Department of Human Services

Multiple and Complex Needs Initiative

Responding to Complexity – The Multiple and Complex Needs Initiative Lyndall Grimshaw, Manager MACN Initiative

Centre for Public Policy, 31 May 2005

Context for change – the drivers

• History of concerns - raised by service providers, clinicians, carers, Office of Public Advocate, Police, Magistrates and others

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

• Poor service responses - lacking, inadequate, fragmented and individuals refused services or excluded due to service eligibility requirements

• Significant public expenditure with limited impact – access to funding has not necessarily led to better outcomes

Context for change - Leadership and ‘champions’

• Support from Ministers for Health & Community Services

• Sponsorship from Secretary of DHS• 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

Context for change - Sponsors

The MACN Initiative involves:• Department of Human Services

Mental Health Disability Services Drug and Alcohol Services Child Protection Juvenile Justice Housing and Support

• Department of Justice

Research to inform direction

Phase 1 Tasks (2002-2003) included:• Profiling target population • Detailed case studies and annualised

costings• Consultations – Statewide and regional• Literature Review - international• Service Model development• Business Case with financial modelling and

cost benefit analysis• Legislative advice

•Mental Health•Drug Treatment

•Housing & Support•Child Protection•Juvenile Justice

•Disability Services

Cross Sector

Responses

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

247

Findings - Characteristics of profiled individuals

• Relatively young population – 18 to 35 years • 2:1 ratio of men to women• Combinations of mental health, intellectual disability,

acquired brain injury, substance abuse• More than half had chronic health problems• High volume users of emergency services• Significant accommodation issues – 35% homeless, short

term or crisis housing• 91% were socially isolated, few had regular contact with

family• High rates of harm and high risk to self, staff and

community• High rates of contact with criminal justice system

Findings – characteristics of service response

• Responses - often crisis driven, unplanned and unco-ordinated

• Assessment - fragmented, incomplete or resulted in multiple and/or disputed diagnoses

• Lack of comprehensive cross sector planning • Increasing reliance - on one-off

accommodation, intensive support and supervision responses at high cost

Model development - considerations

• Strong external stakeholder pressure to compel individuals to participate

• Early model development included a residential treatment facility

• Existence of legislative, policy & program silos• Focus on building capacity in the existing

service system• Supporting a culture of change and active

learning

Facilitating Change - Core elements of MACN Model

• Human Services (Complex Needs) Act 2003- voluntary, provisions for information sharing, unique eligibility criteria eg. intellectual impairment

• Regional gateway & referral process- new co-ordinator position created in each region, regional cross program mechanisms established, problem solving focus

• Multiple and Complex Needs Panel- highly experienced & credible membership, external perspective, leverage

Facilitating Change - Core elements of Model

• Multidisciplinary assessment and care planning service- Initiative in microcosm, community development approach of central team

• Intensive case management service- modelling better practice, mentoring, respite

• Three year independent Evaluation- influence, impact, contribute to evidence base

• Central Initiative Team- strategically plan, guide & support the Initiative

Multiple and Complex Needs

Service Model

Existing Service System

Department of Human Services Region (Inquiry, Consultation,Referral)

MACN Panel

(Eligibility, Care Plan, Care Plan Coordinator, Care Pan Review)

Care Plan

Assessment & Care Planning ServiceCollaborative service provision with identified

lead case manager from either the existing system or the new Intensive Case

Management Service

3

2

4

5

1

Outcomes

• Improved individual outcomesstable housing,health and well being, social

connectedness & safetya platform for long term engagement

• Co-ordinated Service Response

• Effective & efficient expenditure of public monies

Initial Achievements

• Service model is operational• Successful prioritisation strategies

developed between Depts. of Human Services and Justice

• Consistent entry point & pathway across the state

• Effective targeting reflected in high level of appropriate referrals

Initial Achievements

• Value-adding role of regional co-ordinators in facilitating cross program problem solving

eg. early data analysis indicates approx. 30% of eligible matters are being resolved at the regional level

• All regions have introduced (or enhanced) cross program mechanisms to improve service responsiveness & co-ordination

• Balancing, and at times moderating, the expectations of a diverse range of stakeholders

Early Regional Data Analysis – April 2005

Figure 2. Comparison - Total Inquiries, Consultations and Referrals November 2004, March 2005 and April 2005

101

77

37

109

127

51

113

134

52

0

20

40

60

80

100

120

140

160

Inquiries Consultations Referrals

November

March

April

Early Regional Data Analysis – April 2005Of the 21 referrals endorsed by Regional Directors:• 10% appear to meet all four conditions

• 43% appear to meet three conditions 10% mental disorder and ABI

• 47% appear to meet two conditions 34% mental disorder, ABI and substance

abuse 33% mental disorder, ABI and intellectual impairment 11% ABI, intellectual impairment and substance abuse

Reflections

Complexity? Whose complexity? Local service response – implications re-approx. 30%

resolved at regional levelService system divided by categories of conditions &

needs Limited knowledge base – re- understanding & responding

to impact for an individual of living with multiple conditions & disadvantage

Managing change is a sophisticated exercise

The Initiative is a step in the right direction

To find out more

• For detailed information about the Initiative:

www.dhs.vic.gov.au/complexclients