4.1.1 RationaleAs noted earlier, considerable resources and effort have been invested by all jurisdictions to introduce an outcomes focus within mental health service delivery. Despite the progress made to date, there is agreement between all parties that substantial work lies ahead beyond the basic implementation tasks to achieve the vision of an 'informed mental health industry'. Long term sustainability depends ultimately on the extent to which consumer outcomes data are applied in ways that support service delivery and are perceived to be useful tools within a quality improvement framework. To this end, further National Mental Health Program funding is being made available by the Australian Government to assist States and Territories in ensuring that sustainable systems are in place by 2006.
In addition to initiatives to be taken by individual States and Territories, more work is needed to develop accessible, nationally comparable information on mental health consumer outcomes. The recent establishment of AMHOCN as the vehicle for national information has commenced the process and needs to be developed in the years ahead.
Further work to refine the measurement instruments used to collect consumer outcome data and develop supplementary measures for specific purposes was foreshadowed in the first edition information priorities framework, but not progressed to any significant degree. The experience to date in implementing routine consumer outcome measurement in Australia's mental health services has emphasised the need to keep this work on the agenda.
4.1.2 Consolidation activities
Completing the basic implementation tasksAdditional steps will be undertaken by all jurisdictions to complete the comprehensive implementation of routine consumer outcome measurement across specialist mental health services under their control:
- For most State and Territory jurisdictions, this involves completing the information infrastructure enhancements and orientation training programs for the clinical workforce commenced under the previous Information Development Agreements.
- Within the private hospital sector, the work program to establish routine outcome measurement is well advanced but will require consolidation targeted at promoting the uptake and application of available information by clinicians and service managers.
Local reporting systems to facilitate utilisation of consumer outcomes dataAll States and Territories are committed to the development of outcome reporting systems that provide timely feedback to clinicians, consumers and carers. These will aim to integrate outcome measurement within clinical practice and support their use as tools for quality improvement initiatives.
National analysis and reportingSteps commenced under the Second National Mental Health Plan to establish arrangements for the national pooling and reporting of consumer outcome information (through AMHOCN) will be extended over the 2003-08 period. A range of publications that provide aggregated results and norms, derived from the national collection, will be produced to facilitate interpretation of local data by service delivery agencies and benchmarking between agencies. Results will be stratified in ways that meet the needs of the various subspecialties within the mental health sector (for example, child and adolescent services).
Expert advisory groupsExpert advisory groups on adult, child & adolescent and older persons mental health will be maintained to advise on the use and ongoing development of outcome and casemix information in mental health services.
4.1.3 New initiatives
Review and refinement of clinical outcome measures for adult, child & adolescent and older personsWhere permitted by the various licenses governing use of copyrighted instruments, the consumer outcomes measures implemented nationally will be reviewed with the aim of improving their utility. This will be based on analysis of the data collected and reported by States and Territories, the views of clinicians, consumers and carers and advice from the outcomes expert groups. Special attention will be given to review and improvement of the HoNOS 'family' of instruments (HoNOS, HoNOS65+ and HoNOSCA). The scope for developing a single, consolidated instrument of clinical symptoms and functioning for adult populations will be examined. Parallel work on child and adolescent measures will also be undertaken.
Enhancement of consumer self-report measuresAction will be taken by States and Territories, individually and collaboratively, to move towards a national standard self-report measure that incorporates the domains identified by consumers as critical to the assessment of outcomes. This will be based on review of experience in the use of existing measures, in consultation with consumers, and may replace or supplement those measures.
Development of measures of carer outcomes and perceptions of careConsistent with the National Mental Health Plan 2003-2008 emphasis on improved responsiveness to the needs of carers, available measures of carer wellbeing and burden will be evaluated, with a view to developing a national standard measurement tool for inclusion in the core outcomes suite. This work will also incorporate a measure of carer perceptions of care.
Information about Indigenous consumer outcomesPreliminary explorations by several jurisdictions, aimed at adapting available clinical measures to improve their utility and validity in assessing outcomes for adult Indigenous consumers, will be continued and extended to include child and adolescent and older person populations. New work will be commissioned to develop nationally agreed, culturally valid alternatives for self reporting on outcomes by Indigenous consumers and their families.
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