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: bpearce@vaada.org.au

Web: www.vaada.org.au