Evaluation of the consumer - directed care initiative - Final Report
5.4 Provider implementation
Table of contents
- Executive summary
- Glossary
1 Introduction- 2 The consumer-directed care initiative
- 3 Evaluation of the consumer-directed care initiative
- 4 Profile of participants and the supports they accessed
5 Implementation and operation of the initiative- 6 Impact of the initiative for CDC participants and their carers
- 7 Impact of the initiative for CDRC participants and the people they care for
- 8 Impact on providers and the broader service system
- 9 Cost assessment and cost-effectiveness of the initiative
- 10 Key findings
- 11 Lessons learnt and strategies for consideration
- Appendices
- References
Development of an organisation’s approach
Providers undertook a number of activities relating to the development and set-up of their organisation’s approach to CDC/CDRC, including:- determining how their approach would operate in practice
- identifying how to market their packages and recruit suitable participants
- engaging with other stakeholders such as ACATs and brokered service providers
- developing participant information, participant agreements and budgeting templates
- identifying the internal systems changes or developments required to support the operation of CDC/CDRC.
Staff selection, development and training
CDC and CDRC providers relied on highly experienced, existing staff to implement their organisation’s approach, and manage the participant selection, planning and support coordination. Usually, these were manager-level staff or senior coordinators who had been involved in the development of their CDC model.A small number of providers undertook specific recruitment for coordinator/case worker positions. During the pilot period, providers tended to use one or two coordinators to work specifically on all aspects on CDC or CDRC (including the administration components), rather than a larger number of coordinators each having one or two CDC or CDRC participants amongst a wider standard care client load.
Providers identified a number of key skills and attributes required for CDC and CDRC coordinators – outlined in the box below.
Skills and attributes of coordinators identified by providers
- Skills and experience in individualised assessment and goal-based planning
- Skills in client capacity building and case management
- Knowledge of aged care or respite, but no preconceived ideas about what community aged care or respite ‘is’ or ‘looks like’ – an ability to ‘think outside of the box’
- Financial skills, both in terms of managing individual budgets and helping clients to understand their budget statements (this is quite different to the standard packaged care approach)
- Commitment to client empowerment and self-determination.
There was a considerable degree of informal and on-the-job training and skills development for coordinators, rather than specific formal training. This included:
- involvement of coordinators in the development of the organisation’s approach and application of CDC and CDRC
- understanding the language and philosophy of consumer-direction, generally through sector-initiated information sessions, conferences and research
- one-on-one support from managers relating to interpretation and application of the guidelines or the organisation’s approach
- specific skills development – particularly related to support around budgeting and budget reporting
- sharing experiences of CDC with other providers through provider networks.
Differences in implementation and operation between providers
There were variations in the way CDC in particular was implemented and operated across different providers, and the degree to which CDC was different from standard packaged care. Variations were particularly evident in planning processes, in providers’ degree of flexibility around the range and choice of services offered to participants, and in providers’ openness to innovative or non-traditional services.These variations related to differences in:
- the extent to which CDC was understood by providers as being ‘different’ from standard packaged care
- the extent to which providers were already flexible or person-centred in their approach
- the provider’s degree of comfort with the CDC model and their assessment of the ‘risk’ to them of giving more control to clients
- their motivation for applying for CDC (to gain access to additional packages, or to test a way to do things differently).
The manager(s) or project officer(s) responsible for designing and implementing CDC appeared to be a key factor that influenced a provider’s capacity to embrace the self-direction ‘spirit’ of CDC, and to implement the model in a way which distinguished it from standard packaged care. Their personal level of commitment to the principles of CDC and the extent to which they saw CDC as an opportunity to do things differently (as opposed to an opportunity for additional packages) was an important enabler for making CDC work.
Key points – Program and provider implementation
Support and guidance from the Department- Many providers would have appreciated some initial training or a help desk function by the Department, earlier provision of operating guidelines, and better communication of changes between draft and final guidelines.
- Some providers appreciated the flexibility of the operating guidelines during the pilot period, but would have liked clarification about a number of specific program issues.
- Providers needed more time to operationalise CDC and CDRC and to develop their approach.
- Providers relied on the skills and experience of existing staff to develop and implement CDC and CDRC. There were specific skills and attributes identified for CDC and CDRC care coordinators: relationship building and case management skills, assessment skills, financial management skills, knowledge of community aged care, respite and wider social services, a commitment to client empowerment and self-determination, and an ability to think laterally and ‘outside the box’. A lack of preconceptions about what community care or respite “is” or “looks like” was also important.
- While providers selected existing coordinators with the best mix of skills and attributes to work on CDC and CDRC, coordinators generally did not have all of the necessary skills and attributes required, and some training and skills development was needed.
- Coordinators’ skills and knowledge were developed primarily through informal training and on-the-job experience – predominantly by being involved in the development of the organisation’s own approach to CDC/CDRC, one-on-one support from managers, provider and industry-led initiatives, and specific training to develop new skills (such as budgeting and budget management).