Adult community based alcohol and other drug service provision review

While there are a lot of dedicated providers in the alcohol and other drug (AOD) service system who work hard to achieve outcomes for clients, a range of external reviews - including the Aspex Review - found that the current system can create barriers for clients to access services.

Joining assessment with treatment will mean treatment providers can build therapeutic relationships with clients earlier. This will improve client experiences by improving engagement and reducing the number of times they have to tell their story.

The department has worked closely with the sector to identify new arrangements that will improve access to treatment and maximise the benefits to clients while being the least disruptive for clients and the sector. The new arrangements:

• maintain a statewide approach to client pathways
• recognise that assessment is an important part of building the therapeutic relationship and thus needs to be conducted by treatment providers
• retain an intake function that allows for clear points of access for eligible drug treatment clients
• create a faster pathway for clients to access treatment providers and reduce disruption in care pathways
• minimise the change in funding and service delivery required to achieve the policy change
• minimise the number of providers affected
• are expected to improve capacity for face-to-face assessment provision.

Catchment-based intake services will continue to provide catchment oversight and monitoring. Under the new arrangements, treatment services will continue to provide completed assessment information to catchment-based intake services.

It is expected that the majority of new clients will continue to present to catchment-based intake services first.

Under the new arrangements, initial intake and triage is expected to be streamlined. Through funding flexibility, treatment services have always been able to directly accept clients first presenting to them. The new arrangements mean that treatment services will gain funding and service delivery targets for assessment.

A key reason for transitioning to the new arrangements is to ensure that accessing AOD treatment will be simple and easy, no matter which pathway a client chooses.

Retaining a catchment-based intake point will give clients and service providers the benefit of knowing what options they have for treatment, providing them with real choice.

Catchment-based intake services will continue to work closely with treatment providers to make sure that referrals are managed well and relevant information is shared. This will ensure that clients get a high-quality, joined-up service response.

The new intake and assessment arrangements will be achieved through a policy change, rather than through a competitive tender process.

Some tools, systems and processes will change to support the new arrangements, though core service requirements will remain the same.

New program guidelines have been released to provide greater clarity and guidance to the AOD sector on service delivery expectations.

During recommissioning, the department had limited ability to communicate with the sector due to probity requirements. As no competitive tender is being undertaken, the department is able to communicate strongly with providers throughout the change process. Providers of publicly funded services will continue to be able to contribute to service and process design.

There will be greater cross-sectoral collaboration and consideration of achieving joined-up client pathways, particularly with mental health and family violence sectors.

The department will work with other sectors including general practitioners (GPs) to ensure that information about the changes is available.

There will continue to be catchment-based intake services in rural areas. This will allow clients to access assessment at a wider range of adult community-based AOD treatment providers.

The Australian Community Support Organisation (ACSO) will continue to deliver a high-quality intake service and provide specialist support to people who are waiting for assessment and treatment in rural areas.

Retaining a common provider for the intake function across multiple rural catchments promotes consistent, high quality care for rural Victorians wherever they live. It ensures best use of available alcohol and drug treatment services for all rural Victorians who need them, prioritising those with the greatest need.

Under the new assessment arrangements, catchment-based intake providers and existing local access points will be retained. This will reduce confusion for clients as they will not have to learn new entry points. Retaining catchment-based intake services improves equity of access to treatment by prioritising vulnerable and at-risk clients.

The streamlined intake and triage process is expected to be easier for vulnerable clients, and will enable them to access appropriate treatment faster.

One of the key drivers for the change was to allow clients to undertake comprehensive assessment and treatment planning with their treatment provider (e.g. a counsellor). This aims to allow clients to build a relationship with a treatment provider earlier and hopefully reduce the number of times they have to tell their story.

A factsheet for clients is available from the Downloads section on this page. It explains what the new arrangements will look like, and where clients can go for more information.

There will be no change to overall funding for the sector as part of these changes. There will be no change to the total amount of funding available for intake or for assessment, and there will be no change to the amount of funding that is available in each catchment.

Consistent with directions identified in the Aspex Review, responsibility for conducting comprehensive assessment and treatment planning will move from intake providers to treatment providers. Treatment services that were recommissioned in the 2014 recommissioning reforms will receive funding to deliver comprehensive assessment and treatment planning for voluntary clients.

Analysis of recent intake and assessment data indicates that 35 per cent of the current function funding is being used to provide the combination of intake, bridging support, brief interventions and single sessions. An additional five per cent has been added to this to ensure capacity for screening and referral.

This means that in total 40 per cent of the intake and assessment function funding would remain with intake services to deliver intake, screening, brief interventions and bridging support up until the client's assessment.

The remaining 60 per cent of the current intake and assessment function funding will be distributed amongst treatment providers to deliver comprehensive assessment, including treatment planning.

As the majority of intake providers also provide treatment services, the impact of the funding changes will be minimised in several catchments.

The Department of Health & Human Services will be working closely with the sector to progress implementation of these changes from 1 July 2017.

The department will work closely with affected providers to manage the transition impacts on affected organisations.

The new streamlined intake function reaffirms the department’s commitment to catchment-based intake as the primary entry point to the AOD service system.

Catchment-based intake supports a consistent state-wide approach to accessing treatment, and allows intake services to improve equity by consistently prioritising clients according to need.

Under the new arrangements, catchment-based intake services will work closely with the state-wide screening and referral service and other treatment providers. Using the department-endorsed intake tool and clinical judgment, intake services will facilitate client intake, triage, and referral to treatment, including the use of brief interventions and bridging support as required. They will also support families and significant others of people with AOD issues.

Intake services will continue to provide local knowledge to support client pathways to all Victorian services, including youth, adult, residential and non-residential, state and Commonwealth-funded AOD services.

Catchment-based intake services will maintain records of client flow across the entire catchment in order to understand the capacity of services to which intake and assessment refer. Understanding service level capacity will inform the pattern and volume of referral from intake to treatment and support services.

It is expected that local services will work together to agree on options for facilitating access to intake services for walk-in clients. Flexibility will remain for treatment providers to conduct direct intake for clients requiring a face-to-face service where urgent need exists. Where intake is conducted by treatment providers, services should ensure that information is shared with the catchment-based intake provider to enable capacity monitoring and support client movement through the AOD service system.

The new program guidelines provide further clarity on the department’s expectations of intake providers.

Under the new arrangements, assessment is conducted by treatment services to enable therapeutic treatment relationships to begin at the point of assessment. Where possible, the assessment should be conducted by a clinician who is appropriate for the client’s ongoing treatment to reduce 'extra steps' in a client’s treatment journey.

In most instances, client flow will be directed through the catchment-based intake service. Assessment providers will work closely with catchment-based intake services, the state-wide screening and referral service, and other treatment providers to facilitate comprehensive assessment and treatment planning.

Assessment providers will use the department-endorsed comprehensive assessment tool and clinical judgement as a basis for determining the level and type of treatment required. Information collected through intake, conduct of the comprehensive assessment, identified treatment needs, and the client’s own preferences will inform the development of an initial treatment plan.

The assessment function supports client pathways to all Victorian services, inclusive of youth, adult, residential and non-residential, Aboriginal, state and commonwealth-funded AOD services. This whole-of-system picture of treatment availability enables prioritisation and referrals to be made according to client’s needs, rather than client pathways being based only on relationships between service providers.

There may be cases where the comprehensive assessment reveals a client requires (or prefers) treatment services delivered by another provider. In order to refer appropriately, assessment providers should work with catchment-based intake services to understand the AOD treatment system and the range of available services both within their catchment and at a state-wide level where relevant.

To enable capacity monitoring and support client movement through the AOD service system, treatment services should provide, with the appropriate consent, client summaries to the original referral source, the catchment-based intake service, as well as the services the client has been linked with.

The new program guidelines provide further clarity on the department’s expectations of assessment providers.

The Australian Community Support Organisation’s (ACSO) Community Offenders Advice and Treatment Services (COATS) program will remain the provider of intake and assessment services for the majority of forensic clients. This includes all clients referred through Community Corrections and the Adult Parole Board.

Following intake and assessment by ACSO COATS, forensic clients will be referred to a treatment provider for ongoing treatment and support, drawing on the initial treatment plan developed following the comprehensive assessment.

Catchment-based intake services will continue to provide intake, triage, bridging support and brief intervention services for diversion clients. These include people referred by Victoria Police through the Drug Diversion Appointment Line (DDAL), the Magistrates’ Court, and other clients seeking treatment to address the AOD-related offending behaviour.

Assessment for diversion clients will take place by all treatment providers following referral from a catchment-based intake service. Assessment providers will use the department-endorsed comprehensive assessment tool and clinical judgement as a basis for determining the level and type of treatment required.

Catchment-based intake services and assessment providers use department-endorsed tools and clinical judgement to identify and respond to a client’s treatment and support needs.

Providers must consider offering:

• Bridging support, which is a form of regular contact that aims to support client engagement, retention, motivation and stability while clients wait for assessment and treatment.
• Brief interventions, which focus on providing education and advice to achieve a short-term reduction in harm associated with AOD use. Brief interventions may include crisis intervention, harm reduction measures, relapse prevention planning, and support for co-occurring issues, such as mental health.
• Single and family sessions, which are sessions of consultation or courses of counselling provided to support family members or significant others.

Similar to the initial treatment planning sub-product, bridging support, brief interventions, and family single sessions are recorded as additional activity lines within the intake, assessment, counselling and withdrawal functions. Agencies should report such activities to the department under each of the completed activity sub-products. For example, the assessment activity target can be met through reporting a combination of the comprehensive assessment and initial treatment plan, brief intervention, bridging support, and family single sessions.

While the Drug Treatment Activity Unit (DTAU) pricing has been derived from an average length of a course of treatment across the entire client group, there is no set number of contacts, sessions or hours that equate to a course of treatment being completed for an individual client. Agencies should provide as much treatment as is required for each client and are expected to adjust the duration and intensity of the treatment response to meet the complexity of the client’s presentation.

Part 3 of the new program guidelines provides further clarity on the funding provided to service providers.

To support client movement through the system, intake services and treatment services should provide, with the appropriate consent, client summaries to the original referral source. This includes catchment-based intake service providing information back to the original referral source (such as a GP) and the treatment service providing information back to the catchment-based intake service on the treatment and support that the client has been linked with.

A ‘client summary’ is information provided in connection with the further treatment of a client, with client consent and within relevant legislative obligations. For example, a client summary provided with a referral from a catchment-based intake service to an assessment provider may include information on the treatment needs and preferences of a client. A client summary provided by a treatment service to a client’s GP on their completion of a course of treatment may include information about a client’s progress or their achievement of significant treatment goals.

Local protocols and agreements between referring and receiving services will support this process.

The new program guidelines provide further clarity on the department’s expectations of intake providers and assessment providers.

There will be no change to overall funding for the sector as part of these changes. There will be no change to the total amount of funding available for intake or for assessment, and there will be no change to the amount of funding that is available in each catchment.

Consistent with directions identified in the Aspex Review, responsibility for conducting comprehensive assessment and treatment planning will move from intake providers to treatment providers. Treatment services that were recommissioned in the 2014 recommissioning reforms will receive funding to deliver comprehensive assessment and treatment planning for voluntary clients.

Analysis of recent intake and assessment data indicates that 35 per cent of the current function funding is being used to provide the combination of intake, bridging support, brief interventions and single sessions. An additional five per cent has been added to this to ensure capacity for screening and referral.

This means that in total 40 per cent of the intake and assessment function funding will remain with intake services to deliver intake, screening, bridging support, brief interventions and single sessions up until the client's assessment.

The remaining 60 per cent of the current intake and assessment function funding will be distributed amongst treatment providers to deliver comprehensive assessment, including treatment planning.

As the majority of intake providers also provide treatment services, the impact of the funding changes will be minimised in several catchments.

The department will work closely with service providers, particularly those most significantly affected, to ensure a smooth transition to the new arrangements.

Each catchment-based intake service has a minimum allocation of 10 per cent of all intake DTAU funding for forensic clients.

Forensic targets for assessment will be covered under the existing requirement of a 20 per cent forensic treatment target at the consortium level.

Each directly funded agency/consortium has a notional allocation of at least 20 per cent of all DTAU funding to treat forensic clients referred to adult non-residential AOD services. A referral should be made directly to the agency lead who will then allocate clients to an agency within their consortium and to allow each consortium to manage their available resources flexibly to meet demand.

Should a consortium exceed the notional allocation of 10 per cent DTAU for forensic intake or the 20 per cent DTAU for forensic treatment and prepayment for adult non-residential in any quarter, ACSO will pay an additional fee for each service. This will be provided to the consortium lead based on the forensic unit price for the particular product.

Referrals do not have to be evenly distributed between member agencies if there are varying levels of expertise, experience, preference and/or capacity.

While there will be no change to the total amount of funding available to the sector as part of these changes, changes will be made to service agreements (including statements of priorities) to reflect the new service delivery arrangements and associated funding and targets.

The delivery of and funding for activity number 34302: Intake and Assessment will cease on 30 June 2017.

From 1 July 2017, two new activity numbers will be created:

• activity number 34306: Intake
• activity number 34307: Assessment.

Under the intake activity, catchment-based intake services will continue to receive funding and targets to deliver intake, triage and screening, brief interventions and bridging support up until the client’s assessment.

Under the assessment activity, treatment services will receive funding to deliver comprehensive assessment and initial treatment plans (assessments) for voluntary clients. Treatment services will also deliver bridging support and brief interventions to clients from the point of assessment.

The department has delivered formal written notice to funded providers to confirm the revised service delivery arrangements and associated funding and targets to take affect from the 2017–18 financial year.

The Alcohol and Drug Information System (ADIS) and the supplementary DTAU spreadsheet will be updated to reflect the new intake and assessment arrangements and associated activity numbers (see the service agreements changes above), effective 1 July 2017.

ADIS and the supplementary spreadsheet reporting arrangements will remain in place until organisations transition to the new Alcohol and Drug Collection (VADC).

During transition, the department’s primary focus is on ensuring stability and service continuity, so clients continue to get the help they need. This can be achieved if everyone works together.

To support a smooth transition to the new service delivery arrangements, the department has worked closely with the sector to develop a transition plan to support clients, service providers and workers, available for download below.

Central and operational division offices of the department have committed to closely monitor the implementation process to ensure service continuity for clients and to reduce the likelihood of unintended consequences, such as increases in wait times or inappropriate referrals to treatment services. As the impact of the changes will be felt differentially across catchments and providers, the department will take a flexible approach to transition support, engaging through regional managers to understand any significant impacts that might be felt at a local level.

Operational division contacts are meeting individually with providers, in particular those who will be gaining assessment responsibilities, to discuss the changes and prepare for transition. Over the transition period providers are encouraged to provide feedback to operational division contacts about their experience of the transition process and to discuss any adjustments that can be made at a local level to support the change.

Beginning on 31 May 2017, the department will host a series of state-wide intake and assessment implementation monitoring workshops. These workshops will give providers an opportunity to collaborate, explore emerging issues and provide feedback on the transition progress. These forums will be supplemented by regular teleconferences between central office and intake providers, to be held from mid-June to late July.

After the reforms have had time to bed down, the department will review whether the funding allocations for the assessment and intake functions continue to be appropriate to support the new arrangements.

The department will continue to provide regular updates on the transition, and other projects underway that support these changes to the sector via a range of media including the health.vic.gov.au website, newsletters and VAADA E-News.

The Adult Community-Based Alcohol and Other Drug Sector Reference Group will continue to meet in 2017 to oversee ongoing progress in responding to the Aspex Review, including providing ongoing feedback to the department about the transition process. The department will also look to harness existing forums, such as the Change Agent Network and communities of practice, to aid the flow of information.

The department is committed to providing strong, ongoing communication across the transition period, and has developed a number of resources to provide greater certainty and consistency leading up to the commencement date.

A Transition and implementation plan, developed through working closely with the sector, is available for download below.

New Alcohol and other drugs program guidelines were released in April 2017. In addition to refreshing current program and service descriptions and requirements, the guidelines have been updated to describe the objectives and functions of the treatment system under the new arrangements. The guidelines will apply from 1 July 2017, when the new arrangements commence. More information is available via the Guidelines page.

In addition, the department has created a series of factsheets to communicate the changes with:

• clients
• the AOD workforce
• state-wide and non-recommissioned AOD services
• referrers, such as GPs, community health services, local hospitals and other specialist providers.

The factsheets highlight key information in the guidelines and can be used by anyone to find out what the new arrangements will look like, and where to go for more information. They are available for download below.

The department will continue to provide regular updates across the coming months, including uploading further answers to key questions on this web page.

Important work continues on a number of other fronts to support reform. This includes:

• Reviewing and improving AOD screening and assessment tools and processes to improve the efficiency of client intake and to better respond to clients' needs – with workforce training to be delivered by Turning Point from June to August 2017.
• Improving the way the department collects data to improve data quality and reduce the reporting burden for service providers – the VADC Data Specification (v1.0) was released in April 2017.
• Developing Alcohol and other drugs program guidelines in collaboration with the sector to provide clarity about the department's expectations of state-funded providers – released in April 2017, the department will work with service providers to update the guidelines’ content as required.
• Developing a new performance management framework to tackle some of the issues the sector has identified and to outline the department's approach to managing the performance of state-funded providers.
• Developing an AOD workforce strategy that will support workforce development into the future - work on the new strategy commenced in April 2017.