The 7th Australasian Mental Health Outcomes and Information Conference

Programme

Workshops, Wednesday 30 October, 2019
8:00am
Registration desk open
9:00am
Concurrent workshops
Workshop 1
9.00am - 12.00pm

Warm Data Lab - Nora Bateson, Bateson Institute, Sweden

Workshop 2
9.00am - 12.00pm

Feeding back to move forward - Sandra Baxendine, Talya Postelnik, Mark Smith, Paul Hanton - Te Pou o te Whakaaro Nui, New Zealand

12:00pm
Lunch
1:00pm
Concurrent workshops
Workshop 1
1.00pm - 4:00pm

Putting health back into mental health care - engaging AMHOIC stakeholders to design systematic solutions for mental health and mental illness measurement, treatment, and prevention - Joep Van Agteren and Matthew Iasiello, South Australian Health and Medical Research Institute (SAHMRI)

Workshop 2
1.00pm - 4:00pm

Finding the Care Factor – the integration of routine outcome measurement and care planning for adult consumers - Tim Coombs and Rick Bastida, Australian Mental Health Outcomes Classification Network (AMHOCN)

4:00pm
Registration desk open
6:30pm
Elliott Rooms - Welcome drinks and canapés
Day 1, Thursday 31 October, 2019
7:30am
Registration desk open
8:30am
Ballroom - Põwhiri/Welcome
9:00am
Welcome by Te Pou o te Whakaaro Nui chief executive, Rae Lamb and Master of Ceremonies, Josiah Tualamali’i
9:10am
Opening Address - Associate Minister of Health, Hon Peeni Henare
9:25am
Deputy Director-General Mental Health and Addiction, Robyn Shearer
9:40am
Master of Ceremonies – set the scene
9:50am
Morning tea
10:15am
Ballroom - KEYNOTE: Nora Bateson – Warm Data
11:05am
Concurrent Streams (60 mins)
Stream 1 - Ballroom - Chair: Mark Smith
11:05am - 11:35am

Advances in Data Visualisation the Qlik resource - Barry Welsh and Hilary Sharp - New Zealand Ministry of Health Keywords: data, information, visualisation, putting people at the centre

Qliksense was launched at MoH in October 2018. The Mental Health and Addiction Qlik application (app) was the first app to be developed and released.

The MH&A Qlik app begins to overcome some of the sectors' concerns particularly about the accessibility of PRIMHD data. Over 290 users now have access to Qlik, of which 124 (including both MoH and Sector users) have accessed the MH&A app. Roll out of access to further users is planned, along with a review of the processes for licence distribution.

All users are required to undergo training and complete assessments in order to gain access to Qlik, and this also covers working with sensitive health data.

This session will focus on how MoH is using the current MH&A app, and the insights it provides. A video recording/demo will cover the different data sources that make up the app, including PRIMHD, Pharms and NMDS to give a view of MH&A services being accessed and provided across a range of settings.

There are currently nine MoH Qlik apps available to the sector in production, with work underway on more. Potential future apps with a focus on MH&A include a Mental Health ED attendances app which links up data from PRIMHD and ED attendances from NNPAC, and an app to allow further drilling down and analysis of PRIMHD data.

11:35am - 12:05pm

A culturally appropriate online mental health measure for the NRL (National Rugby League) in Australia and Aotearoa New Zealand - Dr Monique Faleafa - Le Va Keywords:  Well being, Assessment, Rugby League

Stream 2 - Elliott Room 1 - Chair: Paul Hanton
11:05am - 11:35am

Te Kete Pounamu - A voice for Māori with Lived Experience - Kerri Butler and Leilani Maraku - Te Rau Ora. Keywords: Putting People at the Centre, Mental Health and Addiction, Lived Experience

Following a national consultation process Te Kete Pounamu - The National voice of Māori with lived experience of mental illness and/or addictions was formed (Baker, 2015) . Te Kete Pounamu provide whaiora Māori  a voice at local, regional and national levels to improve health outcomes for Māori.

Representatives of Te Kete Pounamu host regular hui in their rohe (areas), to whakawhanaunga (build relationships) and to hear the korero of whaiora Māori.  The korero is analysed to identify themes that inform what is important for whaiora Māori.

The outcome from these hui has resulted in identifying key factors that ensure whaiora Māori have a voice at local, regional and national levels:

  • Approach is informed by Mātauranga Māori
  • Kaupapa Māori evaluation approaches that contribute to whaiora Māori influencing the changes that ensure positive outcomes for themselves
  • Whaiora Māori are supported and resourced to develop solutions that are locally led and nationally navigated
  1. Baker, M (2015). He kai i nga Rangatira  He korero o nga whānau whaiora. Wellington: Te Rau Matatini Ltd
  2. Whaiora Māori - Māori with Lived Experience of mental distress and/or addictions
11:35am - 12:05pm

Whānau engagement and wellbeing: How can we measure this to inform service delivery? - Jennifer Lai - Te Pou o te Whakaaro Nui. Keywords: Putting People at the Centre, Mental Health and Addiction, Education

Putting people at the centre includes engagement and wellbeing of whānau and family members. Whānau wellbeing is a fundamental component in Māori and Pasifika models of health. Whānau can provide a range of support for their loved ones who experience mental health and addiction issues, and this support often occurs beyond the journey through services. Thus, mental health and addiction services have an important role in engaging whānau and supporting them in building their strengths, knowledge and resiliency. In Aotearoa New Zealand, practitioners and mental health services are required to consult with whānau, however in 2017, only 60 percent of whānau on average were consulted about Mental Health Act assessment/treatment events.

In order to usefully inform service delivery, it is important to understand the different ways in which data measures can capture people’s experiences of whānau engagement in mental health and addiction services. This presentation will highlight the work Te Pou is currently doing to support whānau engagement and describe some of the whānau engagement data measures currently available in Aotearoa New Zealand. This includes data collected through service activity and real-time feedback. Whānau engagement measures utilised in other countries at the national-level will also be explored, including Australia and the UK.

Stream 3 - Elliott Room 2 - Chair: Rosemary Dickson
11:05am - 11:35am

What is required to improve the uptake of consumer rated outcome measures to support continuous quality improvement in mental health care? - Dr Tim Coombs, Contractor AMOCHN. Keywords: Working Together to Improve Wellbeing, Mental Health, Clinical

Consumer rated measures are a core component of the National Outcomes and Casemix Collection (NOCC) but Australia began outcome measurement in the public mental health sector with 3 different measures across the country – the BASIS-32, MHI-38 and the K-10. The NOCC Strategic Directions 2014-2024 Final Report identified that, with a few exceptions, there was generally poor uptake of these consumer rated measures, regardless of how many questions were asked. Factors that may have impacted on the use of the measures include: the relevance of the domains being measured for the consumer and for the clinician, the need for a greater focus on social inclusion and recovery, and access to easily interpretable reports that support clinical interactions between consumer and clinicians.

Australia is now developing a single consumer rated measure for national use with the aim of producing a measure that has domains of importance to consumers, carers and clinicians and that lends itself to support the dialogue between the consumer and the clinician. However, it is not expected that these changes will drive increased compliance. A range of other activities are essential to improving the uptake of a consumer rated measure. This paper will explore: the importance of the use of the consumer rated measure to improve care, the need for information systems that are easily accessible and provide meaningful reports of the results of the collection for both consumers and clinicians, and the need for engaged clinical leadership that develops a culture that values routine outcome measurement from the consumer’s perspective.

11:35am - 12:05pm

Clinical Information Champions (CIC's) - The conduit to change! - John Dillon and Ossi Beck - Queensland Health. Keywords: Working Together to Improve Wellbeing, Mental Health, Clinical

Initiating and sustaining change across mental health services is challenging and cannot be achieved without sufficient commitment from stakeholders at all levels.  Increasingly, new procedures, policies, monitoring of standards and key performance indicators reply on the collection, reporting and analysis of mental health information.  Clinical Information Champions sit within mental health teams and are the conduit by which changes are introduced and feedback is provided.  Their role is critical in supporting the use of digital clinical record systems. The identification and development of CICs is promoted through bi-annual forums using various approaches to education and consultation.  Typically, CICs are senior clinicians who have expressed an interest and/or willingness to accept an “information portfolio”; in addition to their clinical load.  They support Team Leaders in utilising clinical information and reporting systems, orient new clinicians into their model of service and monitoring performance.

This paper explores the different CIC models adopted throughout Queensland over the past 10 years and the range of topics and issues presented at the forums.  It will highlight the importance of effective communication around change within mental health services and report on what has been achieved to date and what lies ahead.

Stream 4 - Elliott Room 3 - Chair: Peter Brann
11:05am - 11:35am

What I say three times is true - Rob Warriner - WALSH Trust. Keywords: Information for Prevention, Mental Health, Data

Particularly since the introduction of the national Programme for the Integration of Mental Health Data (PRIMHD) in 2009, data collection has become a core element of WALSH Trust’s work in providing community based, mental health support services.

In the years since 2009 we have become significantly richer in data. However that doesn’t automatically equate to our accruing a similar increase in riches around information. Particularly information that then leads to action.

Engaging with data and information, questioning, doubting, feeling disappointed and challenged, feeling affirmed and assured… are typical outcomes of the conversations that have needed to happen across the organisation and at all levels.  How we connect this information together, to provide a clearer picture of what is happening, asking “What does this all mean?”; and “What do we do about it?”; are essential elements of our commitment to making decisions about our services and our organisation based upon good information that is relevant and well understood.

It is the latter part of this process that we are needing to prioritise, develop and grow.

A KPI dashboard is provided each month and posted on notice boards across the organisation. A “measures that matter”; presentation (again updated monthly) has been shared with teams. The purpose of these is to share what is happening across the organisation (according to some of the data we collect) and provoke conversation and discussion about what the data is saying, its accuracy and relevance, information is missing, and  what we need to be doing because of what this data is telling us.

This presentation will illustrate our journey - from “why do we have to do this…..?” to “what should be a realistic benchmark to evaluate this?”.

11:35am - 12:05pm

Surfing the fourth wave: A conceptual framework for describing and measuring system change - Phillipa Gaines - Lattice Ltd. Keywords: System and Delivery Change, Mental Health and Addiction, Education

Surfing the fourth wave: A conceptual framework for describing and measuring system change.

A combination of the government’s acceptance of the majority of recommendations from the Mental Health Inquiry (He Ara Oranga, 2018) and the placement of mental health and child poverty at the heart of the government’s Wellbeing Budget 2019 signals major changes to the way that mental health and addiction services will be delivered in New Zealand in the future.

Whilst the need for ‘system transformation’ has been evident for some time in the mental health and addiction sector, the reality is that the change process has been slow, complex and difficult.

In the absence of a common framework that can help localities to  ‘join the dots’ and better coordinate their activities, there is a risk that system change efforts will not be targeted at the right things and will not generate the desired level of impact.

This presentation offers an overview of a conceptual framework for describing and measuring system level change. The framework could help key stakeholders break down the amorphous notion of ‘system transformation’ into some clear activities and goals - based on the seven high priority areas that have been identified in On Track: Knowing where we are going (Platform Trust & Te Pou, 2015).

Attendees to this presentation will be supplied with details regarding the various components of this framework - including the outputs of activities, outcomes and possible measurement options.

The presenter welcomes dialogue about possible improvements to the framework with the aim of developing a shared understanding of sytem change.

Stream 5 - Victoria Room - Chair: Frank Bristol
11:05am - 11:35am

Better mental health, one click at a time. An introduction to Just a Thought, New Zealand’s new online Cognitive Behavioural Therapy tool - Anna Elders - Just a Thought. Keywords: Putting People at the Centre, Mental Health, Clinical

With the current state of our mental health system defined in He Ara Oranga, we find ourselves doing some soul searching. Is it possible to turn our much-challenged reality around? Are we willing to embrace innovative and engaging solutions that put people at the centre of improving their mental health?

This presentation will outline Just a Thought - a new online Cognitive Behavioural Therapy tool with a proven history of efficacy, recently redeveloped specifically for New Zealand people. Just a Thought delivers evidence-based, immediately accessible, free and specific psychological help to New Zealanders. It gives people the right support they need, at the right time, in a way that works for them.  New Zealanders will have the choice of either independent, self-care access or the option to work alongside their healthcare professional - who will receive timely information to help track progress and offer support along the way.  We’ll outline the clinical evidence behind the tool, explore it’s application and the opportunities it offers services and people working in healthcare and social settings to enhance the support they can offer people experiencing a range of mental health challenges. Changing minds to change lives, together.

11:35am - 12:05pm

Building Trust - Using lived experience stories for system change - Taimi Allen and Borni Te Rongopai Tukiwaho - Changing Minds. Keywords: System and Delivery Change, Mental Health, Lived Experience

Changing Minds collect and collate stories from their peer community for the purpose of articulating issues and activating solutions. This presentation will walk you through how we look outside the square to build, celebrate and support lived experience leaders and service user networks.

The focus of the presentation will be on several innovative pieces of work that harnessed lived experience stories for the purpose of advocating for system transformation including the Lived Experience submission to Te Ara Oranga, “Nuggets of Gold”; Suicide Survivors Research, our Complex Service User Needs work, The Atawhai Festival,  and our work in Entertainment, Media and new technology including recoVRy, our Virtual Reality app.

12:05pm
Lunch
12:50pm
Ballroom - KEYNOTE: Dr Barbara Disley - The Reality of a “Big Community” Mental Health and Addiction Response
1:35pm
Concurrent Streams (90 mins)
Stream 1 - Ballroom - Chair: Fiona Hamilton
1:35pm - 2:35pm

Symposium - A Housing First response to Homelessness in Hamilton, New Zealand - Kerry Hawkes and Carole McMinn – The People’s Project  Keywords: Homelessness, Data, Housing First, Vulnerability Assessment

In Hamilton, people experiencing homelessness are served by a number of community-based organisations, including The People’s Project (TPP). TPP was established in Hamilton in 2014 in response to the perception of an increasing number of rough sleepers in the central business district.  

Today, TPP is a successful collaboration between a large number of organisations: Hamilton City Council, New Zealand Police, Ministry of Social Development, child protection agency Oranga Tamariki/Ministry of Children, social housing provider Housing New Zealand, the justice department’s Department of Corrections, Waikato District Health Board, primary health care provider Midland’s Pinnacle Health Network, Hamilton Central Business Association, Māori development department Te Puni Kōkiri, tangata whenua of the Waikato region WaikatoTainui and, mental health and wellbeing non-government service provider the Wise Group.  

Since opening in 2014, more than 2,000 people have registered for help with The People’s Project. To date, more than 1,000 men, women and children have been supported into housing. A further 900 have received a little help and advice in order to help themselves. A core 75 households are receiving ongoing support to sustain their tenancies, improve their wellbeing and return to social inclusion, at a level and pace determined by the client.  

Permanent Pathways Housing First clients typically have high and complex health, social and wellbeing support needs. The TPP Hamilton team of 12 case managers are a multi-disciplinary team, include two clinical staff seconded from Adult Community Mental Health and Community Alcohol and Drug services. Having the seconded staff as part of the team allows for speedy triage of clients into mental health and substance dependency services if required.  

From the beginning, The People’s Project has been committed to collecting the right data to support research that contributes to robust evidence and a framework for developing a model for ending homelessness in New Zealand. TPP works closely with population study experts from the University of Waikato and the University of Otago and is involved in six concurrent research projects. TPP’s data has provided evidence which has been the basis of significant positive local systems change, and is shared widely with government policy makers, local community groups, researchers and Iwi.  

TPP has adopted the internationally recognized Vulnerability Index – Service Prioritization Decision Assistance Tool (VI-SPDAT). This tool is used to assess people’s level of support need. The tool uses a 10-minute survey, made up of 17 questions, to determine how complex a client’s care will be. The content of the survey has been extensively researched by the American developer. Areas covered include legal matters, health and wellbeing issues, and level of victimization on the street. The tool has been integrated into the TPP client management system, Recordbase. The average score for TPP Hamilton clients is 8.5 out of 17, indicating client requires full Housing First support. TPP has advocated the adoption of this tool across relevant social services, including hospitals, night shelters, and MSD.  

2:35pm - 3:05pm

From listening to learning — for safe and respectful data use - Danny Mollan, Engagement Lead and Fiona Wharton, Principal Adviser, Data Protection and Use Policy - Social Investment Agency Keywords: Information for Prevention, Data Integration

Improving people’s wellbeing depends in part on the quality of social sector insights, and the how effectively we apply them.
Insight quality is founded on how well we collaborate over data and information which might be useful, and how safely and respectfully we develop those insights. It also relies on the trust and confidence people have in the overall approach. If it’s about me — it needs to be done ‘with me’, not ‘to me’.

The foundation of a trusted approach to richer insight starts with listening to the people and communities we serve. How do you do that? How do you really listen?

We have developed a Data Protection and Use Policy for the social sector, by the sector, by listening to a wide range of people about what respectful and inclusive data use means to them, and how they’d like to see the ideas and practices work for them.

To do this we needed to learn to listen, and then listen, to learn.

Stream 2 - Elliott Room 1 - Chair: Rosemary Dickson
1:35pm - 2:35pm

Symposium - 'What' is in the box with the dots? - Rick Bastida and Jason Monk - Queensland Mental Health Clinical Improvement Team. Keywords: System and Delivery Change, Mental Health, Clinical

The dots of the national data from the Australian public mental health sector record the consumer story, for example, how long and how often they receive services, who they receive services from, and whether it is an individual or group and if it is with, or on behalf, of a consumer.  “What” the consumer receives is a missing dot in this picture. Traditionally, the sector has found it challenging to articulate and classify “what” is delivered to consumers.

An intervention code-set was required to reflect the changing landscape and workforce composition of contemporary public mental health services. What began as a purely clinical workforce had developed to include a range of non-clinical direct care workers such as peer workers and Indigenous mental health workers. A new code set was required. It had to be capable of aggregation up to meaningful domains for high-level reporting as well as having utility at a clinical level.

This symposium is organised around two inter-related papers that report on a review of the intervention code-set used in the Queensland state-wide mental health clinical information system.

Paper one

Developing the dots -A novel iterative approach to grass roots consultations

An overview of a three-phase state-wide consultation process undertaken by the Queensland Mental Health Clinical Improvement Team (MHCIT) is presented.

In the first phase, underpinned by feedback from the field, consultations with policy and planning stakeholders established a set of requirements. A discussion paper was prepared that posed a series of questions and explained the scope and parameters of the review.

Phase two involved face-to-face consultations with approximately 350 mental health clinicians, peer and other non-clinical direct care mental health workers, information managers, clinical managers and executives over a four-month period. Following each consultation, an example of a ‘could-be’ code-set was updated with stakeholder feedback. When no new suggestions were received, saturation was assumed.

Phase three involved defining each code and the development of online and printable resources. Just prior to the implementation of the code-set into the clinical information system, MHCIT conducted a ‘familiarisation tour’ across Queensland to over 1300 end-users.

Paper two

Do the dots look different? -Analysis of the new code set and comparisons between professions and different models of service

The new CIMHA Intervention and Activity code-set is showcased. The structure, domains and interventions and activities that reflect clinical and non-clinical direct care provided in Queensland public mental health services that align with national planning tools and state policy directions are discussed.

The presentation concludes with the findings of the first year of use. High-level data are presented, disaggregated by setting, Special Service Type, provider discipline, consumer and carer participation and location. A key outcome of this work to date is the ability to understand “what” consumers receive from a public mental health service. This contributes valuable insights that help link the dots in mental health service planning and improvement.

 

2:35pm - 3:05pm

Outcome measurement across lifespan: Health of the Nation Outcome scale for children and infants (HoNOSI) - Peter Brann and Gordana Culjak - Eastern Health Keywords: Infants, Measurement, Mental Health, Data

Australia and New Zealand have made admirable progress on routine outcome measures though with many challenges yet to be filled.  Amongst those unrepresented are pre-schoolers and infants.   

Since identification of this gap in the strategic review of routine outcome measures in Australia, the National CAMHS Information Development Expert Advisory Panel has persevered with designing a HONOS like instrument for this group.  A working group with significant New Zealand contribution, built upon the existing structure of HoNOSCA, to develop the Health of the Nations Outcome Scales for Infants (HoNOSI).  Ideally, there is a triad of perspectives, the infant, the parents or family, and the clinician.  In this situation, the perspective of the clinician was chosen as the first to pursue.    Progress on the design and face validity trial of HoNOSI has previously been presented.  

Since the last conference, the validity and reliability of the instrument has been examined.  The validity trial involved a range of clinicians across Australia assessing infants and pre-schoolers with HoNOSI and other instruments.  The comparison between all the instruments was positive and suggested HoNOSI related well to other indicators of severity.  

The inter rater reliability trial used vignettes rather than actual clinical cases.  Although the internal consistency of the instrument was good, the inter rater reliability between clinicians varied between scales.  The majority of scales achieved either slight, fair or moderate levels of reliability.  

Three issues are thought to have contributed to the apparent finding that clinicians could use HoNOSI well with their actual clients but do not have great agreement with each other when using it with the same vignettes.  The nerdy aspects of two of these issues, as well as the possibility that there is a fundamental problem in the scale or the constructs will be discussed.  We are currently undertaking a revised approach to interrater reliability and hope to also present these results.  

There is energy for a controlled release of HoNOSI.  It would be good to have at least one perspective on infant's voices enter the dialogue, even if subsequent research leads to further refinement.

Stream 3 - Elliott Room 2 - Chair: Paul Hanton
1:35pm - 2:05pm

Front facing data use - engaging front line staff in the use of business intelligence to transform work practices - Chris Carter - Pathways Health Ltd. Keywords: System and Delivery Change, Mental Health, Data

Many organisations now have a wealth of data, much of it delivered ‘top down’ to try and improve business practises - this is directive intelligence. Directive intelligence can drive compliance behaviours - focusing resources on what gets measured, whilst ultimately having little organic effect on overall service quality. In addition, a wealth of disparate KPIs and reporting systems can lead to information overload and staff disengagement, particularly in a workforce that is primarily people-focused.

Front-facing data use looks at how ‘one-click’ business intelligence systems delivered to front-line staff had a transformative effect on key areas of service delivery including:

  • Data quality
  • Incident management
  • Activity reporting
  • Family/whanau engagement
  • Service user wellbeing.

We present case-studies from within Pathways, a large NGO mental health provider, exploring the early roll-out of a new Business Intelligence system across a large organisation, through it being embedded in the culture of the organisation.

We look at specific before-and-after scenarios to explore how front-facing data use can empower staff and transform work practises - ultimately significantly improving service delivery.

2:05pm - 2:35pm

Using data to inform improvements in mental health and addiction services - Natalie Horspool - Health Quality & Safety Commission. Keywords: System and Delivery Change, Mental Health and Addiction, Data

Do you work in frontline mental health and addiction services, and spend time inputting data? Are you unsure how this data is used, and how it informs how service quality is improved?

This presentation will provide an example of how the Health Quality & Safety Commission (the Commission) is currently using data to inform improvements in mental health and addiction services.

The Commission is a quality improvement agency tasked with measuring and improving the quality of healthcare services across the country. The Mental Health and Addiction Quality Improvement Programme which commenced in 2017, is a five-year Commission initiative, funded and supported by district health boards. It uses an evidence-based approach, which includes identifying and testing different ways of improving health services, so that people receive high-quality, and safe, care and support.

We will discuss how data is used for two programme areas currently underway - Zero seclusion: towards eliminating seclusion by 2020, and Connecting care: improving service transitions. These initiatives use data from the PRIMHD national collection, along with local data within services, to understand how well our system is working overall and how we are improving it with our work. The presentation will also show how survey data is used to inform improvement, with findings from the Ngā Poutama staff survey - a 2018 quality and safety culture survey of over 2,500 health professionals.

This presentation will discuss some of the challenges with using data to inform change, while demonstrating how vital data is to inform improvement activity.

2:35pm - 3:05pm

Longitudinal Investigation of the Stable and Dynamic Components of the World Health Organisation Quality of Life Measure (WHOQOL-BREF) Using Generalisability Theory - Phoenix Norden and Associate Professor Chris Krageloh - AUT. Keywords: Putting People at the Centre, Mental Health and Addiction, Research

Background

The WHOQOL-BREF is a widely used 26-item self-report measure of an individual’s subjective Quality of Life (QOL). However, this scale has not been examined using appropriate methods to distinguish between dynamic (state) and stable (trait) aspects of QOL. Generalisability Theory is the most suitable method to differentiate between state or trait aspects and to evaluate the overall reliability and generalisability of the WHOQOL-BREF.

Methods

A longitudinal design was used with 130 medical students who completed the 26-item WHOQOL-BREF at three time points. Generalisability theory was applied to estimate state and trait components and to examine potential sources of measurement error within the WHOQOL-BREF. Results The results from this study provide evaluation of the temporal reliability and generalisability of the WHOQOL-BREF and distinguish between stable and dynamic aspects at the scale, subscales and individual item levels.

Conclusions

The ability to distinguish to what extent items of each subscale of QOL are measuring state or trait will advance the knowledge of which QOL aspects are likely to change in one’s subjective QOL. The potential implications of this study are information about areas where target interventions are likely to have the most impact, and which aspects of QOL are likely to undergo relatively minimal change.

Stream 4 - Elliott Room 3 - Chair: Tim Coombs
1:35pm - 2:05pm

Health of the Nation Outcome Scale (HoNOS) the data tells the tale - Sandra Baxendine and Mark Smith - Te Pou o te Whakaaro Nui. Keywords: Working Together to Improve Wellbeing, Mental Health, Data

The Programme for the Integration of Mental Health Data (PRIMHD) has been collected in New Zealand for 11 years. The HoNOS family of measures are a group of outcome tools part included in PRIMHD. To ensure the PRIMHD data collection is utilised to its full potential we have investigated the use of matched pairs for outcomes (HoNOS), and Mental Health activity information. Matched pairs are when two collections for a tangata whai ora are joined together to measure change over a period of time. For example, it could be admission to review, review to review or admission to discharge.

This paper will investigate some interesting results found using matched pairs for different scenarios with HoNOS and the PRIMHD dataset. Does different type of activity affect the outcome for service users? Is there anything we can learn from the data? There is a need to continue to question the data by looking at different scenarios. Good analysis is about asking questions and seeing if there are any answers. It is important that the data we get is used to the best of its ability. The take home messages then are that the PRIMHD information can help improve services.

2:05pm - 2:35pm

Using the DUNDRUM pillars of care and the HoNOS to guide individual rehabilitation programmes - Stacey Bromell - Buchanan Rehab (ADHB). Keywords: System and Delivery Change, Mental Health, Clinical

I recently reviewed whether there was a structure that could be implemented within an inpatient mental health rehabilitation unit to better support clients with their rehabilitation and reintegration into the community.

To do this I combined the services group programme and client’s individual rehabilitation programmes, with the DUNDRUM pillars of care guided by the HoNOS.

The Dangerousness Understanding, Recovery and Urgency Manual (DUNDRUM) is a forensic manual established in Ireland. The manual refers to pillars of care which are several life domains that can be focussed on to support people with rehabilitation in mental health services. The pillars also lend themselves to having different phases within them to reflect a person’s ability and current mental state. These pillars reflect questions that are asked by the Health of the Nation Outcome Scales (HoNOS) which is a standardised twelve-question tool used in mental health.

As the HoNOS reflects the pillars of care, it can be used to see what pillars may require the most support in regards to rehabilitation; as well as which phase within the pillar the person may be in based on their HoNOS score. This helps to ensure that rehabilitation is always individualised. 

The benefit of implementing this structure within my service is that is allows clinicians to clearly see areas of strength as well as areas for improvement based on a clinically relevant tool. It is also a guide that can be used to support people to transition to community rehabilitation.

A structure like this means that rehabilitation; not just treatment is central to a client’s care.

2:35pm - 3:05pm

Recognising progress in inpatient mental health care - Mark Smith and Sandra Baxendine - Te Pou o te Whakaaro Nui. Keywords: Information for Prevention, Mental Health, Research

This paper will make a case for progress in mental health care.

The paper will briefly survey historical approaches to mental health care and show that there is progress in mental health care and that this is a consistent and improving trend.

The paper will focus on inpatient care.

The paper poses a question: given the emphasis on transforming mental health services how does this square with the data?

The paper will attempt to answer the apparent paradox.

Stream 5 - Victoria Room - Chair: Wendy Donaldson
1:35pm - 2:35pm

Symposium - Improving inpatient safety outcomes - Lesley Turner - Waitemata DHB Keywords: safety, inpatient care, information for prevention

Zero Seclusion is a New Zealand national project  which aims to reduce seclusion and aggression on all inpatient units by 2020.  Waitematā DHB are aware of the traumatising impact seclusion has on both staff and service users.  Further to this there is also a clear disparity in seclusion rates for Māori and Pacific people across the country.  To address these issues, system and delivery changes have been required across our adult inpatient units and forensic services.  The aim of the project is to create safer wards and support service users to manage their distress so seclusion does not need to be used.

This presentation will explore how information was used to identify and drive changes to reduce seclusion.  Firstly we will share how the Model of Improvement and a co-design process was utilised to understand why seclusion occurs.  Secondly we will cover how PDSA cycles were used to plan, test and evaluate potential changes on each unit, with a strong focus made on staff’s experience and expertise to identify these change ideas.  Finally will also share the outcome, process and balance measures that have been used to evaluate the effectiveness of the project.

2:35pm - 3:05pm

The acceptability and effectiveness of the ‘Safewards Model’ within two New Zealand acute mental health units - Michelle Dawson - Waitemata DHB. Keywords: System and Delivery Change, Mental Health, Seclusion

The Safewards model was introduced within two inpatient acute mental health units in Waitemata DHB, following staff concerns that the wards were becoming increasingly unsafe, feeling there was an increase in violence and abuse directed towards them. Along with ensuring we were working towards the National direction to reduce restrictive practices.

Safewards is an evidence-based model with 10 interventions, focused on effecting lasting change in organizational culture and working practices. It was developed in 2008 in the UK and continues to gather pace both nationally and internationally within mental health care. The model is aimed at making mental health settings more peaceful and safe places, by reducing episodes of containment and conflict, to improve more time for staff to spend in meaningful engagement with services users.

The presentation will provide an overview of an ongoing project. It will describe how the interventions have been implemented and the challenges. As well as an overview of a research project that is currently underway, that involves data collection, a fidelity checklist and a staff survey.

The objective of this study is to answer the following questions:

  • Has Safewards been effective in reducing containment of service users within the two units?
  • Has Safewards been effective in improving safety and conflict in the two units?
  • How acceptable is Safewards to the nurses and health care assistants working within the two units?
  • Have the two units achieved fidelity with the Safewards interventions?
  • Do staff believe the Safewards model needs to be adapted, or new interventions introduced for the New Zealand environment?
3:05pm
Afternoon tea
3:35pm
Ballroom - KEYNOTE: Dr Ruth Cunningham - Using integrated data to improve mental health outcomes
4:20pm
Master of ceremonies day one wrap up
4:30pm
Registration desk open
7:00pm
Ballroom - Conference dinner
Day 2, Friday 1 November, 2019
7:30am
Registration desk open
8:30am
Ballroom - Welcome back by master of ceremonies
8:40am
Ballroom - KEYNOTE: Elida Meadows - Measuring Recovery? Beyond consumer-rated measurement of care
9:25am
Master of ceremonies activity
9:35am
Concurrent Streams (60 mins)
Stream 1 - Ballroom - Chair: Marion Blake
9:35am - 10:05am

Dealing (confidently?) with uncertainty: Current challenges for routine outcome measurement - Philip Burgess - AMHOCN. Keywords: System and Delivery Change, Mental Health, Across Lifespan, Research

Routine outcome measurement (ROM) in Australia’s specialised public sector mental health services has been a cornerstone of five successive National Mental Health Plans (NMHPs) since 1992. Implementation started in 2000 and consolidated with the creation of the Australian Mental Health Outcomes and Classification Network (AMHOCN) in 2003.

Each iteration of the NMHPs has increasingly focused on accountability and public reporting. To that end, AMHOCN has invested in a range of web-based standard reports and decision support tools to support that endeavor. Further, AMHOCN has been responsible for the development and publication of key performance indicators from Australia’s National Outcomes and Casemix Collection (NOCC), the national protocol for the collection of clinician and consumer‑rated outcome measures.

The analysis and reporting of the NOCC was established more than 10 years ago, based on then best-practice reporting. Reporting of health and mental health outcomes has evolved since then. Those developments include standards for reporting outcome estimates that include “margin of error” and alternative metrics to measure outcomes that focus on aspects of “recovery” rather than changes in consumers’ “mental health status”. There remain significant gaps in our efforts including the relatively poor uptake of consumer‑rated vs. clinician-rated outcomes.

This presentation highlights the challenges, opportunities and gaps with our current methods for public reporting and clinical decision support. We hope this conversation will help us develop a road-map for the next steps in ROM reporting.

10:05am - 10:35am

Consumer reported outcome measures: why bother asking? - Meredith Harris - AMHOCN. Keywords: Putting People at the Centre, Mental Health, Across Lifespan, Research

Background

Under Australia’s National Outcomes and Casemix Collection (NOCC), consumer-reported and clinician-rated outcomes are assessed at admission, 91-day review and discharge. Controlled studies of consumer-reported outcome measurement plus feedback have shown modest positive effects on consumer outcomes. We explored whether offer and completion of a consumer-reported measure predicted later clinician-rated clinical and functional outcomes in routine practice.

Methods

We used a retrospective, pre-post, matched groups design. The sampling frame was all consumers with an ambulatory care admission in any year between 2007-08 and 2017-18. The cohort was consumers who: completed a consumer-reported measure at admission; had a valid in-scope outcome score at admission and subsequent review or discharge; and did not have a brief episode of care or were not discharged to another setting. The comparator group was consumers who did not complete a consumer-reported measure, selected using propensity-score matching methodology. Regression analyses, predicting change in outcome, were stratified by episode type (ongoing or completed).

Results

An earlier analysis among a cohort of 93,098 adult consumers showed that one-quarter (26.9%) completed a consumer-reported outcome measure. After matching and controlling for patient and treatment factors, completion of a consumer-reported measure resulted in an average improvement in Health of the Nation Outcome Scales (HoNOS) total score of 2.8% (p<0.001) for consumers in ongoing episodes, and 1.7% (p<0.001) for consumers in completed episodes. Other age groups, outcomes and variations by consumer-reported measure will be considered.

Discussion

Findings may help address clinicians’ concerns about the utility of consumer-reported outcome measures in their routine practice.

Stream 2 - Elliott Room 1 - Chair: Rhonda Robertson
9:35am - 10:05am

Our experience of your experience reporting - Marc Currie and Jessica Giles – SA Health. Keywords: Putting People at the Centre, Mental Health, Lived Experience

The implementation of an experience measure can pose challenges to all services in relation to process, technology and in some cases distance. Consumers and Carers experience is critical to service development and meaningful means to hear their voices need to be established. Country Health SA Carer Expert Jessica Giles  will outline their experience of implementing the Australian Experience Measures (YES and CES) and how this has impacted on their service delivery. This process has enhanced the capacity for Country Health to include consumers and carers in service delivery and outcome improvement.

10:05am - 10:35am

Showcasing the transformational power of peer support for jobseekers who have experienced mental distress - Lisa Archibald - PeerZone. Keywords: Working Together to Improve Wellbeing, Mental Health, Lived Experience, Employment

In 2017-18, MSD identified the potential benefit of peer support to assist people on Supported Living Payment into employment.

PeerZone was contracted by MSD to conduct a pilot peer support program for up to 60 people on Supported Living Payment who:

  • reported a mental health issue as their primary incapacity
  • were between 18 and 59 years old
  • were registered with the Porirua and Naenae Work and Income offices.

This pilot was fully evaluated by Red Panther and we will present our findings which clearly demonstrate the transformational power of peer support to participants in our project at this event.

Stream 3 - Elliott Room 2 - Chair: Sandra Baxendine
9:35am - 10:05am

Your Wellbeing: Towards item banking to increase acceptability and utility - Ross Phillips and Associate Professor Chris Krageloh - Pathways Health Ltd and AUT. Keywords: System and Delivery Change, Mental Health, Data

Pathways is a national NGO in New Zealand with a workforce of over 800 people. We have worked with the Auckland University of Technology and other NGOs for the past five years using the World Health Organisations Quality of Life Questionnaire (NZ WHOQoL Bref). Along with other outcome measures we have been better able to understand the subjective wellbeing and experiences of social inclusion for people using our services.

Picking up on the concept of ‘item banking’ we set about to determine the series of questions across multiple tools that were most acceptable to people using our services, most aligned to utility at a practice level and most useful when considered against the strategic intent of our organisation.

We undertook a range of studies that helped us determine a set of questions from our measures that were smaller, evidenced as more acceptable to people and that had greater utility for our practice and business intelligence. AUT then determined the psychometric properties of the new measure named, Your Wellbeing.

This presentation will demonstrate the processes followed to determine item inclusion in the new measure, the results of acceptability testing and the results of a range of psychometric tests. Findings from the initial analysis of the tool will be presented including challenges of understanding sensitivity to change. The presentation will make a case for the value of ‘item banking’ for the purposes of enhanced practice utility and for person-centred outcome measurement.

10:05am - 10:35am

Ensuring responsive community mental health support for adults following acute hospitalisation - Liam McKenny, Paul Saunders and John Beveridge - Canterbury DHB. Keywords: System and Delivery Change, Mental Health, Clinical

Responsive community support for consumers who experience an acute hospitalization helps to maintain clinical and functional stability, minimize the need for hospital readmission and promote continuity of care. There is evidence of increased vulnerability immediately following discharge which can mean an increased risk of suicide. The national KPI programme recognizes the importance of this support and DHBs routinely collect data on the percentage of inpatient discharges for which a community service contact was recorded within seven days of discharge. A target has been set that 80% of all discharges meet this requirement.

CDHB SMHS view this data as a quality improvement opportunity. This data connects directly to how our care processes are functioning and we use it to signal problem areas and drive forward practice improvements. SMHS produces data on cases in the previous month that did not meet the seven day threshold and provide the data to community teams. Each individual case is reviewed, and followed up on with remedial actions where necessary. Issues identified are explored by the service leadership teams and outcomes are routinely report back to mental health divisional leadership on their ongoing efforts to meet the seven day follow-up target.

This presentation will explore the processes put in place that have enabled us to meet the target, explore the ongoing work to sustain this and identify themes highlighted through analysis of cases that are non-compliant.

Stream 4 - Elliott Room 3 - Chair: Rosemary Dickson
9:35am - 10:05am

Joining the dots for older people: Using data and information to build workforce responsiveness - Joanne Richdale and Caro Swanson - Te Pou o te Whakaaro Nui. Keywords: Information for Prevention, Mental Health and Addiction, Older People, Education

In New Zealand, people aged 65 years and older (older people) tend to be invisible in conversations about mental health and problematic substance use, and these problems are often overlooked in discussions about the health of older people. This situation reflects widespread myths that these are uncommon experiences for older people and do not really matter.

In New Zealand the incidence of mental health and substance use problems among older people is not well understood, and data about service access is incomplete. The information we do have (national and international) suggests there may be substantial unmet need for mental health and addiction support among older people.

New Zealanders are living longer. Over the next 10 years the size of the older population will grow at 8 times the rate of younger adults and children. Increasing diversity in the older population will require a wider range of mental health and addiction services based on cultural understandings of health, wellbeing and ageing, particularly for Maori people, and to meet the needs of other groups such as people with limited English.

This paper outlines results from the first year of a 3-year project by Te Pou to better understand mental health and addiction workforce development needed for working with older people. We describe how data, qualitative information and lived experience were used collectively to identify 10 priorities that inform efforts to improve workforce responsiveness to older people.

10:05am - 10:35am

On the same page: integrated clinical documentation for Queensland public mental health alcohol and other drug services - Roslyn Williams - Office of the Chief Psychiatrist, Queensland Health. Keywords: Information for Prevention, Mental Health and Addiction, Clinical

Integrating electronic medical information for mental health and addiction services, thereby improving access to data related to the clinical care of consumers, represents the next step in the evolution of the information agenda for Queensland public specialised services.

Statewide standard clinical forms have been used since 2010 in Queensland public mental health services to document the care provided to consumers at key points. The forms address screening, care planning, risk, assessments, case review, transfer of care and are therefore also a tool to communicate with other care providers, the consumer and their support people. The need to expand the mental health suite of clinical forms to be suitable for consumers receiving care from addiction services was identified as part of a project to integrate the alcohol and drug clinical information system into the mental health electronic medical record (CIMHA).

To support further service integration, a suite of integrated clinical forms was created. This was supported by an Expert Advisory Group led by the Chief Mental Health Alcohol and Other Drugs Officer and guided by reference documentation including the National Safety and Quality Health Service Standards 2017 and examples of alcohol and drug clinical forms from other jurisdictions. The integrated forms developed are intended to be used by both mental health and alcohol and drug service clinicians and align to the consumer journey through services.

This presentation aims to describe the process of development of integrated clinical documentation, key considerations, the challenges faced and plans for implementation.

Stream 5 - Victoria Room - Chair: Cara Thomas
9:35am - 10:05am

"Let's deep dive into data" - Utilising mental health service data to engage senior leaders in system change - Rick Bastida and Ossi Beck - Queensland Mental Health Clinical Improvement Team. Keywords: System and Delivery Change, Mental Health, Clinical

Clinical leaders and mental health service managers are busy people. They also face an avalanche of data and information that often can be overwhelming and/or confusing.

The Queensland Health Mental Health Alcohol and Other Drugs Branch provides clinical and operational leaders of public mental health services the opportunity to consider topical issues and engage in a sector-wide dialogue by hosting three, 1-day forums per year. In March 2019 a forum was held that focused on entry pathways to public mental health services.

This paper describes the process of engagement with the sector, development of the workshop and the ongoing follow-up with services focusing on data and information-driven system reform.

We will present high-level data leveraged from a newly developed linked dataset derived from both emergency departments (ED) and mental health services. The data highlights pressure points at the interface between ED and mental health services and the changing nature of entry pathways over the last several years. This data offered leaders an insight into where changes to service models are likely to have the most impact to achieve optimal entry pathways.

10:05am - 10:35am

Lessons for mental health reforms and changing models of care - integrating Mental Health, Addiction and Intellectual Disability Services in 3DHBs - Nigel Fairley, General Manager in MH, 3DHBs and Naila Naseem, Partner at Francis Health. Keywords: Service and Delivery Change, Mental Health, Intellectual Disabilities. DHB

The primary objective was for Mental Health, Addiction and Intellectual Disability (MHAID) Services in Wairarapa, Hutt Valley and Capital and Coast DHBs to operate as one organisation by developing an integrated consumer-centric service approach. The purpose was to reduce fragmentation and duplication in service delivery, improve preventative health and empowered self-care, provide relevant services closer to home and quality hospital care, including highly complex care, for those who need it. The main challenge was to seamlessly integrate the three very different models of care in each of the three DHBs.

3DHB and Francis Health co-developed a service model, organisational design and integration plan for three DHB’s MHAID services. The combined services included 3 district-wide adult and youth mental health and addictions and intellectual disability services, regional forensic mental health services as well as New Zealand-wide intellectual disability services. In total, some 1400 staff form part of the newly integrated service.  

Lessons for mental health reforms and changing models of care that seek to strengthen integration include:  

  • complexity lies in changing both services and in the structures that run them  
  • effective clinical governance is key  
  • needing to balance the matrix of service with localities; local managers and clinical leads are important as are standard policies & procedures  
  • change takes time – even now four years since launching the new service, consultation as part of moving to a single employer is only now underway  
  • practical hurdles add ‘noise’ and include multiple HR & finance systems, resources and facilities  
  • DHB boundaries and collaborating with Primary Health Organisations and NGOs is a sector-wide challenge.  

Most important was that staff were engaged from the outset in defining the values, culture and nature of the new service.

10:35am
Morning tea
11:00am
Concurrent Streams (90 mins)
Stream 1 - Ballroom - Chair: Caro Swanson
11:00am - 11:30am

He Waka Tapu - Whaiora Online - Jackie Burrows and Tanith Petersen - He Waka Tapu. Keywords: Information for Prevention, Addiction, Lived Experience

He Waka Tapu is a leading Kaupapa Maori organisation with 23yrs experience in the field of mental health and wellbeing. With strong internal digital capabilities, they understand how to leverage the benefits of digital tools to maximise availability, capability, services offered with strong outcomes reporting.

With a clear rise in the number of Alcohol and Other Drug (AOD) referrals and Domestic Violence (DV) referrals each year, plans were put in place to develop an online tool which would enable more whaiora to connect and seek support when they needed it most.

Whaiora Online was born 6 years ago from humble beginnings. Offered primarily as a free tool to whaiora but also the community. Members are able to communicate and support one another in addition to the He Waka Tapu clinicians and kaimahi and other supporters who were also online using the tool.

Whaiora are given special access to tautoko; which is an area dedicated to inspirational videos and stories can be viewed and added to their kete of knowledge gained from He Waka Tapu’s offline programmes run from their Christchurch premises.

From an outcomes perspective, what really sets Whaiora Online apart from other online tools, is that whaiora continue to use Whaiora Online and its tools after exiting their various programmes. Through reporting, He Waka Tapu can draw a much truer picture of recovery sometimes up to years after a whaiora have been exited.

He Waka Tapu were invited as keynote speakers to the AMHOIC 2017. We discussed the data received and how we could use this to see if people were improving in areas they chose to track.

As the Whaiora Online population has grown, activity has also significantly raised. People are sharing more than ever about their successes and times of weakness which gives us real anecdotal evidence on wellness and progress. This could be in the form of textual posts with photos or video.

This above data has been pivotal as Whaiora Online data can start merging with corrections data, enabling more detailed information on what services a whaiora is accessing or equally importantly, how much less?

A snapshot of data collated from 10 users tell us the following outcomes have been achieved.  Wording varies as this has been collated using their words and outcomes that matter to them in their everyday lives:

  • 40 days post discharge still clean and sober
  • Reconnected with whanau
  • Enrolled in level 5 Te Reo diploma
  • Joined kapa haka group, gaining diploma in performing arts
  • Continuing to attend AA & narcotics meetings twice a week
  • Gained full time employment
  • Enrolled in polytechnic
  • No longer requiring medication
  • Connection and strengthening wairua
  • 8 years passed and no longer have any kids in CYFS
  • 58 days clean and sober
  • No longer addicted to Meth
  • 4 1/2 months clean and sober

These outcomes feed into high level outcome for Māori, whanau are self-managing, whanau are leading healthy lifestyles, whanau are participating in society, whanau are confidently participating in Te Ao Māori, whanau are successfully involved in wealth creation, whanau are cohesive, resilient and nurturing, whanau are responsible stewards of their living and natural environments.

The importance of this tool has not gone un-noticed with the likes of Vodafone supporting Whaiora Online by supplying free mobile data to those that access the service over their network.

He Waka Tapu, openly welcomes other health organisations whom share a similar journey, to start a korero so they may jump on and use this great free tool. Several external organisations are already registered or have shown strong interest in participating on Whaiora Online.

A new initiative Piri has recently been created based on Whaiora Online to show a strong connection with rangatahi with their whanau and connect the community in with local wellbeing activities and events.

11:30am - 12:30pm

Workshop - NZ Peer Support and Advocacy - by the stats and by the story - Frank Bristol and Cassandra Laskey - Balance Aotearoa and Counties Manukau DHB. Keywords: Working Together to Improve Wellbeing, Mental Health, Lived Experience

What is the NZ PRIMHD data telling us over the last 5 years? 

We'll also explore the variation of peer work service delivery by region, district and model. 

Stream 2 - Elliott Room 1 - Chair: Peter Brann
11:00am - 11:30am

Evaluating the implementation of the Choice and Partnership Approach in the Western Australian Child and Adolescent Mental Health Service - Dr Simon Davies - CAMHS (Western Australia). Keywords: System and Delivery Change, Mental Health, Child and Adolescent, Research

The Choice and Partnership Approach (CAPA) was fully implemented in WA CAMHS in 2015. This study is an evaluation of its implementation three years on. A mixed methods approach guided by the Rogers-Greenhalgh Diffusion of Innovations Framework was used to obtain quantitative and qualitative information. Firstly, we obtained self-report ratings from staff in each of the 10 community-based teams about how well and how fully they thought the 11 key components of CAPA were implemented, using a Components Rating Scale (CAPA11-CRS). Additionally, we identified attitudinal factors and beliefs which are known to affect the degree and rate of adoption and sustainability of an innovation being introduced into a system, using the Perceived Characteristics of Intervention Scale (PCIS). Finally, we used a focus group methodology to obtain opinions, beliefs and experiences about the implementation.

Overall we had 81 responses to the PCIS and 93 to the CAPA11-CRS from clinical staff members across all the 10 community teams. We present the data overall for all CAMHS teams as well as by service. Overall, there was a high agreement between participants in each service in relation to the 11 key components although they varied between services. The findings suggest the key components of CAPA have been variably implemented. The attitudes and beliefs toward CAPA expressed by the just over half of the staff were positive with the remaining expressing either neutral or negative attitudes. This is the first scientific approach to evaluate the implementation of CAPA. Our approach provides for assessing ‘fidelity’ to the model and allows for addressing attitudinal challenges in service reform.

References

  1. York A, Kingsbury S. CAPA: the Choice and Partnership Approach: A Service Transformation Model. CAPA Systems; 2013.
  2. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.
  3. Cook JM, Thompson R, Schnurr PP. Perceived characteristics of intervention scale: development and psychometric properties. Assessment. 2015 Dec;22(6):704-14.
11:30am - 12:00pm

Improving access to Child and Youth Mental Health Services - Rebecca Webster, Deborah Selwood and Chantelle Marshall - Specialist Mental Health Services Canterbury DHB. Keywords: System and Delivery Change, Mental Health, Child and Adolescent, Clinical

Significant demand for Child and Youth Mental Health services in Canterbury continues. In a system with finite resources the service has been actively working to review referral and triage processes and management for those children who are on a waiting list.

Identifying the issues in the current service has been key. It was clear that the current system wasn’t working through consumer feedback mechanisms, and monitoring of referral rates. Data showed that those that progressed to a choice appointment (for further discussion, assessment and development of a plan) and for those whom it was decided a partnership appointment was required, were experiencing significant delays.

Clearer referral and acceptance criteria, understood across the referral system and improved processes within the CAF Access team has begun to improve the time children and families are waiting for support. As at June 2019, this has resulted in a 25% reduction in the wait times.

Coupled with improved mechanisms and monitoring of those children on the waitlist for a partnership (comprehensive) assessment has also lead to a significant reduction in time elapsed to access treatment.

12:00pm - 12:30pm

Using data to enhance implementation, delivery and evaluation of Aboriginal mental health services in CAMHS - Roger Golling - A/Director Community CAMHS, Phillippa Farrell - Regional Policy and Development Officer and Aaron Panaia – Aboriginal Mental Health Worker. Keywords: Working Together to Improve Wellbeing, Mental Health, Child and Adolescent, Data

Evaluation of outcome and engagement data provides opportunities to improve service design and provision, particularly for indigenous populations.

Since 2014, the WA Mental Health Commission has supported CAHS CAMHS to implement an Aboriginal Mental Health Service, which aims to facilitate improved access to culturally appropriate mainstream services and improve mental health outcomes for indigenous children and young people.

As an integral part of this process a series of 15 Key Performance Indicators (KPI’s) where implemented that spanned both engagement analysis, treatment outcome data and re-admission/follow-up data to drive change and improve service delivery

Initial analysis indicates that clinics with an AMHW receive 2.1 times as many referrals and 2.7 times as many activations of indigenous young people, when compared to those teams without an AMHW.

Feedback indicates that AMHWs are highly valued by clinicians, families and communities. A periodic review has shown that 88% of Aboriginal clients demonstrated an improvement in overall HoNOSCA.

This paper will describe in detail the CAMHS Aboriginal Mental Health Service approach, and how it has impacted referral demand and engagement and an improvement in client outcomes via using data including HoNOSCA, CGAS and SDQ.

Stream 3 - Elliott Room 2 - Chair: Mark Smith
11:00am - 12:00pm

Symposium - Using routinely collected data to lever and drive change - Helen Lockett, Angela Jury, Ruth Cunningham and Ashley Koning - Te Pou o te Whakaaro Nui. Keywords: System and Delivery Change, Mental Health and Addiction, Research

Equally Well, is an evidence informed and evidence-driven collaborative. In the past four years partners in the New Zealand collaborative have been applying a mental health and addiction equity lens to the analysis of routinely collected data in order to identify the issues and use the evidence to drive systems change. With Equally Well collaboratives now in the UK and Australia, this approach is being replicated in other countries.

This symposium will provide case study examples of how information is used to support the efforts of the Equally well collaborative. This will include:

  • sharing the methodology and results from two separate analyses of the NZ Health Survey
  • an audit of enrolled patient data at Pegasus Primary Health Organisation to understand access to and quality of primary care for people with experience of mental health and addiction issues
  • a review of international literature and NZ data sets to understand the association between cardiovascular disease risk and mental health and addiction issues.

These examples will demonstrate how feasible it is to access and analyse routinely collected data, and how the analyses make visible health inequities, which otherwise are invisible within these data sets. The presenters will focus on the methods of data analysis, but most importantly how the information is being disseminated through the partners in the Equally Well collaboratives to inform and drive practice and systems change.

References

  1. Lockett, H., Jury, A., Tuason, C., Lai, J. & Fergusson, D. (2018). Comorbidities between internalising disorders and long-term physical health conditions: An analysis of the New Zealand Health Survey data. New Zealand Journal of Psychology, 47(3), 5-11. Retrieved from https://www.psychology.org.nz/wp-content/uploads/Comorbidities-between-Mental-and-Physical-Health-Problems.pdf
  2. Lockett, H., Lai, J., Tuason, C., Jury, A., & Fergusson, D. (2018). Primary healthcare utilisation among adults with mood and anxiety disorders: an analysis of the New Zealand Health Survey. Journal of Primary Health Care, 10, 68-75. Retrieved from https://www.publish.csiro.au/HC/HC17077
12:00pm - 12:30pm

Using Health of the Nation Outcomes Scales (HoNOS) to inform the reduction of seclusion - Ashley Koning - Te Pou o te Whakaaro Nui. Keywords: Information for Prevention, Mental Health and Addiction, Clinical

Seclusion negatively impacts on people’s wellbeing. In 2017, seclusion was experienced by almost 9 percent of people who accessed adult mental health inpatient services in New Zealand. Recent media and anecdotal reports highlight that restrictive practices have frequently been used in response to people presenting with perceived substance use problems. In particular, there have been growing concerns  around issues related to the impact of methamphetamine use.

HoNOS is a clinician rated outcome measure that provides an overview of a person’s ‘behaviour, impairment, clinical symptoms, and social functioning.’ Using 2016/17 HoNOS data from the Programme for the Integration of Mental Health Data (PRIMHD) three HoNOS items significantly predicted the likelihood or risk that a person would be secluded. These included overactive, aggressive, disruptive, or agitated behaviour; problem drinking or drug-taking; and problems with hallucinations and delusions. Most notably about one in five people, who were identified as experiencing all three of these HoNOS items, were secluded.

This research has implications for both clinical practice and workforce development. This includes needing to enhance the knowledge and skills of the workforce in using timely screening and comprehensive assessments; a focus on effective communication; recognising and working with coexisting problems; and using trauma-informed approaches. Findings also highlight the importance of screening for and recording data about coexisting substance use issues for people accessing mental health services.

Stream 4 - Elliott Room 3 - Chair: Tim Coombs
11:00am - 11:30am

Failing small to get big outcomes - Joanna Price and George Furstenburg - Lakes DHB. Keywords: Putting People at the Centre, Mental Health and Addiction, Clinical

Success in clinical outcomes as measured by service users is related to their feedback about what is not working.

Feedback Informed Treatment (FIT) is an approach that underpins clinical practice putting people at the centre of their care. This pantheoretical evidenced based methodology uses patient feedback to tailor and change the way clinicians work alongside people accessing mental heath and addiction services. FIT and its tools enable both clinician and client to monitor their progress and outcomes while the use of regular feedback drives changes to meet the idiosyncratic needs of individuals.

Lakes DHB Mental Health & Addictions Services (MH&AS) are implementing this approach in a variety of sub-specialties. The Primary Mental Health Team (PRIMHIS) have fully implemented FIT and progressed to a sustainable stage having several years of validated data that is used to make sense of peoples experience and focus on what matters to the person accessing the service. Two other teams - Perinatal and the inpatient unit are in the middle stages of implementation and are advancing the quality of how services are delivered. 

The backbone of FIT is the therapeutic alliance and successfully creating a culture of critical feedback from patient to clinician enabling adjustments to the way clinicians work to ensure better alignment with the persons needs. The research demonstrates this approach improves outcomes; decreases Did Not Attends (DNA)’s and decreases hospital admission length of stay.

This presentation will focus on a very brief overview of FIT, supporting evidence, outcomes achieved to date across the teams, lessons learned and recommendations to the audience about fist steps for engaging with FIT.

11:30am - 12:00pm

Towards understanding cultural efficacy in addiction treatment for Māori - Yi Chung Lim and Ken Kerehoma - Odyssey. Keywords: Putting People at the Centre, Addiction, Education

"Culture as a cure" is the well-established view that greater cultural efficacy and engagement with Māori cultural identity can act as a protective factor against negative outcomes for Māori (Durie, 1994; Muriwai, Houkamau & Sibley 2016; Williams, Clark & Lewycka 2018; Fox, Neha & Jose 2018;). Based on this concept, Odyssey offers programmes of work to strengthen Māori cultural engagement as part of AOD treatment. However, the treatment sector currently lacks an established Māori identity measure. This talk outlines Odyssey’s development of longitudinal Māori identity measures to fill this gap. We aimed to develop measure that can be used to:

  1. quantify the diverse identities of Māori who access our services;
  2. evaluate the effectiveness of programmes of work and strategies for Māori wellbeing;
  3. provide data to allow development of a theory of change relating cultural efficacy with establishing and maintaining stable recovery.

We will present reflections on our development journey starting with how we engaged research collaborators; consulted with whaiora and Māori to ensure suitability of measures; and our ongoing efforts to validate our measures. We will also present recommendations on how to embed these measures into clinical practice and implications for other treatment providers.

12:00pm - 12:30pm

Understanding how we make a difference. A difference in MHA recovery. - Stacey Greaney and Rodger McLeod - MASH Trust. Keywords: System and Delivery Change, Mental Health and Addiction, Data

MASH Trust mission statement: Working together to achieve great lives has driven a commitment to evidence the difference we make in people’s lives. Showing we make a difference, our foundation results based accountability framework, reveals outcomes of all that we do supporting people with mental health and addiction challenges. Every health worker wants to make a difference and organisations that strive for continual improvement want to deliver what is needed to their communities. The rationale for developing an outcome based approach (how much, how well, and most importantly is anyone better off) is that people experience different impacts from complex problems that affect recovery. Outcomes tell a story for staff, services and the organization to support planning service delivery and quality. It is the stories that matter and are rich in meaning. Using data in practice and the feedback it gives makes building aggregated information easy and gives statements about how that picture has changed for a person, a service and the organisation. Good outcomes come from sound information, planning and practice delivery and having these all lining up together. For MASH Trust, evidence is every day practice supporting quality improvement. Meeting the challenge of measuring what’s important:

  • Client experience and recovery
  • Staff capability and capacity
  • Person centred recovery outcomes

MASH Trust have worked in partnership with MidCentral DHB to develop an outcomes agreement with a changed reporting structure that is based on a results based accountability framework and the heavy focus is on how well and the difference we make in services offered to our community.

12:30pm
Lunch
1:20pm
Ballroom - KEYNOTE: Matthew Iasiello and Joep van Agteren - Mental health and mental illness – two dots that must be connected
2:05pm
Concurrent Streams (60 mins)
Stream 1 - Ballroom - Chair: Wendy Donaldson
2:05pm - 3:05pm

Symposium - Honouring employment aspirations - what a new addiction and mental health system needs to know - Helen Lockett and Rebecca Priest - Wise Management Services. Keywords: Putting People at the Centre

“It’s just life, drink and drugs … I got schizophrenia and meth became like a poison to me. Then the convictions, my life was over, so when someone suggested I think about work, well I laughed cos they couldn’t really mean me.” - IPS employment program participant.

People who experience mental health issues and/or addiction would like to be employed and there is rigorous evidence on how best to achieve this. Yet current policy and delivery systems prevent application of the evidence-based practices (Lockett, Waghorn & Kydd, 2018; OECD, 2018).

In reviewing NZ’s welfare, employment, health and education policy, the OECD recommended scaling-up effective pilots, including the Individual Placement and Support (IPS) employment program in Northland DHB (Priest & Lockett, in press) and ensuring equity of access. A similar review was conducted in Australia in 2015.

This an opportunity to hear first hand about the OECD methods and findings. The audience will be encouraged to consider the implications for transforming the mental health and addiction system.

“She hit me in my values, she had aspirations for me that I didn’t have for myself - hope and a belief for a better life.” - IPS program participant.

The second part of the symposium will present the findings from the implementation of IPS employment support blended with Te Ao Maori through the stories of the program participants.

The audience will gain insights and understanding of the way in which science and cultural knowledge can be successfully implemented in their local areas.

Stream 2 - Elliott Room 1 - Chair: Mark Smith
2:05pm - 2:35pm

Looking back at data to move forward effectively - Maree Matthews - Higher Ground Keywords: Working Together to Improve Wellbeing, Addiction, Research

What does research data have to do with helping people and whānau look back to move forward? In this presentation we explain how Higher Ground's research programme is used to prove and improve its impact - using robust evidence for service planning, continuous improvement, and demonstrating results to stakeholders. 

Higher Ground provides abstinence-based treatment, within an 18-week, 52-bed therapeutic community for adults. The majority of clients present with histories of addiction, particularly to methamphetamines and alcohol, often significantly associated with mental health (e.g., depression, anxiety, stress, and PTSD) as well as physical health, relationships, work, accommodation and criminal behaviour. 

A multi-therapy approach is followed which includes helping clients with the lasting impacts of early trauma. This includes the structured and staged environment of the therapeutic community, guiding principles such as individual responsibility and Narcotics Anonymous 12-step recovery, evidence-based therapies including group, individual and family approaches, cognitive behaviour therapy, dialectical behaviour therapy, motivational interviewing, psycho-education, relapse prevention, moral reconation therapy, trauma therapy, a Māori programme, and continuing care after graduation. 

Higher Ground collects longitudinal data on all consenting clients using a battery of validated tools, with repeated measures at up to nine points in time from first presentation through to 12-month post-discharge follow up. Qualitative or 'soft' data are also captured in order to better understand client experience of the programme. This commitment to ongoing research provides evidence that clients who complete the programme and engage in continuing care experience recovery. 

Maree manages the community team at Higher Ground, this team works with tangata whaiora pre and post residential treatment. This involves preparing clients for admission and supporting them in continuing care once they have completed the programme. She has been with the organisation for the past eight years in various roles and is passionate about her work in the addiction sector.

2:35pm - 3:05pm

Designing a mental health data project for success: once the why is clear, the how is easy – Jillian Pennington – Wild Bamboo Keywords: Data

In an increasingly data-driven world, more and more organisations are taking up the big data challenge. The problem - Gartner estimates over 85% of big data projects ultimately fail.

So… what makes the difference between success and failure when it comes to data analytics?

Turning data into meaningful insights to tell the real story is no trivial undertaking, often demanding significant organisational investment (e.g. time, new technology and resource). The potential for informative views is limitless, so uncovering the right ‘why’ is a critical step in creating the scope for the ‘how’ and keeping the project on track.

Condensing observations and lessons learned from hundreds of data projects across the mental health and addiction sector, this session focuses on what makes a successful data project, with concrete examples of what works and what doesn’t – and why. It discusses best practices and potential pitfalls; and offers practical and pragmatic advice to help your organisation design, implement and ultimately deliver a successful data project.

Stream 3 - Elliott Room 2 - Chair: Rhonda Robertson
2:05pm - 2:35pm

Reduce your alcohol and see the benefits - Jennifer Lai, Paul Hanton, Angela Jury, Charito Tuason - Te Pou o te Whakaaro Nui Keywords: Working Together to Improve Wellbeing, Addiction, Research

The Alcohol and Drug Outcome Measure (ADOM) is a self-rated measure that is used to feed back to people accessing alcohol and other drug services in the community, it is currently used by 77 organisations and 230+ teams across New Zealand. The data from ADOM collections is stored anonymously in the Programme for Integrated Mental Health Data (PRIMHD). The research question arose as to whether reduced days of alcohol use was associated with improved lifestyle and wellbeing. This was examined using matched pair data from treatment start and treatment end collections of the Alcohol and Drug Outcome Measure (ADOM) held in PRIMHD. The resulting paper has been accepted by the New Zealand Medical Journal.

Findings show decreased days of alcohol use was on average positively associated with self-rated lifestyle and wellbeing. Even a one-day reduction in alcohol use may lead to small positive changes in wellbeing. Results were similar for amount and total volume of alcohol consumption. The clinical implications for this research and the messages that might be delivered in the sector are explored in this presentation as well as the robust research methods used.

This presentation will show clearly how outcomes data can be analysed and used to share information with people that access services, to improve their lifestyle and wellbeing through clear practice messaging. 

2:35pm - 3:05pm

Mārama Real Time Feedback; From invitational to aspirational - Paul Hanton - Te Pou o te Whakaaro Nui Keywords: Putting People at the Centre, quality improvement, consumer voices

By inviting the people that use services, their whānau and friends to feedback to those services a repository of responses can be created telling services how they are doing?

The questions are rated using a Likert scale and this presentation will outline teh questions and some data related to the responses.

Services should aspire to be better, and the context of ‘better’ in terms of service improvement, is that the people that access services inform improvement, and just as importantly have that improvement fedback to them, a virtuous feedback loop.

Stream 4 - Elliott Room 3 - Chair: Frank Bristol
2:05pm - 2:35pm

Putting clients at the centre of outcomes data management - a client centric approach to the routine monitoring of therapeutic outcomes - Dr Brian Rodgers - AUT Keywords: Putting People at the Centre, Mental Health, Data

The routine collection of therapeutic outcomes data has become common place in many practice settings around the world. Funding bodies often require the completion of standardised measures at specific intervals of treatment (e.g. pre, post and mid treatment). However, such an approach can reinforce a “treatment on” rather than “treatment with” approach.

A client centred approach to practice can redress this by adopting a more collaborative approach to outcomes data utilisation. Particularly when combined with Patient Generated Outcome Measures (PGOMs), clients can be supported in actively using outcomes data to enhance treatment outcome.

This paper will explore the potential for a further step towards an even more client centric approach to outcomes data collection and management. Drawing on the ideas of Szolovits et al (1994), an approach is proposed that frames the client not just as a collaborative partner, but as the manager of their own data. Rather than services or practitioners holding data and sharing this with clients, these roles are reversed with the client ‘holding’ their own data, and choosing to share this with their practitioner. Mechanisms for supporting this approach are discussed, along with some potential benefits and pitfalls.

2:35pm - 3:05pm

Women’s experiences after using residential respite and home-based support services - Rhiannon Lehndorf-Moore and Laura Sanchez-Jimenez - WALSH Trust Keywords: Putting People at the Centre, Mental Health, Women, Research

Background: For many women, pregnancy and the postnatal period is a challenging time that can be overshadowed by mental illness. Research shows that mental health disorders interfere with optimal mothering. Therefore, services like Mother and Baby Units and Respite facilities provide support with mother-baby relationships, mothering abilities, and promoting their recovery. He Kākano Ora (HKO) offers residential respite and home-based support to mothers recovering from mental health difficulties. 

Currently, there is a gap within respite facilities of how to incorporate client feedback into everyday practices, in order to best support clients’ needs. The objective of this study is to examine the information in HKO exit surveys, in order to identify the mothers’ experiences after utilising these services.

Methods: A thematic analysis will be conducted using pre-existing exit survey data which ranges from December 2017 until March 2019.  The analysis will be specifically examining themes and codes that relate to factors that impede or promoted recovery during their stay in HKO. 

Results: Results of the study will be presented. 

Conclusion: The feedback received from clients will provide us with valuable information on how best to support future clients. Additionally, the emerging themes will help to identify areas within HKO where we can build upon current practices to improve the quality of the service, to further support mothers in their recovery.

Stream 5 - Victoria Room - Chair: Sandra Baxendine
2:05pm - 3:05pm

Symposium - Measure what Matters: Measuring Whānau Engagement through New Zealand’s Mental Health Key Performance Indicator Programme - Rebecca Merrington, Dr Sati Sembhi and Megan Jones - Northern Regional Alliance Keywords: System and Delivery Change, Mental Health, Family / Whānau, Data

The Mental Health and Addictions Key Performance Indicator Programme (MHAKPI) is a sector led initiative that supports quality and service outcomes through collaboration, improvement and learning.

The MHA KPI Programme is an essential part of New Zealand’s mental health system, providing benchmarking and quality improvement forums as well as access to secure analytical tools.

New Zealand’s MHA KPI programme is unique in its benchmarking approach with its emphasis on community and integrated care as well as inpatient care. The MHA KPI Programme has the full participation of all 20 DHBs and many of New Zealand’s largest mental health NGOs.

In 2018, the MHA KPI Programme participants decided to focus on lifting whānau – family engagement. This focus was chosen as whānau have much to contribute in supporting positive outcomes for tangata whaiora – service users. Whānau also hold collateral information that can contribute to assessment and treatment outcomes, and they are often with tangata whaiora for longer than any clinicians or support worker could be. Lifting whānau engagement is critical to the provision of safe and effective services.

Following the decision to focus on whānau engagement, the MHA KPI Programme worked with a network of family/whānau advisors, clinicians, consumers and managers to develop robust indicators of whānau engagement. These indicators describe contacts made with whānau – family.

In this symposium we will:

  1. Provide participants with an overview of the Mental Health and Addictions Key Performance Indicator Programme (MHAKPI)
  2. Discuss the rationale for the whānau indicators, and highlight the value of including whānau experience in the development of the indicators
  3. provide examples of initiatives to lift whānau engagement in New Zealand. 

To conclude the session we will demonstrate the MHAKPI Programme’s web based data display tool.

3:05pm
Transition break
3:15pm
Ballroom - Critical conversations over coffee - joining the dots to turn talk into action – Get up close and personal with AMHOIC’s keynote speakers - ask the big questions, expand thinking and progress ideas into actionable steps.
4:00pm
Master of ceremonies and Te Pou o te Whakaaro Nui CE wrap up and conference close

The final details of the conference programme may be updated and amended by the organising committee if required.