NSW Central West headspace

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NSW Central West headspace
An Integrated Primary Care Model
2
Overview

• Overview of NSW Central West headspace
• Pathways to care how our model works
• Staffing structure
• Difficulties encountered
• Key learnings

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What is headspace?

• Australias National Youth Mental Health
  Foundation established in 2006 under the Federal
  Governments Promoting Mental Health Youth
  Mental Health initiative.
• 30 headspace centres established in Australia (9
  in NSW, 2 in inland NSW).
• The headspace mission is to promote and
  facilitate improvements in the mental health,
  social wellbeing and economic participation of
  young Australians aged 1225.

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Why have headspace?

• Mental health is the number one health issue
  affecting young Australians today.
• One in four young people (YP) aged 12 to 25 will
  experience a mental health problem in any
  12-month period (only 25 seek help).
• Between 1992-2007, the number of young people in
  NSW aged 16-25 who saw a GP in the last 12 months
  dropped from 84.8 to 65 in males and from
  91.9 to 77.6 in females. (The NSW Population
  Health Survey 1992-2007 Report on Young Adults,
  2008)

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NSW Central West headspace

• Covering Bathurst, Blayney, Oberon and Cowra
  12-24 year old population approx 6,250.
• Opened hub centre in Bathurst in July 2008.
  Second site opened in Cowra in Feb 2009.
• Services include primary care (GPs) psychology
  drug and alcohol counselling vocational and
  social services dietician exercise physiology
  sexual health and womens health.
• All services provided free of charge.

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NSW Central West headspace

• Consortium responsible for establishing the
  service includes NSW Central West Division of
  General Practice (lead agency), Bathurst Regional
  Council, Greater Western Area Health Service,
  Central West Group Apprentices, TAFE, DET,
  Housing NSW, Centacare and Charles Sturt
  University.
• A total of 11.7 FTE staff working across the two
  sites, including salaried, contracted, visiting
  and private staff.

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What has been the response?

• More than 500 young people supported in just 10
  months 7.5 of the local population aged 12-25.
• More than 4500 occasions of service delivered,
  including assessments, psychology, GP, drug
  alcohol counselling, vocational and social
  assistance, dietician, exercise physiology,
  sexual health womens health.
• 11 of young people seen are indigenous, compared
  to local community representation of 2-3.
• 43 male 57 female.

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What has been the response?

• 66 of young people identify mental health as the
  primary reason they have attended headspace. 9
  of these have also identified DA as a concern
  they want to address.
• 13 of young people attending for DA counselling
  as their primary concern.
• 10 of young people also receiving vocational
  assistance.

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Pathway to care
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Pathway to care referral

• Open door policy so referrals received from all
  sources. Currently
• 30 of young people have self referred
• 30 are referred by family and friends
• 9.5 of referrals from GPs
• 6.5 of referrals from schools
• Registration form completed with basic
  demographic information and entered into shared
  electronic client management system (MHAGIC) used
  for all services.

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Pathway to care assessment

• Appointment made for psychosocial assessment with
  first available Youth Care Co-ordinator (YCC) to
  identify needs primary care, mental health, AOD
  and/or social and vocational services
• If requires acute MH support referred to acute
  MH services. Once acute episode resolves, may
  re-enter headspace if appropriate, for other
  services
• If YP assessed as requiring headspace services,
  YCC takes on care co-ordination responsibilities
  which do not cease until client discharge.

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Pathway to care Primary care

• If MBS funded care required (psychology,
  dietician, exercise physiology), YP booked in to
  see headspace or family GP for 2710, 723, 721
  etc
• Assessment notes provided to GP to assist with
  care plan and avoid YP repeating their story
• After GP appointment complete, YCC schedules
  appointments with psychologist, dietician,
  exercise physiologist or MH nurse, as outlined in
  GP care plan
• GP appointments also beneficial in enabling
  opportunistic primary care, eg sexual health,
  etc

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Pathway to care treatment

• If psychology counselling required, young person
  booked in for up to 6 sessions. Clinician then
  communicates progress with GP and YCC books GP
  appointment for 2712. Further 6 psychology
  sessions booked if required
• If non-MBS funded care required (DA, WHN, SHN),
  YCC books appointment with clinician and clinical
  services delivered at headspace by visiting
  clinicians
• Clinical feedback forms used by visiting
  clinicians as feedback and reviewed in Intake
  Meeting (incl G.P ordered Pathology etc)

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Organisational Chart
Consumer Forum
CW Division of GP Board
General Practice Advisory Group
CW Division of GP CEO
Consortia
Youth Board
Service Integration Manager

• Visiting service providers (1.9FTE)
• GPs
• Women's Sexual Health Nurses
• MH Youth Care-Link Worker
• Drug and Alcohol Worker
• Dietician
• Exercise Physiology
• Private Psychs

ATAPS SP Salaried Psych (2x0.5FTE)
Program Support/ Admin Officers (2.4FTE)
Education and Promotion Coordinators (1.6FTE)
Clinical Leader (1FTE)
Youth Care Coordinators (2.4 FTE)
0.4FTE Cowra Psychologist
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Clinical Leader

• Clinical advisor/support to clinicians
• Minimal clinical load, but available for
  overflow clients/those that cant access MBS
• Provides assistance to Manager in questions of
  clinical professional development, supervision,
  consent and confidentiality etc.
• Key responsibility is in area of clinical
  governance
• Importantly, NOT operational manager (distinction
  has advantages and disadvantages)

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Youth Care Co-ordinators

• 2.4 FTE salaried Youth Care Co-ordinators (YMHI)
• Intern Psychologist, Social Work psychology/
  teaching backgrounds
• Key responsibilities include engagement,
  assessment and co-ordination of care for YP
• Require vast knowledge of local services and
  their barriers - not a traditional clinical
  skill, but consistent with headspace ethos.

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Psychologists (ATAPS-SP/Private)

• 0.5FTE salaried (ATAPS-SP), 0.5FTE private
• Entirely bulk-billed, but added benefits of free
  rent and admin support promotion of service and
  income security through part-salary in
  establishment phase
• Maintain electronic records same as full salaried
  staff
• Organisational governance achieved in salaried
  time (supervision, intake/clinical meetings etc).
  This adds to capacity to involve in headspace
  TEAM.

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GPs

• Five local experienced GPs providing sessions at
  a frequency that suits (ie weekly, fortnightly or
  monthly)
• Averaging 24 hours per month to end of May 09
• Currently paid a flat hourly rate (RDA rate)
  regardless of FTAs etc, with headspace receiving
  100 of MBS generated

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GPs

• Currently, MBS generated is equal to GP costs, so
  service is cost neutral
• 66 of clients receiving mental health
  assistance, so require 2710 to access FPS.
  Therefore, GP hours currently filled with
  headspace clients, without promoting drop-in-
  service to the community
• Registered for AGPAL accreditation, with the aim
  of attracting a GP registrar in future and then
  encouraging drop-in services
• Using MD for notes and administration staff
  scanning notes into central electronic client
  system.

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Visiting services non-MBS funded

• Through MOU and SLAs, a range of services
  provided in-kind by AHS, incl
• Social worker for assessments (0.1FTE)
• DA Counsellor (0.1FTE)
• Womens Health Nurse (0.1FTE)
• Sexual Health Nurse (0.05 FTE)

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Visiting services MBS funded

• Psychology
• 0.5FTE salaried (ATAPS-SP), 0.5FTE private
• Entirely bulk-billed, but added benefits of free
  rent and admin support promotion of service and
  income security through part-salary in
  establishment phase
• Maintain electronic records same as full salaried
  staff
• Organisational governance achieved in salaried
  time (supervision, intake/clinical meetings etc).
  This adds to capacity to involve in headspace
  TEAM.

22
Visiting services MBS funded

• Dietician Exercise Physiology
• Private clinicians
• Entirely bulk-billed through TCAs
• Notes are scanned into electronic records by
  administrative staff.

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Visiting services MBS funded

• Mental Health Nurse
• 0.09FTE salaried at a rate higher than receiving
  through AHS, but lower than the MBS rebate, so
  should be income generating
• Providing coordinated clinical care and treatment
  for clients with severe mental disorders
  relieving the more acute clients from the YCC
  client load
• Liaising closely with acute MH services for
  step-down transition of their clients to
  headspace, or step-up of headspace clients in
  crisis

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Attracting Workers

• headspace staff
• Work environment
• Dynamic new approach to service delivery
• Career opportunity (Intern Psych and private
  practice)
• Built on past personal connections with services
  (especially Area Health Service) eg MHN
• EP staff promoting service resulting in word of
  mouth
• Apparently the website and advertising played
  little part in recruitment of workers

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Attracting Workers

• Visiting services
• Work environment innovative model
• MOU and SLA with services (eg Div of GP, AHS)
• Built on past personal connections with services
  (especially Area Health Service)
• Link to their key objectives ie what can we do
  for them, eg data, combined funding submissions
• Local service layout (location, access rates etc)
• Built in security (salary/private combination)

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Benefits of model

• Acting as a team to avoid multiple hand offs
• More points of support for the client and
  diversity of skills experience
• Better care planning, coordination and
  integration Access to services (eg vocational)
  that would not have been provided in other
  models/services
• See Gunn WB, Blount A. Primary care mental
  health a new frontier for psychology. Journal
  of Clinical Psychology 65(3)235-252.

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Challenges

• Unable to coordinate a full Multi-disciplinary
  Team Meeting incorporating all visiting staff
• Space though co-located, some visiting services
  may never be on-site at the same time
• Timely communication between visiting services
  and headspace staff (especially YCCs)
• that medical professionals are busy may increase
  the psychologists discomfort initiating
  contact co-location and team approach assist

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Solutions

• Weekly clinical meeting involves Clinical Leader,
  YCCs and psychologists to conduct case review,
  care planning etc
• Developed feedback form for visiting services to
  highlight key points for headspace
  follow-up/awareness. Does not replace clinical
  files, but highlights follow-up/red flags
• YCCs blocking time to be free at the conclusion
  of visiting clinicians sessions, where possible

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Solutions

• Developed form letters to streamline
  communication
• Providing an optional structured debrief session
  for GPs with Clinical Leader
• Conducting a Key Learning review meeting
  involving all visiting clinicians in July. May
  become six-monthly to facilitate feedback
  improvement

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Challenges

• Confidentiality clear to clients from the outset
  headspace adopts team approach to care
• Parallel play as opposed to collaboration
  between clinicians
• GP referrals to specific clinicians vs team
• GP resistance to assessment prior to therapy
• Resistance to use of new electronic client
  management system, particularly with GPs and
  visiting services with limited time/appointments

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Solutions

• Standard confidentiality brochure and consent
  forms developed and provided at assessment
• Centralised electronic client files enables all
  clinicians to review client progress, follow up
  etc

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Solutions

• Introduced fortnightly intake, case review and
  care planning meeting between YCC (one rep) and
  DA to improve communication
• Increased admin support to enable scanning of
  files, as necessary for visiting clinicians
• Ongoing education and promotion, particularly to
  GPs re outcomes for services outside mental
  health eg vocational, to improve appreciation of
  team approach and need for assessments

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Challenges

• Managing care transition between professionals
• YCC as constant assists to overcome this
• Means of payment 12 appointments not always
  appropriate care
• Diagnosis not all GPs comfortable with this and
  some clients are not suitable, so how do they
  access care under this model?

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Thank you
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Contact details

• Narelle Stocks
• Service Integration Manager
• NSW Central West headspace
• 253 George Street, Bathurst
• Cowra Mall, 39-43 Kendal Street, Cowra
• P. [phone]
• E. headspace_at_hscw.org.au