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7/29/2019 ngo grant - successful mental health program in Australia
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31 July 2012
ANNUAL REPORTNGO GRANT
NORTHCOASTLOCALHEALTHDISTRICT&
MIDNORTHCOASTLOCALHEALTHDISTRICT
1ST JULY 2011 - 31ST JULY 2012
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ABSTRACT
The following report is indicative of the success of the NGO Grant program for the
2011/2012 year. The results have been compiled through a comparative cost analysis
along with both qualitative and quantitative data of the services delivered. On Track
Community Programs have not only provided services as specified within the contract
from the NSW Health, but have clearly demonstrated a cost saving to the department forthe 2011/2012 financial year.
In addition to meeting all key performance indicators further evidence of the
effectiveness of the program have been exemplified through quantitative data collated
for 12 months pre and post intervention. This data was compiled through a snap shot
audit report utilising both internal and external records from NSW Health, Housing NSW
and On Track Community Programs. Further validity was attained through qualitative
data from direct interviews with ex-participants of the service.
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OUTLINE IN BRIEF ALL SERVICES PROVIDED IN2011/2012
USING NSW HEALTH GRANTS
SERVICES PROVIDED
On Track Community Programs entered into an agreement with North Coast Area Health
Service to provide the following psychosocial support and rehabilitation services across
the Tweed/Byron and Lismore regions.
Residential Rehabilitation
Outreach accommodation support across the region
The funding allocation for the above supports is $1, 319,790 for North Coast Local Health
District, with an additional amount for the Mid North Coast of $424,500, an overall
allocation of $1,744,290 per annum.
KEY PERFORAMCE INDICATORS
The following Key Performance Indicators (KPIs) were developed by NSW Health in
collaboration with On Track Community Programs to measure both qualitative and
quantitative evidence to track program efficacy as well as inform service improvements.
The key performance indicators utilised below are those reported against during the
2011/2012 financial year before the newly agreed contractual obligations were
instigated.
1. Grant funding cost per consumer
a. Number of consumers / annual funding amount (annual cost) (divide by = quarterly cost)
2. Percentage of outreach hours in direct face to face care provided by fundedprogram
a. Benchmark 60% face to face hours
3. Percentage of 13 week clinical reviews attended for joint consumers
a. Benchmark 100%
4. Quality improvement activity collaboratively developed, implemented andevaluated with MHS over 12 months.
a. Benchmark; narrative of evidence of quality improvement activity progresseach quarter
5. NGO demonstrates compliance against 5 National Mental Health Standards forMental Health Services (2010)
On Track Community Program Snapshot Report 3 | P a g e
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a. Benchmark; narrative evidence of specific occasions of service that meetfive different National Health Standards per quarter.
The key performance indicators have been reported against from July 2011 to June 2012
based on the previous contract and quarterly reporting templates advised from NSW
Health. The newly agreed contract which is awaiting Ministerial signature, with the
revised key performance indicators will begin in good faith as of July 1st 2012.
PERFORMACE AGAINST INDICATORS PER QUARTER
The tables below illustrate the performance per quarter for each area. There is a
discrepancy in average cost per consumer as a direct result of the unequal funding
allocation per site. Overall figures are calculated in table 3, and are indicative of overall
program costings. The additional KPIs of quality improvement and compliance against
National Mental Health Standards are articulated as met for the sake of brevity, and
evidenced by quarterly reports.
$627,505
Lismore
Number of
Consumer
s in 24/7
Support
Number of
Consumer
s in
Outreach
Support
Total
Number
of
Consume
rs
Percentag
e
face/face
hours
Cost per
Consumer
per
Quarter
1. July -
September
14 19 33 62% $
4,753.002. October -
December
16 14 30 63% $
5,229.003. January
March
17 12 29 62% $
5,409.004. April June 29 9 38 74% $
4,128.00
Quality Improvement activity collaboratively developed, implemented and evaluated
100% each quarter as evidenced in quarterly reports.
Compliance against 5 national Mental Health Standards 100% met each quarter as
evidenced in quarterly reports.
$692,285
Tweed
Heads/Byron Bay
Number of
Consumer
s in 24/7
Support
Number of
Consumer
s in
Outreach
Support
Total
Number
of
Consume
rs
Percentag
e
face/face
hours
Cost per
Consumer
per
Quarter
1. July -
September
5 24 29 56% $5,968 .
002. October -
December
7 24 31 65% $5,583 .
00
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3. January
March
3 26 29 66% $5,968 .
004. April June 5 27 32 74% $
5,409.00
Quality Improvement activity collaboratively developed, implemented and evaluated
100% each quarter as evidenced in quarterly reports.
Compliance against 5 national Mental Health Standards 100% met each quarter as
evidenced in quarterly reports
$424,500
Coffs Harbour Number of
Consumer
s in 24/7
Support
Number of
Consumer
s in
Outreach
Support
Total
Number
of
Consume
rs
Percentag
e
face/face
hours
Cost per
Consumer
per
Quarter
1. July -
September
0 34 34 60% $
3,121.002. October -
December
0 36 32 63% $
3,316.003. January
March
6 19 25 66% $
4,245.004. April June 6 17 23 72% $
4,614.00
Quality Improvement activity collaboratively developed, implemented and evaluated
100% each quarter as evidenced in quarterly reports.
Compliance against 5 national Mental Health Standards 100% met each quarter as
evidenced in quarterly reports
N.B It is noted that due to transitioning into a new model of support as per the request
of NSW Health, residential rehabilitation was not provided pre January 2012, therefore
the increased outreach statistic through the provision of a variety of day program
supports.
ANNUAL PERFORMACE AGAINST INDICATORS
Successfully working alongside of 346 consumers on the North Coast of NSW to reachtheir individual goals of wellbeing and recovery On Track Community Programs are
outcomes focussed whilst still reaching all KPIs exceeding face to face percentage by
over 5%, whilst keeping the annual cost per consumer to a minimum of just over $17,000
per annum.
Lismore & Tweed
Heads/Byron Bay
Combined
Number of
Consumer
s in 24/7
Support
Number of
Consumer
s in
Outreach
Support
Total
Number
of
Consume
rs
Percentag
e
face/face
hours
Average
Annual
Cost per
Consumer
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1. July 2011
June 2012
73 145 228 65.25% $18,935.
00
Coffs Harbour Number of
Consumer
s in 24/7
Support
Number of
Consumer
s in
Outreach
Support
Total
Number
of
Consume
rs
Percentag
e
face/face
hours
Average
Annual
Cost per
Consumer
1. July 2011
June 2012
12 106 118 65.25% $15,296.
00
NB: The differing amounts per region are a reflection to Coffs Harbour beingfunded at a lesser amount and with On Track agreeing for 12 months to fundthe shortfall.
OVERALL PROGRAM EFFECTIVENESS AND EFFICIENCIES
The effectiveness and efficiencies of the On Track Community Programs NGO Grant
program in the North and Mid North Coast Local Health Districts will be proven by the
wellbeing and stability of participants of this program across multiple key areas.
METHOD
Effectiveness and efficiencies were measured by assessing quantifiable indicators of
wellness for the 12 months prior to and 12 months post exit, along with a comparative
cost analysis between the cost of mental health support of NSW Health and the NGO
Grant program.
Figure 1 - Flowchart
Five wellness indicators were chosen to assess the program:
1. Hospital Admissions
2. Appointments kept with psychiatrists
3. Medication compliance
4. Accommodation stability
5. Accommodation type
On Track Community Program Snapshot Report 6 | P a g e
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The wellness indicators cover areas of mental stability, compliance with medication and
housing stability. The additional qualitative data forwarded opportunity for the
participants themselves to add humanity to the figures through feedback and interviews.
Congregated data from primary and secondary sources were collated inclusive of; NSW
Community Mental Health Case Managers, NSW Housing, On Track Community Programs
database along with the participants themselves.
RESULTS
A snapshot review of 35 participants who exited the service during the last 12 months,
along with qualitative data from interviews conducted with 28 ex-participants of the
program.
Table 1 - Average responses to Indicators
Indicator 12 Months Prior to
Exit
12 Months Since
Exit
1. Hospital AdmissionsNumber of admissions to the mental health
unit
1.2 0.3
2. Appointments with
psychiatristsAppointments attended
3.2 4.9
3. Medication non-complianceNumber of times medication non-compliance
recorded
3.6 1.4
4. Accommodation stabilityNumber of relocations
2.7 0.8
5. Accommodation typeNumber of consumers in own accommodation
3 18
Table 2 - Transition through accommodation types
Accommodation type Prior To
Intake
On Exit 12 months post
intervention
Patient in Mental
Health Ward
18 0 0
Own Accommodation
3 13 18
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Staying With Family or
Friends
4 12 7
No accommodation
2 0 0
At 12 months post-intervention a 79% reduction in mental health unit episodes
clearly exemplifies not only the reduction in fiscal and human resources to the
NSW Government, but also demonstrates the increased dignity and independence
of these individuals.
The increased engagement of the consumers post intervention with the mental
health system is demonstrated through the 75% increase in appointments kept
with Psychiatrists.
Accommodation stability is a strong indicator of mental stability with the majority
of consumers entering the program under a status of homelessness, and exiting
in stable and sustainable housing is exemplary.
Figure 2 - Pre & Post Results for Assessed Indicators
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Figure 3 - Transition of Housing Types over Time
Accommodation Type
QUALITATIVE FEEDBACK
A concise collation indicating the large majority of consumer feedback is inclusive of the
following;
On Track Community Program Snapshot Report 9 | P a g e
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Mandara decreases my stress
Makes me more relaxed
I can deal with my voices and hallucinations better
Helps me relax
I am not alone, I enjoy the company of other residents and staff
I no longer need any pills
I have been homeless for years, now I have my own place
COMPARITIVE COST ANALAYSIS
This cost analysis forwards a comparison of psychiatric hospital care and community care
within the NGO Grant Program. Expenditure and income data in both settings were
collected with costs analysed on an episode per consumer basis.
The NSW Health estimated bed cost per day across the region is $862, with the annualcost standing at $311,710 per annum. With an average hospital stay of seventeen days
per episode across North Coast and Mid North Coast Local health Districts, equates to
cost for NSW Health of $14, 654 per stay. This extensive cost presents an overwhelming
need to decrease the prevalent relapse rates, which will show a direct correlation to the
reduction of the fiscal and human costs associated with mental illness. At the 12 month
pre intervention rate of 1.2 hospital stays per consumer, as noted previously, equating to
$18,317 per consumer. For the 346 consumers currently supported across the region, an
average of 1.2 episodes per consumer equates to an overall cost of $ 6,337,682 to NSW
Health.
This figure is then extrapolated over the estimated 75% reduction in hospital stays from
1.2 average episodes to .3 stays 12 months post intervention from the NGO Grant
program, at $ 1,584,420. This equates to an estimated annual cost savings of $4,753,262
for the North and Mid North Coast Area Health Service.
According to a recent extensive national study undertaken by SANE, the average length
of hospital stay per consumer is 40 days per episode. An assumption is therefore made
that for consumers on the North and Mid North Coast, an early discharge is only
achievable due to the step down support available at the On Track 24/7 facilities.
Therefore an estimated saving of $19,826 per consumer per episode can be assumed.
An average cost per consumer supported through the NGO Grant is $17,000 per annum
per consumer. With the additional salary of community mental health staff of $66,200
holding an average client load of 17. Additional 30% on-costs = $87,600 / 17 = $5,152
clinical supports provided.
On Track Community Program Snapshot Report 10 | P a g e
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Total cost per consumer in the community with both NGO Grant support coupled with
clinical supports from community mental health equates to $22,152 per consumer per
year.
OUTLINE ANY INTERACTION BETWEEN YOURORGANISATION, OTHER NGOS, GOVERNMENT
DEPARTMENTS AND HEALTH SERVICES
The overall success of the NGO Grant program can be attributed to the collaboration of
our partners across both the NSW Health system and the wider community sector. During
the last 12 months NSW Health provided high quality case management for program
participants, along with the clinical advice and support to On Track staff. The strong
partnership between North Coast Area Health Service and On Track Community
Programs have provided the opportunity for joint case planning, complex case
coordination and well planned entries and exits to the service has proven invaluable. This
partnership is demonstrated through ht following across the region;
The attendance of On Track key staff to 100% of the 13 week clinical reviews in
each location,
Attendance of On Track staff to 100% of ward rounds.
Attendance of On Track staff to Case conferences for complex cases as required.
100% attendance of all NSW Health partnership meetings.
Continual communication mediums through individual face to face meetings when
requested by either party, email and written correspondence.
Regular face to face meetings between the Manager Partnerships, NSW Health
and Executive staff of On Track Community Programs.
100% submission of all reporting requirements.
Attendance of annual program reviews across the region.
Cross invitation between On Track staff and Area Health staff on interview panels
100% attendance from On Track staff to all specific meetings, e.g. collaborative
discussions around recovery tools, cross department training and other
imperatives for improved service delivery.
Open door policy between On Track Community programs and our North Coast
and Mid North Coast Area Health partners
The above are just a few of the daily indicators of this partnership in action.
On Track Community Program Snapshot Report 11 | P a g e
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Below are an example of the varied active partnerships with other community and
Government departments across the region.
PARTNERSHIPS IN ACTION
One of many examples, which clearly demonstrates the success of crossGovernment and community partnerships to support complex cases within the
NGO Grant program;
SP presented with a diagnosis of Bipolar disorder and frontal lobe damage from a recent
overdose. On Track liaised with a number of partners, including SPs Guardian, an
appointed advocate, and ADHC. The Department of Ageing, Disability and Aged Care
have assisted with costs associated with neuropsychologist assessments, at the Lismore
Adult Mental Health Unit, with psychiatrists compiling a full psychiatric assessment.
Whilst in care, NSW Housing have agreed to maintain SPs housing status to allow
On Track Community Program Snapshot Report 12 | P a g e
Switch (NRSDC)
North Coast CommunityHousing
District Mental Health
Community Mental health
NSW Housing
LAMHU
Lived Experience Project(NRSDC)
On Track CommunityHousing
On Track HomelessnessService
New Horizons HASI
New Horizons PHAMS
New Horizons RRSP
Office of the ProtectiveGuardian
Commonwealth CarerRespite centre
Bugalweena
Nexus Mental Health Rehabilitation &Recovery Service
ADHC
Carers NSW
Gurgun Bulahnggelah
Tarmons House Mental Health Service
Lismore Sexual Health Service (SHAIDS)
Riverlands Drug & Alcohol Centre
Interrelate
On Track Australian Disability Enterprise
Prema House Medical Centre
On Track HASI
CASPA
Centrelink
Community Centres
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efficient time for On Track staff have worked alongside of SP to achieve her goals with
independent living skills.
Due to this partnership SP is able to live three days a week with her daughter in her own
NSW Housing property, and four days a week in On Tracks psychosocial residential
rehabilitation. The assessments have informed support levels across several Government
Departments and community services to ensure that SP will achieve her goal to live
permanently with her daughter. SPs daughter continues to receive specific Carer support
from Carers NSW.
CONCLUSION
The analysis demonstrated overall that with limited fiscal and human resources, the NGO
Grant program attained the overall objective to provide a continuum of care and support
that is efficient, effective and person centric. The provision of this fluidity of supports has
clearly reduced the inpatient episodes per consumer by 75%.
The economic imperative alone clearly communicates program efficiencies, when these
are coupled with wellness indicators and evidence of positive partnerships, provides
insight into the human aspect that the NGO Grant program is successful in assisting
people to increase their overall level of wellness.
ACKNOWLEDGEMENTS
On Track Community Programs acknowledges that the success of the NGO Grant
program has been through the ongoing support of our clinical partners across the LHD,
where many staff continues to work above and beyond the roles to work alongside On
Track to increase the wellness of our most vulnerable members of the community.
We also acknowledges the contributions to this report from the following staff; Chris
Maylea BSW MHSMP, Mental Health Services Manager, Jodi Watts, Residential Services
Coordinator, Christopher Tricker, Mental Health Support Worker.
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