitment, and on-the-job Capacity Building were listed in the top five workforce development and commitment enablers for organisations completing both the ASM PREPARE and the ASM PREPARE–Express tool. Follow-up phone calls and focus groups confirmed ASM training and level of staff commitment as key enablers. There were some differences in the Systems Change and Support enablers identified by organisations completing the ASM PREPARE and those completing the ASM PREPARE–Express tools. For ASM PREPARE organisations, management support, partnerships and reviewing policies and procedures provided the important foundations for change at a systems level. For ASM PREPARE–Express organisations, the process of developing the ASM implementation plan and the self-assessment process linked to the CCCS quality framework were identified as important. Management support and partnership work featured very highly in the follow-up consultations. 1.5.2 Barriers

Consumer expectations, limited resources and high demand for services were in the top three barriers for those completing the ASM PREPARE and ASM PREPARE–Express tools. There was widespread recognition in the follow-up consultations that changing client expectations will take time. 1.5.3 Most significant change

Considerable investment in and commitment to ASM by HACC organisations was evident from the data collected through the online tool and the follow-up consultations. The main areas of change included:


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Building staff knowledge and skills to work effectively within an ASM framework

Reviewing policies, procedures and position descriptions to embed ASM

Strengthening partnerships and increasing collaborative practices

Focussing on goal setting and Care planning

Reorienting staff and clients’ understanding of HACC services under an ASM framework.

1.6 Opportunities to continue to support ASM

Analysis of the findings from the online tool and the follow-up consultations identified a number of opportunities to continue to support ASM work: Maintain ASM focus when transition to the Commonwealth occurs: Organisations

expressed a clear desire to continue working under an ASM framework and for the Department to advocate strongly on this front.

Training and support: There was strong support for the continuation of training and

workforce development opportunities for staff and volunteers. Future training needs to build on the skills and knowledge staff have gained over the past four years. Particular areas of focus should include:

A sector-wide focus on the service coordination element of Service Closure and/or Transition would assist HACC agencies to enhance their practices in this area in line with the other service coordination elements.

A greater focus on the practice areas of Interagency Care planning and Gathering information on client outcomes would be beneficial for all HACC agencies. This is supported by the consultations, where agencies identified the need to explore ways of measuring and reporting client outcomes.

In Service delivery, a focus on all three practice areas would be useful, but as a means of prioritising, Diversity planning and practice requires the most attention.

Continuing to support all HACC service types in their ASM work. Specific support for Property maintenance, Volunteer coordination, Café style support may be useful as they reported less progress with ASM compared to other service types.

Sharing the innovations: The need to find more opportunities to share and celebrate the

good work that has occurred across the sector was raised. While it was recognised that there was good sharing of information occurring within regions (via the ICs or alliances), it was believed that more should be done to share information between regions. Organisations were keen to hear about innovations, creative project ideas, and practical applications of ASM as well as to share resources.

Marketing/communication: Wider community education about ASM was requested. In particular, organisations would like this targeted at General Practitioners (GPs) and the acute sector to ensure more appropriate referrals.

Aligning the ASM initiative with other primary care strategies: The need for better integration of the ASM agenda with other primary care strategies was highlighted.


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Overwhelmingly, one of the main barriers identified by HACC agencies remains engaging clients/carers and the broader community (including the health and medical sector) with the ASM approach. Greater attention and guidance is needed to address this issue. This was supported through the follow-up consultations where agencies highlighted this as a major issue and requested further assistance with communicating the key messages and shifting client/carer and community expectations in relation to the HACC program.

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Part 1: Introduction Methods Data Analysis Overview

2. Introduction

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2 INTRODUCTION

2.1 Review background

The HACC Program has been a central plank of the suite of aged and community care services for frail older people and younger people with disabilities since it was introduced in 1985. It is jointly funded by the Commonwealth and State governments and administered by the Victorian Department of Health and Human Services (DHHS). The HACC program provides basic support and maintenance services for people whose capacity for independent living is at risk, or who are at risk of premature or inappropriate admission to residential aged care, as well as carers of these individuals.

2.1.1 Transfer of HACC services for older people to the Commonwealth

In May 2013, the Prime Minister and Victorian Premier signed the Heads of Agreement between the Commonwealth and Victorian Governments on the National Disability Insurance Scheme (NDIS), which will see the implementation of the National Disability Insurance Scheme from July 2016. As part of this agreement, the Commonwealth will take full funding and administrative responsibility for Victorian HACC services for people aged 65 years and over (and 50 years and over for Aboriginal and Torres Strait Islander people) at a date to be agreed in 2015-16. Victorian HACC services for older people will be incorporated into the Commonwealth Home Support Program after they are transferred to the Commonwealth. The Victorian Government will continue to fund and manage services for people aged under 65 years (and under 50 years for Aboriginal and Torres Strait Islander people). Reviewing HACC organisations’ progress towards implementing ASM and their views about the barriers and enablers has been important for the department in engaging with the Commonwealth Department of Social Services about the role of wellness promotion, reablement and restorative care in the Commonwealth Home Support Program. 2.2 The HACC Active Service Model

2.2.1 Overview

The Victorian Department of Health and Human Services implemented the HACC Active Service Model to assist people in the HACC target group to live in the community as independently and autonomously as possible.2

The ASM aligns with the broader policy context of earlier intervention and prevention in all services for older people, helping them to ‘stay involved in everyday activities to maintain or rebuild their confidence and stay active and healthy’.3 Around this time in health and community care more broadly, there was an increasing recognition of the evidence for a shift to person-centred care and a greater focus on coordinated service delivery. In Victoria, a number of related policies and initiatives were developed which shared similar objectives to the ASM, namely: person-centred care; social inclusion; working with people’s strengths and preferences; working collaboratively with the person and the carer; proactively promoting health and

2 Department of Health, Victorian Home and Community Care Manual 2013. Victorian Government, 50 Lonsdale Street, Melbourne. November 2013 3 ibid

2. Introduction

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capacity building opportunities; recognising and supporting carer relationships; providing responsive services; and building partnership across organisations and programs. Key initiatives central to reorientating the Victorian HACC program towards an ASM approach include the Framework for Assessment in the Home and Community Care Program in Victoria (HACC Assessment Framework) and HACC Diversity planning and practice initiative. Both of these initiatives support a person-centred and holistic approach to Assessment and Service Delivery. Other key developments include Integrated Chronic Disease Management Strategy and Primary Care Partnerships (PCPs) amongst others.4 2.2.2 Principles of the ASM

The ASM is focused on assisting people in the HACC target group to live in the community as independently and autonomously as possible. To this end, the ASM is based on the principle of working collaboratively with clients to assist them to in gaining the greatest level of independence they can and wish to achieve, which is consistent with a person-centred approach to service delivery. 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

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 service providers.

From a service delivery perspective, the 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

Taking an holistic and family-centred approach to care

Actively involving clients in setting goals and making decisions about their care

Providing timely and flexible services that support people to reach their goals.5 2.2.3 ASM development and implementation

A comprehensive review of the Australian and international literature supported a shift towards the implementation of ASM in Victoria. Positive responses to subsequent consultation activities demonstrated the readiness of the HACC sector to develop and implement the approach. A state-wide plan to implement the ASM in Victoria was put in place for the period 1 July 2009 to 30 June 2011, and included a range of activities to support HACC providers to reorient their service delivery.

4 Victorian Department of Health, ASM Policy Website, http://www.health.vic.gov.au/hacc/projects/asm_policy.htm, accessed 20 September 2013 5 Victorian Government 2007, Framework for Assessment in the HACC Program

2. Introduction

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ASM PREPARE and ASM PREPARE–Express (discussed below) were developed in 2010 as an audit tool and methodology for agencies to assess their current practices and identify priorities for planning ASM implementation strategies. Since 2010, HACC-funded agencies have been required to develop and submit individual ASM implementation plans. The Community Care Common Standards (CCCS) Quality Reviews, which commenced in 2011, are a further tool used to monitor the progress of ASM implementation in HACC agencies. 2.3 ASM PREPARE

As the ASM is a continuous quality improvement initiative, change was expected to be incremental and HACC agency readiness was expected to vary. In 2010, the ASM PREPARE and ASM PREPARE–Express practice review and planning tools were developed to assist HACC-funded agencies to:

Develop a structured view of their current strengths and areas for improvement in delivering an ASM approach

Identify current practices that are already consistent with an ASM philosophy of care

Identify changes in structure and practice required to move to an ASM approach

Prioritise and plan their strategies for their initial agency implementation plan which was due on 30 September 2010.6

Following a pilot of the ASM PREPARE tool, the need for a more streamlined version for smaller agencies was identified, which led to the development of the ASM PREPARE–Express. The key difference between the two tools is how they deal with the point of Service Commencement. In the ASM PREPARE tool, there is an in-depth consideration of the steps of Initial Contact/Initial Needs Identification, Assessment, and Care Planning and Review, whereas the ASM PREPARE–Express rolls up Initial Contact/Initial Needs Identification, Assessment, Care Planning and Review into one combined section called Service Commencement.7 Both tools require organisations to self-rate their alignment with the ASM approach across a number of practice areas (20 areas for ASM PREPARE and 12 areas for ASM PREPARE–Express).

Table 2-1: ASM Practice areas

ASM Prepare ASM Prepare Express Initial Contact/Initial Needs Identification Service Commencement Marketing materials Marketing material Information collection Information collection/initial needs identification Information provision Person-centred approach

Diversity planning and practice Capacity-building, solutions-based and goal-setting approaches

Seamless intake/assessment systems Working in partnership Assessment Care planning Person-centred approach Referral to other organisations Diversity planning and practice Diversity planning and practice

6 ASM PREPARE Website http://www.health.vic.gov.au/hacc/projects/asm_prepare.htm 7 ASM PREPARE Website http://www.health.vic.gov.au/hacc/projects/asm_prepare.htm

2. Introduction

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Strengths-based and goal setting approaches Review Restorative approach Service Delivery Solution-based approaches Person Centred Approach Working in partnership Diversity planning and practice Care planning Capacity Building Care planning Service Closure and/or Transition Diversity planning and practice Service closure and/or transition Health promotion and early intervention Diversity planning and practice Referral action plans Gathering information on client outcomes Inter-agency care plans Review Service closure and/or Transition Service closure and/or transition Diversity planning and practice Gathering information on client outcomes The first round of the ASM PREPARE and agency ASM plans were completed in 2010. Although at the time this process was optional, most HACC providers completed a self-audit using one of the tools. 2.4 Project requirements

In 2010, HACC-funded agencies completed their ASM review in paper format. The information was not collected by the department at the time. This project required the development of an online tool to support the collection and analysis of review information. The objectives of the project were to:

Implement an online survey of ASM PREPARE 3-Year Review;

Generate individual agency, state-wide and regional results in order to identify agency progress towards implementing ASM. Progress was identified using the same practice areas and self-rating scale as the 2010 ASM PREPARE. Agencies were able to compare their own progress to their self-rating in 2010 but this comparison was not part of the state-wide data collection.

feedback results to individual agencies and the department;

For the service coordination element Service Delivery, capture a self-rating by service type in 3 areas of practice;

Identify the enablers and barriers to implementing an ASM approach in specific areas;

Identify the most significant changes that agencies have made in their practice in order to implement ASM;

Enable HACC-funded organisations to identify their individual priority areas and develop their agency ASM implementation plans for 2014-15;

Enable the department to identify priority areas for ASM implementation in 2014-15 (state-wide and regional).

3. Methods

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3 METHODS

3.1 Overview of project process

The project was undertaken between December 2013 and August 2014 and included the following phases:

Phase Description of activity

1. Workbook and online tool development

Develop ASM workbooks (PREPARE and PREPARE–Express)

Develop IT requirements for the online tool

Develop online tool reference guide

Test online tool

2. Workbook and online tool release Notify all providers of log-in details and requirements

Disseminate workbooks and reference guide

Provide help desk support

3. Data analysis Analyse quantitative and qualitative data

4. Targeted focus groups and follow-up phone consultations

Develop focus group discussion guide

Conduct targeted focus groups and follow-up phone calls

5. Feedback session to the Department Provide detailed feedback to the Department and Project Reference Group

6. Reporting Develop Draft Report

Submit Final Report

3.2 Online tool development

The online tool was developed in consultation with the Department, the PRG and the ICs. In order to capture the changes made by agencies over the last four years, an additional question was added to the end of each service coordination element asking agencies to reflect on the most significant changes that had occurred in their organisation following the implementation of ASM in 2010. Additional questions about the main barriers/challenges and enablers experienced by organisations in implementing the ASM were also added. 3.2.1 ASM workbooks

A series of 23 worksheets for ASM PREPARE and 18 worksheets for ASM PREPARE–Express were developed to assist agencies in undertaking their review. These were made available to agencies to download from the AHA website two weeks prior to the release of the online tool. These workbooks

3. Methods

21

prompted organisations to discuss their achievements and progress to date and to record these discussions for future reference. 3.2.2 ASM online tool Reference Guide

A Reference Guide (the Guide) was developed in consultation with the Department and ICs to support HACC-funded organisations to enter their data onto the online tool. The Guide was made available to all HACC-funded organisation via the ASM webpage. 3.3 Maximising participation

A range of strategies were used to maximise participation rates by HACC organisations, including:

AHA team members were available via a telephone helpdesk throughout the review period to provide support and answer any queries about the process.

AHA continuously monitored completion rates and provided targeted reminders to HACC agencies to complete the online tool.

The Department conducted 23 preparatory workshops across the state for organisations and managers that may not have been involved in the 2010 ASM Prepare process or who wanted a ‘refresher’. Approximately 1,000 people attended. The workshops provided practical advice, emphasised the benefits of the review process for agencies and highlighted the importance of engaging all levels of staff to get a cross section of views. The ICs provided targeted support to smaller agencies that had limited resources.

3.4 Targeted focus groups and follow up phone consultations

In collaboration with the department and ICs, several HACC-funded agencies were identified to participate in targeted focus groups and phone calls in order to develop a richer and more detailed understanding of the barriers and enablers during implementation of the ASM approach. Two focus groups were conducted in the metropolitan area (NWMR and SMR/EMR). These focus groups included HACC agencies who had rated themselves as being in the later stages of ASM implementation. Agencies in metropolitan regions that reported being in the earlier stages of ASM implementation were contacted by phone rather than inviting them to attend a focus group. This decision was made in order to maximise opportunities to hear from individual agencies who were in the earlier stages of implementation. Focus groups were not conducted in rural regions due to resource constraints. Instead, follow-up phone calls were conducted with a small sample of organisations in all rural regions. Organisations were selected to participate based on their stage of ASM implementation. The sample included organisations in both the earlier and later stages of implementation. Table 3-1 provides an overview of HACC agency participation rates in the targeted focus groups and follow-up phone consultations.

3. Methods

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Table 3-1: Agency participation rates in targeted focus groups and phone calls

Region Phone call Focus group

NWMR 2 12

SMR 3 4

EMR 1 4

Grampians 2 N/A

Hume 2 N/A

Loddon Mallee 2 N/A

Gippsland 2 N/A

Barwon SW 3 N/A

Total 17 20 Development of focus group/telephone consultation discussion guide

A short focus group discussion paper was developed and forwarded to focus group and telephone consultation participants. This paper included a summary of the barriers and enablers information provided via the ASM online tool, along with targeted consultation questions and topics for discussion. The general areas for discussion included:

Enablers and barriers to ASM implementation

Key learnings from the implementation process

Innovative or best practice implementation strategies

Identifying opportunities to support agencies to continue to enhance their ASM implementation.

4. Online Tool Data Analysis – Overview

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4 ONLINE TOOL DATA ANALYSIS – OVERVIEW

This chapter provides an overview of the response rates by organisation type for both ASM PREPARE and ASM PREPARE–Express. 4.1 Overall response rate

A response rate of 97.6% was achieved, with 364 of a possible 373 agencies completing the ASM online tool. Approximately half of the HACC agencies completed the full ASM PREPARE (47.5%) and half completed the ASM PREPARE–Express (52.5%). There were fourteen organisations that logged in to the online tool but only partially completed the fields or were subsequently exempted from the review process. The Department exempted 66 HACC agencies from completing the review. Exemptions were primarily granted to agencies that were not funded for direct client services.

Table 4-1: State-wide response rate to ASM PREPARE and ASM PREPARE–Express online tools

Responses ASM PREPARE

n (%) ASM PREPARE–Express

n (%) Total

Logged in to the online tool 183 195 378

Completed the online tool 173 (47.5%) 191 (52.5%) 364 (100%)

4.2 Response rate by organisation type

Table 4-2 illustrates that the majority of HACC organisations using the ASM PREPARE online tool were Local Government Authorities (LGA) or Community Health Centres (CHC). The majority of CALD, Aboriginal Community Controlled Organisation (ACCO), Health/Nursing or Other Non-Government Organisations (NGOs) utilised the ASM PREPARE–Express online tool. This was in line with departmental direction about which tool organisations should use.


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Table 4-2: Comparison of organisation types selecting either ASM PREPARE or ASM PREPARE—Express

Agencies selecting either ASM PREPARE or ASM PREPARE–Express State-wide responses by organisation type

Organisation type ASM PREPARE ASM PREPARE–Express Total

LGA 70 (98.6%) 1 (1.4%) 71 (100.0%)

CALD 3 (7.7%) 36 (92.3%) 39 (100.0%)

ACCO - 19 (100%) 19 (100.0%)

Health/Nursing 15 (38.5%) 24 (61.5%) 39 (100.0%)

CHC 69 (77.5%) 20 (22.5%) 89 (100.0%)

Other NGO 16 (15.7%) 91 (84.3%) 107 (100.0%)

Total 173 (47.5%) 191 (52.5%) 364 (100.0%)

Table 4-2 above provides a summary by organisation type of which online tool HACC agencies selected to complete. A number of the agencies included in Table 4-2 were subsequently deemed exempt from the review process, provided incomplete data or did not complete the online tool. There were 173 complete responses to the ASM PREPARE online tool, two of which were state-wide services and are therefore not included in the regional analysis, resulting in a total of 171 responses in the regional summary for ASM PREPARE below. Figure 4-1 and Figure 4-2 display the distribution of complete responses by region for agencies completing ASM PREPARE and those completing ASM PREPARE–Express.

Figure 4-1: ASM PREPARE state-wide responses by region (n = 171)


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Figure 4-2: ASM PREPARE–Express state-wide responses by region (n = 191)

In addition to the state-wide analysis for both ASM PREPARE and ASM PREPARE–Express, the data was summarised at a regional level. This report is available in Appendix A. 4.3 Self-rating scale and evidence

The ASM online tool included a number of domains of practice. HACC agencies were required to provide a self-rating against each of these domains. The self-rating scale used is described in Table 4-3.

Table 4-3: Self-rating scale for the ASM online tool

Rating Description

1 Not at all

2 Thinking & planning only

3 Implementing ASM in some areas

4 Implementing ASM in most areas

5 Implemented ASM in all areas

Organisations were provided with the following guidance in the reference to applying the ratings:

Ratings 1 and 2 refer to where an organisation is at the stage of not doing anything at all or have only started thinking and planning in a particular area.

A 3 rating would be applied where the ASM approach is being implemented in some of these areas of practice in some of your HACC-funded activities.

A 4 rating would be applied where the ASM approach is being implemented in most of these areas of practice in most of your HACC-funded activities.


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A 5 rating refers to where the ASM approach has been implemented in all of these practice areas in all of your HACC-funded activities.

Caveat The results presented in this report are based on self-ratings by HACC agencies. As they are self-ratings it is likely that some variation in interpretation and application of the ratings by the different agencies has occurred. Organisations were required to list evidence examples to support their self-ratings; however, there was no external verification process around these self-ratings. The results presented in the following chapters should therefore be read and interpreted with this in mind.

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Part 2: ASM PREPARE Results

5. ASM PREPARE – Data Analysis

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5 ASM PREPARE – DATA ANALYSIS

The following sections provide a detailed analysis of the 173 agencies state-wide that completed the ASM PREPARE tool. Chapter 8 provides the results for agencies that completed the ASM PREPARE–Express tool. 5.1 Type of organisation

As expected, the majority of HACC organisations that completed the ASM PREPARE online tool were either LGA (40.5%) or CHC (39.9%) agencies. Other agency types mostly completed ASM PREPARE Express. 5.2 Service coordination elements

The ASM PREPARE tool comprised five service coordination elements: Initial Needs Identification; Assessment; Care Planning and Review; Service Delivery; and Service Closure and/or Transition. This section provides summary findings for four of the five service coordination elements. A detailed analysis of the service coordination element Service Delivery and HACC-funded activity types is included in Section 5.4. State-wide summary statistics for each service coordination element are presented in Table 5-1. Self-ratings were summed and then divided by the number of questions for each of the service coordination elements, resulting in an average self-rating for each element for all organisations. The results for all service coordination elements indicate that agencies are implementing ASM in some to most areas, with Assessment being the service coordination element that was the most progressed in ASM implementation, with a state-wide average self-rating of 4.0. Service Closure and/or Transition was rated as the least progressed with ASM implementation, with a state-wide average self-rating of 3.4.

Table 5-1: ASM PREPARE state-wide summary of self-ratings for service coordination elements

ASM PREPARE – State-wide summary Summary statistics of average self-ratings for each service coordination element

Service coordination element n Minimum Maximum Average Rating

Initial Contact/Initial Needs Identification 173 2.8 5.0 3.9

Assessment 173 2.5 5.0 4.0

Care Planning and Review 173 2.2 5.0 3.7

Service Delivery 173 1.5 5.0 3.8

Service Closure and/or Transition 173 1.7 5.0 3.4

Average across all service coordination elements 173 2.6 5.0 3.8


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Figure 5-1, illustrates the same information showing the most progressed service coordination elements to the least progressed.

Figure 5-1: ASM PREPARE state-wide average self-ratings for service coordination elements (n = 173)

Organisations’ average self-ratings for each of the service coordination elements were rounded to the nearest whole number to examine the distribution of self-ratings from 1 to 5, with the exception of Service Delivery as agencies could be funded for varying numbers of activity types. Figure 5-2 shows the proportions of organisations self-rating at each level for each of the service coordination elements. Results suggest that most agencies are progressing well with implementing ASM. By far the majority of agencies’ self-ratings were either a 4 or 5 in three of the four service coordination elements:

In Assessment, 86% of agencies self-rated as 4 or 5

In Initial Contact/Initial Needs Assessment, 77% of agencies self-rated as 4 or 5

In Care Planning and Review, 69% of agencies self-rated as 4 or 5.

In Service Closure and/or Transition, 46% self-rated as 4 or 5, indicating that this service coordination element is considered less progressed with ASM implementation.


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Figure 5-2: ASM PREPARE state-wide proportions of organisations self-rating at each level (n = 173)

5.3 Practice areas

This section examines four of the service coordination elements summarised in Section 5.2. Results for the three practice areas in Service Delivery are summarised separately in Section 5.4. The four service coordination elements were comprised of 20 practice areas. Organisations rated whether their current practices reflect an ASM approach for each of the practice areas. Summary statistics for state-wide average self-ratings in each of the practice areas are displayed in


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Table 5-2. Self-ratings for practice areas ranged from 1 to 5. The more progressed practice areas were in Assessment. The highest self-rating practice areas included Person-centred approach, Strengths-based approaches, Restorative approach, and Solution-based approaches, and Working in partnerships. All these practice areas had an average self-rating of 4.0 to 4.1. Two other practice areas also had an average self-rating of 4.0: Seamless intake (in IC/INI) and Health promotion and early intervention (in Care Planning and Review). The practice areas less progressed were Interagency care plans (in Care Planning) and Gathering information on client outcomes (in Service Closure). These areas had an average self-rating of 3.2.


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Table 5-2: ASM PREPARE state-wide summary of practice area self-ratings

ASM PREPARE – State-wide summary

Summary statistics of self-ratings for each practice area

Practice area n Min Max Average

Initial Contact/Initial Needs Identification

Marketing materials 173 2 5 3.8

Information collection 173 1 5 3.9

Information provision 173 2 5 3.9

Diversity planning and practice 173 2 5 3.7

Seamless intake/assessment systems 173 1 5 4.0

Assessment

Person-centred approach 173 3 5 4.1


Strengths-based and goal setting approaches 173 1 5 4.0

Restorative approach 173 1 5 4.0

Solution-based approaches 173 2 5 4.0

Working in partnership 173 1 5 4.0

Care Planning and Review

Care planning 173 2 5 3.9


Health promotion and early intervention 173 1 5 4.0

Referral action plans 173 1 5 3.7

Inter-agency care plans* 160* 1 5 3.2

Review 173 1 5 3.7

Service Closure and/or Transition

Service closure and/or transition 173 1 5 3.6


Gathering information on client outcomes 173 1 5 3.2

Note: * 13 agencies did not respond to this question as Inter-agency care plans are not applicable to all agencies.


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The proportion of organisations self-rating at each level for each of the practice areas is displayed in Figure 5-3 to Figure 5-6.

Figure 5-3: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Initial Contact and Initial Needs Identification (N=173)

Table 5-4 shows over 70% of agencies self-rated themselves as either a 4 or a 5 with respect to Information collection and provision, and Intake Processes. Diversity planning and practice and Marketing materials appeared to be slightly less progressed with 65% of agencies self-rating as a 4 or a 5 in this area.

Figure 5-4: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Assessment (n = 173)

Figure 5-4 demonstrates the progress in Assessment. Over 75% of agencies self-rated as 4 or greater in five of the six practice areas.


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Figure 5-5: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Care Planning and Review (n = 173*)

Note: 13 agencies did not provide a self-rating for the practice area of Inter-agency care plans as they are not applicable to all agencies. Figure 5-5 demonstrates a greater spread of progress in the service coordination element of Care Planning and Review. Five practice areas show a small proportion of agencies are self-rating as 2 or 1 and a larger proportion (20%) self-rated a 2 or less for Interagency Care Plans. Health Promotion was the most progressed area with 80% of agencies self-rating a 4 or 5.

Figure 5-6: ASM PREPARE state-wide proportions of organisations self-rating at each level by practice area for Service Closure and Transition (n = 173)

Figure 5-6 shows the biggest spread of agency progress with 22% of agencies self-rating as 1 to 2 in Gathering information on client outcomes. However, around 50% agencies appear to be more progressed (self-rating a 4 to 5) in Service Closure and Diversity planning and practice. This is the service coordination area where more work is still to be done.


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Summary of findings: HACC agencies report that they are progressing well in the areas of Assessment and Initial Needs Identification. Approximately 86% of agencies reported implementing ASM in most or all areas of Assessment. Comparatively, in Service Closure and/or Transition, 46% of agencies rated themselves as implementing ASM in most or all areas, indicating that agencies consider themselves less progressed in this service coordination element (as displayed in Figure 5-2).

The practice area of Person-centred approach was rated the highest with the majority of agencies implementing ASM in most or all areas. The practice areas self-rated the lowest were Inter-agency care plans and Gathering information on client outcomes where, for the majority of organisations, ASM was only implemented in some areas.

5.4 Service delivery

There are 14 different activity types that organisations can receive HACC funding to provide.8 All HACC agencies were asked to self-rate their progress toward implementing an ASM approach to Service Delivery in each of their HACC-funded activities with regard to three practice areas: Person-centred approach; Diversity planning and practice; and Capacity Building. The average state-wide self-ratings for each funded activity type across the three different practice areas ranged from 3.3 to 4.2, and are displayed together in Figure 5-7 to allow a direct comparison. The following sections summarise the self-ratings for Service Delivery in the different funded activities in the each of the practice areas. As displayed in Figure 5-7, Linkages and Access and Support appear to be the most progressed across all three practice areas with average self-ratings between 4.0 and 4.2 for each practice area. A comparison of all three practice areas suggest that Diversity planning and practice was generally self-rated lower than the other two practice areas of Person-centred approach and Capacity Building for most activity types. This was most pronounced with Allied health. One possible explanation for this result is that Diversity planning and practice is a more recent initiative required of HACC agencies when compared to the ASM.

8 Agencies self-rated against the following HACC activities: Allied health, Access/Support, Café style support, Community Connections Program, Delivered meals, Domestic assistance, Flexible Service Response (FSR), Linkages, Nursing, Personal care, Planned activity group, Property maintenance, Respite, Volunteer coordination.


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Figure 5-7: ASM PREPARE state-wide Service Delivery self-ratings for practice areas by funded activity types (n = 173)


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5.4.1 Person-centred approach

Summary statistics of self-ratings for implementing a Person-centred approach in Service Delivery for each of the funded activities are displayed in Table 5-3. Self-ratings across the funded activity types ranged from 1 to 5. Allied health, Access and Support, Domestic assistance, Linkages, Personal care, and Respite all had a similar average self-rating between 4.0 and 4.2, suggesting that ASM implementation was more progressed in these areas. The least progressed activities appeared to be Volunteer coordination, Property maintenance and Café style support with a similar state-wide average self-rating between 3.4 and 3.6. There were only seven agencies that completed the ASM PREPARE online tool that were funded for Café style support. As this is a newly funded activity under HACC, it is not surprising that this activity is in the earlier stages of implementation.

Table 5-3: ASM PREPARE state-wide summary of self-ratings for Person-centred approach by funded activity type

ASM PREPARE – State-wide summary

Summary statistics of self-ratings for Person-centred approach in each funded activity type

Funded activity type n Minimum Maximum Average

Allied health 97 1 5 4.0

Access/Support 26 3 5 4.1

Delivered meals 79 2 5 3.8

Domestic assistance 81 2 5 4.0

Café style support 7 1 5 3.4

Linkages 18 3 5 4.2

Nursing 68 1 5 3.8

Personal care 94 1 5 4.0

Planned activity group 137 1 5 3.9

Property maintenance 82 1 5 3.6

Respite 87 1 5 4.1

Volunteer coordination 100 1 5 3.5

Overall average 73 1.5 5 3.9

Figure 5-8 displays the proportion of organisations self-rating their Person-centred approach at each level for each of the funded activity types. The most common self-rating was 4, and over 55 % of agencies across all funded activities self-rated at 4 or 5. This indicates that ASM is being implemented in most or all areas of Person-centred approaches to Service Delivery. Between 14% and 19% of agencies rated themselves at 2 or less for Café style support (14%) and Volunteer coordination (19%), indicating more work will be required to implement ASM in these areas.


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Figure 5-8: ASM PREPARE State-wide proportions of organisations self-rating their Person-centred approaches at each level for each funded activity type (n = 173)


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5.4.2 Diversity planning and practice

Summary statistics of self-ratings for Diversity planning and practice in Service Delivery for each of the funded activities are displayed in Table 5-4. Self-ratings across the funded activity types ranged from 1 to 5. For Diversity planning and practice in Service Delivery, Linkages and Access/Support had the highest state-wide average self-ratings (ranging from 4.0 to 4.1), suggesting that ASM implementation was most progressed for Diversity planning and practice in these activities. Café style support, Property maintenance and Volunteer coordination had similar state-wide averages (3.3 to 3.4), suggesting that these activities are in the earlier stages of ASM implementation compared to other activities in Diversity planning and practice. There were only seven agencies that completed the ASM PREPARE online tool that were funded for Café style support and subsequently self-rated this activity type. Volunteer coordination and Property maintenance had similar state-wide average self-ratings of 3.4 and were rated by 100 and 82 agencies respectively.

Table 5-4: ASM PREPARE State-wide summary of self-ratings for Diversity planning and practice by funded activity type

ASM PREPARE – State-wide summary Summary statistics of self-ratings for Diversity planning and practice

in each funded activity type

Funded activity type n Min Max Average






Linkages 18 3 5 4.1

Nursing 68 1 5 3.6




Respite 87 1 5 3.8



Figure 5-9 displays the proportion of organisations self-rating their Diversity planning and practice at each level for each of the funded activity types. Over 50% of agencies rated themselves at 4 or 5 across all of the activity types, with the exception of Café style support and Property maintenance where self-ratings of 3 and 4 represented the largest proportion of responses. Between 13% and 20% of agencies rated themselves at 2 or 1 for Volunteer coordination (20%), Café style support (14%) and Property maintenance (13%).


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Figure 5-9: ASM PREPARE State-wide proportions of organisations self-rating their Diversity planning and practice for each funded activity type (n = 173)


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5.4.3 Capacity Building

Summary statistics of self-ratings for Capacity Building in Service Delivery for each of the funded activities are displayed in Table 5-5. Self-ratings across the funded activity types ranged from 1 to 5. For Capacity Building in Service Delivery, Linkages, Allied health, Access/Support, Domestic assistance and PAG had similar state-wide average self-ratings ranging from 4.0 to 4.1, suggesting that ASM implementation was the most progressed in these activities. As with the previous practice areas Café style support, Property maintenance and Volunteer coordination appeared to be the least progressed reporting similar state-wide average self-ratings ranging from 3.3 to 3.5.

Table 5-5: ASM PREPARE State-wide summary of self-ratings for Capacity Building by funded activity type

ASM PREPARE – State-wide summary Summary statistics of self-ratings for Capacity Building in each funded activity type







Linkages 18 3 5 4.1

Nursing 68 1 5 3.7




Respite 87 1 5 3.9



Figure 5-10 displays the proportion of organisations self-rating their Capacity Building at each level for each of the funded activity types. The self-ratings suggest that ASM implementation is progressing well in the areas of Allied health, Personal care, Linkages, Domestic assistance, PAG, Access and Support and Respite with approximately 80% of agencies self-rating 4 or 5 for these activities. Between 12% and 19% of agencies rated themselves at 2 or less for Volunteer coordination (19%), Café style support (14%), and Property maintenance (12%).


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Figure 5-10: ASM PREPARE State-wide proportion of organisations self-rating of their Capacity building for each funded activity type (n = 173)


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Summary of findings: Self-ratings suggest that Linkages and Access and support were the most progressed with ASM implementation across all three practice areas, with at least 80% of agencies self-rating at 4 or a 5 in each practice area. This level of progress across all three practice areas may be explained by considering the nature of the service delivery models associated with these service types. For example, Linkages provides longer term case managed care and Access and support services provide individual support to people. Both of these services potentially provide more opportunities to place the service user at the centre of the care being provided. Agencies reported that Allied health, Personal care, Domestic assistance, PAG, and Respite were also well progressed with ASM implementation, particularly in Person centred care and Capacity building. At least 75% of agencies self-rated either a 4 or a 5 for these activities in these two practice areas. Comparatively, Volunteer coordination, Property maintenance, and Café style support appeared to be the least progressed across the three practice areas, with the majority of agencies (between 67% and 76%) self-rating at 3 or 4 in each practice area for these three activities. In general, agencies self-rated as comparatively less progressed in Diversity planning and practice compared to Person-centred approach and Capacity building.

6. ASM PREPARE – Enablers and Barriers

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6 ASM PREPARE – ENABLERS AND BARRIERS TO ASM IMPLEMENTATION

This chapter presents an analysis of the enablers and barriers reported by organisations using the ASM PREPARE online survey. Enablers are discussed under three main categories:

Resources

Workforce development and commitment

Systems change and support.

Findings related to both the enablers and barriers are disaggregated by:

Stage of implementation

- Earlier stages

- Later stages. Defining earlier and later stages of implementation:

To summarise each HACC agency’s review results, self-ratings were summed across the 20 questions. The maximum summary score available for agencies that completed the ASM PREPARE online tool was 100. The average score was 75.6 out of 100. Agencies above a combined score of 80 were classified as being in the later stages of implementation. Those falling below 70 were categorised as being in the earlier stages of implementation. This accounted for 53.2% of the responding agencies (45/173 = 26.0% in the later stages and 47/173 = 27.2% in the earlier stages). 6.1 Resource enablers

Organisations were provided with a list of nine resource options in the online survey and asked to indicate which of these resources had been the most useful in implementing the ASM approach; a maximum of three resources could be selected.

State-wide, the five most common resources listed by ASM PREPARE organisations in order of frequency were:

1. Strengthening Assessment and Care planning: A Guide for HACC Assessment Services (DH 2010) (94/173 organisations, 54.3%)

2. Goal Directed Care planning Toolkit (EMR Alliance 2013) (90/173 organisations, 52.0%)

3. Local/regional networks of agencies (88/173 organisations, 50.9%)

4. ASM Communication Toolkit (DH 2010) (68/173 organisations, 39.3%)

5. ASM Prepare (DH 2010) (63/173 organisations, 36.4%).

Figure 6-1 provides a state-wide count of the most frequently listed resource enablers.


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Figure 6-1: ASM PREPARE resource enablers (n = 173)

6.1.1 Earlier stages of ASM implementation

The top three state-wide enablers for all agencies also featured in the top five enablers for organisations in the earlier stages of ASM implementation. The ASM Communication Toolkit and ASM Industry Consultants emerged as equal fourth. 6.1.2 Later stages of ASM implementation

Organisations in the later stages of implementation also listed the top three state-wide enablers among their top three enablers. ASM Prepare (DH 2010) and ASM Industry Consultants were ranked fourth and fifth respectively. This suggests that the ASM Communication Toolkit was more influential for those in the earlier stages of implementation and that ASM Prepare (DH 2010) had a greater impact on organisations in the later stages of implementation. Locally-developed resources In addition to the list of options provided in the online survey for resource-related enablers, organisations had the opportunity to provide details of any locally-developed or other resources that had facilitated ASM implementation. A total of 19 organisations included locally-developed resources in their list of three top resource enablers, including:

Having an ASM champion

Use of assessment tools (including validated tools).

– Living and Home Assessment Tool

– Flinders Care Plan

Internal training packages

Implementation of a new model of care

Broader PAG activities

Cross-disciplinary work practices


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Changes to policies and procedures

Undergoing the Community Care Common Standards accreditation process.

Other resources

In the other resources section, the main resources listed included:

Training

Staff model/structure

ASM web-based induction toolkit launched in 2013.

6.2 Workforce development and commitment enablers

The online survey provided a list of 10 workforce development and commitment enablers, and organisations were asked to indicate which three of these had been the most useful in implementing the ASM approach. The five most common enablers (in order of frequency) were:

1. On–the-job capacity building of staff (110 /173 organisations, 63.6%)

2. ASM training (99/173 organisations, 57.2%)

3. Level of staff commitment to the ASM approach (74/173 organisations, 42.8%)

4. Existing HACC staff perception and interpretation of the ASM approach in practice, and

5. HACC assessment service: recruitment of assessors with relevant tertiary qualifications (equally ranked, 39/173, 22.5%).

Figure 6-2 provides a state-wide count of the most frequently listed workforce development and commitment enablers.


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Figure 6-2: ASM PREPARE State-wide workforce development and commitment enablers (n = 173)


Organisations in the earlier stages of ASM implementation listed the same top five enablers as the state-wide list. Organisations in the earlier stages of implementation listed one additional enabler in their top five (as two enablers held equal fifth position), namely new staff have job descriptions which promote the ASM philosophy (fourth highest enabler listed). 6.2.2 Later stages of ASM implementation

The top five enablers for organisations in the later stages of ASM implementation were the same as the top five enablers state-wide. 6.3 Systems change and support enablers

Organisations were provided with a list of 11 Systems Change and Support enablers in the online survey and asked to indicate which three of these had been the most useful in implementing the ASM approach. State-wide, the five most commonly listed Systems Change and Support enablers in order of frequency were:

1. Management understands and supports the ASM approach (80/173 organisations, 46.2%)

2. Review and revision of internal policies and procedures to reflect the ASM approach (77/173 organisations, 44.5%)

3. Partnership development with local agencies (74/173 organisations, 42.8%)

4. Development and review of ASM implementation plans (64/173 organisations, 37.0%)

5. Staffing model and team structure support an ASM approach (50/173 organisations, 28.9%).


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Figure 6-3 provides a state-wide count of the most frequently listed systems and support enablers.

Figure 6-3: ASM PREPARE State-wide Systems Change and Support enablers (n = 173)


Organisations in the earlier stages of implementation listed the first four of the state-wide enablers in their top five enablers. Staffing model and team structure support was listed equal sixth with DHS-funded ASM seeding grants and ASM projects within the organisation. For organisations in the earlier stages of implementation, the self-assessment, review process and resources associated with the CCS supported ASM implementation was the fifth most common enabler listed. 6.3.2 Later stages of ASM implementation

Organisations in the later stages of implementation listed all five top state-wide enablers in their top five. 6.4 Barriers to ASM Implementation

State-wide, the five barriers to ASM implementation most commonly listed by HACC organisations in order of frequency were:

1. Consumer expectations (93/173 organisations, 53.8%)

2. Limited resources (78/173 organisations, 45.1%)

3. High demand for services: implementing ASM takes time (69/173 organisations, 39.9%)

4. Existing HACC staff perception and interpretation of the ASM approach in practice (54/173 organisations, 31.2%)

5. Organisation IT system does not accommodate the ASM approach (52/173 organisations, 30.1%)


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Figure 6-4 provides an overview of the barriers to ASM implementation.

Figure 6-4: ASM PREPARE State-wide barriers to ASM implementation (n = 173)


Organisations in the earlier stages of implementation listed the same top five barriers as the state-wide list. 6.4.2 Later stages of ASM implementation

While organisations in the later stages of implementation listed all top five state-wide barriers in their top five barriers, tied rankings meant that six barriers were listed. Limited consumer/family engagement with the ASM philosophy was the fourth most commonly listed barrier for organisations in the later stages of implementation, but sixth state-wide. Organisation IT system does not accommodate the ASM approach and existing HACC staff perception and interpretation of the ASM approach in practice were ranked equal fifth by organisations in the later stages of ASM implementation.

7. ASM PREPARE – Most Significant Changes

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7 ASM PREPARE – MOST SIGNIFICANT CHANGES

The most significant changes reported by organisations completing the ASM PREPARE online tool are presented below. These have been organised into overarching significant changes that span across all five service coordination elements, as well as under each individual service coordination element, where specified. Differences between agencies in the earlier and later stages of ASM implementation have also been highlighted where applicable. 7.1 Overarching most significant changes

Significant changes identified across all five service coordination elements included: Training

Most agencies reported significant cultural change within their organisations as a result of implementing ASM. One of the most frequently reported drivers for this change was investing in staff training for all levels of staff, including direct care staff, assessment officers and management. The introduction to ASM training and the motivational interviewing training were reported most frequently. A few organisations reported that large numbers of staff were supported to attend ASM training (e.g. 191 staff in one organisation). Investing in training was seen to be critical in reorientating staff understanding of HACC and developing ways of working more effectively with the target population. Some of the agencies in the later stages of ASM implementation highlighted internal training packages they had developed as a means of training new staff and continuing to build on the skills of existing staff. Models of training included ASM champions, observational training with an OT or assessment officer, online competency-based training packages, case discussion models, and group training. A number of agencies in both the earlier and later implementation groups also reported including ASM principles and practices in their induction programs for new staff. Volunteer training was also being undertaken by numerous agencies to ensure volunteers gained the necessary ASM knowledge and identified different ways of working with clients. Shifting volunteers’ thinking from ‘doing for’ to ‘doing with’ was highlighted as a significant change by many organisations. Partnerships and collaboration

Building and enhancing partnerships with other organisations was the second most frequently reported significant change, irrespective of the stage of ASM implementation. This included establishing formal memorandums of understanding (MOUs), developing shared assessment and care planning documents, interagency protocols and strengthening referral pathways. The co-location of workers was also highlighted, particularly placing occupational therapists (OTs) within local governments. Collaboration at a senior management level across organisations was also seen as important to establishing an environment in which staff could coordinate care for clients.

“Our partnership with council has meant that we can be more creative

with the options we provide our clients….We now have a common approach which means clients can

feel more confident that we are working together for them.”

Other NGO

“We have spent a lot of time and resources on training. All staff have received training so the

message is clear”. LGA


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Revising and developing new policies and procedures

Revising and developing policies and procedures to reflect the ASM approach was reported at significant change by agencies across all stages of ASM implementation. For many agencies, this involved a complete update of their policies and procedures to ensure ASM was embedded into the practices of all staff involved in HACC Service Delivery. For some, this included amended organisation-wide policies to ensure an ASM focus at a strategic level and alignment with other key policies. Restructuring

Another frequently reported significant change was the restructuring of program delivery and staff teams to enable staff to work more effectively together. Agencies reporting this change highlighted the important role of multi-disciplinary teams to ensure the holistic needs of service users were considered and could be addressed through one assessment and shared care planning process. Where possible the involvement of Allied health staff in these teams, particularly occupational therapists, was seen to be important in facilitating an ASM approach. The role of the direct care workforce

The role of the direct care workforce has also been a focus of change in a number of agencies, particularly those in the later stages of ASM implementation. Recognising the important role the direct care workforce has in implementing care plans, organisations have invested heavily in training and building the capacity of these workers to operate within an ASM framework. For some organisations, a change of title from ‘carer’ or ‘direct care worker’ to ‘community support worker’ (CSW) has been important. Greater diversity in the CSW role was also reported, including involving CSWs in case conferencing with complex clients, encouraging CSWs to take a more active role in providing feedback to assessment staff about changes in clients’ functioning, and involving them in care plan reviews where possible and appropriate. Upgrading IT and client information systems

Many agencies reported improving their IT and client information systems to support the ASM approach. This included upgrading IT systems to allow for easier sharing of client files, improved documentation of care plans and improved reporting functions to monitor adherence of practices with the ASM approach (e.g. if each client has a care plan, monitoring the number of referrals made, and tracking discharge and service closure).

7.2 Most significant changes: Initial Contact/Initial Needs Identification

Intake

Intake and initial needs identification processes were the most frequently identified significant changes for this service coordination element. This included: appointing intake workers, introducing single points of entry and undertaking more detailed screening of new clients. Intake workers and/or frontline staff were also being up-skilled to provide more information about community options and to a send a clear and consistent message about what HACC can provide and the focus on strengths and reablement.

“The CSWs have more pride in what they do; they feel more connected to

achieving outcomes with clients”

LGA


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Changes to intake processes were reported as significant by agencies across all stages of ASM implementation.


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Marketing materials and client information

The next most frequently reported significant change for this service coordination element was developing or updating Marketing materials and information provided to new clients/carers. The ASM key messages were included in the Marketing materials and client information to ensure a clear and consistent message about HACC services was communicated to clients and their carers. According to these agencies, this has been important in beginning to shift the views held by clients, community and referring organisations from HACC services being an entitlement service to it being more of strengths-based, goal-focussed service. Updating Marketing materials and client information to reflect the diversity of population groups eligible to use HACC services was also raised. A few agencies in the later stages of ASM implementation reported developing Marketing materials to communicate with non-funded referring providers, particularly GPs and health services. Some organisations also reported using local media to communicate to the wider community about the changes to HACC Service Delivery, through promoting good news or ‘success’ stories. 7.3 Most significant changes: Assessment

Assessment tools and forms

Updating Assessment tools and forms to guide staff in undertaking more comprehensive and holistic assessments was the most frequently reported significant change for this service coordination element. For some agencies, this included developing shared assessment tools with partner organisations to reduce duplication and ensure a more streamlined experience for clients and their carers. A number of agencies also reported adopting validated or existing assessment tools, including the Flinders Assessment Tool and Activity Card Sort (2nd edition). Three organisations mentioned using the Outcome Star in their Assessment and Care planning processes. Assessments were reported to be taking much longer as a result of applying an ASM approach. Client centred practice

Numerous organisations reported they were now much better at placing the client at the centre of the Assessment process. This involved starting the assessment with identifying the client’s strengths and goals and working flexibly and creatively to match HACC and non-HACC services to meet these. A lot of work and time has been put into educating and building the capacity of clients to feel confident enough to set goals and explore options. Linking of assessments to Care planning

Better linking of the assessment process to goal setting and the development of care plans was identified by many agencies as a significant change. This was linked to training of staff and the use of ASM developed resources (e.g. Goal Directed Care planning; Better Questions, Better Answers).

“Traditionally, our clients saw HACC as a forever service; now we are

increasingly seeing clients achieve goals and gain independence and

leave the service”.

LGA


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Undertaking service-specific assessments and linking these to the development of individualised care plans within planned activity groups was also frequently reported.


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7.4 Most significant changes: Care Planning and Review

Clients have a goal directed care plan

Most organisations reported working to establish goal directed care plans for all HACC clients. Establishing care plans within PAGs was highlighted by many as a significant achievement, particularly as some of these PAGs had not had care plans previously. In some organisations, care plan templates had been modified to ensure the role of clients as well as the service providers was documented. In other organisations, task lists linked to the care plan had been developed, with a column detailing activities for clients to complete and another column detailing the tasks to be undertaken by the direct care worker. Setting individualised goals and linking these to Service Delivery was identified by many organisations as a significant change. Linking these individual goals to planning in PAGs and respite services was also highlighted. Undertaking more regular client reviews was identified as another significant change. Although this was highlighted as being challenging and time consuming, organisations recognised the importance of undertaking reviews to ensure the service is achieving outcomes and meeting clients’ goals. Increased multi-disciplinary care planning

Increased multi-disciplinary care planning was reported as significant change by organisations in both the earlier and later stages of implementation. This included partnerships both within agencies and with other organisations. Team restructuring often enabled greater care coordination work to occur, but having a whole-of-organisation shared agenda also assisted.

Strengthening and establishing links with partner organisations also helped to support some organisations to undertake more inter-agency care coordination work. The development of one single care plan, or a reduction in the number of care plans for clients was reported as a direct outcome of multidisciplinary care planning. 7.5 Most significant changes: Service Delivery

Clients’ involvement in planning

The most frequently reported significant change for organisations across all stages of ASM implementation for this service coordination element was improved client involvement in planning decisions regarding their own care. This included ensuring the care plan was developed with the client and that he/she received a copy of the plan. It also involved defining client and agency roles and responsibilities, more clearly, and improving clients’ ability to choose when and how the services were delivered. Some organisations in the later stages of ASM implementation reported formalising client/carer involvement in service development planning through establishing client advisory committees or consultative forums and running focus groups to develop new tools or programs.

“The care plan is now a more valuable tool which helps set

the foundation of the relationship between the client

and the service.

We hope to take small steps towards achieving larger goals

to motivate and empower clients – that’s what the care

plans help us track” CHC


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Improved client involvement in planning was also highlighted in PAGs where clients were more actively involved in decision making about the range of programs and activities to be delivered.


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Improved service options

Organisations reported providing broader and more creative options for clients as a result of ASM. Stronger links to other community services and programs were seen as essential in being able to offer more options. Numerous examples of new initiatives and programs were provided, including: exercise programs, choir groups, creative dance, greater menu options, community delivered meals, smarter rider programs, smaller group activities, cooking skills programs, etc. A smaller number of organisations identified providing aids and equipment programs to support clients to be more independent, for example: light-weight vacuum cleaners, mops with extended handles, long handled toe washers, etc. Where these programs existed, the aids and equipment were made available to clients at a reduced cost. In some of these programs, an occupational therapist was available to work with clients to identify appropriate equipment. 7.6 Most significant changes: Service Closure and/or Transition

Increased number of referrals

The most frequently listed significant change under this service coordination element was the increase in the number of referrals to other services. This change was reported by organisations in both the earlier and later stages of implementation. Increased referral was often linked to improved partnerships and connections to other community agencies. Planning for service closure

Planning for service closure or transition was highlighted as a significant change by organisations in the later stages of ASM implementation. This included documenting policies and procedures to support this practice where previously clients had entered a service and never left it. Some organisations highlighted providing more short-term episodic care, undertaking more frequent reviews and planning for service closure or transition in early stages of a client’s engagement with the service. A small number of organisations in the earlier stages of ASM implementation reported no significant change under this service coordination element.

“We plan for service closure at the time of assessment and

care planning” LGA

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Part 3: ASM PREPARE–Express Results

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8 ASM PREPARE–EXPRESS – DATA ANALYSIS

The following sections provide a detailed analysis of the state-wide ASM PREPARE–Express responses. 8.1 Type of organisation

As expected, almost half of the HACC organisations that completed the ASM PREPARE–Express online tool were Other NGO agencies (47.6%) followed by CALD agencies (18.9%). The remaining responses were mostly Health/Nursing (12.6%), CHC (10.5%), and ACCO (9.9%). It should also be noted that the vast majority of agencies completing the ASM PREPARE – Express version were those funded for Volunteer coordination and Planned activity groups (PAGs). The distribution of organisation types that completed the ASM PREPARE–Express online tool is displayed in Figure 8-1.

Figure 8-1: ASM PREPARE–Express state-wide responses by type of organisation (n = 191)

8.2 Service coordination elements

ASM PREPARE–Express contained three service coordination elements: Service Commencement, Service Delivery, and Service Closure and/or Transition. This section provides a summary of the three service coordination elements. A detailed analysis of Service Delivery and HACC-funded activity types is provided in Section 8.4. Self-ratings were summed and then divided by the number of questions for each of the service coordination elements, resulting in an average self-rating for each element for all organisations. State-wide summary statistics for each of the service coordination elements are displayed in Table 8-1. The average self-ratings for all service coordination elements indicate that agencies are implementing ASM in some or most areas. Service Delivery was the service coordination element that was the most progressed, with a state-wide average self-rating of 4.0.

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When compared to the other service coordination elements, Service Closure and/or Transition was less progressed, with state-wide self-ratings ranging from 1.0 to 5.0 and a state-wide average self-rating of 3.4.

Table 8-1: ASM PREPARE–Express state-wide summary of self-ratings for service coordination elements

ASM PREPARE–Express – State-wide summary Summary statistics of self-ratings for each service coordination element

Service coordination element n Min Max Average

Service Commencement 191 1.3 5.0 3.9

Service Delivery 191 2.0 4.9 4.0

Service Closure and/or Transition 191 1.0 5.0 3.4

Average across all service coordination elements

191 1.3 5.0 3.8

Figure 8-2 illustrates the average self-ratings for each of the Service coordination elements from most progressed to the least progressed.

Figure 8-2: ASM PREPARE–Express state-wide average self-ratings for service coordination elements (n = 191)

Organisations’ average self-ratings for each of the service coordination elements were rounded to the nearest whole number to examine the distribution of self-ratings from 1 to 5. As agencies could be funded for varying numbers of activity types, Service Delivery is analysed separately in Section 8.4. Figure 8-3 shows the proportions of organisations self-rating at each level for both remaining service coordination elements. The self-ratings suggest that ASM implementation is progressing well in Service Commencement. Service Commencement combines practices under IC/INI, Assessment, and Care planning, with 74% of agencies self-rating at 4 or 5. Service Closure was less progressed with 51% of agencies self-rating at 4 or 5 and 20% self-rating at 1 or 2.

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Figure 8-3: ASM PREPARE–Express state-wide proportions of organisations self-rating at each level (n = 191)

8.3 Practice areas

This section summarises the practice areas within Service Commencement and Service Closure/Transition in Section 8.2, while Service Delivery is summarised separately in Section 8.4. The two service coordination elements were comprised of nine practice areas under Service Commencement and three practice areas under Service Closure and/or Transition. Organisations self-rated whether their current practices reflect an ASM approach for each of the practice areas. State-wide summary statistics for the self-ratings of the practice areas are displayed in Table 8-2. In Service Commencement, all nine practice areas were self-rated quite highly, ranging from 3.7 to 4.1. Person centred approach and Information collection/initial needs identification were the most progressed, with agencies implementing ASM in most areas (an average self-rating of 4 or above) and Referral to other organisations was comparatively less progressed (average self-rating of 3.7). In Service Closure, all three practice areas were self-rated lower compared to those in Service Commencement. Gathering information on client outcomes, Diversity planning and practice and Service closure and/or transition had average self-ratings between 3.3 and 3.5 (see Table 8-2).

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Table 8-2: ASM PREPARE–Express state-wide summary of practice area self-ratings

ASM PREPARE–Express – State-wide summary

Summary statistics of self-ratings for each practice area

Practice area n Minimum Maximum Average

Service Commencement

Marketing material 191 1 5 3.8

Information collection/initial needs identification

191 1 5 4.0

Person-centred approach 191 1 5 4.1

Capacity-building, solutions-based and goal-setting approaches

191 1 5 3.9

Working in partnership 191 1 5 3.8

Care planning 191 1 5 3.9

Referral to other organisations 191 1 5 3.7


Review 191 1 5 3.8

Service Closure and/or Transition

Service closure and/or transition 191 1 5 3.5


Gathering information on client outcomes 191 1 5 3.3

The proportion of organisations self-rating at each level for each of the practice areas is displayed in Figure 8-4. Figure 8-4 shows that within Service Commencement, at least 70% of agencies rated themselves at 4 or 5 in six of the nine practice areas. The practice areas self-rated as the least progressed were Marketing material, Referral to other organisations, and Review. These three practice areas had higher proportions of 1, 2 or 3 self-ratings. In each of the three practice areas within Service Closure and/or Transition, approximately half of the agencies self-rated at 4 or 5, and half self-rated as still in the earlier stages of implementation (self-rating 1, 2 or 3).

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Figure 8-4: ASM PREPARE–Express state-wide proportion of organisations self-rating for each practice area (n = 191)

8. ASM PREPARE–Express – Data Analysis

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Summary of findings: Agencies rated themselves as more progressed with ASM implementation in Service Commencement compared to Service Closure and/or Transition. The Service Commencement self-ratings suggest that most agencies were progressing well, with at least 70% of agencies self-rating at 4 or 5 in six practice areas. The practice area most progressed was Person-Centred Care, while the areas least progressed were Marketing materials, Referral to other organisations, and Review. Within Service Closure and Transition, approximately 50% of agencies self-rated their ASM implementation at 4 or 5 across the three practice areas. As with ASM PREPARE agencies, this is the service coordination element where further work is required. 8.4 Service Delivery

All HACC agencies were asked to rate whether their Service Delivery in each of their HACC-funded activities reflected an ASM approach. Organisations self-rated each of their funded activities with regards to the following three practice areas: Person-centred approach; Diversity planning and practice, and Capacity Building. It should be noted that some Service Delivery types have very low numbers of agencies responding so the data should be interpreted with caution. Table 8-3 shows that there are very low numbers in Linkages (n=3), Flexible Service Response (n=10) and Delivered meals (n=10). The most common service types delivered by agencies completing ASM PREPARE–Express were Volunteer coordination (n=89) and Planned activity groups (128). Only one agency provided a self-rating for the Community Connections Program and these results have been excluded from this section. No agencies using ASM PREPARE Express provided Café style support. A total of 46 agencies self-rated the Access and Support activity type; half of these agencies completed ASM PREPARE and half completed ASM PREPARE–Express. Of the 108 nursing services reporting, there was a 40/60 split between ASM PREPARE and ASM PREPARE-Express. This suggests that the Service Delivery results for ASM PREPARE–Express agencies do not give a complete picture of how progressed each of the service types are with ASM implementation. Readers interested in the comparison between service types should also read the ASM PREPARE results in Section 5.4. The average state-wide self-ratings for each funded activity type across the three different practice areas are displayed together in Figure 8-5 to allow a direct comparison. Figure 8-5 shows that, overall the average self-ratings were consistently high across some service types. Linkages, PAG, Nursing, and Access and Support had average self-ratings of 4 or above in each of the practice areas. In comparison, Property maintenance, Respite, and Delivered meals appeared to be less progressed. A summary of the self-ratings for Service Delivery in each of the three practice areas is described in Sections 8.4.1, 8.4.2, and 8.4.3.


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Figure 8-5: ASM PREPARE–Express State-wide Service Delivery self-ratings for practice areas by funded activity types (n = 191)

3.7

3.7

3.9

3.9

3.9

3.9 4.0

4.0 4.1

3.9

4.2

4.2

3.8

3.7

3.9

3.9

3.5

3.8

4.0

4.0

4.0

4.0

3.8

4.3

3.3

3.8

3.8

3.8

3.8 3.9 4.0 4.1 4.2

4.2

4.2

4.2

PropertyMaintenance

Respite Personal Care DomesticAssistance

Meals Volunteercoordination

Linkages PAG Nursing AlliedHealth

FSR Access/support

Person centred approach Diversity planning and practice Capacity building


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8.4.1 Person-centred approach

Summary statistics of self-ratings for implementing a Person-centred approach in Service Delivery for each of the funded activities are displayed in Table 8-3. All service types were self-rated between 3.7 and 4.2 so the results did not display a wide variation. Access and Support, Flexible Service Response (FSR), Nursing, and Planned activity group (PAG) all had a similar state-wide average self-rating between 4.1 and 4.2, suggesting that ASM implementation was the most progressed in these areas activities. The activities that appear to be less progressed with ASM implementation in Person-centred approach to Service Delivery were Property maintenance and Respite.

Table 8-3: ASM PREPARE–Express State-wide summary of self-ratings for Person-centred approach by funded activity type


Summary statistics of self-ratings for Person-centred approach in each funded activity type






Flexible Service Response 10 1 5 4.2

Linkages 3 4 4 4.0

Nursing 40 3 5 4.1




Respite 24 1 5 3.7


Overall average 33.7 1.9 4.9 4.0

Figure 8-6 displays the proportion of organisations self-rating their Person-centred approach to Service Delivery for each of the funded activity types.


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For all funded activities, 63% or more of agencies rated themselves at 4 or 5, indicating that nearly two-thirds of the agencies that completed ASM PREPARE–Express are well-progressed in implementing Person-centred approaches to Service Delivery. Due to the low number of agencies self-rating some of the service types, the results displayed in Figure 8-6 should be interpreted with care.


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Figure 8-6: ASM PREPARE–Express State-wide self-ratings for Person-centred approach to Service Delivery by funded activity type (n = 191)


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8.4.2 Diversity planning and practice

Summary statistics of self-ratings for Diversity planning and practice in Service Delivery for each of the funded activities are displayed in Table 8-4. Allied health, Access/Support, Linkages, Nursing and PAG had the highest state-wide average self-ratings, ranging from 4.0 to 4.3, suggesting that ASM was most progressed for Diversity planning and practice in these activities.

Table 8-4: ASM PREPARE–Express state-wide summary of self-ratings for Diversity planning and practice by funded activity type


Summary statistics of self-ratings for Diversity Planning & Practice in each funded activity type







Linkages 3 4 4 4.0

Nursing 40 2 5 4.0




Respite 24 1 5 3.7



Figure 8-7 displays the proportion of organisations self-rating their Diversity planning and practice at each level for each of the funded activity types. For all activities, 67% or more of agencies rated their Diversity planning and practice in Service Delivery at 4 or 5, with the exception of Respite where 67% of agencies rated themselves at 3 or 4. Due to the low number of agencies self-rating some of the service types, the results displayed in Figure 8-7 should be interpreted with care.


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Figure 8-7: ASM PREPARE–Express State-wide self-ratings for Diversity planning and practice in Service Delivery by funded activity type (n = 191)


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8.4.3 Capacity Building

Summary statistics of self-ratings for Capacity Building in Service Delivery for each of the funded activities are displayed in Table 8-5. Allied health, Access/Support, Flexible Service Response, Nursing and PAG had similar state-wide average self-ratings ranging from 4.1 to 4.2, suggesting that ASM implementation was the most progressed in these activities. The least progressed activity was Property maintenance with a state-wide average self-rating of 3.3, suggesting that this activity is in an earlier stage of ASM implementation compared to other activities.

Table 8-5: ASM PREPARE–Express state-wide summary of self-ratings for Capacity Building by funded activity type


Summary statistics of self-ratings for Capacity Building in each funded activity type







Linkages 3 4 4 4.0

Nursing 40 3 5 4.2




Respite 24 1 5 3.8



Figure 8-8 displays the proportion of organisations self-rating their Capacity Building at each level for each of the funded activity types. For all activities except Property maintenance, at least 70% of agencies rated themselves a 4 or 5, indicating that ASM implementation is well progressed in over two-thirds of the agencies for Capacity Building approaches to Service Delivery.


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Figure 8-8: ASM PREPARE–Express state-wide self-ratings for Capacity Building in Service Delivery by funded activity type (n = 191)


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Summary of findings for Service Delivery: Overall, agencies that completed ASM PREPARE–Express reported that they were well progressed with ASM implementation in Service Delivery. The most common activity types reported through ASM Express were PAGs,, Volunteer coordination and Nursing. Agencies reported that they are progressing well with these activity types. Average self-ratings were between 3.8 and 4.2 across the three practice areas. Looking at the individual practice areas for Service Delivery, results generally showed:

For Person-centred approach, at least 80% of agencies self-rated at 4 or 5 for just over one-third of the activities.

For Diversity planning and practice, at least 75% of agencies self-rated at 4 or 5 for two-thirds

of the activities.

For Capacity Building, at least 75% of agencies self-rated at 4 or 5 for almost two-thirds of the activities.

On average, agencies self-rated the individual practice areas of service delivery similarly. The Person-centred approach was self-rated as slightly more progressed with ASM implementation than Diversity planning and practice or Capacity building. Diversity planning and practice was self-rated slightly lower, on average, than the other two practice areas for agencies completing the ASM PREPARE this difference was not observed in the self-ratings provided by agencies completing the ASM PREPARE–Express. This may be due, in part, to a large proportion of CALD agencies completing the ASM PREPARE –Express.

9. ASM PREPARE–Express – Enablers and Barriers

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9 ASM PREPARE–EXPRESS – ENABLERS AND BARRIERS

This chapter presents an analysis of the enablers and barriers reported by organisations completing the ASM PREPARE–Express online tool. Enablers are discussed under three main categories: Resources Workforce development and commitment Systems change and support.

Findings related to both the enablers and barriers are disaggregated by stage of implementation: Earlier stages Later stages.

Defining earlier and later stages of implementation

To summarise each HACC agency’s review results, self-ratings were summed across the 12 self-rated questions. The maximum summary score available for agencies that completed the ASM PREPARE–Express online tool was 60. The average score was 45.0 out of 60. Agencies that had a total score that was greater than or less than one standard deviation above or below the average were considered to be in the earlier or later stages of implementation. This accounted for 31.8% of the responding agencies (36/191 = 18.8% in the later stages and 25/191 = 13.0% in the earlier stages). 9.1 Resource enablers

Organisations were provided with a list of nine resource options in the online survey and asked to indicate which three of these had been the most useful in implementing the ASM approach. State-wide, the five most common resources listed by ASM Express organisations in order of frequency were:

1. Local/regional networks of agencies (89/191 organisations, 46.6%)

2. Goal Directed Care planning Toolkit (EMR Alliance 2013) (86/191 organisations, 45.0%)

3. ASM Prepare (DH 2010) (66/191 organisations, 34.6%)

4. ASM Communication Toolkit (DH 2010) (84/191 organisations, 44.0%)

5. ASM Industry Consultants (77/191 organisations, 40.3%).

Figure 9-1 provides a state-wide count of the most frequently listed resources enablers by ASM PREPARE–Express organisations.


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Figure 9-1: ASM PREPARE–Express resource enablers (n = 191)


Organisations in the earlier stages of ASM implementation listed all the top five state-wide resources in their top five enablers. 9.1.2 Later stages of ASM implementation

Organisations in the later stages of ASM implementation listed four of the top five state-wide enablers in their top five. Strengthening Assessment and Care planning: A Guide for HACC Assessment Services, was listed among the top five enablers for organisations in the later stages of ASM implementation, but was sixth at state-level. ASM Prepare (DH 2010) fell just outside the top five resource enablers for organisations in the later stages of ASM implementation. One interesting feature of organisations in the later stages of ASM implementation is the relative importance of their top five enablers. Goal Directed Care planning Toolkit, ASM Communication Toolkit, and Local/Regional Networks of Agencies were ranked equal first. Strengthening Assessment and Care planning: A Guide for HACC Assessment Services and ASM Industry Consultants were ranked equal fourth.


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Locally-developed resources In addition to the list of resource options provided in the online tool, organisations had the opportunity to provide details of any locally-developed or other resources that had facilitated ASM implementation. Although 16 organisations indicated that locally-developed resources had been used, no details of these resources were provided. Other resources Other resources listed by agencies included:

Training (staff/management)

Networks, partnerships and meetings with other providers

ASM newsletters.

9.2 Workforce development and commitment enablers

Organisations were provided with a list of 10 workforce development and commitment enablers in the online survey and asked to indicate which three of these had been the most useful in implementing the ASM approach. State-wide, the five workforce development and commitment enablers most commonly listed by ASM PREPARE–Express organisations in order of frequency were:

1. ASM training (131/191 organisations, 68.6%)

2. Level of staff commitment to the ASM approach (91/191 organisations, 47.6%)

3. Existing HACC staff perception and interpretation of the ASM approach in practice (66/191 organisations, 34.6%)

4. ASM forums (61/191, 31.9%)

5. On-the-job Capacity Building of staff (58/191, 30.4%).

Figure 9-2 provides a state-wide count of the workforce development and commitment enablers most frequently listed by organisations completing ASM PREPARE–Express.


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Figure 9-2: ASM PREPARE–Express workforce enablers (n = 191)


Organisations in the earlier stages of ASM implementation included the first four state-wide enablers in their top five. New staff have job descriptions which promote the ASM philosophy was ranked fifth (n = 4 organisations) while On-the-job capacity building of staff was listed seventh. 9.2.2 Later stages of ASM implementation

All five of the top state-wide enablers were listed in the top five by organisations in the later stages of ASM implementation. 9.3 Systems change and support enablers

Organisations were provided with a list of 11 Systems change and support enablers in the online survey and asked to indicate which three of these had been the most useful in implementing the ASM approach.


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State-wide, the five Systems change and support enablers most commonly listed by organisations completing ASM Express were, in order of frequency:

1. Development and review of ASM implementation plans (98/191 organisations, 51.3%)

2. Review and revision of internal policy and procedures to reflect ASM approach (94/191 organisations, 49.2%)

3. Management understands and supports the ASM approach (70/191 organisations, 36.6%)

4. The self-assessment, review process and resources associated with the CCCS supported ASM implementation (57/191 organisations, 29.8%)

5. Client and carer engagement and support (55/191 organisations, 28.8%).

Figure 9-3 provides a state-wide count of the Systems change and support enablers most frequently listed by organisations completing ASM PREPARE–Express.

Figure 9-3: ASM PREPARE–Express Systems Change and Support enablers (n = 191)


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9.3.1.1 Earlier stages of implementation

Organisations in the earlier stages of implementation included the first four of the top state-wide enablers in their top five, with DH funded ASM seeding grants replacing Client and carer engagement and support. Interestingly, DH-funded ASM seeding grants ranked ninth state-wide. 9.3.1.2 Later stages of implementation

Organisations in the later stages of implementation listed the first four of the top state-wide enablers in their top five, with Our staffing model and team structure support an ASM approach replacing Client and carer engagement and support in fifth place. Our staffing model and team structure support an ASM approach was ranked seventh state-wide. 9.4 Barriers to ASM implementation

Organisations were provided with a list of 21 obstacles to ASM implementation in the online survey and were asked to select which of these had been the main barrier(s) to implementing ASM in their organisation. A maximum of five obstacles could be selected. State-wide, the five barriers to ASM implementation most commonly listed by organisations completing ASM PREPARE–Express were, in order of frequency:

1. Limited resources (106/191 organisations, 55.5%)

2. High demand for services: implementing ASM takes time (77/191 organisations, 40.3%)

3. Consumer expectations (66/191 organisations, 34.6%)

4. Funding model limits our HACC services being delivered with an ASM approach (44/191 organisations, 23.0%)

5. Limited consumer/family engagement with the ASM philosophy (37/191 organisations, 19.4%).

Figure 9-4 present the barriers to ASM implementation by frequency identified by ASM PREPARE–Express organisations. 9.4.1.1 Stage of implementation

Organisations in the earlier stages of implementation listed four of the top state-wide barriers in their top five. Not clearly understanding how to implement ASM in our organisation ranked fourth among the organisations in the earlier stages of implementation. Limited consumer/family engagement with the ASM philosophy was listed by only one organisation. Organisations in the later stages of implementation listed all top five state-wide barriers in their top five barriers.


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Figure 9-4: ASM PREPARE–Express Barriers to ASM implementation (n = 191)

10. ASM PREPARE–Express - Most Significant Change

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10 ASM PREPARE–EXPRESS – MOST SIGNIFICANT CHANGE

The most significant changes reported by organisations completing the ASM PREPARE–Express online tool are presented below. These have been organised into overarching significant changes that span across all three service coordination elements as well as under each service coordination element individually, where specified. Differences between agencies in the earlier and later stages of ASM implementation have also been highlighted where applicable. 10.1 Overarching most significant changes

Staff and volunteer training

Similar to those organisations completing ASM PREPARE, staff and volunteer training was frequently reported by organisations completing the ASM PREPARE–Express as the most significant change, irrespective of stage of implementation. For some smaller organisations, having all staff attending training was a significant achievement as there were often no resources to back-fill staff. Internal training was more often delivered to volunteers along with regular information about ASM practice through newsletters, handbooks and meetings. Again organisations identified the Introduction to ASM and Putting Active Service Into Practice training as beneficial. Motivational Interviewing training was also identified as useful by a number of agencies. Review and development of policies and procedures

Reviewing and/or developing policies and procedures to reflect the ASM principles was frequently reported as a significant change. Again, this was irrespective of the organisation’s stage of ASM implementation. Embedding ASM into all aspects of service delivery and for all clients was highlighted as important. Developing or updating assessment and care planning templates also featured highly. Updating position descriptions for staff and volunteers to include ASM principles were more frequently reported by agencies in the later stages of ASM implementation. Staff and volunteer understanding and application of ASM

Cultural change, including shifting pre-existing perceptions of HACC, was reported by numerous agencies as a significant achievement. The investment in training and developing/revising policies and procedures were large contributors to this change. The notion of having to re-train staff and volunteers to change their thinking was also raised. Organisations reported staff and volunteers now having a much clearer understanding of ASM and greater preparedness to work within this framework.

“ASM has become embedded into practice. It is no longer

just a concept but what we do” Other NGO

“Volunteers are recognising and accepting what we always do or have done

doesn’t suit everyone and are more willing to take an individual’s strengths into

consideration” CALD


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10.2 Most Significant Change: Service Commencement

Some differences in the most significant change in Service Commencement were evident between organisations in the earlier and later stages of ASM implementation. 10.2.1 Organisations in the earlier stages of implementation

The most significant changes to Service Commencement identified by organisations in the earlier stages of implementation included: Introduction and use of goal setting in care plans

A few organisations reported that they were in the very early stages of using care plans and setting goals. Some were yet to commence using care plans for clients. The use of care plans in PAGs, where these were not previously in place, was highlighted by numerous organisations. Changes to Marketing materials and client information Updating language and client information to reflect an ASM approach was identified as a significant change by many organisations. This work was seen to be important to help shift clients/carers and community views of what HACC was. Changes to Marketing materials and client information were also being made to ensure these were more culturally appropriate. Client Capacity Building

Organisations in the earlier stages of implementation reported that clients were now more involved in the assessment and care planning process and that greater emphasis was now placed on what clients can do for themselves. 10.2.2 Organisations in the later stages of implementation

The most significant changes to Service Commencement identified by organisations in the later stages of implementation included: Inclusion of individualised goals in care plans

Organisations in the later stages of implementation reported greater emphasis on developing individualised goals in care plans linked to the information gathered through the assessment process. Clients were also reported to be more involved in setting these goals. This included taking the time to build capacity with clients to understand the process of identifying goals. Many organisations also reported undertaking more regular client reviews to measure progress towards goals.

Changes to Marketing materials and client information

Similar to organisations in the earlier stages of ASM implementation, organisations in later stages of implementation reported making changes to their Marketing materials and client information to better reflect ASM language and concepts.

“Now the goals are much more diverse

and reflective of individuals’ lives and

aspirations”

LGA


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Partnerships and collaborations

The development and/or enhancement of partnerships with other organisations was more frequently reported as a significant change by organisations in the later stages of implementation in Service Commencement. Multidisciplinary Care planning

Increased multidisciplinary Care planning was occurring in organisations in the later stages of implementation. Some of these organisations identified team restructuring that had assisted in facilitating improved communication and information sharing between staff. Some multidisciplinary Care planning was reported between agencies, along with greater sharing of client information to reduce duplication.

10.3 Most Significant Change: Service Delivery

The most significant changes for service delivery were similar between organisations in the earlier and later stages of ASM implementation. It should be noted that the most common service types delivered by organisations that completed ASM PREPARE–Express were PAG and Volunteers Coordination, which has an impact on the type of significant changes identified. The key significant changes identified in relation to Service Delivery included: Greater diversity of programs

Increased diversity in the programs provided was the most frequently reported significant change in Service Delivery. This included clients having a more active role in planning new programs and activities. A strong social connection focus was apparent in these programs, along with promoting exercise and healthy eating (e.g. exercise programs, strength training, cooking programs, community Delivered meals, connections to existing community groups, small café groups, walking programs, singing groups, travel groups, etc.). Establishing and strengthening partnerships

Establishing and strengthening partnerships with a wide range of external service providers and community groups was reported as a significant change, particularly in relation to broadening program options and referral pathways.

10.4 Most Significant Change: Service Closure and/or Transition

Some differences were evident in the findings for the most significant changes for organisations in the earlier and later stages of implementation under this service coordination element. 10.4.1 Organisations in the earlier stages of implementation

Several organisations in the earlier stages of ASM implementation had not yet engaged in Service Closure and/or Transition. In these cases, ASM had increased their awareness of the need to develop

There are so many more choices now…clients

can pick a bit more what they would like to do rather than what the

group is doing” LGA


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pathways to closure/transition and processes were being developed to achieve this. This included changes to data systems and the information collected, and formalising processes. Twelve organisations in the earlier stages of ASM implementation reported that ASM had not resulted in any significant changes to Service Closure and/or Transition (four ACCO organisations, three health/nursing organisations and five other NGOs). Those who listed changes included the following:

Service closure planning

Policy and procedure development

Review of client experiences on exit

Use of a client exit survey.

10.4.2 Organisations in the later stages of implementation

Increased number of referrals

Organisations in the later stages of implementation frequently listed an increase in referrals to other organisations and community groups as a significant change. For some organisations, there was a connection between increased referrals to other services and programs and an increase in clients no longer needing their services. Upgrade/changes to IT systems

Making better use of, or upgrading client information systems was reported as significant change by organisations in the later stages of implementation. Using these systems to monitor length of service and developing and reviewing care plans was commonly reported.

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Part 4: Targeted Focus Groups and Phone Consultations

11. Targeted Focus Groups and Phone Consultations

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11 TARGETED FOCUS GROUPS AND PHONE CONSULTATIONS

11.1 Purpose of the follow up consultations

This section presents the key themes from the targeted focus groups and telephone consultations conducted with a sample of organisations completing the ASM PREPARE and the ASM PREPARE–Express online tools. Organisations were selected to participate based on their stage of ASM implementation. The sample included organisations in both the earlier and later stages of implementation and those completing either version of the online tool. Each of the eight regions was represented in the sample. The purpose of these focus groups and consultations was to gather more in-depth information about the issues relating to ASM implementation, including:

Enablers and barriers to implementation

Key learnings

Identifying opportunities to support agencies to continue to enhance their ASM implementation.

11.2 Enablers for ASM implementation

Organisations were asked to reflect on the top enablers identified through the online tool and comment on whether these were reflective of their own experience. Most organisations agreed with the top five enablers, with a few exceptions discussed below. Organisations were also asked to comment on how these enablers may have changed over time as they had progressed with implementing ASM. Resources

Most organisations participating in the follow-up consultations identified the ASM resources as useful, particularly in the early days of ASM implementation as agencies became familiar with the concepts. Commonly used resources cited were:

Strengthening assessment and Care planning: A guide for HACC assessment services in Victoria

Victorian HACC Active Service Model Discussion Paper

Goal Directed Care planning Toolkit

Better Questions, Better Answers

Communication Toolkit.*

*The Communication Toolkit was identified as both an enabler and a barrier by organisations. Although some organisations identified this toolkit as useful, there were a number of organisations who said that the toolkit was not at all useful in supporting agencies to market and communicate ASM. There was an expectation among these organisations that there was going to be a central approach to marketing ASM so that messages were consistent and more far reaching. Some local communication and marketing was occurring, but organisations felt that there was still much to be done in this area. The timing of the communication toolkit being released was also seen to be a barrier, as it came out too late and was needed in the early days of the reform.

“The resources were useful in the early days for setting the scene and getting us all on

the same page”. CALD


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One organisation in particular disagreed with the written resources being an enabler. This agency was located in a highly culturally diverse area, with both staff and clients coming from diverse backgrounds. This organisation believed that the written materials did not have culturally transferrable concepts and were not useful for people with low literacy levels. This meant this organisation had developed their own targeted cultural messages, using practical examples to communicate concepts to staff and using plain language materials. This organisation also adopted a validated tool (Activity Card Sort) to undertake assessments and care planning with clients attending the PAG program, which reportedly worked well for CALD clients and those with low literacy levels. Industry Consultants

There was wide spread acknowledgement of the important role the Industry Consultants (ICs) had played in implementing and driving ASM. Industry Consultants were seen as very supportive and able to provide practical solutions to issues. Some organisations had engaged with the ICs at a strategic organisational change level, whereas others had used the ICs to provide support and training at a program level. Some organisations believed that the ICs’ role was not as vital now as it was in the earlier days of implementation when their role had been more critical. Others argued that the IC role was still very useful as HACC agencies were at different stages of implementation. Staff commitment

Most organisations identified the level of staff commitment to ASM as one of the main enablers. These organisations recognised the huge cultural change that had occurred within their organisations and that the high level of commitment from the staff was a significant part of supporting this change. Some organisations reported that many of their staff were working over and above what they were paid to ensure ASM was well implemented. Increased documentation, more comprehensive assessments and care planning and improving program options for clients were all identified as taking more time and requiring greater efforts from staff. Although staff commitment was reported as high in these organisations, it was acknowledged that some staff had remained resistant to change, resulting in some of these staff leaving. At least two organisations said that ASM required constant focus and monitoring to measure its impact and ensure staff continued to work in this way. High-level support for ASM

Senior management support for ASM was seen as essential to facilitating the necessary changes to policies and practices. Some organisations reported a whole-of-organisation approach to ASM, including embedding the key principles into strategic directions and aligning all policies, procedures and position descriptions. Leadership support was also linked to being able to work more effectively across teams, and to supporting partnerships with other organisations.

“The IC was really helpful…I was new to this area [HACC]

and the IC was very good…providing me with the right information, templates, practical ideas and above all

support”. Other NGO

“Management are on board with ASM now,

which has given staff the ‘permission’ to change the

way they have always worked”.

CHC


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Training Training was identified as major driver for change. In the early days of ASM, organisations reported sending a lot of HACC staff to training funded through ASM seeding grants. Opinion was divided about how well this training was targeted. At least four organisations said that the training was focused mostly towards direct care staff, leaving a gap for those with higher qualifications (e.g. clinicians, assessment staff, etc.). Another organisation said that the training did not focus on the needs of direct care staff enough. Overall, there was general satisfaction with the training provided in the earlier days of implementation. The training courses identified as most useful were:

Introduction to ASM

Motivational interviewing

Change management (eastern region).

Organisations identified the need for ASM training that continued to build on the knowledge and skills staff had acquired over the past four years. Better targeting of training at a professional staff and management level was also raised. The way in which training was being provided has changed over time. Many organisations reported developing their own internal training to meet the requirements of ASM. This training included staff training sessions, group supervision, case discussions and more formalised training packages. The use of case discussions was raised by most of the organisations as a useful way of engaging staff. Some used these discussions primarily with their assessment staff, whereas others used case models as a way of communicating the concepts of ASM with direct care staff. Using actual examples was identified as useful as it provides a building block whereby good work was acknowledged and opportunities for improvement could be identified. Some organisations also discussed training of volunteers and identified that more focus needed to be given to up-skilling volunteers. Raise the profile of the direct care workforce

There was wide-spread recognition of the significant role of the direct care workforce in ASM implementation. A lot of time has been spent on ensuring the direct care workforce understands their role and how they can adjust their work practices to better reflect ASM. At least three organisations reported taking direct care workers out on an assessment so that they understood the link between assessment, goal setting and service delivery. Handover meetings between the assessment officer and the direct care worker were also reported in two organisations. It was acknowledged, however, that while these activities were extremely beneficial, they were not funded and so were not sustainable into the future.

“At the beginning it was about education and

awareness of the concepts – now we have shifted our

focus to finding ways to adjust what we do to

practically implement the concepts”.

Other NGO

“Raising the profile of our direct care workforce has

been very important – rather than cleaners or carers they are now community support

workers…their role in the ASM loop is essential”.

LGA

“At the beginning we picked work that was already

happening that reflected ASM principles. This helped to engage staff rather than them thinking everything

they were doing needed to change”.

LGA


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Alliances and networks Participation in ASM alliances and networks was considered very beneficial for most organisations. Management participation in these alliances and networks was also seen as an enabler, as it provided the foundation for collaborative work. Some smaller HACC organisations reported using these networks as a key source of information and support for implementing and sustaining ASM. They were also seen as beneficial for sharing innovative practices. Two organisations believed the local networks were not useful and in fact a barrier to ASM. Differences in organisational readiness for change was cited as the main issue with the network these organisations were involved with. Partnerships

Partnerships between agencies were identified as a main enabler for sustaining ASM work. In the early days of ASM implementation, organisations were focused internally as they became familiar with the concepts and expectations of ASM. As organisations have become more confident, partnership work has become more important. Joint initiatives (e.g. joint assessment forms, GP education projects, training and resource development), co-location of staff, and strengthening of referral pathways have been some of the outcomes of partnership work. Department support

Most organisations believed that the Department had set a clear agenda for ASM and had implemented a number of structures that had enabled ASM work to occur. These included:

Seeding grants

ASM training

Annual agency ASM implementation plans

Industry consultants.

11.3 Barriers to ASM Implementation

Organisations were asked to reflect on the top five barriers identified via the online tool and comment on whether these reflected their own experiences. Organisations were also asked to discuss how they had overcome any of the barriers identified. The findings are summarised into key themes below. Client/carer expectation

Client/carer expectations of HACC services were identified by all organisations as one of the main barriers to ASM implementation. Consumer expectations of HACC were difficult to shift, particularly where clients had been using services for many years. Changing the messages and language used to communicate with clients was important to begin shifting expectations. Organisations found it easier with new clients as the expectations and understanding of HACC could be set from their initial contact with the service. Four organisations working with CALD clients discussed the difficulties they faced in changing the expectations of clients when there were cultural expectations involved. This was particularly hard

“Some clients are very resistant – when clients have

been using the service for 20 years or more they

become very entrenched in the dependency model”.

LGA


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where staff themselves were from the same community. The belief that “I am old, I have worked all my life…now you take care of me.” was often well entrenched. Tailoring the messages and reasons for making changes was raised as a way of shifting the expectations. One ACCO discussed the difficulties they had finding the language that worked for their community. The concepts of the ASM approach were not always understood. Another challenge reported by this organisation was trying to implement a change that was not driven from the community themselves. GP and acute sector understanding of ASM

Organisations reported that the lack of understanding of HACC by referring agencies, particularly GPs and hospitals, created challenges. Clients’ sense of entitlement about the services they should receive through HACC were often fuelled by GPs and the acute sector’s misunderstanding of the capacity and services available through HACC. More often than not, clients expected a higher level of service than agencies could provide, and were not aware of the reablement focus of HACC. This in turn created extra pressure for organisations that must mitigate these expectations. Most organisations agreed that action was required to educate the GP and acute sectors about the changes in HACC and ensure more appropriate referrals. Demand for services

The increasing demand for HACC services was a major barrier identified by all organisations involved in the consultations. Organisations highlighted that while the demand for services continues to increase, the requirements of ASM have also increased the workload. These organisations reported that working in an ASM manner had a ripple effect from Assessment all the way through to Service Delivery. Assessments and goal-orientated care planning and the documentation related to these was identified as the most time consuming. The need to undertake more regular reviews of clients to monitor progress towards individual goals was also having an impact on workload and resources. Acknowledging that ASM has required a huge cultural change in the HACC sector, organisations pointed out that it takes time to embed such a change, and that, in order to be effective, it needs to be continually reviewed and the focus on it maintained. Smaller, stand-alone organisations highlighted the lack of resources to backfill staff attending ASM training, and the impact on workload to meet the requirements of ASM was also highlighted. Client information systems (CIS)

A number of organisations raised the limitations of their client information systems in supporting ASM work. The main issue was the inability of these systems to allow for one care plan to be shared across teams. This was resulting in organisations developing workarounds such as duplicating the care plan or creating ‘dummy’ care plans. Many organisations reported having had some discussions with their CIS providers but often the cost to make these changes was prohibitive. Long waiting lists for aids and equipment and access to Allied health staff

Delayed access to aids and equipment or to an Allied health practitioner to maintain a client’s independence was raised as a limitation for many organisations. Reportedly, the long waiting list associated with the aids and equipment program limits the work agencies can do with some clients in

“They [clients] come to us with almost a

prescription in hand of the HACC services the doctor has told them they will get

from us“. LGA

“ASM is labour and resource

intensive”. Other NGO


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promoting and maintaining their independence. These delays have made it necessary for organisations to support clients while they are waiting. Clients are then said to be deteriorating before they receive their aids or equipment, resulting in the need for a reassessment and a reapplication for more appropriate equipment. Limited access to Allied health professionals was raised by organisations located in rural areas. Community Services Training Packages

There was a common concern raised by the organisations regarding students emerging from training institutions having no knowledge of ASM. This was particularly related to Certificate III courses. Organisations reported that new staff needed to be trained in ASM once they had started their roles as there were often significant gaps in their knowledge. 11.4 What has changed?

Organisations were asked to reflect on how things were different now since the implementation of ASM in 2010. The main themes are presented below under the subheadings of staff, clients, organisation and other stakeholders. Staff

Improved staff capacity and confidence in working with ASM

More cross disciplinary work

Staff report higher satisfaction with their roles as they can see how goals are linked to the outcomes they are achieving with clients

Staff have more variety in their roles

Staff have more skills in how they interact with clients

More opportunities for professional development

Staff can be more creative with their solutions

Assessment staff operate at a higher, more professional level

ASM is validating for staff who were already working in this way

Increased workload and demands on staff time – there are a lot more referrals and follow up work.

Clients

Clients have one care plan and fewer goals

Fewer visits and assessments as staff are working together

More seamless care between different HACC agencies

Increased opportunities to ask questions about their own care

The information and the messages clients receive have changed and focus strongly on independence, client-centred care and reablement

Clients have more choices and are more actively involved in planning their care.

“I use to arrive at the client’s door and know what services I was going to give them before

even walking in the door”

LGA

“Our clients used to have multiple care plans with lots of

goals. They (goals) were not meaningful

for anyone”. CHC


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Organisations

ASM is now embedded into strategic plans, policies, procedures and position descriptions

Management support and commitment to ASM

Staff restructuring to support multidisciplinary work.

Other stakeholders

Increased partnerships and collaborations

Shared philosophy to client care

Collocation of staff (e.g. OTs)

Increased number of joint assessments and external referrals

Improved referral pathways.

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Part 5: Where To From Here?

12. Synthesis of Key Findings and Opportunities

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12 SYNTHESIS OF KEY FINDINGS AND OPPORTUNITIES

Implemented since 2009, the Active Service Model represented a major policy and practice reform for the Victorian HACC program. Given the shift in approach required, a range of activities were put in place by the Department of Health to support HACC organisations to reorientate their service delivery. ASM PREPARE and ASM PREPARE–Express were developed as audit tools and methodology for organisations to review, reflect on and self-rate their practices, then identify priorities for planning ASM implementation strategies. Organisations develop ASM implementation plans detailing these strategies and their progress towards ASM implementation and submit them to the Department each year. The first round of ASM PREPARE and agency ASM plans were completed in 2010. At the time, this was a paper based activity and the Department did not collect the information. This current project required the development of an online tool to support the collection and analysis of ASM review information at the state-wide level. 12.1 ASM review online tool response rate

As discussed in Chapter 4, this project achieved an excellent response rate (97.6%) from HACC organisations. Approximately half of the HACC agencies completed the full ASM PREPARE (47.5%) and half completed the ASM PREPARE–Express (52.2%). As would be expected, the majority of HACC organisations that completed the ASM PREPARE online tool were from a LGA or CHC. The majority of HACC organisations completing the ASM PREPARE–Express online tool were CALD, ACCO, Health/Nursing or Other NGO agencies. 12.2 Stages of ASM implementation

An in-depth analysis of the self-ratings provided by organisations completing the ASM PREPARE (20 practice areas) and the ASM PREPARE–Express tools (12 practice areas) has been provided in Chapters 5, 6, 9 and 10. Some variance was reported in the level of ASM implementation across the different service coordination elements and the individual practice areas within these elements. Areas where HACC agencies are doing well Practice areas: ASM implementation was reported to be most progressed in Assessment and Initial Needs Assessment for agencies completing ASM PREPARE. Approximately 86% of agencies reported implementing ASM in most or all areas of Assessment and IC/INI. For those agencies completing ASM PREPARE–Express, the result was similar with most progress in Service Commencement. The practice area of Person-centred approach was self-rated the highest with agencies completing both versions of the review tool who reported implementing ASM in most areas.

For ASM PREPARE agencies in the service coordination element of Care Planning and Review, approximately 69% of agencies self-rated as a 4 or 5. The practice area of health promotion in Care Planning and Review was the most progressed area with 80% of agencies giving themselves a self-rating of 4.


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Service Delivery Looking at ASM implementation across all service types, most agencies in both PREPARE and Express are progressing well in delivering HACC service activities with an ASM approach. The practice areas of Person-centred approach were generally self-rated higher than diversity planning or Capacity Building. In Diversity practice and planning, ASM PREPARE–Express agencies generally self-rated higher compared to PREPARE agencies For the practice area of Capacity Building, ASM appears to be comparatively more progressed in Linkages, Domestic assistance, Allied health, PAG, Access, and Support than other service types (self-ratings of 4.0 to 4.2) Similarly, for ASM PREPARE–Express agencies, the funded activity types of Access and Support, Nursing, PAG and Linkages showed more progress across all three practices areas than other service types.

Areas requiring more focus The least progressed area of practice reported by both ASM PREPARE and ASM PREPARE–Express agencies was Service closure and/or transition. This finding was supported by information provided by organisations in the Most Significant Change sections of the review tool. Substantially more significant changes were reported around Assessment and Care Planning practices and noticeably fewer in Service Closure and/or Transition. This suggests that cross-sector work in the area of Service Closure and/or Transition would be beneficial. The practice areas showing the least progress for ASM PREPARE were Interagency Care Plans and Gathering information on client outcomes. Similarly for ASM PREPARE–Express, Gathering information on client outcomes rated the least advanced. For ASM PREPARE agencies, Café style support, Volunteer coordination and Property maintenance were less progressed across all three practice areas, indicating that more support may be needed for these activity types. For ASM PREPARE–Express agencies, Property maintenance, Respite and Delivered meals rated as least progressed across the three practice areas. For all agencies, the practice area showing the least progress was diversity practice and planning. 12.3 Barriers and enablers to ASM implementation

A range of enablers and barriers to implementing ASM were identified by organisations completing the ASM review tools. A detailed analysis of these is presented in Chapters 6 and 9. Follow-up focus groups and telephone calls with a representative sample of HACC organisations were used to verify the barriers and enablers identified (Chapter 11). 12.3.1 Enablers

Enablers were organised into three main areas: resources, workforce development and commitment and systems change and support. Organisations completing either version of the review tool identified similar resource enablers, but provided slightly different weightings for each enabler. For example, organisations completing the ASM PREPARE–Express tool placed greater importance on local and regional networks when


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compared to organisations completing the ASM PREPARE review tool. For ASM PREPARE agencies, the Strengthening Assessment and Care planning, closely followed by the Goal Directed Care planning Toolkit were identified as the most useful resources to support ASM implementation. Follow-up phone calls and focus groups highlighted the important role played by industry consultants in facilitating the implementation of ASM in their region. Regional networks and alliances were also identified by most organisations as central plank to driving and supporting the ASM approach. ASM training, staff commitment and on-the-job Capacity Building were listed in the top five workforce development and commitment enablers for organisations completing both the ASM PREPARE and the ASM PREPARE–Express tool. Follow-up phone calls and focus groups confirmed ASM training and level of staff commitment as key enablers. Training was identified as more important in the early days, whilst the reliance on the level of staff commitment as an enabler had continued. The level of innovation and progress towards ASM implementation in all areas was reported by many organisations to be directly linked to high levels of staff commitment and drive. It was apparent through the online tool and follow-up consultations that many organisations had invested heavily in training and implementing a range of on-the-job Capacity Building strategies to reorientate staff thinking and approaches to HACC service delivery. There were some differences between the systems change and support enablers identified by organisations completing the ASM PREPARE and those completing the ASM PREPARE–Express tools. For ASM PREPARE organisations, management support, partnerships and reviewing policies and procedures provided the important foundations for change at a systems level. For ASM PREPARE–Express organisations, while management support featured among the top enablers, the process of developing the ASM implementation plan and the self-assessment process linked to the CCCS quality framework were identified as important. Management support and partnership work featured very highly in the follow-up consultations. 12.3.2 Barriers

A wide range of barriers was identified by organisations completing both versions of the online tool, although some commonalities were apparent. Consumer expectations, limited resources and high demand for services were in the top three barriers for those completing the ASM PREPARE and ASM PREPARE–Express tools. There was widespread recognition in the follow-up consultations that changing client expectations will take time. Changing the messages going out to clients and their carers was seen as important in counteracting some of these expectations. Generating broader community awareness, including among health professionals, was seen as important work for the future. Restructuring teams, mitigating client expectations in the early stages of their engagement with the service, and linking clients to other services and community groups were some of the strategies organisations used to manage the limited resources and high demand for services. Despite improvements, a clear message from the sector was that ASM is more time and resource intensive.


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12.4 Most Significant Change

Considerable investment and commitment to ASM by HACC organisations was evident through the online tool and the follow up consultations. The wide range of changes and innovation has been discussed in Chapters 7 and 10. Overall, there has been significant attention given to improving the knowledge and skill of the HACC workforce to work effectively within an ASM framework. The vast majority of organisations reported supporting staff to attend training, and developing ongoing Capacity Building strategies to continue to build on these skills. Substantial efforts in this area appear to have been directed towards up-skilling and supporting the direct care workforce as well as assessment staff. A significant amount of work in reviewing policies, procedures and position descriptions to ensure they align with the ASM principles was also reported. This work was highlighted as important to setting the foundation for reorientating work practices. Improved partnerships and collaborations between HACC service providers and the broader community and health sector were reported by the vast majority of organisations. The data analysis highlighted a greater sector-wide focus on goal setting and Care planning practices, including work on redeveloping assessment and Care planning tools, training and inter- and intra-agency Care planning. Implementing goal setting and Care planning in funded activity types where this had not previously occurred (e.g. planned activity groups) was frequently reported. There was recognition of the huge cultural shift that had occurred in HACC as a result of implementing ASM. Shifting the traditionally held views of staff, clients, carers, referring agencies and the broader community has taken a lot of time and effort. A strongly held view was that maintaining these changes will require ongoing attention and work. 12.5 Areas for improvement

12.5.1 Agency identified improvements

In recognition of the significant progress made over the past four years, organisations were asked to identify opportunities for continuing to support the HACC sector to embed ASM. These suggestions are summarised below. Maintain ASM focus when HACC transitions to the Commonwealth: Organisations

expressed a clear desire to continue working under an ASM framework. One of the main concerns organisations raised was the uncertainty about how the new model would look, particularly where it appeared assessment was being separated from service delivery. In light of these concerns, organisations wanted the Department to advocate strongly to the Commonwealth for the need to maintain a reablement focus in HACC, and to support the sector to maintain the momentum in relation to this work.

Training: There was strong support for the continuation of training and workforce

development opportunities for staff and volunteers. Future training needs to build on the skills and knowledge staff had gained over the past four years. There was a view that much of the training available now was pitched at an introduction level which was not relevant to where the sector has moved to. Some areas for training identified included: strengthening goal setting


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and Care planning, practical application of ASM for particular client groups (e.g. dementia, CALD, vulnerable, etc.), change management and reflective practice.

Sharing the innovations: Finding more opportunities to share and celebrate the good work

that has occurred across the sector was raised. While it was recognised that there was good sharing of information occurring within regions (via the ICs or alliances), it was believed that more should be done to share information between regions. Organisations were keen to hear about innovations, creative project ideas, and practical applications of ASM, and to share resources. It was felt that there was a greater urgency to do this now, before HACC was moved to the Commonwealth where there was the potential for the focus on this work to be lost.

Marketing/communication: Wider community education about ASM was requested. In

particular, organisations would like this targeted at GPs and the acute sector to ensure more appropriate referrals. While some local work was occurring in this area, organisations advocated for a more centralised approach to this issue.

Aligning the ASM agenda with other primary care strategies: The need for better integration of the ASM agenda with other primary care strategies was highlighted. Organisations believed that ASM continues to sit outside other key strategies which created competing demands. There was a common view that ASM principles sit across all areas of health.

12.5.2 Improvements identified from the data

Following the analysis of the online survey data and the follow-up consultations, a number of areas were identified where more work may be required to further embed the ASM approach, including:

A sector-wide focus on the service coordination element of Service Closure and/or Transition would assist HACC agencies to enhance their practices in this area in line with the other service coordination elements

A greater focus on the practice areas of Interagency Care planning and Gathering information on client outcomes would be beneficial for all HACC agencies. This is supported by information gathered through the consultations, where agencies identified the need to explore ways of measuring and reporting client outcomes

While there are opportunities to support ASM work with all HACC activity types, particular focus on Property maintenance, Volunteer coordination, Café style support is required to bring these activity types in line with others in relation to stages of ASM implementation. Focus on all three practice areas in service delivery would be useful, but as means of prioritising Diversity planning and practice requires the most attention.

Overwhelmingly, one of the main barriers identified by HACC agencies remains engaging clients/carers and the broader community (including the health and medical sector) with the ASM approach. Greater attention and guidance is needed to address this issue. This finding was supported through the follow-up consultations, where agencies highlighted this as a major issue and requested further assistance with communicating the key messages and adjusting client, carer and community perceptions of the HACC program.


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12.6 Conclusions

The ASM represented a major change in policy and practice for the Victorian HACC sector. Significant change management processes have occurred within HACC agencies to meet the requirements of ASM, resulting in wide spread up-skilling of the HACC workforce and a more innovative and flexible service model. This project required the development of an online tool to collect and analysis HACC agencies progress over the past four years in implementing the ASM approach. Follow-up consultations with a sample of HACC agencies shed light on the main enablers and barriers to ASM implementation. Along with the themes emerging from the online tool, these insights have provided direction on where the Department can focus efforts in the coming 12 months to further embed ASM. Since the introduction of ASM, a wide range of policy, training and support initiatives have been provided by the Department. On the whole, these have been very well received by HACC agencies. Continued focus on workforce training and opportunities to share knowledge (through networks and Industry Consultants) were highlighted as important to sustain the progress made to date. One of the most noteworthy findings from this project was the high level of commitment to the ASM approach reported by agencies. Continuing to find opportunities to support and maintain the momentum will be important moving forward, particularly in the light of the transition to the Commonwealth. This report identifies opportunities to build on the progress made in the HACC program and to further embed the ASM approach.

asm prepare 3 year revie · final report march 2015 this project was supported with funding under...

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