31 July 2012

ANNUAL REPORT
NGO GRANT
NORTH COAST LOCAL HEALTH DISTRICT

&
MID NORTH COAST LOCAL HEALTH DISTRICT

1 JULY 2011 - 31 JULY 2012

ST ST

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 for the 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 IN 2011/2012 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 funded program 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 evaluated with MHS over 12 months. developed, implemented and

a. Benchmark; narrative of evidence of quality improvement activity progress each quarter 5. NGO demonstrates compliance against 5 National Mental Health Standards for Mental Health Services (2010) On Track Community Program Snapshot Report 3|Page

a. Benchmark; narrative evidence of specific occasions of service that meet five 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 14 16 17 29

1. July September 2. October December 3. January March 4. April June

Number of Consumer s in Outreach Support 19 14 12 9

Total Number of Consume rs 33 30 29 38

Percentag e face/face hours 62% 63% 62% 74%

Cost per Consumer per Quarter

$ 4,753.00 $ 5,229.00 $ 5,409.00 $ 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 5 7

1. July September 2. October December

Number of Consumer s in Outreach Support 24 24

Total Number of Consume rs 29 31

Percentag e face/face hours 56% 65%

Cost per Consumer per Quarter

$5,968 . 00 $5,583 . 00

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3. January March 4. April June

3 5

26 27

29 32

66% 74%

$5,968 . 00 $ 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 0 0 6 6

1. July September 2. October December 3. January March 4. April June

Number of Consumer s in Outreach Support 34 36 19 17

Total Number of Consume rs 34 32 25 23

Percentag e face/face hours 60% 63% 66% 72%

Cost per Consumer per Quarter

$ 3,121.00 $ 3,316.00 $ 4,245.00 $ 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 reach their 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 12

1. July 2011 June 2012

Number of Consumer s in Outreach Support 106

Total Number of Consume rs 118

Percentag e face/face hours 65.25%

Average Annual Cost per Consumer

$15,296. 00

NB: The differing amounts per region are a reflection to Coffs Harbour being funded at a lesser amount and with On Track agreeing for 12 months to fund the 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

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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 program. conducted with 28 ex-participants of the

Table 1 - Average responses to Indicators Indicator 1. Hospital Admissions

Number of admissions to the mental health unit

12 Months Prior to Exit 1.2 with 3.2 3.6 2.7 3

12 Months Exit 0.3 4.9 1.4 0.8 18

Since

2. Appointments psychiatrists
Appointments attended

3. Medication non-compliance
Number of times medication non-compliance recorded

4. Accommodation stability
Number of relocations

5. Accommodation type
Number of consumers in own accommodation

Table 2 - Transition through accommodation types Accommodation type Prior To Intake 18 On Exit 0 12 months post intervention 0

Patient in Mental Health Ward 3 Own Accommodation 13 18

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4 Staying With Family or Friends 2 No accommodation

12

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|Page

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 annual cost 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.

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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 YOUR ORGANISATION, 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

Below are an example of the varied active partnerships with other community and Government departments across the region.

Switch (NRSDC) North Coast Community Housing District Mental Health Community Mental health NSW Housing LAMHU Lived Experience Project (NRSDC) On Track Community Housing On Track Homelessness Service New Horizons HASI New Horizons PHAMS New Horizons RRSP Office of the Protective Guardian Commonwealth Carer Respite 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

PARTNERSHIPS IN ACTION One of many examples, which clearly demonstrates the success of cross Government 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

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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