Department of Human Services

Responding to People with Multiple and Complex Needs

MULTIPLE AND COMPLEX NEEDS INITIATIVELyndall Grimshaw, Manager - MACN Initiative project team

30 April 2004

Background

• Established in early 2002• History of concerns raised by service providers,

clinicians, carers, OPA, Police, Magistrates and others

• Poor service outcomes for a small but significant group with complex needs that challenge existing policy and legislative frameworks

• Service responses lacking, inadequate and clients refused services or excluded due to service eligibility requirements

• Strong stakeholder support for Project

Program Areas

• Mental Health • Disability Services, • Drug and Alcohol Services• Child Protection• Juvenile Justice• Housing and Support• Department of Justice (Office of

Corrections, Court Services, Police)

Leadership for change

• Strong support by Ministers for Health & Community Services

• Sponsorship from Secretary of DHS and Executive Director, Operations

• Steering Committee – senior departmental executives with ability to determine future cross program policy

• Reference Group – external and internal stakeholders to provide expert opinion and advice eg. OPA, IDRP,HSC, Regions, NGOs

Phase 1: research & model development

Tasks included:• Profiling target population • Detailed case studies and annualised costings• Consultations – Statewide and regional• Literature Review• Service Model development• Business Case with financial modelling and

cost benefit analysis• Legislative advice

Client Profile

• A total of 247 clients identified208 DHS directly provided or funded

services39 Corrections custodial and community

based services

• 226 are 16 years and above and are eligible to be referred to new service model

Characteristics of Client Group

• Relatively young population – 44% are 18 to 35 years.• 2:1 ratio of men to women.• Major presenting problems – combinations of mental

disorders, intellectual impairment, acquired brain injury, substance abuse.

• Behaviours present significant levels of risk to community, staff and self.

• 90% - at least one incidence of harm to self, staff and community, 47% harm for all three.

• 71% - current or past contact with criminal justice system• High volume users of emergency services.• Significant accommodation issues – 35% homeless, short

term or crisis accommodation.• 91% are socially isolated, few have regular contact with

family.• 55% have chronic health problems.

•Mental Health•Drug Treatment

•Housing & Support•Child Protection•Juvenile Justice

•Disability Services

Cross Sector

Responses

247

Majority of client service activity – specialist service system

Cross program activity – including collaborative partnerships and jointly funded initiatives

Attempts to meet multiple and complex needs across program boundaries

DHS Client Service Activity

Findings - costs

• On average, each client costs around $248,000 per annum – total cost of $56m(69% funded by DHS)

• Increasing reliance on ad hoc non-recurrent service responses

• 20% receiving tailored funding packages - $5.6m in 2001/02

• Highest cost package in 2002/03 was $643,000

• Ad hoc expenditure is not sustainable for the future

Outcomes to be Achieved

• Improved client outcomesWhile many clients will continue to have long term

and high level needsModel will assist in stabilising client and improving

health and well being

• Co-ordinated service response• Sustainable cost savings

Require alternative to escalating, high cost, ad hoc responses

A targeted, new solution will reduce costs

Service Model Objectives

A time limited intervention that:• enables stable housing,health and well

being,safety,social connectedness• provides a platform for long term

engagement in the service system• pursues planned and consistent

therapeutic goals for each client

Core Elements of Model

• Regional gateway & referral process• Multiple and Complex Needs Panel• Multidisciplinary Assessment Service• Intensive case management services

• Underpinned by legislation• Evaluation

Multiple and Complex Needs

Service Model

Existing Service System

Department of Human Services Region (Referral)

Panel

Care Plan Assessment Service

Collaborative service provision with identified lead case manager from either the

existing system or the new Intensive Case Management

agencies

123

1. Regional Gateway

• Referrals can be initiated by DHS and funded agencies, Courts, Police and Correctional services

• Provides a single point of entry / gateway• Preliminary eligibility assessment• Check existing local service system

responses insufficient• Facilitate case co-ordination if Panel referral

unnecessary• Endorsement by DHS Regional Director for

referral to proceed to Panel

2. Multiple and Complex Needs Panel

• Direct a multidisciplinary assessment and a Care Plan

• Body with status and authority• Accepts referrals from Regional Directors for

individuals 16 years and above• Panel quorum -chairperson and 2 others • Members with significant mental health, drug

and alcohol, disability and welfare experience• Capacity to co-opt other expertise as advisors• Client, family and carers to participate in

consideration of Care Plan

3. Multidisciplinary Assessment Service

• Recognises difficulty for people with multiple and/or disputed diagnoses

• All clients will receive multidisciplinary assessment – community, bed based, prison

• Complexity and duration of assessment may vary - up to 3 months

• Assessment informs development of draft Care Plan

• Assessment Service to report back to Panel

4. Intensive Case Management

• Build on existing expertise• To implement 12 month Care Plan when

existing services unable to implement and oversight Care Plan

• To address client needs in relation to:Stable housingHealth and well beingSafetySocial connectedness

• Therapeutic, clinical and treatment functions to be provided by existing services

Care Plan Coordinator

• The Panel appoints a Care Plan Coordinator• The Act specifies responsibilities to

– monitor care plan and client’s progress– coordinate services in accordance with care plan– provide review reports to Panel

• May be located in any part of existing human services (incl. public or community housing), or in new intensive case management service

• Expectation that will undertake role within existing funding arrangements

Human Services (Complex Needs) Act 2003

• To facilitate and coordinate services for eligible people with multiple and complex care needs

• Provide for a referral process • Establish eligibility criteria • Establish panel and its functions • Provide for establishment of assessment

service • Outline the assessment and care plan

development process

“The Act” cont.

• Provides express authority for disclosure of relevant personal and health information

• Provides for clients to be notified of information disclosure and procedures of the Panel

• Establishes a process for clients to communicate refusal to participate

• Provides appropriate safeguards and penalties for privacy of client information

Eligibility criteria

• A person who has attained 16 years of age; and• Appears to have 2 or more of the following:

– A mental disorder– An intellectual impairment– An acquired brain injury– Is an alcoholic or drug–dependent person; and

• has exhibited violent or dangerous behaviour that caused serious harm to himself or herself or some other person, or

• is exhibiting behaviour which is reasonably likely to place himself or herself or some other person at risk of serious harm; and

• is in need of intensive supervision and support and would derive benefit from receiving coordinated services.

Building Capacity in Existing Service System

• Existing Services will continue to be primary service providers

• Assessment Service will facilitate and Panel will determine a planned and co-ordinated response

• Specialist agencies will supplement existing service options

• Specific initiatives to support client group being negotiated with each program area

Phase 2: Implementation

• Regional gateway & referral process– Regional coordinators appointed– Operational guidelines and processes developed– Regional visits underway

• Multiple and Complex Needs Panel– Executive officer appointed since December 2003– Awaiting Cabinet & Governor-In-Council approval of Chair

and members– The Act to be proclaimed when members appointed

• Multidisciplinary Assessment Service– Consortium appointed– Staff selection underway

Phase 2: Implementation

• Intensive Case Management Response– Consortium appointed– Staff selection underway

• Evaluation– Evaluators appointed

www.dhs.vic.gov.au/complexclients