Non-residential rehabilitation submission guidelines

SUBMISSION GUIDELINES:
Innovative non-residential rehabilitation
Department of Health and Human Services Victoria
SUBMISSION DUE DATE: 12 NOON THURSDAY 18 JUNE 2015
CONTACT:
Email: icetreatmentgrowth@dhhs.vic.gov.au
CONTENTS
1.
INTRODUCTION ................................................................................................................................... 3
2.
PROGRAM REQUIREMENTS ................................................................................................................ 3
3.
4.
2.1
WHAT WILL BE FUNDED? ............................................................................................................ 3
2.2
SCOPE AND CLIENT GROUP ....................................................................................................... 4
2.3
POTENTIAL LOCATIONS FOR INVESTMENT ................................................................................ 4
2.4
KEY COMPONENTS OF PROGRAM .............................................................................................. 5
ACTIVITY LEVELS AND FUNDING ........................................................................................................ 7
3.1
COMMENCEMENT ................................................................................................................... 7
3.2
PERFORMANCE, MONITORING AND ACCOUNTABILITY .......................................................... 7
3.3
PRICING .................................................................................................................................. 7
SUBMISSION & ASSESSMENT ............................................................................................................. 8
4.1
WHO CAN MAKE A SUBMISSION?................................................................................................ 8
4.2
SUBMISSION REQUIREMENTS .................................................................................................... 8
KEY DATES ................................................................................................................................................. 9
APPENDIX 1: STATEMENT OF OUTCOMES ............................................................................................... 10
APPENDIX 2: ALCOHOL AND DRUG TREATMENT PRINCIPLES ................................................................. 14
APPENDIX 3: OVERVIEW – NON-RESIDENTIAL DRUG REHABILITATION PROGRAMS ............................... 15
APPENDIX 4: KEY DOCUMENTS AND REFERENCES ................................................................................. 17
KEY DOCUMENTS: ............................................................................................................................ 17
REFERENCES: ................................................................................................................................... 17
2
1. INTRODUCTION
In March 2015 the Victorian Government released a $45.5 million Ice Action Plan. The Plan
was developed to tackle the growing use of methamphetamines in the Victorian community
and the harms associated with use.
Alcohol and drug treatment services are an essential part of responding to these problems,
and the Plan includes $18 million over a 4 year period to expand non-residential drug
rehabilitation services. It is expected that this funding will deliver services for at least 500
clients per annum when fully operational. This investment will focus on establishing
innovative non-residential rehabilitation services in rural and regional communities.
Suitably qualified providers of funded alcohol and drug and community health services are
invited to submit proposals to develop and deliver drug treatment programs that deliver a
range of outcomes (Appendix 1) consistent with the alcohol and drug treatment principles
that underpin all state funded drug treatment services in this State (Appendix 2).
2. PROGRAM REQUIREMENTS
2.1
WHAT WILL BE FUNDED?
This funding will be utilised to establish non-residential rehabilitation programs for people
recovering from methamphetamine and other substance misuse.
It will fund programs of intensive, structured interventions to address psychosocial causes of
drug dependence though evidence-based treatment, They should provide client-centred
rehabilitation services addressing the psychosocial causes of drug dependence.
This typically includes motivational enhancement, cognitive behavioural therapies and
individual and group counselling, self-help and peer support, and supported reintegration into
the community and re-engagement with recreation and activities.
Non-residential rehabilitation programs provide an alternative to residential rehabilitation.
Participants do not live on site, while completing the programs, so that connections with
family, friends and community can be maintained throughout the rehabilitation period.
Emerging international and local evidence is showing that intensive non-residential
rehabilitation models are demonstrating effective outcomes for some alcohol and drug
clients, including those for whom methamphetamine is their primary drug of concern.
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In addition, it shows that moderately intensive programs over a longer period are showing
positive outcomes, particularly for methamphetamine users. A brief overview of some of the
available evidence to date is provided at Appendix 3, with an additional list of relevant
evidence and literature at Appendix 4.
2.2
SCOPE AND CLIENT GROUP
Consistent with the Ice Action Plan, the funding is for non-residential service delivery only.
Funding will be allocated to proposed non-residential rehabilitation programs that are able to
meet the needs of methamphetamine clients, while recognising that many clients are polydrug users and may be using other drugs and alcohol. The service provided therefore needs
to be suitable for a wide range of drug types, while ensuring the particular needs associated
with recovering from methamphetamines are catered for.
While non-residential programs in Victoria have, to date, tended to operate five days a week
over a period of 4-6 weeks, other models may be proposed which structure programs in a
different way.
Non-residential rehabilitation aims to provide an alternative for clients requiring a
rehabilitation program, rather than providing a step-up step-down option. Non- residential
rehabilitation will not be a suitable option for all clients. Clients who have access to family
support and stable housing, or who have dependent children may be more suitable for a
community based rehabilitation option rather than a bed-based option. However, care
planning should always be flexible to reflect the clinical assessment of a client’s needs.
2.3
POTENTIAL LOCATIONS FOR INVESTMENT
The Premier’s Ice Action Taskforce identified ice as a particular concern in rural communities.
This initiative aims to maximise access for clients in non-metropolitan areas, including regional
towns, rural areas and outer-metropolitan locations where access to existing rehabilitation
services may be difficult.
A range of Local Government Areas have been identified as potential priorities for additional
services based on a range of data (Table One), although proposals targeting communities in
other locations will be considered where the submission demonstrates a compelling case for
investment.
Funded alcohol and drug services in Victoria may accept clients from any area or catchment.
Successful proposals will be expected to be available to all clients and may, as part of this,
suggest strategies that directly target people from the identified areas.
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Table One: In scope Local Government Areas identified as potential priorities for investment
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Ballarat
Campaspe
Cardinia
Casey
Glenelg
Greater Bendigo
Greater Geelong
Greater Shepparton
Horsham
Hume
Latrobe
Maribyrnong
Melton
Mildura
Mitchell
Warrnambool
Whittlesea
Wyndham
2.4
KEY COMPONENTS OF PROGRAM
In order to be considered for funding, the non-residential rehabilitation program proposal
should include:
1. An outline of the proposed structure and mode of delivery of the program, and the
key considerations (including evidence base) which have led to the recommended
approach. Where a specific cohort or client group is proposed, evidence to illustrate
why that approach is recommended and how those clients will benefit should also be
provided.
2. How the program would respond flexibility to client needs, including those related to
methamphetamine and other drug use.
3. How the proposed program will provide culturally safe services to clients, including
Aboriginal people.
4. A description of proposed governance and other risk management/quality assurance
mechanisms, including clinical governance arrangements.
5. A description of how services will be tailored to reflect individual’s care plan,
including consideration of care needs before and after involvement in the nonresidential rehabilitation program (e.g. withdrawal, community-based counselling, care
and recovery coordination).
5
6. A description of how the proposed service model will deliver client-focussed, holistic
support which addresses substance issues and strengthens the life skills that support
sustainable recovery.
7. Key referral pathways and linkages to other services such as alcohol and drug
treatment service providers, intake and assessment providers , Aboriginal community
based organisations and the Australian Community Support Organisation (ACSO)
Community Offenders Advice and Treatment Services (COATS) program.
8. A description of how consumers, families and other supporters will be actively
involved in the program’s development, implementation and continuous
improvement.
9. A brief description of the proposed staffing structure, including how the proposed
skills and qualifications mix aligns to the proposed service model, treatment principles
and client group.
10. Confirmation that the program will be consistent with current government policies,
standards and requirements for funded alcohol and drug service delivery, which can
be accessed at http://www.health.vic.gov.au/pfg/.
11. A brief summary of the proposed budget for the program, which demonstrates
sustainable cost structure that delivers value for money.
12. A brief summary of the proposed implementation plan to deliver the required services
in the designated timeframes, should the proposal be successful.
13. A description of the physical infrastructure that will support the model, including
access to appropriate space/s for group based activities; access to kitchen and dining
facilities; access to office facilities for permanent and contracted staff; and information
technology resources.
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3. ACTIVITY LEVELS AND FUNDING
3.1
COMMENCEMENT
Funded programs must commence operation no later than 1 October 2015.
3.2
PERFORMANCE, MONITORING AND ACCOUNTABILITY
Successful providers will be required to report activity to the Department on a regular basis.
Service requirements will be monitored through agreed performance indicators and
supported by an analysis of issues impacting on the performance achieved. Service providers
are accountable for the use of the funding for the delivery of the programs specified in the
department’s service agreement.
The monitoring and review processes that apply to funded services are outlined in the
department Policy and Funding Plan. The Victorian Health Policy and Funding Guidelines can
be accessed on the department’s Funded Agency Channel website
(http://www.dhs.vic.gov.au/funded-agency-channel).
As part of this accountability, service providers are required to comply with data collection
and other reporting requirements.
Successful providers and their partner agencies will be required to actively participate in the
evaluation of this project which will be undertaken by the department. This includes the
collection of data required to support program monitoring, evaluation and review.
3.3
PRICING
Operational funding will be provided through an allocation of Drug Treatment Activity Units
(DTAU) for courses of non-residential rehabilitation. Non-residential rehabilitation is
equivalent to a DTAU weighting of 11.0. This equates to $7,358 (2014-15 prices) for a course
of treatment for each client. This must include all associated costs, among these program
costs, on costs, consumables and related accommodation and administration costs.
The total funding available per program will depend on the model proposed and the
anticipated number of clients participating and completing the program. It is therefore
important that proposals include accurate program costings to ensure the viability of the
service and assist in identifying which proposals offer the best value for money.
Please note that the department will be seeking to maximise client access as well as
effectiveness, so any opportunities to increase the number of clients who can be supported
while maintaining the quality and integrity of the program should be identified in proposals.
The standard loadings will apply for forensic and Aboriginal clients. Aboriginal clients attract a
price loading of 30 per cent, and forensic clients attract a price loading of 15 per cent. If a
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client is both Aboriginal and a forensic client, only the 30% Aboriginal loading will apply.
Services should therefore make allowances for the likely representation of these clients group
in programs, when calculating the anticipated cost per client.
In the initial year, funding may include a small component for establishment costs. This should
be specified in submissions. However, establishment costs should not exceed the equivalent
of three month’s annual funding, as services are expected to be commencing no later than 1
October 2015.
4. SUBMISSION & ASSESSMENT
4.1
WHO CAN MAKE A SUBMISSION?
Proposals will be accepted from all agencies that:
 currently deliver drug treatment services and/or
 are funded community health services.
In addition, proposed providers must:
 Demonstrate capacity and experience in delivering effective, evidence based alcohol
and drug treatment services.
 Have an existing contractual arrangement with the Department of Health and Human
Services, and an established record in complying with its terms and conditions. Have
current accreditation within existing accreditation frameworks by an entity that is
certified by the International Society for Quality Health Care or the Joint Accreditation
System of Australia and New Zealand.
 Have capacity and willingness to report on service delivery, and participate in program
evaluation and review.
4.2
SUBMISSION REQUIREMENTS
Proposals should provide a clear description of how the proposed non-residential
rehabilitation program will be structured and delivered including addressing the key program
components identified in section 2.4 of this document.
All submissions must be
 Submitted via email to icetreatmentgrowth@dhhs.vic.gov.au and received no later
than 12 noon Thursday 18 June 2015.
 Be submitted on the attached template.
 Be no more than 20 pages in length (excluding any supporting attachments that may
be included).
Late submissions will not be accepted.
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You should receive an email confirming receipt of your submission within 1 business day. If
you do not receive a confirmation email, please contact us via
icetreatmentgrowth@dhhs.vic.gov.au.
Copies of the submission template, these submission guidelines and other relevant
documents will also be available on the Departmental website at www.ice.vic.gov.au.
Please submit any queries or questions to icetreatmentgrowth@dhhs.vic.gov.au.
4.3
ASSESSMENT
Proposals will be assessed on the basis of the written proposal, according to a range of
submission criteria described in the template, including:

Alignment with the stated requirements and scope of the program, as outlined in this
document.

Demonstrated capacity to deliver program outcomes across the domains outlined in
Appendix 1.

Alignment with Victorian alcohol and drug treatment principles as outlined in
Appendix 2.

Evidence of unmet need or identified service gap, drawing on both evidence provided
in the proposal and external sources (e.g. service data, information on existing
services).
KEY DATES
Date
29 May 2015
18 June 2015, 12 noon
18 June - 22 June 2015
26 June 2015
Deliverable
Call for submissions released
Closing date and time for submissions
Review, assessment and selection of proposals
Outcomes of submission process announced
July – September 2015
No later than 1 October
2015
Establishment
Non-residential services commence operation
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APPENDIX 1: STATEMENT OF OUTCOMES
Please note this information is illustrative only. The Department reserves the right to amend any
aspect of this statement of outcomes.
Table 1: Indicative outcomes and benefits to client to which alcohol and drug treatment services are
expected to contribute:
Outcome
domains
Effectiveness
Indicative Outcome
Ways benefit might be measured
Alcohol and drug taking
behaviours of clients
stabilised, improved or
ceased
Improved quality of life
status
Improved social
connectedness/reduced
social isolation
Reduced frequency and/or level of alcohol and/or drug
use
Increased protective behaviours associated with alcohol
and/or drug use
Client reports better/greater satisfaction with living
conditions
Family or significant other are positively engaged with
the client and are part of the support system provided to
the client
Improved quality of personal relationships
Improved safety and wellbeing of dependent children
Client participates in mainstream social and recreational
activities that are meaningful to them
Client reports fewer or less severe physical health
symptoms
Improved engagement with primary health for
prevention and/or management of chronic health
problems
Reduction in preventable illness, key health risks and
chronic disease (for example obesity, diabetes, smoking)
Reduction in co-occurring health problems (including
mental health issues)
Clients have the skills, knowledge and confidence they
need to make informed choices about the type of
treatment and ongoing support they need
Clients articulate recovery oriented treatment goals
Self-management capacity
Health outcomes
Clients’ capacity for
engagement in alcohol
and drug treatment
services and decision
making about their own
treatment planning
improved
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Outcome
domains
Indicative Outcome
Ways benefit might be measured
Contribution to
improved long-term
housing security
Reduction in number of clients experiencing repeated or
chronic homelessness
Timely access to appropriate and affordable stable
housing
Maintenance of stable tenancy
Engagement by clients in schooling/ vocational training
opportunities of their choosing
Improved employment participation
Improved engagement with primary health for
prevention and/or management of chronic health
problems
Improved engagement with human services and social
supports (e.g. housing, community services).
Reduction in the number of clients that come into
contact with the justice system and the frequency of
contact by individual clients
Families have the skills, knowledge and confidence they
need to support the person they care for
Active, respectful involvement of family in decisions
related to the provision of support
Services delivered at minimum cost.
Contribution to
improved economic
participation
Client engagement with
health, human services
and other key social
supports
Reduced involvement
with the justice system
Improved involvement
of families in support
provided to the client
Efficiency &
sustainability
Responsiveness
Services are cost
efficient
Responsiveness to
population diversity
Services are culturally safe
Services effectively engage and respond to diversity
Services effectively engage and respond to
individuals/groups known to experience significant
disadvantage, particularly:
Aboriginal people, their families and the community
People experiencing or at risk of homelessness
People with a dual diagnosis/disability
People with criminal justice involvement
People from culturally and linguistically diverse
backgrounds
Improved
Family members provided with timely information,
responsiveness to family referral and advice to support
members including
children and significant
others
Improved
Dependent children identified and needs recognised in
responsiveness to
client care and support
dependent children of
Dependent vulnerable children referred to appropriate
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Outcome
domains
Accessibility
Indicative Outcome
Ways benefit might be measured
clients
supports
Clients more confident in managing parenting
responsibilities
Referral agencies, clients, and family members find it
easy to locate alcohol and drug treatment services
Services are able to accept new clients on referral within
a timely manner
People with high-level alcohol and drug problems receive
priority access and support in a timely manner
Alcohol and drug
treatment services are
easy to find and access
People who are most in
need are prioritised for
access
Continuity
The alcohol and drug
treatment services
system is easy to
navigate
Clients do not have to retell their full histories multiple
times.
Complex clients are actively supported through their
treatment
People have reasonable
access to alcohol and
drug treatment services
no matter where they
live
People living in rural Victoria have reasonable access to
alcohol and drug treatment services
More people and services are accessing treatment via
centralised screening and catchment based intake units
More people are accessing online screening and selfdirected treatment options through the centralised
screening and referral service
No gaps exist in the alcohol and drug treatment pathway
for clients because:
Coordination at the statewide, catchment based, service
and client level is effective and supports continuity of
care for clients
Coordination and referral pathways between intake and
assessment and alcohol and drug treatment services, are
effective and support continuity of care for clients
Alcohol and drug treatment services and human
services/social support services collaborate and plan
together to achieve improved outcomes and continuity
of care for shared clients.
Well established and effective referral pathways exist
between alcohol and drug treatment services and human
services/social support services e.g. no gaps exist
between elements of the treatment and support
pathway
Pathways between
alcohol and drug
treatment streams,
including intake and
assessment, are well
established and support
continuity of care
Pathways to and from
local human services
and other social support
services are well
established and support
continuity of care
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Outcome
domains
Safety
Indicative Outcome
Ways benefit might be measured
Client safety
Family safety
Number of critical incidents involving clients
Number of critical incidents involving families and
dependent children
Number of critical incidents involving workers
Worker safety
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APPENDIX 2: ALCOHOL AND DRUG TREATMENT PRINCIPLES
The delivery of Victorian alcohol and drug treatment services is underpinned by treatment
principles that inform practice and service delivery.
 Substance dependence is a ‘complex’ but treatable condition that affects brain
function and influences behaviour
 Treatment is accessible
 Treatment is person-centred
 Treatment involves people who are significant to the consumer
 Policy and practice is evidence informed
 Treatment involves integrated and holistic care responses
 The treatment system provides for continuity of care
 Treatment includes a variety of biopsychosocial approaches, interventions and
modalities oriented towards people’s recovery
 The lived experience of alcohol and drug consumers and their families is
embedded at all levels of the alcohol and drug treatment system
 The treatment system is responsive to diversity
 Treatment is delivered by a suitably qualified and experienced workforce.
In addition to delivering services in ways that align to the treatment principles, funded
alcohol and drug treatment providers will be expected to:



Provide a friendly, welcoming and culturally safe environment for all clients,
including Aboriginal and Torres Strait Islander people and people from culturally
and linguistically diverse backgrounds, and their families.
Deliver services in ways that are also consistent with the Victorian alcohol and
other drug client charter.
Ensure clients have the right to privacy and should provide informed consent for
any information regarding their care to be exchanged between workers within an
alcohol or drug treatment service or with other agencies. There is a need to
balance the client’s right to privacy with the needs of significant others involved in
the person’s informal day to day support for information essential to this role.
Service providers must have clear policies and processes regarding this that are
consistent with the Victorian Information Privacy Act and associated Information
Privacy Principles.
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APPENDIX 3: OVERVIEW – NON-RESIDENTIAL DRUG REHABILITATION PROGRAMS
Rehabilitation is client-centred recovery designed to address the psychosocial causes of drug
dependence. The Victorian Government funds rehabilitation programs delivered through
residential or day program settings, counselling or care and recovery approaches.
Non-residential rehabilitation programs are intensive, structured interventions to address
psychosocial causes of drug dependence though evidence-based treatment, with the aim of
sustainable recovery. These interventions include a variety of individual and group cognitive
behavioural therapies and additional educational and therapeutic elements designed to
promote client mental health and wellbeing. This typically includes motivational
enhancement, cognitive behavioural therapies and individual and group counselling, self-help
and peer support, and supported reintegration into the community and re-engagement with
recreation and activities. The key difference between this and traditional bed based
rehabilitation services is that people do not live on site, but return home for evenings and
weekends, so that connections with family, friends and community can be maintained
throughout the rehabilitation period.
While residential rehabilitation plays an important role, there is evidence in Victoria and other
jurisdictions that demonstrates that there can be other ways of delivering effective,
community-based, rehabilitation services.
Emerging international and local evidence is showing that intensive non-residential
rehabilitation models are demonstrating effective outcomes for alcohol and drug clients,
including methamphetamine clients. In addition, it shows that moderately intensive programs
over a longer period are showing positive outcomes, particularly for methamphetamine users.
These programs identified that transition into treatment may be affected by ongoing
experience of withdrawal, however, treatment strategies such as motivational enhancement,
cognitive behavioural therapies and ongoing family support, can improve treatment
outcomes, in conjunction with the provision of ongoing support after treatment completion.
Clients have achieved good outcomes from attending non-residential rehabilitation programs
that use a mix of evidence-based group work and individual psychosocial approaches such as
Cognitive Behavioural Therapy (CBT), mood and management therapies, and Motivational
Enhancement Therapy (MET). While day programs are generally designed around a full
program of therapeutic interventions, some services provide a combination of compulsory
and optional units that allow clients to choose which sessions to attend. Optional units
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typically include holistic support sessions designed to increase overall health and wellbeing,
treatment retention, and client satisfaction. These units could include life skills training, such
as financial or employment counselling, nutrition, exercise, and art therapy classes.
Existing models of day programs are generally provided for a minimum of 4-6 weeks. The
program promotes daily attendance at the initial stages, with levels of intensity tapering off
towards the end of the program to promote community integration. Scheduled free time
enables clients to develop coping mechanisms and promote family and social interaction.
Some programs offer drop-in aftercare support sessions to allow clients to remain linked in
with treatment, and allow for rapid re-entry in the event of relapse. Discharge support and
aftercare are critical elements of day programs. Comprehensive post-program care can
include access to refresher or extension programs, or repeating the program when needed.
Similar to residential rehabilitation, services provide clients with clear and structured
connections with a range of appropriate continuing treatment interventions, such as
counselling and mutual aid groups. Aftercare models such as ongoing group work, which
continue to apply cognitive behavioural and motivational enhancement strategies, can help
clients maintain their goals by coping with urges, solving problems related to their substance
use and working to establish lifestyle balance.
Evidence shows that intensive, non-residential alcohol and drug rehabilitation options may be
suitable for clients who require more intensive support than individual counselling but who
are not suitable for, or cannot access, residential rehabilitation. Eligibility criteria for existing
programs suggests that clients need to be self-motivated, capable of self-management, have a
moderate level of social and intellectual functioning, and be of reasonably stable mental
health and life circumstances.
Clients who have not undergone withdrawal, a confirmed period of abstinence, or stabilisation of use
of drugs of dependence are generally not considered suitable for community rehabilitation
programs.However, clients who have withdrawn from methamphetamine can experience agitation,
disturbed sleep and poor concentration for longer periods after withdrawal treatment. This means
methamphetamine clients require a flexible approach early in the program to maximise
treatment retention and positive treatment outcomes.
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APPENDIX 4: KEY DOCUMENTS AND REFERENCES
KEY DOCUMENTS:
1. Department of Premier and Cabinet, Ice Action Plan, State Government of Victoria, 2015.
https://4a5b508b5f92124e39ffccd8d0b92a93a9c1ab1bc91ad6c9bfdb.ssl.cf4.rackcdn.com/2015/03/Ice-Action-Plan-FinalSummary-Document-Web-Version.pdf.
2. Department of Health and Human Services, Catchment based intake and assessment guide,
State Government of Victoria, 2015. http://docs.health.vic.gov.au/docs/doc/Catchmentbased-intake-and-assessment-guide-April-2015
3. Department of Health and Human Services, Victorian AOD Client Charter, State Government of
Victoria, 2011. http://docs.health.vic.gov.au/docs/doc/English---Victorian-AOD-Client-CharterBrochure-(2011)
4. Department of Health and Human Services, Victorian alcohol and drug treatment principles,
State Government of Victoria, 2013. http://docs.health.vic.gov.au/docs/doc/Victorian-alcoholand-drug-treatment-principles
5. Department of Health and Human Services, Information for health and human service
providers, State Government of Victoria, 2015. http://docs.health.vic.gov.au/docs/doc/Factsheet-Alcohol-and-other-drug-treatment-in-Victoria-April-2015
6. Department of Health and Human Services, Service specification for the delivery of selected
non-residential alcohol and drug treatment services in Victoria, State Government of Victoria,
2014. http://docs.health.vic.gov.au/docs/doc/Service-specification-for-the-delivery-ofselected-non-residential-alcohol-and-drug-treatment-services-in-Victoria
7. Department of Health and Human Services, Victorian policy and funding guidelines 2014-15
http://docs.health.vic.gov.au/docs/doc/Victorian-health-policy-and-funding-guidelines-201415
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