“Everything you ever wanted to know about Service Coordination” Workshop

1. “Everything you ever wanted to know about Service Coordination”Workshop Jean Crewe & Sharyn Rognrust

2. purpose of the workshop • Provide overview of Service Coordination principles • Share available resources to support Service Coordination • Explore ways of embedding Service Coordination in your agency

3. Outcome At the end of today’s session you will be able to: • Identify key Service Coordination principles • Identify available resources to support Service Coordination implementation in your agency

4. Why do we need Service Coordination? Leanne’s Story Leanne is a 59 year old woman who was diagnosed with schizophrenia in her early 20s. Leanne has been prescribed clozapine for a number of years by a psychiatrist at the local mental health clinic. She also sees a case manager at the same clinic. Leanne is unemployed and smokes around 20 cigarettes a day. She has indicated little desire to cease smoking although admits it causes a strain on her finances. Leanne describes a sedentary lifestyle and has recently been diagnosed with Type 2 diabetes. This diagnosis has caused Leanne to suffer from increased anxiety. She has a supportive family but they live across the other side of town. Leanne has a GP that she sees periodically.

5. Why do we need Service Coordination? Consumers and workers experience: • A lack of information about service system • A lack of clear and transparent referral pathways • Inconsistent practice across agencies • A lack of coordination between agencies • Inconsistent quality in providing services • Poor information sharing and feedback

6. What is Service Coordination? Service Coordination = Better Access to Services SC places consumers at the centre of service delivery to ensure that they have: • access to the services they need • opportunities for early intervention • improved outcomes

7. SC Across Government Organisations • The Victorian Health Policy and Funding Guidelines 2012–13 • Under Section 1.4health funded organisations are expected to: • provide quality service coordination and use the Service Coordination Tool Templates (where relevant) to make referrals and share consumer information • participate actively in Primary Care Partnerships, and encourage staff to participate in Primary Care Partnership activities where appropriate.

8. What are the benefits of SC? From your perspective: • improved networks • common practice standards • reduced duplication • improved waiting list management • Service Coordination aligns with accreditation standards of providing quality services

9. What are the benefits of SC? From a consumer perspective: • up-to-date information about services • timely response • the same standards of service from each agency • supported access to the most appropriate service • clear entry points and referral pathways • support to be actively engaged in the planning and delivery of services

10. Service Coordination – 13 years on

11. Service Coordination principles

12. Service Coordination principles • A central focus on consumers • Partnerships and collaboration • The social model of health • Consistency in practice standards • A duty of care • Competent staff • Engagement of other sectors • Protection of consumer information

13. Central Focus on Consumers

14. Partnerships and Collaboration

15. What is North East Primary Care Partnership? Primary Care Partnerships are established networks of local health and human service organisations working together to find smarter ways of making the health system work better, so that the health of their communities is improved.

16. The NEPCP covers the local government areas of Banyule, Darebin and Nillumbik Where are we? NILLUMBIK DAREBIN BANYULE

17. WHO ARE OUR MEMBERS? Austin Health Banksia Palliative Care Banyule City Council Banyule Community Health Dassi Darebin City Council Darebin Community Health Mind Neami Nillumbik Health Nillumbik Shire Council North East Valley Division of GP North Western Mental Health Northern Health RDNS Spectrum Migrant Resource Centre Women’s Health in the North

18. How can you be involved? • NEPCP website www.nepcp.org.au • Snippets eBulletin: fortnightly, latest news and updates • Working Groups: • Integrated Chronic Disease Collaborative • Integrated Health Promotion Network • Problem Gambling Steering Committee • Closing the Health Gap

19. Social Model of Health

20. Example Gary 34 yo, is depressed and drinking too much after the breakdown of his marriage. He is in financial difficulty after losing his job and money through gambling. He has several issues and a shared care plan is being developed. One of his goals is to gain shared custody of his two children.

21. Consistency in Practice Standards

22. Service Coordination operational elements –establishing common language

23. Establishing Common Language

24. QUIZ How well do you know the Service Coordination Tool Templates (SCTT)?

25. True OR False • The SCTT is used only for the purpose of making referrals False • It is appropriate for a consumer to be offered a copy of their SCTT True • When using the SCTT for referral purposes you are required to complete all the SCTT profiles False • GPs use the SCTT True • The SCTT is only available in paper format False • The SCTT can be used to develop a consumer care plan True

26. SCTT • Facilitates Service Coordination • Supports the collection and recording of Initial Contact, Initial Needs Identification, Referral and Shared Care/Case Planning information in a standardised way.

27. Benefits of SCTT tools Service Providers: • Know what forms are required to make referral • Can record information in consistent way • Can inform consumers about privacy of information • Can deliver consumer-centered care • Can share information electronically

28. Benefits of SCTT tools Consumers: • Screening health and social needs • Reducing the need to repeat the information • Assisting more timely access to services • Reducing duplication of assessments

29. SCTT 2012 Revision What's new?

30. SCTT 2012 Revision What's new? (cont)

31. How does SCTT fit in Service Coordination?

32. Using the right tool for the job Process The right tool for the job

33. DH Timelines • SCTT 2012 online training module available by June 2013 • SCTT 2012 embedded in electronic consumer data management systems by the end of 2013

34. A Duty of Care

35. Competent staff

36. Service Coordination On-line Learning Module Available at: http://elearning.health.vic.gov.au/scol/

37. Engagement of Other Sectors • Service Coordination embraces the broadest range of partnerships across organisation types (small to large, non-government to government etc) and across disciplines. • Partnership or inter-agency agreements are documents that record the agreed terms and conditions of collaboration between separate agencies and/or sectors. • Resource http://www.communitydoor.org.au/node/139

38. Human Services Directory • HSD aims to provide Practitioners and Service Providers with access to accurate and up-to-date information about health, social & disability services in Victoria. • http://humanservicesdirectory.vic.gov.au

39. Your Agency Information on HSD • Can people find your service? • Is your information current and correct? • Is there an assigned position in your agency to update HSD?

40. Protection of Consumer Information

41. Privacy and Consent • The privacy resources provided here are designed to assist practitioners in their discussions with consumers regarding how their information will be dealt with and have been developed in line with commonwealth and state privacy legislation. http://www.health.vic.gov.au/pcps/coordination/privacy.htm

42. Supporting publications

43. Victorian Service Coordination Practice Manual 2012 Provides a vision for Victoria’s Service Coordination and Practice A Reference Guide Consumer Outcomes & Good Practice Indicators Consumer Pathways Tools & Resources Covers Initial Contact Initial Needs Identification Assessment Care Planning Referral Available online at: http://www.health.vic.gov.au/pcps/downloads/sc_pracmanual2.pdf

44. Victorian Service Coordination Practice Standards An example of the standards for care planning Source: http://www.health.vic.gov.au/pcps/downloads/sc_pracmanual2.pdf

45. Good Practice Guide 2012 Available online at http://www.health.vic.gov.au/pcps/downloads/good_practice.pdf

46. Continuous Improvement Framework 2012 Supports organisations to monitor and improve service coordination implementation and practice Based on PDSA (Plan, Do, Study, Act) cycles of improvement Available online http://www.health.vic.gov.au/pcps/downloads/continuous.pdf

47. Service Coordination Tool Templates 2012User Guide Suite of referral templates Standardised format for collection and sharing of consumer information Supports service coordination practice Formalised documentation of consumer consent Available online: http://docs.health.vic.gov.au/docs/doc/0043138AFA564E4FCA257A5B0019239A/$FILE/1206018_SCTT_jun12_12.pdf

48. Service Coordination Survey • PCP’s annual reporting requirement to the Department of Health. • Component of the Continuous Improvement Framework that supports the Victorian Service Coordination Practice Manual

49. Purpose of the SC Survey • to identify areas that require greater focus • to inform areas of future work • 2012 Survey results: http://www.nepcp.org.au/resources/north-east-primary-care-partnership-service-coordination-survey-2012#attachments

50. Benefits for your agency • Reviewing your current practices & systems • Acknowledging areas of good performance • Identifyingopportunities for improvement in Service Coordination