Outcome Measurement The Policy Context

1. Outcome MeasurementThe Policy Context The OM Team Service Monitoring & Review Unit Mental Health Branch

2. The Time is Right • Increasing focus on consumers • Trend towards evidence-based medicine • More sophisticated monitoring approaches • Advances in information technology

3. Early Initiatives • Commonwealth-sponsored research and trials since 1994 • Victorian HoNOS field trial 1996 • Mental Health Classification and Service Costings (MH-CASC) project (1996) • Round 1 of OM implementation (2000)

4. What we’ve learned so far • The introduction of OM is a complex change management process which requires strong high-level support within the organisation • Focus on a ‘suite’ rather than on individual measures • Pay attention to process issues and involve consumers • Ensure clinicians have instant access to informative reports

5. Current Policy Context • 2nd National Mental Health Strategy • Strengthen focus on consumer outcomes • Support improvements in service quality • Improve nationally comparable information • Promote evidence based practice • Information Development Plan initiatives • Nationwide commitment to implement OM by end 2002-2003 – core suite agreed nationally

6. National Objective • To build an informed mental health system where information is available to guide decisions at all levels to: • support clinicians in their treatment decisions • inform consumers about the services they receive • help managers manage • inform policy makers in planning and paying for services

7. Scope of Implementation • A nationwide initiative • All clinical public mental health services • Children & Adolescents • Adults • Aged Persons • Statewide and Specialist Services • Separate processes for PDSS and Private Psychiatry

8. Choosing an appropriate measure • Applicability: address dimensions important to consumers (symptoms, disability and satisfaction); • Acceptability: brief with clear purpose, wording and interpretation; • Practicality: time, costs, training and skill level required must also be considered; • Validity: have sound psychometric properties and measure what it is intended to measure;

9. Each Suite Includes Measures that • are age-specific and applicable irrespective of diagnosis • are complementary, covering short-term symptoms as well as general functioning • can be used by clinicians to inform case planning and review and by consumers to rate their own mental health • have the potential to inform the OM agenda of Quality Improvement as well as the further development of a Casemix classification

10. OM = • the most significant initiative in the mental health sector since de-institutionalisation • Shift in organizational culture at all levels • Business process re-engineering

11. DHS role • Designated contact officer for each AMHS • Local information sessions • Best Practice Forums • OM Website • Enhancements to RAPID/CMI - Wellbeing & Wellbeing Reporting • Local Implementation Plans • Financial support

12. Local Implementation Tasks • Clinician Engagement • Consumer Engagement • Development of local protocols • Review of clinical paperwork • Review of local IT infrastructure & communications -  data entry load & need to provide feedback to clinicians

13. Benefits of OM • Systematic means of documenting progress – can highlight progress,deterioration or maintenance • Assists case reflection • Facilitates dialogue with consumers • Standardises assessment tools/processes • Provides feedback re impact of interventions, procedures, policies, training • Support management decisions (eg case allocation?)

14. The Longer Term • NOCC protocol likely to be refined over time • Measures may be amended or replaced • Current review of Consumer Self-Rating about to be completed • Introduction of a Carer measure is a likely development – esp in APMHS • Further development of Casemix classification of mhs