Victorian AOD sector reform: Back to the future
Victorian Alcohol and Drug Association
Brad Pearce – 2014 ATDC Conference
Who is VAADA?
The peak body for funded alcohol and other drug (AOD) services in Victoria
Membership comprises health and community organisations, as well as individuals who have an interest in prevention, treatment, rehabilitation or research that minimises the harms associated with AOD use
Our vision:
A Victorian community in which the harms associated with alcohol and other drug use are reduced and well being is promoted
Guiding Principles:
1. VAADA works within a harm minimisation and evidence informed framework
2. We will undertake our work with compassion and integrity, respect and inclusion
(supports diversity and cultural inclusion)
3. We will promote stability, integration and coherence across the AOD Sector
4. We are committed to collaboration to achieve the best possible outcomes for
individuals, families and communities.
Today’s presentation
The last 15 years in Victoria…
Our system: current environment with significant reviews and reform
New priority areas & system design
Consultations…But are we being heard?
Looking forward: consumers, families, the Victorian community
& this is relevant for you because?……..
Mid – Late 1990’s
Turning the Tide (1997) was the Victorian Government’s response to the recommendations of the Premier’s Drug Advisory Council
This framework initiated the final phase of the redevelopment of specialist drug treatment services which commenced in 1994 with the closure of large government run institutions
Initiatives would significantly add to the existing network of services by filling the gaps in service provision, particularly in regional and rural locations
It aimed to inform the public debate by presenting up-to-date facts and current issues that should provide a basis for ongoing discussion and action in our community
The strategy promoted:
- Strengthening of community based approaches
- Development of Youth AOD services
- Competitive tendering
- Training for health professionals
The State Government emphasised four principles on which health and community services were to be based:
- Put people first rather than institutions or systems
- Ensure a fairer distribution of limited resources
- Obtain value for taxpayers’ funds
- Provide a better health status and outcome for all Victorians
What happened?
Victorian Auditor General (March 2011)
• Fragmented system
• Equity of access
• Quality of data collected
• Funding model
• Performance management
• ORT barriers
32 reviews and evaluations 1999-2010
Limited actioning of findings and recommendations
- Recurring themes:
Service integration
Workforce qualifications/training, career pathways
Unit pricing
Design of ORT system
Key ingredients of the current reforms…
Election of the current Liberal government in late 2010
A Minister that is engaged, understands community consultation and had a clear sense of what government needs to achieve
Reforms align with the Victorian Health Priorities Framework (2012-22)
Service Sector Reform: A roadmap for community and human services reform (Peter Shergold)
- Promotes diversity, but strength is size
Services Connect (housing, disability, child protection, youth and families)
WOVG AOD strategy
An AOD sector that has for a long time called for change
Current system: What's really going on?
8 Department of Health regions
Over 20 different funded treatment types
105 funded agencies
Approximately 30,000 clients in treatment system
53, 574 closed treatment episodes (2011-12)
Alcohol most common principal drug of concern in closed episodes – 45%
Counselling most common type of treatment -54% of closed episodes
14, 000 pharmacotherapy clients (2012)
New system priority areas
1. A simpler system: centralised access, fewer treatment streams, simplified funding model
2. Integrated services: local area planning, links with other systems, holistic provision
3. A strong, capable workforce: learning and professional development, promoting leadership
4. Quality service provision: principles, tools and mechanisms to enhance quality
5. Accountability for outcomes: from outputs to outcomes, a new performance framework
6. Information management: increased capabilities with long term technology solutions
How will the reforms impact?
Stage 1: Adult non residential services
Competitive process
Partnerships, consortiums, mergers
Recovery oriented
Shift from outputs outcomes
Redeveloped catchments
Consultations with the sector
Reduction in treatment types
Centralised intake & assessment
Activity based funding model
Workforce strategy
Consultations
The language is very much geared towards co-design and co-development
In many ways it was a strategy to encourage the sector to engage and feel comfortable…but it seems many are unsure of our role in decision making
VAADA functions as the peak… - Advisory groups on all new treatment types - Principles of treatment - Facilitated discussions with various groups - Exploring how national projects intersect with state reforms - Surveys gauging implications of change - Transition program activities
How have the voices of service users and families/significant others been
heard
The new treatment types
Centralised intake and assessment
Central state wide access point and local catchment based intake and assessment units
Counselling
Face-to-face, online and telephone. Classified as standard or complex
Care and recovery coordination
In each catchment and can assist the person throughout their treatment journey if required
Withdrawal
Consolidates home-based, outpatient, rural and residential into resi and non-resi
Residential rehabilitation
Therapeutic communities. Second stage of recommissioning. Will look at flexible models that vary in terms of intensity, service mix and length of stay.
Pharmacotherapy
Development of five area based networks
Intake and Assessment
Centralised intake and assessment function
Regional hubs to become key in each catchment
Common screening and assessment tool
Adapted to various target groups (Aboriginal, forensic, youth, pregnancy)
Self help online screening and support
Bed vacancy register
This new approach will require services to respond differently
Activity based funding model
Funding capped for voluntary clients in each catchment
Some capacity for extra funding for forensic clients
20% flexibility across funded activities
Loading for forensic clients (15%) and Aboriginal clients (30%)
Catchment based planning function - $48,000 per year
All prices are intended to cover direct costs, fixed costs and overheads.
Drug Treatment Activity Unit (DTAU) Price (2013/14) $ 644
Product: DTAUs Per Unit Of Activity (Weighting):
Price: 2013-14
Intake & Referral – Phone Contact (Completed Referral)
0.091 $ 58.60
Intake & Referral - Face To Face (Completed Referral)
0.091 $ 58.60
Intake & Referral - Via Internet (Completed Referral)
0.072 $ 46.40
Comprehensive Assessment & Initial Treatment Plan (Comprehensive Assessment & Initial Treatment Plan)
0.781 $ 503.00
Care & Recovery Coordination (Course Of Coordination)
2.222 $ 1431.00
Counselling – Standard (Course Of Counselling)
0.91 $ 586.00
Counselling – Complex (Course Of Counselling)
3.414 $ 2198.60
Withdrawal - Non Residential - Standard (Course of Withdrawal)
0.849 $ 546.80
Withdrawal - Non Residential - Complex (Course of Withdrawal)
2.124 $ 1367.90
Equation: DTAU x Weighting = Product price
Pharmacotherapy
Community based prescribers and dispensers
5 specialist clinics
6% of GPs prescribe. Of these, very few hold vast majority of permits
Recent policy changes allowing non trained GPs to prescribe bupe/naloxone combination to up to 5 patients
First stream to undergo reform
Five area based networks
Redeveloped training program for GPs and pharmacists
Workforce Strategy
Objectives:
1. People – recruitment and retention
2. Place – geographic distribution
3. Environment – positive, leadership, culture of collaboration
4. Performance – competently skilled
Challenges and opportunities:
- Attracting a qualified workforce
- Workforce development
- Career pathways
- Peer workforce
- Harnessing new technologies
Current examples:
- Change Agent Network
- Workforce Study
Other activities supporting the changes
Developmental projects:
Performance management framework
Demand modelling
Client management systems
Data collection and reporting
Stage 2:
Youth and adult residential services
Selection of preferred providers
Call for submissions late 2013
Call for High Level Delivery Plans March 2014
Approved providers to be determined mid May
Funding and service agreements negotiated
New system to begin August 1st
Challenges related to transition. Namely: Available timelines Staffing changes Client records Ceasing of business Establishment and infrastructure
Considerations for Implementation
VAADA supported gradual change, but complete reform was opted for
It’s essential to manage such significant changes effectively
Some other important contextual considerations - Community Mental Health System - Medicare Locals - Corrections Victoria sentencing reforms
Do competitive processes have long term impacts on relationships? Does reform ensure a client centred approach to service delivery? Will the focus on consortia address fragmentation? Does activity based funding address ‘gaming’ of the system? Can diverse data collection programs address planning needs?
Will this process ensure we are not being set up for the next major
reform?
Thank You
Further Information
Brad Pearce
Phone: (03) 9412 5600
Email: [email protected]
Web: www.vaada.org.au