The Victorian drug and alcohol (AOD) sector has seen significant change since centralised service re-commissioning began in 2014. More recently, the Victorian State Government has been investing in new services in regional Victoria, including for 100 new residential rehabilitation beds and care.
In Victoria, a diverse range of organisations provide treatment and care to people with alcohol and other drug use problems, and providers within the sector are from multiple disciplines including youth workers, medical practitioners, nurses, social workers, Certificate level AOD workers, counsellors, alternative therapy providers and others.
Problems the sector are grappling with include a lack of resources to meet demand and to provide adequate intake and aftercare services, updating service models or innovating with new service models in response to the rapidly evolving evidence base in addiction medicine and AOD treatment, and clinical governance and safety in a complex treatment environment.
Many Primary Health Networks have recognised some of these issues and are beginning to commission AOD partnerships and services, which is changing the landscape again. PHNs are commissioning new planning approaches and innovative models of care along a stepped spectrum of needs. PHNs are also looking to work with sector partners to better integrate AOD services and primary care. For example, there are real opportunities to drive earlier intervention and more holistic, person-centred care in general practice settings with referral to ‘step up’ AOD specialist services in both community and tertiary settings.
Commissioning into an existing, primarily state and private-funded sector means that collaboration is critical. It is promising to see PHNs working with regional state government divisional offices and agencies to address some of the sector’s issues.
We briefly describe two approaches in south eastern Melbourne and western Victoria.
AOD service models: The Matrix Model for intensive outpatient treatment
The South Eastern Melbourne PHN (SEMPHN) invited service providers to respond to a tender opportunity to deliver the Matrix Model in its catchment.
Matrix is an evidence-based outpatient treatment program, comprising sixteen weeks of structured intensive treatment followed by 36 weeks of continuing care. Individual therapy sessions are combined with focused group sessions. Group sessions include:
- early recovery skills groups
- relapse prevention groups
- family education groups
- continuing care social support groups.
During the first (intensive) phase, clients receive professional one-on-one treatment three days per week and attend informal treatment sessions (e.g. 12-step/SMART recovery groups) the remaining days.
Initially, the focus is treatment for adults. Further roll out will provide services for other population cohorts.
Co-designing regional models of care: person centred, needs driven, integrated
The Western Victoria PHN supported the development of a new regional partnership model of AOD care in each of its four subregions. The goal was to develop a more comprehensive, person centred, needs driven, and integrated AOD system. Each model considered:
- the redesign / recommissioning of existing PHN funded services
- integrating state-funded services including the catchment-based intake system
- integrating primary care providers including prescribers and dispensers of pharmacotherapy
- integrating other PHN commissioned services such as mental health, suicide prevention, and chronic illness management.
Western Victoria PHN used a co-design approach to development. Co-design is defined as “a collaborative and shared process of planning, designing and delivering in which organisations engage in a joint relationship with their communities, consumers of services and other organisations”. The aim is to ensure the most effective and locally responsive care models are adopted.
Western Victoria PHN commissioned multidisciplinary project teams to come together in each region to produce an integrated regional model. The collaborative project teams comprised local:
- AOD treatment providers
- community organisations
- primary care providers
- general practices.
Co-design needs to ensure that a spectrum of consumers and system users are engaged. Larter recommends that particular attention be paid to including the voices of harder-to-reach populations and those more vulnerable to service access barriers, which can include young people, women, Aboriginal and Torres Strait Islander people, unemployed people, LGBTI people, and culturally and linguistically diverse communities. Our experience in the AOD and mental health sectors has shown that very focused and unique methods are often required to engage these groups.
The models and recommendations that emerge from these projects will support an overarching integrated model for Western Victoria and will guide future commissioning activity.
Contact Larter if you are interested in hearing about new funding opportunities or if you would like support to prepare tender or grant applications.