PRIMARY MENTAL HEALTH CARE MINIMUM DATA SET - … · INFORMATION PAPER PRIMARY MENTAL HEALTH CARE MINIMUM DATA SET Overview of purpose, design, scope and key decision issues 16 SEPTEMBER

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PRIMARYMENTALHEALTHCAREMINIMUMDATASET

Overviewofpurpose,design,scopeandkeydecisionissues

16SEPTEMBER2016

FordetailsonthePMHCMDSgoto:https://www.pmhc-mds.com/

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VersionHistory

Date Details17June2016 VersionpreparedforinitialconsultationwithPHNPMHCMDSReference

Group8July2016 VersionreleasedforPHNconsultation

16September VersionpreparedtoaccompanyreleaseofV1.0ofPMHCMDSspecifications

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TABLEOFCONTENTS1. PURPOSE.............................................................................................1

2. BACKGROUND......................................................................................1

2.1 Primarymentalhealthcarereforms.........................................................................12.2 Keyperformanceindicators......................................................................................22.3 Minimumdatasetspecifiedasrequirementoffundingschedules..........................3

3. OVERVIEWOFTHEPMHCMINIMUMDATASET..............................................3

3.1 Designprinciples........................................................................................................33.1.1 Minimumdatasettomeetarangeofpurposes...............................................33.1.2 Scope–activitiesincludedandexcluded...........................................................43.1.3 BuiltonexistingATAPSfoundation....................................................................53.1.4 Flexibilitytoincorporateemergingrequirements............................................5

3.2 Thedatatobecollected...........................................................................................53.3 Datamodel................................................................................................................63.4 ComparisontocurrentATAPSsystem.......................................................................83.5 WhatthenewarrangementsmeanforPHNsandcommissionedserviceproviders 93.6 Timelines...................................................................................................................93.7 Consultationprocess...............................................................................................10

4. KEYDESIGNISSUES...............................................................................11

4.1 Definingepisodes....................................................................................................114.2 Identifyingandclassifyingcommissionedepisodesofcaretoenablemonitoringof

policyimplementation.............................................................................................124.3 Howsuicidepreventionactivitywillbemanagedinthecollection........................164.4 Determiningwhatactivitiesareinscopeforreportingasservicecontacts............164.5 Classifyingtypesofservicesdeliveredateachservicecontact...............................184.6 Diagnosiscoding......................................................................................................194.7 Selectingcoreoutcomemeasures...........................................................................22

ATTACHMENTA:PRIMARYMENTALHEALTHCAREMINIMUMDATASET–DATA

ELEMENTSSUMMARY..................................................................................25

ATTACHMENTB:DRAFTDEFINITIONSFORSERVICETYPE.......................................28

ATTACHMENTC:DIAGNOSISLISTUSEDINPMHCMDS.......................................31

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1. PURPOSEThispaperoutlinestheapproachtakentothedesignofthePrimaryMentalHealthCareMinimumDataSet(PMHCMDS)andassociatedreportingarrangementstobeimplementedacrossallPrimaryHealthNetworks(PHNs).ThePMHCMDSarrangementswillprovidethebasisformonitoringandevaluationofprimarymentalhealthcareservicescommissionedthroughthePHNsflexiblefundingpool.Theywilldothisby:

• definingthecommondatatobecollectedinrelationtoallmentalhealthservicescommissionedbyPHNs;

• settingstandardsforhowthevariousdataitemsaredefined;and• specifyingtherequirementsfornationalreporting.

ThePMHCMDSdatareportedthroughPHNswillformthebasisforproductionofkeyperformanceindicatorsusedtomonitorservicesdeliveredacrossthe31PHNregionscoveredbyPHNs.Summarydetailsoftheseindicatorsareincludedinthecurrentpaperandhavebeenmorefullydocumentedinaseparatepaper.1

ThispaperprovidesanoutlineofwhatthePMHCdatasetandreportingarrangementswillentail.ThefinalsectionofthepaperdescribescriticaldecisionpointsinthedesignofthecollectiononwhichfeedbackwillbesoughtfromPHNsviathePMHCMDSReferenceGroup.

2. BACKGROUND2.1Primarymentalhealthcarereforms

FundinghasbeenprovidedtoPrimaryHealthNetworks(PHNs)throughaPrimaryMentalHealthCareFundingPooltosupportcommissioningofmentalhealthandsuicidepreventionservicesinsixkeyservicedeliveryareas:

• lowintensitypsychologicalinterventionsforpeoplewith,oratriskof,mildmentalillness;

• psychologicaltherapiesdeliveredbymentalhealthprofessionalstounderservicedgroups;

• earlyinterventionservicesforchildrenandyoungpeoplewith,oratriskofmentalillness;

• servicesforpeoplewithsevereandcomplexmentalillnesswhoarebeingmanagedinaprimarycaresetting;

• enhancedAboriginalandTorresStraitIslandermentalhealthservices;and

1PerformanceindicatorsforPrimaryHealthNetwork-ledmentalhealthreform:DraftspecificationsforreportingbyPrimaryHealthNetworks.MentalHealthReformTaskForce,DepartmentofHealth

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• aregionalapproachtosuicidepreventionactivitieswithafocusonimprovedfollow-upforpeoplewhohaveattemptedsuicideorareathighriskofsuicide.

ThePMHCMDSisdesignedtocaptureservicedeliveryacrossallsixareas.

2.2Keyperformanceindicators

Asetof11keyservicedeliveryperformanceindicators(KPIs)hasbeenspecifiedformonitoringoveralldeliveryofservicescommissionedbyPHNs,coveringfourperformancedomains–access,efficiency,appropriatenessandeffectiveness(Figure1).

Figure1:Servicedeliveryperformanceindicatorsandassociatedperformancedomains

PERFORMANCEINDICATORNumberofperformanceindicators

PERFORMANCEDOMAIN

Access

Efficiency

Approp

riatene

ss

Effectiven

ess

ProportionofregionalpopulationreceivingPHNcommissionedmentalhealthservices:

• Lowintensitypsychologicalinterventions• Psychologicaltherapiesdeliveredbymentalhealth

professionals• Clinicalcarecoordinationforpeoplewithsevereand

complexmentalillness

3 ▲

AveragecostofPHNcommissionedmentalhealthservices:


professionals• Clinicalcarecoordinationforpeoplewithsevereand

complexmentalillness

3 ▲

ProportionofregionalyouthpopulationreceivingPHNcommissionedyouth-specificmentalhealthservices 1 ♦ ▲

ProportionofPHNcommissionedmentalhealthservicesdeliveredtotheregionalIndigenouspeoplewheretheserviceswereculturallyappropriate

1 ♦ ▲

ProportionofpeoplereferredtoPHNcommissionedservicesduetoarecentsuicideattemptorbecausetheyareatriskofsuicidefollowedupwithin7daysofreferral

1 ♦ ▲

ClinicaloutcomesforregionalpopulationreceivingPHNcommissionedmentalhealthservices:


professionals

2 ▲

▲ Primarydomain ♦Secondarydomain

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TheperformanceindicatorshavebeenspecifiedonthepremisethatacomprehensiveprimarymentalhealthcaredatasetisdevelopedandreportedbyallPHNcommissionedservices.

2.3Minimumdatasetspecifiedasrequirementoffundingschedules

FundingschedulesdevelopedtoprovidementalhealthfundingtoPHNsstipulatethereciprocalobligationsoftheDepartmentandPHNorganisationsinthedevelopmentandreportingofthenewPMHCMDS.Theschedulesrequire:

• theDepartmenttodevelopspecificationsforthePMHCMDSandestablisharrangementsforreportingofdatabyPHNsbyDecember2016,usingasafoundationthepreviousdatacollectionandreportingarrangementsestablishedfortheATAPSandMHSRRAprograms;

• theDepartmenttoundertakethisworkinconsultationwithPHNstoensurethatallmandatorydataarebothrelevanttomonitoringachievementofkeyobjectivesandfeasibleforreporting;and

• PHNstoensureallmandatorydataarereportedtothePMHCMDS,achievingfullcompliancewithreportingby30June2017.

3. OVERVIEWOFTHEPMHCMINIMUMDATASET

3.1Designprinciples

3.1.1 Minimumdatasettomeetarangeofpurposes

ThePMHCMDSisdesignedtomeetanumberofregionalandnationalpurposes.Attheregionallevel,thecollectionisaimedatsupportingtheroleofPHNsby:

• providingthebasisformonitoringservicedeliverybycommissionedorganisationsacrossthekeyperformancedomainsandinformingjudgementsaboutoutcomesandvalueformoney;

• supportingongoingregionalneedsanalysisandplanningbyidentifyingservicecoverageandpotentialgaps;

• providingmeaningfuldataforbenchmarkingbothwithinacrossregionstosupporttargetedregionalservicequalityimprovementinitiatives;

• establishingabasecollectionforlocalprogramevaluationsthatcanbeaugmentedbyadditionalpurpose-specificdata;and

• informingcommunicationwithregionalstakeholderandthebroadercommunitybasedoninformationthatiscomparabletootherregions.

ThePMHCMDSdoesnotconfinePHNstothedataspecified.Rather,itsetstheminimumandcommongroundforwhatdataaretobecollectedandreportedforservices

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commissionedbyPHNs.ItisanticipatedthatmanyPHNswillseektocollectanenhancedsetofdatatomeetlocalneeds,howeverthisdatawillnotbesubmittedtotheMDS.

Atthenationallevel,thecollectionwill:

• providethebasisformonitoringtheimplementationofGovernmentprimarymentalhealthcarereforms;

• beusedasafoundationforaccountabilityarrangementswithPHNsandinformregularreviewandupdatingofannualactivityworkplans;

• serveasthecoredataforuseinnationalevaluationsofmentalhealthreforms;and• supportongoingnationalplanningandpolicydevelopmentforprimarymental

healthcare.

3.1.2 Scope–activitiesincludedandexcluded

ThenewarrangementsaredesignedtocapturedataonPHN-commissionedmentalhealthservicesdeliveredtoindividualclients,includinggroup-baseddeliverytoindividualclients.Initiallythiswillinclude,butnotrestrictedto:

• psychologicaltherapiesdeliveredbymentalhealthprofessionals(asperpreviousATAPS/MHSRRAprograms);

• servicesdeliveredbymentalhealthnurses,formerlycapturedthroughtheMentalHealthNurseIncentiveProgram(MHNIP)sessionclaimprocessmaintainedbytheDepartmentofHumanServices;

• mentalhealthinterventionsdeliveredbyanew‘lowintensity’workforce;• carecoordinationtargetedatpeoplewithsevereandcomplexmentalillness;• suicidepreventionservicesdeliveredtoindividuals;and• servicesdeliveredtoAboriginalandTorresStraitIslanderpeople.

TheintentistoensurethatthePMHCMDShascapacitytocollectandreportonabroaderrangeofservicesthanthecurrentATAPS/MHSRRAminimumdataset,coveringthefullspectrumofindividualclient-centredservicesexpectedtobedevelopedthroughPHNcommissioningprocesses.

Thescopeofcoveragedoesnotextendtoservicestargetedatcommunities,suchasthecommunitycapacitybuildingactivitiespreviouslyfundedunderprojectssourcedfromNationalSuicidePreventionProgramfunding.Collectionandreportingofactivitiesofthistyperequiresadifferentapproachto‘counting’andidentificationofthe‘client’.PHNscommissioningactivitiesofthistypewillhaveflexibilitytoestablishlocaldatareportingarrangementsthatsuitrequirements.

Firststagedevelopmentwillfocusontheaboveareasandnotincludeexistingyouth-specificservices(headspace,EarlyPsychosisYouthServices)thatcurrentlycollectandreportastandardiseddatasettoheadspaceNationalOffice.Pendingthefutureofthesearrangements,andaccesstodatabyPHNs,thePMHCminimumdatasetcanbeexpanded

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atafuturestagetoallowincorporationofheadspaceandEarlyPsychosisYouthServicesshouldthisberequired.

3.1.3 BuiltonexistingATAPSfoundation

ThePMHCMDSdoesnotrepresentagroundupdevelopmentbutratherisbuiltonthefoundationestablishedbythecurrentATAPS/MHSRRAminimumdataset.Establishedin2003tocoverthethennewATAPSprimarymentalhealthprogram,thissystemhasbeenusedsuccessfullybyDivisionsofGeneralPractice,andlater,MedicareLocalstocollectandreportunitrecorddatatotheDepartment.In2015-16,thesystemwasbroadenedtocovertheMHSRRAprogram.InJuly2015PHNstookoverresponsibilityfortheATAPSandMHSRRAprogramsandwithitcollectionoftheminimumdataset.Currently,allPHNshaveaccesstothesystemandarereportingdatatotheDepartment.

ThisATAPS/MHSRRAdatacollectioncomprisessocio-demographicandclinicalinformationcollectedbythegeneralpractitionerorreferrerandservice-levelinformationcollectedbythementalhealthprofessionalateachsession,whichisenteredoruploadedfromlocalsystemsintoaweb-basedportal.

3.1.4 Flexibilitytoincorporateemergingrequirements

ChangestothePMHCMDSareexpectedtobemadefollowingtheestablishmentphase,andinresponsetoexpansionbyPHNsandtheirexperienceofthedatacollection.Thedesignofthedatamodelisaimedtobesufficientlycomprehensivetoallowfuturemodifications.

ChangestorequirementswillbeundertakeninconsultationwithPHNs.

3.2 Thedatatobecollected

ThecontentofthePMHCdataisdesignedtoanswerthecomplexmulti-partquestion:“Whoreceives,whatservices,deliveredbywhom,atwhatcost,andwithwhateffect?”CollectionofdatatoanswereachelementofthisquestionisequallyimportanttoPHNsintheircommissioningroleasitistoGovernmentinmonitoringtheimplementationofmentalhealthpolicyreforms.

ThedatabroadlycoversthesamecontentascapturedintheATAPS/MHSRRAsystem,coveringperson-level(demographics,clinical)andserviceevent-levelinformation(e.g.,sessiondetailssuchasduration,placeofdeliveryetc).Figure2summarisesthetypeofdatatobecollected.

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Figure2:Summaryofinformationtobecollected

Question Whatdatawillinformthisquestion?

Whoreceives… Demographicandclinicalcharacteristicsofserviceconsumers,collectedatepisodelevelbyserviceproviders

Whatservices… Rangeofdatacollectedbyserviceproviderforeachindividualserviceevent(e.g.,dateandtypeofservice,duration)

Fromwhom… Serviceproviderandorganisationdetailscharacteristics

Detailsoforganisationandmentalhealthworkforcedeliveringservices,reportedbyprovider

Atwhatcost… CostdatatobederivedfromannualfinancialstatementsmaintainedbyPHN,supplementedbyoutofpocketcoststoconsumercollectedandreportedbyprovidersforeachserviceevent

Withwhateffect Clientoutcomedata,maintainedbyproviderusingstandardinstruments

SummarydetailsoftheitemstobecollectedareprovidedatAttachmentA.Fulldetailsofallitemsincludingdefinitions,datadomainsandformatsareavailableon-lineathttps://www.pmhc-mds.com/.

3.3 Datamodel

ThebasicmodelfollowsthestructuralconceptsthathavebeensuccessfullyappliedforATAPS/MHSRRA.TheseconceptshavebroadapplicabilityandarenottiedexclusivelytothetypesofservicesdeliveredthroughATAPSandMHSRAA.ThedatamodelissummarisedinFigure3.

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Figure3:Thedatamodelanddatatobecollectedateachlevel

Datacollectedateachlevel(indicativeonly)Socio-demographicdataUniqueidentifier

ReferralsourceReferraldateDiagnosisPrevioustreatmenthistory

Datacollectedforeachservice:DateofserviceTypeofservicedeliveredServicemodality(face-face,phone,web)

Organisation ServicedurationProvidercategory Providerinformation

Copaymentdetails

Client

ServiceEpisode

'Sessions'(services)

Aclientmayhaveoneormorereferrals/episodes

Outcome

Outcomeassessedbycomparing pre- and

post-treatmentscoresonstandardised

scales

Providers

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3.4 ComparisontocurrentATAPSsystem

InadditiontocontinuationofmuchofthedatacontentcapturedinthecurrentATAPS/MHSRRAarrangements,thePMHCMDSretainsmanyofthepreviousdesignfeatures.Theseincludethebasicdataflow(Figure4)andfollowingfeatures:

• datamanagedviaanationaldatawarehouse• datasubmittedbyserviceprovidersthroughasecureweb-basedportal,ortoPHNs

tocollate/aggregateandsubmitthroughtheweb-basedportal,withoptiontobatchuploadfromlocalsystemsordirectdataentryviawebinterfaceforproviderswithoutsuitablesystems

• standardreportstobedesignedtomeetPHNanddepartmentalrequirements• capacityforPHNstodownloaddataforfurtherdetailedanalytics• automatedreceiptingandvalidationofdata.

Figure4:Dataflowsinexistingarrangementsthatwillbemaintained

Changestotheexistingarrangementshavefocusedon,butlimitedto:

• additionofnewdataitems,oramendmentstoexistingitems,necessarytoaccommodatethebroaderrangeofprimarymentalhealthcareservicesbeingcommissionedbyPHNs;

• anenhancedapproachtodefiningepisodes;• introductionofaprocessforallocationofregion-wideuniqueclientidentifiers;• improvementstothetypeofdatacapturedonthementalhealthworkforce

deliveringPHN-commissionedmentalhealthservices;• alignmentofdataitemswithnationalstandardsthathaveemergedsince2003;and• retirementofpreviousdataitemsthathavenotdemonstratedtheirworth,to

reducedatacollectionburdentothemaximumextentpossible.

National datawarehouse

PHNs

Contractedproviders

Optionsexistsforproviderstosubmitdatadirectlyusingwebinterface,orbatchupload

fromlocalsystems

Referrers

TwooptionsforPHNsubmission:1.Directdataentrytowebinterface2.Batchuploadfromlocalinformationsystems

StandardreportstoDOH

StandardreportstoPHNs

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3.5 WhatthenewarrangementsmeanforPHNsandcommissionedserviceproviders

ThePMHCMDSsetstherequirementsfordatacollectionandreportingthatareexpectedbyallPHNs.PHNsthereforeneedtoensurethattherequirementsaremetbyallcontractedprovidersofindividualclientmentalhealthservices.

DecisionsabouthowthedataarecollectedandreportedacrosstheregionwillbeatthediscretionofeachPHN.

3.6 Timelines

ThePMHCMDSisprogressinginstages,commencingwithdevelopmentofdataspecificationsandfollowedbyprogressiveupgradingoftheexistingweb-baseddatasubmissionandreportingarrangements.Theprocessentailsasetofshort-term,interimarrangementsforreportingofdatacoveringnewservicesthatwillrunalongsidetheexistingATAPS/MHSRRAsystem.

Thetimetableforrolloutofthenewarrangementisoutlinedbelow.

11July2016 ReleaseoffirstdraftofdataspecificationsdevelopedfollowingfeedbackfromPHNMDSReferenceGroup.

ThesewerereleasedtoforeshadowtoallPHNstheindicativecontentofmandatorydatatobereportedandinvitecommentpriortofinalisation.

21September)2016

FullminimumdatasetspecificationsreleasedforusebyPHNsindevelopinglocalsystemsandsettingreportingrequirementsofcommissionedproviders.

ByendOct2016

STAGE1ofnewdatasubmissionarrangements

Interimweb-baseddatasubmissionprocessreleasedforreportingbyPHNsonallaspectsofclientservicedeliveryincludingthosenotcurrentlycapturedintheATAPS/MHSRRAsystem.

Theinterimprocessincorporatesallnewdataitemsandexcludesthose‘retired’fromtheformerATAPS/MHSRRAminimumdataset.

Stage1requiresPHNsandtheirserviceproviderstoeither:

• exportdatafromtheirclientsystemsanduploadtotheMDS;or• manuallycreatespreadsheetsthatcanthenbeuploaded.

ItalsoincludesausermanagementinterfacetoallowPHNstomanagetheirserviceprovidersandacoresetofreportsrelatingtodepartmentalreporting.However,theinterimdatasubmissionprocesshassignificantlylessfunctionalitythantheATAPSsystem,includingweb-baseddataentryandediting.

TheATAPS/MHSSRAsystemwillbemaintainedandrunalongsidetheseinterimarrangementsforPHNsthatarereliantonthissystemfordatacaptureorchosetomaintainparallelsystems.However,newdata

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itemsbeingintroducedtothePMHCMDSarenotincluded.

TheATAPS/MHSRRAsystemwillbemaintaineduntilanewintegrateddataentryinterfaceisavailableinstagetwo.

Byfinalquarter2016-17

STAGE2–integrateddatasubmissionarrangement

Thisstagewillbringtogetherallreportingintoasingledatasubmissionprocess.Itwillincludeare-designeddataentryuserinterfacethatallowsonlineeditingofthedataintheMDS,amasterpatientindextoallowserviceproviderstomanageclientidentifiersacrossPHNsandotherreportingfunctionality.

TheexpectedimplementationtimetableforPHNs,includingdecisionstobemaderegionallyis:

From1July2016

HaveinplacedatacollectionarrangementstocoverservicesthatfallinscopeofpreviousATAPS/MHSRRAprogramsandthenewrangeofservicesbeingcommissioned.

Basedonregionalrequirements,decidewhetherto:

• maintaintheexistingATAPS/MHSSRAdatacollectionandsubmissionarrangementsinparallelwithinterimarrangementsfornewservices,or

• tomoveacrosstoasingleapproachtocollectionthatwillusetheinterimdatasubmissionprocessfrom1November2016

From1Nov2016

Commenceprocessesrequiredforreporting/uploadingofnewserviceactivityusinginterimreportingsystem.

MaintainexistingATAPS/MHSRRAreportinginparallelifthePHNdecidedtomaintainthisarrangementpendingintegratedStage2developments.

Byfinalquarter2016-17

BeginadoptionofStage2integratedPMHCdatacollectionandsubmissionarrangements.

30June2017 Fullcompliancewithintegratedreporting.

3.7 Consultationprocess

TheDepartmentiscommittedtoengagingwithPHNsinundertakingthedevelopmentworkandestablishedaReferenceGrouptooverseetheredesignoftheMDS.ExpressionsofinterestwerecalledinAprilandmetwithsignificantinterest.Atotalof16ofthe31PHNsnominatedforReferenceGroupmembership.Aninitialmeetingofthegroupwasheldon21June2016.

TheDepartmentappreciatesthatPHNsneedtobeawareofthespecificdataitemstheywouldneedtoreportontoensurethatthecommissionedservicesarecollectingand

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reportingonsuchdataitems.TothisenditmadeavailabletoallPHNsallmaterialspreparedfortheReferenceGroupconsiderationandrequestedcommentstobesubmittedbythosePHNswhoarenotReferenceGroupmembers.CommentsandsuggestionssubmittedbyPHNshavebeenusedtodevelopthefinalversionofthespecifications.

4. KEYDESIGNISSUESLikeallminimumdatasets,designofthePMHCMDShasentailedanumberofcriticaldecisionsaboutwhattocollect,whentocollectandhowtocollecttherequireddata.ThissectionofthepaperdescribesthekeydecisionissuesconsideredbytheDepartmentandhowthesewereresolved.

4.1 Definingepisodes

AcentralfeatureofthePMHCMDSdesignisthattheunitofservicedeliveryistheepisodeofcare.Episodesinturncompriseaseriesofoneormoreservicecontacts.Thisstructureallowsfordeterminingalogicaldatacollectionprotocolthatspecifieswhatdataarecollectedwhen,andbywhom.DifferentsetsofPMHCMDSitemsarecollectedatvariouspointsintheclient’sengagementwiththeproviderorganisation.Someitemsareonlycollectedonceattheepisodelevel,whileothersarere-collectedateachservicecontact.

Conceptsofepisodesareusedwidelythroughoutthehealthsystemasamethodtodescribetheactivitiesofhealthservicesandtoorganisedatacollection,reportingandanalysis.Ingeneral,anepisodeofcareisusedtorefertoaperiodofcarewithdiscretestartandendpoints.Mostworkondefiningepisodeshasbeentiedtoacutehospitalsettings,wheretheprincipleisrelativelysimple–oneepisodeperpatientperhospitalatanyonetime,withtheepisodebeginningatadmissionandendingatdischarge.

Thereareseveralissuesthatmakethedefinitionofanepisodeinprimarycaresettingsparticularlydifficult.First,whilsttheinitiationofprimarymentalhealthcareisusuallyaccompaniedbyformal,well-definedprocesses,itsterminationoftenismoredifficulttodefine,eitherclinicallyoradministratively.Second,manyclientsmayundergotreatmentoverextendedperiods.Finally,multipleorganisationsorpractitionerswithinorganisationsmaybeinvolvedinprovidingcareduringaparticularperiod,witheachprovideragencyorpractitionerregardingtheirinterventionasadiscreteepisode.

ApproachtakeninPMHCMDS

• ForthepurposesofthePMHCMDS,andepisodeofcareisdefinedasamoreorlesscontinuousperiodofcontactbetweenaclientandaPHN-commissionedproviderorganisationthatstartsatthepointoffirstcontact,andconcludesatdischarge.

• Threebusinessrulesapplytoepisodesofmentalhealthcare:

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1. Oneepisodeatatimeforeachclient,definedattheleveloftheproviderorganisationWhileanindividualmayhavemultipleepisodesofmentalhealthcareoverthecourseoftheirillness,theymaybeconsideredasbeinginonlyoneepisodeatanygivenpointoftimeforanyparticularPHN-commissionedproviderorganisation.Thepracticalimplicationisthatthecareprovidedbytheorganisationtoanindividualclientatanypointintimeissubjecttoonlyonesetofreportingrequirements.

2. Episodescommenceatthepointoffirstcontact3. Dischargefromcareconcludestheepisode

Dischargemayoccurclinicallyoradministrativelyininstanceswherecontacthasbeenlostwiththeclient.Anewepisodeisdeemedtocommenceifthepersonre-presentstotheorganisation.

4.2 Identifyingandclassifyingcommissionedepisodesofcaretoenablemonitoringofpolicyimplementation

Monitoringofservicedeliveryneedstohavecapacitytogroupepisodesofcareintohighlevelcategoriesthatalignwithpolicyprioritiesforprimarymentalhealthcarereform–thesehavebeenthebasisfortheKPIssetforPHNs.OfparticularimportancearethesixkeyservicedeliveryareasrequiredofPHNsidentifiedinfundingschedulesdescribedinbriefas:

• lowintensitypsychologicalinterventions• psychologicaltherapiesdeliveredbymentalhealthprofessionals• earlyinterventionservicesforchildrenandyoungpeople• servicesforpeoplewithsevereandcomplexmentalillness• enhancedAboriginalandTorresStraitIslandermentalhealthservices;and• regionalapproachtosuicidepreventionactivitiesfocusedonimprovedfollow-upfor

peoplewhohaveattemptedsuicideorareathighriskofsuicide

GovernmentrequiresareliablemechanismtomonitorservicedeliveryacrosstheseareasjustasPHNsrequireameanstomonitorregionalservicedelivery.

AnuancedsolutiontothisissuehasbeenadoptedintheproposedPMHCMDS.Thisisbasedonthefollowingconsiderations:

• Principalcategorytobereportedbytheserviceprovider

o Whileallkeyserviceareascouldbe‘carvedout’post-factofromactivitydatabyspecificdataanalysisrules(e.g.,onlyclassifyanepisodeaslowintensityifthemajorityofservicesaredelivered‘lowintensity’workers),thereisanover-ridingrequirementtoensurethedatacollectionandreportingsystem

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allowsPHNstomonitorservicedeliveryagainstitscommissioningtargetsinanongoingmanner.

o Thisshouldbebasedondatareportedbyprovidersratherthancomplexmanipulationsofdataafterthefact.Theimplicationisthatepisodesofcaredeliveredneedtoincludeaspecificmarker,reportedbytheserviceprovider,ofthemaincategoryofservicestobeprovidedandforthesetobealignedwherepracticaltothekeyareasofservicedelivery.

• Categoriesneedtobemeaningfulandmutuallyexclusiveo Robustdefinitionsarerequiredthatallowtheprovidertomakeajudgement

aboutcomplexfacts.Servicecategoriesneedtobeasmutuallyexclusiveaspossibletominimiseproviderconfusionabouthowtoassignepisodes.

• Monitoringdeliveryacrossallsixkeyserviceareaswillrequireamixofmethodso Thesixpriorityareascompriseamixofconcepts–rangingfromafocuson

specificsub-populations(e.g.,children)tospecifictypesofservices(e.g.,lowintensity).Asingleapproachtocapturingalloftheseisnotconsideredfeasible.


• Serviceprovidersarerequiredtoreportonthe‘Principalfocusoftreatmentplan’forallacceptedreferrals.

• Thisrequiresajudgementtobemadeaboutthemainfocusoftheservicestobedeliveredtotheclientforthecurrentepisodeofcare,madefollowinginitialassessmentandmodifiableatalaterstage.

• Operationally,theconceptof‘principalfocus’willbedefinedastherangeofactivitiesthatbestdescribestheoverallservicesintendedtobedeliveredtotheclientacrossthecourseoftheepisode.Formostclients,thiswillequatetotheactivitiesthataccountformosttimespentbytheserviceprovider.

• Principalfocusoftreatmentplanisnecessarilyajudgementmadebytheproviderattheoutsetofservicedeliverybutconsistentwithgoodpractice,wouldbemadeonthebasisofatreatmentplandevelopedincollaborationwiththeclient.Itmaybemodifiedthroughoutthecourseoftreatmentiftheinitialassessmentprovedincorrect.

• Itischosenfromadefinedlistofcategories,withtheproviderrequiredtoselectthecategorythatbestfitsthetreatmentplandesignedfortheclient

Expandeddefinitionsforthe‘principalfocusoftreatmentplan’concepthavebeendeveloped.Thecategoriesandmainfeaturesofeachcategoryaredescribedbelow.

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Category Principalfocusoftreatmentplan

• Psychologicaltherapy

Thetreatmentplanfortheclientisprimarilybasedaroundthedeliveryofpsychologicaltherapybyoneormorementalhealthprofessionals.ThiscategorymostcloselymatchestherangeofservicesdeliveredunderthepreviousATAPSprogram.

Theconceptof‘mentalhealthprofessionals’hasaspecificmeaningdefinedintheguidancedocumentationpreparedtosupportPHNsinimplementationofreforms.2Itreferstoserviceproviderswhomeettherequirementsforregistration,credentialingorrecognitionasaqualifiedmentalhealthprofessionalandincludes:

• Psychiatrists• RegisteredPsychologists• ClinicalPsychologists• MentalHealthNurses;• OccupationalTherapists;• SocialWorkers• AboriginalandTorresStraitIslanderhealthworkers.

• Lowintensitypsychologicalintervention

Thetreatmentplanfortheclientisprimarilybasedarounddeliveryoftime-limited,structuredpsychologicalinterventionsthatareaimedatprovidingalesscostlyinterventionalternativeto‘standard’psychologicaltherapy.Theessenceoflowintensityinterventionsisthattheyutilisenilorrelativelylittlequalifiedmentalhealthprofessionaltimeperclient3andaretargetedatpeoplewith,oratriskof,mildmentalillness.

Lowintensityepisodescanbedeliveredthrougharangeofmechanismsincludinguseofindividualswithappropriatecompetenciesbutwhodonotmeettherequirementsforregistration,credentialingorrecognitionasamentalhealthprofessional;deliveryofservicesprincipallythroughgroup-basedprograms;anddeliveryofbrieforlowcostformsoftreatmentbymentalhealthprofessionals.

• Clinicalcarecoordination

Thetreatmentplanfortheclientisprimarilybasedarounddeliveryofarangeofserviceswheretheoverarchingaimistocoordinateandbetterintegratecarefortheindividualacrossmultipleproviderswiththeaimofimprovingclinicaloutcomes.Consultationandliaisonmayoccurwithprimaryhealthcare

2DepartmentofHealth,PHNprimarymentalhealthcareflexiblefundingpoolimplementationguidance:Psychologicaltherapiesprovidedbymentalhealthprofessionalstounderservicedgroups.August2016.http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Tools3BasedonBennet-LevyJ,RichardsD,FarrandPetal.OxfordGuidetoLowIntensityCBTInterventions.OxfordUniversityPress,2010.www.oup.com.au/titles/academic/psychology/9780199590117

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providers,acutehealth,emergencyservices,rehabilitationandsupportservicesorotheragenciesthathavesomelevelofresponsibilityfortheclient’sclinicaloutcomes.Theseclinicalcarecoordinationandliaisonactivitiesareexpectedtoaccountforasignificantproportionofservicecontactsdeliveredthroughouttheseepisodes.

• Complexcarepackage

Thetreatmentplanfortheclientisprimarilybasedaroundthedeliveryofanindividuallytailored‘package’ofservicesforaclientwithsevereandcomplexmentalillnesswhoisbeingmanagedprincipallywithinaprimarycaresetting.Theoverarchingrequirementisthattheclientreceivesanindividuallytailored‘package’ofservicesthatbundlesarangeofservicesthatextendsbeyond‘standard’servicedeliveryandwhichisfundedthroughinnovative,non-standardfundingmodels.Note:Asoutlinedintherelevantguidancedocumentation,onlythethreeselectedPHNLeadSiteswithresponsibilitiesfortriallingworkinthisareaareexpectedtodelivercomplexcarepackages.4Awiderroll-outmaybeundertakeninthefuturependingresultsofthetrial.

• Childandyouth-specificmentalhealthservices

Thetreatmentplanfortheclientisprimarilybasedaroundthedeliveryofarangeofservicesforchildren(0-11years)oryouth(aged12-24years)whopresentwithamentalillness,orareatriskofmentalillness.Theseepisodesarecharacterisedbyservicesthataredesignedspecificallyforchildrenandyoungpeople,includeabroaderrangeofbothclinicalandnon-clinicalservicesandmayincludeasignificantcomponentofclinicalcarecoordinationandliaison.Childandyouth-specificmentalhealthepisodeshavesubstantialflexibilityintypesofservicesactuallydelivered.

• Indigenous-specificservices

ThetreatmentplanfortheclientisprimarilybasedarounddeliveryofmentalhealthservicesthatarespecificallydesignedtoprovideculturallyappropriateservicesforAboriginalandTorresStraitIslanderpeoples.

• Other Thetreatmentplanfortheclientisprimarilybasedaroundservicesthatcannotbedescribedbyothercategories.

ThecategoriesdonotspecificallyaddressoneofthesixkeyservicedeliveryareasrequiredofPHNs(Suicidepreventionactivitiesfocusedonimprovedfollow-upforpeoplewhohave

4DepartmentofHealth,PHNprimarymentalhealthcareflexiblefundingpoolimplementationguidance:Primarymentalhealthcareservicesforpeoplewithseverementalillness,August2016.http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Mental_Tools

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attemptedsuicideorareathighriskofsuicide)becausetodosowouldcreateambiguityindatareportingandcompromisethemutualexclusivityrequirement.

Adifferentapproachisrequiredtoidentifypeoplereferredforepisodeswheresuicideriskwasanissue.Thisisdescribedbelow.

4.3 Howsuicidepreventionactivitywillbemanagedinthecollection

Initialconsiderationwasgiventoincludingsuicidepreventionasaseparate‘principalfocus’episodetype.Thiswasnotconsideredaworkableoptionbecauseitwouldconfusethemutuallyexclusiveboundariesthatneedtobecreated.Servicesdeliveredtoindividualswhohaverecentlyattemptedsuicideorareatriskofsuchmaybeafeatureofalloftheother‘principalfocus’categories.

Aspecificmarkerofsuicideprevention-orientedservicestoindividualsisessentialhowever,giventhatPHNKPIsincludeonethatisfocusedontimelyfollowupofpeoplereferredfollowingarecentsuicideattemptorbecausetheyareatriskofsuicide.


• ThePMHCMDSincludesanew‘suicidereferralflag’inthedataset,recordedbytheserviceproviderattheoutsetoftheepisode.Thisitemisdefinedtoidentifythoseindividualswherearecenthistoryofsuicideattempt,orsuiciderisk,wasafactornotedinthereferral.

4.4 Determiningwhatactivitiesareinscopeforreportingasservicecontacts

ServicecontactsrepresentthebasicunitforcountinganddescribingactivitiesinthePMHCMDS.Aneffective,reliableapproachtodefiningandcountingservicecontactsisessentialforPHNstomonitorservicevolumes,unitcostsandoverallservicecoverageoftheregionalpopulation.Relianceonameasureofservicecontact(or‘occasionofservice’)tomonitorservicedeliveryisconsistentwithallequivalentdatacollectionsinthehealthfield,includingthosecoveringstateandterritorycommunitymentalhealthservices,communityhealthcentresand‘non-admitted’servicesdeliveredthroughpublichospitals.

UnderpreviousATAPS/MHSRRAarrangements,theconceptwasreferredtoasa‘session’.However,withsomeexceptions,sessionscouldonlyberecordedwhentherewasadirectinteractionbetweenaserviceproviderandtheclient,whetheritwasfacetofaceorthroughanothermedium(telephone,internet).Thisapproachexcludedarangeofclient-relatedactivitiesthatwereundertakenonbehalfoftheclient,suchasinteractionwithsignificantothers,carecoordinationactivitiesentailingengagementwithotheragenciesandsoforth.

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AmodifiedapproachisembeddedinthePMHCMDSthatisbasedonthefollowingconsiderations:

• Multiplestudieshavedemonstratedthatasignificantcomponentoftheworkoftreatmentclinicianswhoworkwithpeoplewithmentalillnessentailsengagingwithindividualsotherthantheclient.Typically,theseincludeotherhealthorsocialserviceproviders,familymembersorothersignificantothersintheclient’ssupportnetwork.

• TheincreasedflexibilitygiventoPHNsincommissioningservicestomeetindividualclientneedsrequiresthatabroaderrangeofservicesthantheconstrictedATAPS‘session’concept.

• Statesandterritorieshavegrappledwiththeissueandresolvedmanyyearsagotoallowservicedeliveredonbehalfofclients–wheretheclientwasnotpresent–toberecordedandcountedasservicecontactsinthecommunitymentalhealthinformationcollections,endorsedalsointhenationaldata.Thesemakeupabout30%oftotalcontactsrecorded.

• Theprimarycarereformemphasisinimprovedcarecoordinationforpeoplewithseverementalillnesswhoarebeingprincipallymanagedbyprimaryhealthcareservicesnecessitatesawiderdefinitionofcontacttoallowthefullextentofserviceprovisiontothistargetgrouptobegauged.

• AnybroadeningofwhatcanbereportedasaServiceContactneedstoconfinethescopetoclientrelated,clinicallyrelevantactivity.ThisisnecessarytopreventthePMHCMDSbeingdesignedasanall-encompassing‘timeandmotion’recordofallactivitiesengagedinbymentalhealthserviceproviders.


• Servicecontactsaredefinedusinganapproachbasedonthatestablishedforstateandterritorymentalhealthcommunitymentalhealthservices,withappropriatemodifications.Theessenceofthedefinitionisbelow:

o ServicecontactsaredefinedastheprovisionofaservicebyaPHNcommissionedmentalhealthserviceproviderforaclientwherethenatureoftheservicewouldnormallywarrantadatedentryintheclinicalrecordoftheclient.

o Aservicecontactmustinvolveatleasttwopersons,oneofwhommustbeamentalhealthserviceprovider.

o Servicecontactscanbeeitherwiththeclientorwithathirdparty,suchasacarerorfamilymember,and/orotherprofessionalormentalhealthworker,orotherserviceprovider.

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o Servicecontactsarenotrestrictedtoface‑to‑facecommunicationbutcanincludetelephone,internet,videolinkorotherformsofdirectcommunication.

o Serviceprovisionisonlyregardedasaservicecontactifitisrelevanttotheclinicalconditionoftheclient.Thismeansthatitdoesnotincludeservicesofanadministrativenature(e.g.telephonecontacttoscheduleanappointment).

AnimplicationofthisapproachisthatthedatacollectionrequiresaflagagainsteachrecordedServiceContacttoindicatewhethertheclientparticipated,andifnot,whowastherecipientofthecontact.Twoitemshavebeenaddedtothecollectiontocapturetheseaspects-seethedataitems:

• Mentalhealthservicecontact-clientparticipationindicator• Serviceparticipants

4.5 Classifyingtypesofservicesdeliveredateachservicecontact

Inadditiontobasicdetailsabouteachservicecontact(e.g.,date,duration,locationetc),theMDSalsoshouldincludecaptureofinformationaboutthetypeofservicesdelivered.Thisisnecessarytounderstandthemixofservicesprovidedwithinandacrossepisodesofcare.Thekeyrequirementsaretodesignalistofservicetypesthatis:

• policyrelevant;• meaningfultobothconsumers,practitionersandPHNs;and• minimalistbutcomprehensive

Meetingalltheserequirementsisachallenge.Informationsystemdevelopersinthehealthfieldhavevariouslyapproachedthetask.Acommonapproachistodevelopalistofinterventionsfromwhichtheproviderisrequiredtoselectoneormoreoptionsthatdescribeswhatwasdeliveredateachtreatmentencounter.Typically,thelistsareextensive,aimedatcomprehensivelycoveringalloptions,andoverwhelmserviceproviderswithchoice.Dataqualityisoftenpoorasaresult.

ThepreviousATAPSdatacollectioncollectsinformationabouttypesofservicesdeliveredbasedaroundspecificpsychologicalinterventionsbutthisistoonarrowforthebroaderrangeofservicestobeofferedunderthenewprimarymentalhealthcarearrangements.Dataqualityhasalsobeenproblematicasthecodelistofferedtoclinicianslacksdefinitionalspecificityandisoverinclusive.


• TheapproachadoptedforthePMHCMDSincludesanitemtitled‘Servicecontact–Type’thatrequiresserviceproviderstoreportonthemainservicedeliveredateachservicecontact.Thisisselectedfromasmalllistofoptions,andbasedonthe

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activitythataccountedformostprovidertime.Thecategoriesforselectionofmainservicetypeare:

1 Assessment2 Structuredpsychologicalintervention3 Otherpsychologicalintervention4 Clinicalcarecoordination/liaison5 Clinicalnursingservices6 ChildoryouthspecificassistanceNEC57 SuicidepreventionspecificassistanceNEC8 CulturalspecificassistanceNEC

• DefinitionsareprovidedatAttachmentB.

• ServiceContact–Typediffersfromthedataitem‘Principalfocusoftreatmentplan’becauseitrequiresinformationabouteachservicecontact.‘Principalfocusoftreatmentplan’requiresajudgementabouttheoverallepisodeofcare,madeatthepointofdevelopingtheclientstreatmentplan(butcanbemodifiedlater).Classifyinganepisodeofcareintoa‘Principalfocusoftreatmentplan’categorydoesnotrestrictwhatisrecordedateachservicecontact.Forexample,anepisodewithaPrincipalFocusof‘ClinicalCareCoordination’mayincludecontactsofanytype.

4.6 Diagnosiscoding

CollectionoftheprincipaldiagnosisofclientsreceivingservicesisessentialtounderstandthetypesofmentalhealthproblemsanddisordersmanagedthroughPHN-commissionedservices.Diagnosisistobereportedatoverallepisodelevel,withdiagnosis(PrincipalandAdditional)assignedbythetreatingorsupervisingclinicalpractitioner.

Thekeyissuetoberesolvedconcernedthelevelofdiagnosiscodingthatshouldbesetastheminimumandwhatclassificationsystemistobeused.ThepreviousATAPSspecificationfordiagnosisreportingrepresenteda‘mixedbag’.ItwassetasasmallnumberofcategoriestorecordhighlevelcodesforanxietyanddepressivedisordersbutamendedovertheyearstoincorporatethevariousrequirementsofspecialTier2fundinglevelsastheywereadded.Wherediagnosiswasrecorded,anxiety-relatedanddepressiveconditionstogetheraccountedforaround80%.Diagnosesenteredasun-codedfreetextaccountfor19%.Mostimportantly,diagnosiswasnotrecordedforjustunderathird(28%)ofallclients,likelyduetoanumberofproblemsincludingpoorcompliancewithrequirementsandinadequaciesofthecodingoptionsprovidedtoclinicians.

MultipleoptionsareavailableforuseinthePMHCMDS.Theseinclude:

5NECrefersto‘notelsewhereclassified’–thatis,theactivitycannotbedescribedbytheavailablecategories.

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• IncorporationofthefullICD-10AMcodinglistformentaldisorders.Thiswouldentailallowingmanyhundredsofdiagnosticcodesmostofwhichareveryrarelyseeninprimarymentalhealthcare,ifatall.

• BasethecodingaroundthehighlevelmentaldisorderchaptersoftheICD-10.Thisapproachhastheadvantageofsimplicitybutispoorlytargetedtoreportonthemostcommondisordersseeninprimarymentalhealthcare.Forexample,around80%ofclientstreatedwouldfallwithintwocategories.(F30-F39andF40-48).Amorefine-grainedapproachisrequiredthatallowsbetterclinicalprofilingofclientsbutdoesnotcause‘diagnosisclutter’.

• BasethecodingonthefullsetofcodesdevelopedfortheICPC-2primarycaresystemtodescribepsychologicalproblems,asusedforexampleinthereportingofBEACHstudiesofGeneralPractitioneractivities.Whileintuitivelyappealing,thisapproachmorereflectsanextensivelistofpresentingproblemsthanformaldiagnosticcodes.Itisalsoregardedasunhelpfulbymanymentalhealthclinicians.

• DevelopacustomisedlistofdiagnosiscodesthatarebasedonthemostprevalentconditionsincludedinAustralianNationalSurveysofMentalHealthandWellbeingconductedacrossadultandchildandadolescentpopulationsoverthepasttwodecades(seeFigure5andFigure6).AlthoughbasedonDSM-IVclinicaldiagnosesanddescriptionsratherthanICD-10,thesemorecloselyalignwithdiagnosticapproachesusedbyAustralianmentalhealthclinicians.

• AnadditionalconsiderationconcernstheneedtodesigntheapproachtodiagnosisreportingtoreflectthatPHN-ledreformsrequireextendingservicedeliveryto‘lowintensity’clientswhoareatriskofdevelopingamentalillness.Manyinthisgroupareanticipatedtopresentwithsignificantmentalhealthproblemsthataresubsyndromalanddonotcurrentlymeetformaldiagnosticcriteria.

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Figure5:Diagnosisrangeusedinthe2007NationalSurveyofMentalHealthandWellbeing–Adults16-856

Figure6:Diagnosisrangeusedinthe2013-14SecondAustralianChildandAdolescentSurveyofMentalHealthandWellbeing-4-17yearolds7

%population

%population

Anxietydisorders

Anxietydisorders PanicDisorder 2.6 Socialphobia 2.3Agoraphobia 2.8 Separationanxiety 4.3SocialPhobia 4.7 Generalisedanxiety 2.2GeneralisedAnxietyDisorder 2.7 Obsessive-compulsive 0.8Obsessive-CompulsiveDisorder 1.9 Anyanxietydisorder 6.9Post-TraumaticStressDisorder 6.4 Majordepressivedisorder 2.8

AnyAnxietydisorder 14.4AttentionDeficitHyperactivityDisorder(ADHD) 7.4

Affectivedisorders

Conductdisorder 2.1DepressiveEpisode 4.1 Any12-monthmentaldisorder 13.9Dysthymia 1.3

BipolarAffectiveDisorder 1.8

AnyAffectivedisorder 6.2SubstanceUsedisorders

AlcoholHarmfulUse 2.9

AlcoholDependence 1.4

DrugUsedisorders 1.4

AnySubstanceUsedisorder 5.1

Any12-monthmentaldisorder 20.0


• ThesolutionadoptedforthePMHCMDSusesa‘picklist’ofdiagnosiscodingoptionsdevelopedtobalancecomprehensivenessandbrevity.TheycompriseamixofthemostprevalentmentaldisordersintheAustralianadult,childandadolescentpopulation,supplementedbylessprevalentconditionsthatmaybeexperiencedbyclientsofPHN-commissionedmentalhealthservices.

• ThediagnosisoptionsarebasedonanabbreviatedsetofclinicaltermsandgroupingsspecifiedintheDiagnosticandStatisticalManualofMentalDisordersFourthEdition(DSM-IV-TR).Thecodelistsummarisestheapproximate300uniquementalhealthdisordercodesinthefullDSM-IVtoasetto9majorcategories,and37individualcodes.Diagnosesaregroupedunderhigherlevelcategories,basedontheDSM-IV.CodenumbershavebeenassignedspecificallyforthePMHCMDStocreate

6Sladeetal(2009),ThementalhealthofAustralians2:Reportonthe2007NationalSurveyofMentalHealthandWellbeing.DepartmentofHealthandAgeing,Canberra.7Lawrenceetal(2015),Thementalhealthofchildrenandadolescents:ReportonthesecondAustralianchildandadolescentSurveyofMentalHealthandWellbeing.DepartmentofHealth,Canberra

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alogicalorderingbutarecapableofbeingmappedtobothDSM-IVandICD-10codes.

• Additionalcodeshavebeenaddedtoreflectsubsyndromalconditionstoaccommodatereportingonclientswhodonotmeetdiagnosticcriteria.

• ThediagnosislistisprovidedatAttachmentC.

4.7 Selectingcoreoutcomemeasures

Reportingonclientoutcomesisafundamentalrequirementandcomprisestwoofthe11servicedeliveryKPIssetforPHNs.Beyondthis,ongoingmonitoringbyserviceprovidersofclientprogressusingstandardisedmeasuresiscriticaltoinformingtreatmentdecisionsandongoingdialoguebetweenserviceprovidersandtheirclients.

Therearemanyhundredsofstandardisedmeasuresdevelopedandavailableforinuseinthedeliveryofmentalhealthcare.Whilesomearetargetedatspecificconditions,ordevelopedforuseinspecifictreatmentsettings,othershavebeendevelopedasbroadspectrummeasuresforapplicationacrossthefullrangeofclientswhopresentforassistance.

Australia’sexperienceinintroducingoutcomemeasuresintoroutineclinicalpracticeisunmatchedinternationally.Commencingin2003,routineuseofoutcomemeasureswasintroducedintostateandterritoryspecialisedmentalhealthservices,progressedthroughafundingpartnershipbetweenstateandterritoryandtheCommonwealthGovernments.ThatyeartheAustralianMentalHealthOutcomesandClassificationNetwork(http://www.amhocn.org/)wasestablishedbytheDepartmenttoleadthenationaldevelopmentsandprovidesupportthroughreportingandanalytictools.

Whileregularuseofoutcomemeasureshealthservicesbeenarequirementofspecificmentalhealthfundedprimarycareactivity,includingtheMBSBetterAccessprogramandATAPS,ithasbeensubjecttolessdevelopmentalwork.ThepreviousATAPSallowedanextensivelistofoptionsthatwasselectedattheclinician’sdiscretionbutthesehadrelativelypoorcompliance.

TheapproachtoselectingoutcomemeasuresincorporatedinthePMHCMDSshouldbebasedonthefollowingconsiderations.

• Acore(mandatory)setofstandardoutcomemeasuresshouldbesetforreportingwithanyadditionalmeasuresusedatthediscretionoftheprovider.Theprinciplesof‘lessisbest’,andminimisationofreportingburdenareparamount.

• Thecoremeasuresshouldbemeaningfulandapplicableacrossallclientgroupsandbecapableofbeingusedbyallserviceproviders.

• Coremeasuresshouldreflecttheclient’sperspective–thatis,bebasedonself-report.

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• Coremeasuresshouldbebriefandtakenomorethan10minutestobecompletedbytheclient.

• Coremeasuresshouldhavesoundpsychometricpropertiesandbesensitivetochangeintheclient’scondition.

• Australianpopulationleveldatashouldbeavailableonallcoremeasurestoenablecomparison,andparticularlythecapacitytoassessclientrecovery–i.e.movementintothe‘normal’scorerange.


• Asmallnumberofoutcomemeasureshasbeensetasmandatoryforallepisodesofcare.

• Foradultclients:

o themandatorymeasureistheKessler-10(K10+version).ThisisthemostwidelyusedmeasureusedinAustralia,hascomprehensivenormativedataandhasdemonstratedutilityinmeasuringclientprogress(ordeterioration).Itisalsohasaveryhighcorrelationwithalternativemeasuresalsowidelyused(e.g.,PHQ-9,GAD-7).

o forAboriginalandTorresStraitIslanderclients,theK5maybeusesasanalternativetotheK10.

• Forchildandadolescentclients:

o themandatorymeasureistheStrengthsandDifficultiesQuestionnaire(SDQ).TheSDQisusedwithsignificantutilityinbyallstateandterritorychildandadolescentmentalhealthservicesandalsohasrecentpopulationlevelgatheredthroughthe201314SecondAustralianChildandAdolescentSurveyofMentalHealthandWellbeing.

o MultipleversionsoftheSDQareavailableandvaryaccordingtowhenthemeasureisused(baselinevsfollowup),age(4-10year,11-17years)andwhoprovidestheinformation(parentvschildselfreport).TheversionsspecifiedforPMHCMDSreportingare:

§ PC1-ParentReportMeasureforChildrenaged4-10,Baselineversion;§ PC2-ParentReportMeasureforChildrenandAdolescentsaged4-10,

Followupversion;§ PY1-ParentReportMeasureforYouthaged11-17,Baselineversion;§ PY2-ParentReportMeasureforYouthaged11-17,Followupversion;§ YR1-Youthselfreportmeasure(11-17),Baselineversion;and§ YR2-Youthselfreportmeasure(11-17),Followupversion.

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o Foradolescents,thecliniciansmayusetheK10+(orK5forIndigenousclients)asanalternativetotheSDQisthisisconsideredappropriatetotheclient’ssituation.TheK10hasbeenusedsuccessfullyinanumberofstudiesofadolescentsinAustraliae.g.,thenationalevaluationofheadspace;thesecondAustralianchildandadolescentSurveyofMentalHealthandWellbeing.

• EachPHNhasthecapacitytoaddadditionaloutcomemeasurestotheirownregionaldatacollectionsystemstomeetlocalrequirementsbutthesearenotnecessaryforreportingthenationaldataPMHCminimumdataset.

• Forthemandatorymeasures,theconceptof‘CollectionOccasion’isdefinedasanoccasionduringanEpisodeofCarewhentherequiredoutcomemeasureistobecollected.Ataminimum,collectionofoutcomedataisrequiredatbothEpisodeStartandEpisodeEnd,butmaybemorefrequentifclinicallyindicatedandagreedbytheclient.ThisdiffersfromtheATAPScollectionthatdidnotallowoutcomemeasurestobereportedbeyondEpisodeStartandEnd.

• Individualitemscoresmaybereportedforallscalesandwilleventuallyberequiredoncethesystemhasbeenimplemented.Intheshortterm,acknowledgingthatreportingindividualitemscoresmaynotbepossibleforallproviders,reportingoverallscores/subscalesisallowed.Therefore:

o FortheK10+,providerscaneitherreportall14itemscoresorreporttheK10totalscoreaswellasitemscoresforthe4extraitemsintheK10+.

o FortheK5,providerscaneitherreportall5itemscoresorreporttheK5totalscore.

o FortheSDQ,providerscaneitherreportall42itemscoresorreporttheSDQsubscalescores.

• Detailsofalloutcomemeasures,includingscoringrules,areavailableonthePMHCMDSwebsite(https://docs.pmhc-mds.com/index.html).

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ATTACHMENTA:PRIMARYMENTALHEALTHCAREMINIMUMDATASET–DATAELEMENTSSUMMARYProviderOrganisation

• ProviderOrganisationKey• ProviderOrganisationName• ProviderOrganisationCode• ProviderOrganisationABN• ProviderOrganisationType• ProviderOrganisationState

Practitioner

• OrganisationPath• PractitionerKey• PractitionerCategory• ATSICulturalTrainingFlag• PractitionerYearofBirth• Gender• AboriginalandTorresStraitIslanderStatus• PractitionerActive

Client

• OrganisationPath• ClientKey• StatisticalLinkageKey• DateofBirth• EstimatedDateofBirthFlag• Gender• AboriginalandTorresStraitIslanderStatus• CountryofBirth• MainLanguageOtherThanEnglishSpokenatHome• ProficiencyinSpokenEnglish

Episode

• OrganisationPath• EpisodeKey• ClientKey• ClientConsenttoAnonymisedData• EpisodeStartDate• EpisodeEndDate

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• EpisodeCompletionStatus• EpisodeReferralDate• ReferrerProfession• ReferrerOrganisationType• SuicideReferralFlag• GPMentalHealthTreatmentPlanFlag• PrincipalFocusofTreatmentPlan• Homelessnessflag• AreaofUsualResidence,Postcode• LabourForceStatus• EmploymentParticipation• SourceofCashIncome• HealthCareCard• NDISParticipant• MaritalStatus• PrincipalDiagnosis• AdditionalDiagnosis• Medication-Antipsychotics(N05A)• Medication-Anxiolytics(N05B)• Medication-Hypnoticsandsedatives(N05C)• Medication-Antidepressants(N06A)• Medication-Psychostimulantsandnootropics(N06B)

ServiceContact

• OrganisationPath• ServiceContactKey• ClientKey• EpisodeKey• PractitionerKey• ServiceContactDate• ServiceContactType• ServiceContactPostcode• ServiceContactModality• ServiceContactParticipants• ServiceContactVenue• ServiceContactDuration• ServiceContactCopayment• ServiceContactClientParticipationIndicator• ServiceContactInterpretedUsed• ServiceContactFinal

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• ServiceContactNoShow

OutcomeCollectionOccasion(summarylist-separatefieldsforK10+,K5,SDQ)

• OrganisationPath• CollectionOccasionKey• EpisodeKey• CollectionOccasionMeasureName• CollectionOccasionMeasureDate• CollectionOccasionReason• CollectionOccasionItemScores(individualitemsortotalsandsubscalescores)

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ATTACHMENTB:DRAFTDEFINITIONSFORSERVICETYPE

ServiceType

Themaintypeofserviceprovidedintheservicecontact,asrepresentedbytheservicetypethataccountedformostprovidertime.

1 Assessment2 Structuredpsychologicalintervention3 Otherpsychologicalintervention4 Clinicalcarecoordination/liaison5 Clinicalnursingservices6 ChildoryouthspecificassistanceNEC7 SuicidepreventionspecificassistanceNEC8 CulturalspecificassistanceNEC

Notes:

Describesthemaintypeofservicedeliveredinthecontact,selectedfromadefinedlistofcategories.Wheremorethanservicetypewasprovidedselectthatwhichaccountedformostprovidertime.ServiceprovidersarerequiredtoreportonServiceTypeforallServiceContacts.

1 AssessmentDeterminationofaperson‘smentalhealthstatusandneedformentalhealthservices,madebyasuitablytrainedmentalhealthprofessional,basedonthecollectionandevaluationofdataobtainedthroughinterviewandobservation,ofaperson‘shistoryandpresentingproblem(s).Assessmentmayincludeconsultationwiththeperson‘sfamilyandconcludeswithformationofproblems/issues,documentationofapreliminarydiagnosis,andatreatmentplan.

2 StructuredpsychologicalinterventionThoseinterventionswhichincludeastructuredinteractionbetweenaclientandaserviceproviderusingarecognised,psychologicalmethod,forexample,cognitivebehaviouraltechniques,familytherapyorpsychoeducationcounselling.Thesearerecognised,structuredorpublishedtechniquesforthetreatmentofmentalill-health.Structuredpsychologicalinterventionsaredesignedtoalleviatepsychologicaldistressoremotionaldisturbance,changemaladaptivebehaviourandfostermentalhealth.Structuredpsychologicaltherapiescanbedeliveredoneitheranindividualorgroupbasis,typicallyinanofficeorcommunitysetting.Theymaybedeliveredbytrainedmentalhealthprofessionalsorotherindividualswithappropriatecompetenciesbutwhodonotmeettherequirementsforregistration,credentialingorrecognitionasamentalhealthprofessional.

StructuredPsychologicalTherapiesincludebutarenotlimitedto:

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• Psycho-education(includingmotivationalinterviewing)• Cognitive-behaviouraltherapies• Relaxationstrategies• Skillstraining• Interpersonaltherapy

3 OtherpsychologicalinterventionPsychologicalinterventionsthatdomeetcriteriaforstructuredpsychologicalintervention.

4 Clinicalcarecoordination/liaisonActivitiesfocusedonworkinginpartnershipandliaisonwithotherhealthcareandserviceprovidersandotherindividualstocoordinateandintegrateservicedeliverytotheclientwiththeaimofimprovingtheirclinicaloutcomes.Consultationandliaisonmayoccurwithprimaryhealthcareproviders,acutehealth,emergencyservices,rehabilitationandsupportservices,family,friends,othersupportpeopleandcarersandotheragenciesthathavesomelevelofresponsibilityfortheclient’streatmentand/orwellbeing.

5 ClinicalnursingservicesServicesdeliveredbymentalhealthnursesthatcannotbedescribedelsewhere.Typically,theseaimtoprovideclinicalsupporttoclientstoeffectivelymanagetheirsymptomsandavoidunnecessaryhospitalisation.Clinicalnursingservicesinclude:

• monitoringaclient’smentalstate;• liaisingcloselywithfamilyandcarersasappropriate;• administeringandmonitoringcompliancewithmedication;• providinginformationonphysicalhealthcare,asrequiredand,where

appropriate,assistinaddressingthephysicalhealthinequitiesofpeoplewithmentalillness;and

• improvinglinkstootherhealthprofessionals/clinicalserviceproviders.

6 Childoryouth-specificassistanceNECServicesdeliveredto,oronbehalf,ofachildoryoungpersonthatcannotbedescribedelsewhere.Thesecaninclude,forexample,workingwithachild’steachertoprovideadviceonassistingthechildintheireducationalenvironment;workingwithayoungperson’semployertoassisttheyoungpersontotheirworkenvironment.

Note:ThiscodeshouldonlybeusedforServiceContactsthatcannotbedescribedbyanyotherServiceType.ItisexpectedthatthemajorityofServiceContactsdeliveredtochildrenandyoungpeoplecanbeassignedtoothercategories.

7 SuicidepreventionspecificassistanceNECServicesdeliveredto,oronbehalf,ofaclientwhopresentswithriskofsuicidethatcannotbedescribedelsewhere.Thesecaninclude,forexample,workingwiththeperson’semployerstoadviseonchangesintheworkplace;workingwithayoungperson’steacherto

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assistthechildintheirschoolenvironment;orworkingwithrelevantcommunity-basedgroupstoassisttheclienttoparticipateintheiractivities.

Note:ThiscodeshouldonlybeusedforServiceContactsthatcannotbedescribedbyanyotherServiceType.ItisexpectedthatthemajorityofServiceContactsdeliveredtoclient’swhohaveariskofsuicidecanbeassignedtoothercategories.

8 CulturalspecificassistanceNECCulturallyappropriateservicesdeliveredto,oronbehalf,ofanAboriginalorTorresStraitIslanderclientthatcannotbedescribedelsewhere.Thesecaninclude,forexample,workingwiththeclient’scommunitysupportnetworkincludingfamilyandcarers,men’sandwomen’sgroups,traditionalhealers,interpretersandsocialandemotionalwellbeingcounsellors.

Note:ThiscodeshouldonlybeusedforServiceContactsthatcannotbedescribedbyanyotherServiceType.ItisexpectedthatmanyServiceContactsdeliveredtoAboriginalorTorresStraitIslanderclientscanbeassignedtoothercategories.

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ATTACHMENTC:DIAGNOSISLISTUSEDINPMHCMDSAnxietydisorders

101 Panicdisorder102 Agoraphobia103 Socialphobia104 Generalisedanxietydisorder105 Obsessive-compulsivedisorder106 Post-traumaticstressdisorder107 Acutestressdisorder108 Otheranxietydisorder

Affective(Mood)disorders

201 Majordepressivedisorder202 Dysthymia203 DepressivedisorderNOS204 Bipolardisorder205 Cyclothymicdisorder206 Otheraffectivedisorder

Substanceusedisorders

301 Alcoholharmfuluse302 Alcoholdependence303 Otherdrugharmfuluse304 Otherdrugdependence305 Othersubstanceusedisorder

Psychoticdisorder

401 Schizophrenia402 Schizoaffectivedisorder403 Briefpsychoticdisorder404 Otherpsychoticdisorder

Disorderswithonsetusuallyoccurringinchildhoodandadolescencenotlistedelsewhere

501 Separationanxietydisorder502 Attentiondeficithyperactivitydisorder(ADHD)503 Conductdisorder504 Oppositionaldefiantdisorder505 Pervasivedevelopmentaldisorder506 Otherdisorderofchildhoodandadolescence

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Othermentaldisorder

601 Adjustmentdisorder602 Eatingdisorder603 Somatoformdisorder604 Personalitydisorder605 Othermentaldisorder

Noformalmentaldisorderbutsubsyndromalproblem

901 Anxietysymptoms902 Depressivesymptoms903 Mixedanxietyanddepressivesymptoms904 Stressrelated905 Other

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