Comorbidity treatment service model evaluation

Survey part 2

Page last updated: August 2009

The purpose and nature of the evaluation
Your involvement
Confidentiality
The evaluation report
Questions about participation or the evaluation
How to complete this survey
Consent and survey questions

The purpose and nature of the evaluation

The Australian Government recognises that the appropriate management and treatment of people with comorbid substance use and mental illness is an important and complex issue. As such, the Australian Government is keen to determine how to improve services to better meet client needs, provide support to clinicians and other health workers, and promote examples of good practice resources and models.

To this end, the Australian Institute for Primary Care (AIPC) has been funded under the National Comorbidity Initiative to undertake the Comorbidity Treatment Service Model Evaluation project. The AIPC will be conducting research to increase the understanding of the impact of service structure on comorbidity treatment outcomes, as well as identify and develop good practice models to ensure improvements in comorbidity treatment service delivery.

The Service Model Evaluation has three components:

A literature review to determine the evidence base for different comorbidity treatment service delivery models.

The development of a treatment service model evaluation tool to gather information on the impact of service delivery models on treatment outcomes.

The evaluation of a number of service models, using the evaluation tool, with a focus on the service structure and diagnostic and treatment methods.

This survey is part of the third component of the Comorbidity Treatment Service Model Evaluation. The survey is divided into two parts. This is Part II of the survey.

Your involvement

You have been invited by the Department of Health and Ageing (DoHA) to participate in this survey because your service is perceived as providing high quality services and care. Recommendations for participation have been sought from experts in the field and from DoHA.

The purpose of this survey is to identify characteristics and service models of good quality services, with a focus on the service structure and diagnostic and treatment methods. It is not the purpose of the survey to evaluate the performance of individual treatment services.

We may contact you via email or telephone after completion of this survey if we have any further questions or want to clarify any comments you provide.
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Confidentiality

Your answers to the survey questions will be used for:
  1. A case study in good practice in your organisation, which will be provided to DoHA after you had an opportunity to review it. This case study will not include any problems or issues that you identified unless you agree to these being included. Apart from this case study, none of your comments will appear in project reports or any other future publications in a way that will identify you. However, if you consent, we would like to include your organisation's or program's name in the project report in the acknowledgements section. Question 2 in this survey gives you the option to choose to participate but not be identified in the acknowledgements section of the resulting report.

  2. A final project report for which we will use the data from you and other treatment services in aggregate and de-identified form.

  3. One or more articles in peer reviewed journals and/or conference presentations. We will only use deidentified data for these publications.
To protect your confidentiality, your answers to the questions will only be viewed by Dr Monika Merkes and a research assistant at the Australian Institute for Primary Care.

The project data will be kept for five years and stored at the AIPC, Health Sciences Building II, Level 5, Bundoora Campus, La Trobe University.

Please note that your participation in this project is voluntary. For up to four weeks after the completion of this survey, you may request to withdraw your consent to participate. You can withdraw your consent by emailing m.merkes@latrobe.edu.au advising of the withdrawal of your consent.

The evaluation report

Findings will be reported in summarised form. On completion, a project report will be provided to DoHA, the key informants (i.e. the experts who provided comment on the draft literature review), and the treatment services participating in the evaluation. In addition, it is intended that key findings will be widely disseminated to the sector by DoHA to inform comorbidity service provision. The material from this project will remain the intellectual property of DoHA, and as such, requests for results from the study will have to be made to DoHA. DoHA may decide to make the findings publicly available. However, DoHA will not receive the comments as provided by you in this survey; these will only be provided in deidentified and summarised form.

As indicated above, we will prepare a report (case study) for each service that participated in the survey, summarising the information that the service provided. The draft report about your service will be made available to you to review before it is finalised and provided to DoHA. The report will be a case study in good practice, and we will not highlight any deficiencies or problems with your service/program without your agreement.

Questions about participation or the evaluation

If you wish to receive additional information about the Comorbidity Treatment Service Model Evaluation and/or this survey, or if you have any questions, please contact Monika Merkes via email m.merkes@latrobe.edu.au or phone (03) 9479 3924.
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How to complete this survey

The online survey requires you to tick one or several boxes in response to a question, and/or provide text and comment in a text box. The survey is spread over a number of pages. After completion of the questions on a page, press 'Next' to proceed to the next question, or 'Prev' to go back and review a previous question.

Questions in this survey marked with an asterisk (*) have to be completed to move on to the next question.

You can leave a partially completed survey (click 'Exit this survey' in the top right corner of your screen) and come back to it later on the same computer. Please note that this will only work if you come back to the same computer.

We anticipate that it will take approximately 1 to 1.5 hours to complete this survey.
    Please note that the size of the text boxes in this survey does not limit the amount of text you can provide. Just keep typing and when the text fills up the box, scroll bars will appear.

Consent and survey questions

  1. I (the participant) have read and understood the information provided on this page, and any questions I have asked have been answered to my satisfaction.

    I agree to participate in the project which is being undertaken by the Australian Institute for Primary Care (AIPC) - La Trobe University, on behalf of the Australian Government Department of Health and Ageing (DoHA). I understand that the intellectual property of this project remains with DoHA and requests for results from the study will have to be made to DoHA. I realise that I may withdraw from the project at any time and may request that no data arising from my participation are used, up to four weeks following the completion of this survey.

    I agree that research data provided by me or with my permission during the project may be presented at conferences and published in journals on the condition that my comments will not be attributed to me and no other identifying information is used.

    Accepting the invitation to participate in this project sent to me by DoHA, and having read and understood the information provided above, constitutes my consent to participate in the project.

    By clicking the 'yes' button below, I consent to participate in this survey.

    • yes

  2. Would you like to be acknowledged in the final report as a contributor to the evaluation?

    If you answer 'yes', your name and that of your organisation or service will be listed in the report, but none of your comments will be attributed to you or your organisation.

    If you answer 'no', your name and the name of your organisation or service will not appear in the report.

    • yes, I would like to be acknowledged in the final project report

    • no, I do not want to be acknowledged in the final project report or any other publicationTop of page

  3. Contact details

    • Name of your program/service

    • Name of your organisation (if different from above)

    • Name of contact person (i.e. person completing this survey)

    • Email of contact person

    • Telephone number of contact person

    • Address (street address, address, city/town, postcode)

  4. State/Territory

  5. Please describe the philosophy or guiding principles of your program (e.g. harm minimisation). If the history of your program has influenced these, please feel free to elaborate.

  6. How do you promote your services to potential clients and other organisations? (tick all that apply)

    • advertisements in local print media

    • flyer(s)

    • information stalls at forums, conferences etc.

    • media releases

    • newsletter(s)

    • participation in relevant networks

    • website

    • Other (please specify) Top of page

  7. How does your service recruit clients? (select as many as applicable)

    • referral from primary health services (e.g. GP, community health service)

    • referral from welfare services

    • referral from housing services

    • referral from AOD services

    • referral from MH services

    • referral from criminal justice system

    • referral from Centrelink

    • referral from hospital

    • self referral

    • referral from family/friends/carers

    • Other (please specify)

  8. Please describe your intake processes (e.g. who does it, how and when is it done)

  9. Does your service screen clients to detect co-occurrence of MH and substance use disorders (comorbidity)?

    • yes, all clients

    • yes, most clients

    • yes, some clients

    • no

    • commentsTop of page

  10. If your service screens clients for comorbid problems, when do you do this and who does it?

  11. If your service screens clients for comorbid problems, which disorders do you look for?

  12. If your service screens clients for comorbid problems, how do you do this?

    • we use validated screening tools

    • we use purpose-built, internally designed screening tool(s)

    • we use a combination of the above

    • other

    • Other (please specify)

  13. If you use validated screening tools, which tools do you use? If you use purpose-built tools, please describe these.

    • validated screening tools

    • purpose-built tools

  14. Are clients with certain types of comorbid problems excluded from treatment?

    • yes

    • no

    • If yes, please describe to which comorbidities this applies, whether you refer these clients, and to which service(s) you refer these clients

  15. Does a diagnosis of comorbidity impact on a client's treatment plan? If so, please describe how. Top of page

  16. Do all clients have treatment plans?

    • no, clients do not have individual treatment plans

    • yes, some clients have treatment plans

    • yes, most clients have treatment plans

    • yes, all clients have treatment plans

  17. Are treatment plans communicated to the client and carer?

    • no

    • yes, to the client

    • yes, to the carer

    • yes, to client and carer

    • not applicable because we don't have treatment plans

    • Other (please specify)

  18. Are clients, carers and other providers involved in the development of treatment plans? (select as many as apply)

    • no

    • yes, clients are sometimes involved

    • yes, clients are always involved

    • yes, carers are sometimes involved

    • yes, carers are always involved

    • yes, other providers are sometimes involved

    • yes, other providers are always involved

    • Comments Top of page

  19. Do you have treatment protocols?

    • yes

    • no

  20. If you have treatment protocols, please describe these in regard to:

    1. treatment

    2. treating clinician

    3. sensitivity to gender and particular population groups (e.g. Indigenous people and people from culturally and linguistically diverse backgrounds)

  21. What model(s) of service provision do you use?

    - serial/sequential treatment - treatment for one problem/disorder before treating the other
    - parallel treatment - treatment for one problem/disorder at the same time as providing treatment for another; providing treatment from different services
    - integrated treatment - the same individual, team, or service provides both AOD and MH treatments simultaneously

    • serial/sequential treatment

    • parallel treatment

    • integrated treatment

    • not applicable, because we do not accept clients with both AOD and MH problems/disorders

    • other

    • Other (please specify)/comments

  22. How do you know whether the treatments you provide are successful - Do you use any routine outcome measures?

    • yes

    • no

    • If yes, what outcome measures do you use?Top of page

  23. What data about treatment success do you have and how is it collected?

  24. How successful is the treatment you provide? Please describe.

  25. What changes could be made to your service's treatment model and / or service structure to improve treatment outcomes?

  26. How are referrals made and what are the criteria? Please describe your processes and protocols for referring on and communicating with other providers.

  27. Are staff trained in these processes/procedures?

    • yes, all clinical staff are trained in referral processes/procedures

    • yes, most clinical staff are trained in referral processes/procedures

    • no, clinical staff do not need to be trained in these processes/procedures

    • no, but they should be trained

  28. What are your processes for monitoring treatment quality?

  29. What are your processes for monitoring cost of treatment delivery?

  30. Are there are any State regulatory requirements or other issues with funding sources that impact on your service? If so, how? (For example, certain types of treatments are not funded but you would like to provide them)

  31. Please list your program's/service's funding sources and the proportion of overall funding for each source (e.g. client contribution 5%)Top of page

  32. What is the cost (eg. episode of treatment cost) for the different treatments you provide?

  33. Do your clinical staff receive clinical supervision? (select one or more)

    • yes, on a regular basis and from a supervisor within the service

    • yes, on a regular basis and from an external supervisor

    • yes, on a needs basis and from a supervisor within the service

    • yes, on a needs basis and from an external supervisor

    • yes, regular case presentations and discussions

    • yes, occasional case presentations and discussions

    • yes, group supervision from a supervisor within the service

    • yes, group supervision from an external supervisor

    • no

    • not applicable (no clinical staff)

    • Other (please specify) and/or further comments

  34. How many hours of clinical supervision does each clinician receive per month? (select one)

    • One to two hours

    • Three to five hours

    • Six to ten hours

    • Eleven to fifteen hours

    • More than fifteen hours

    • Other (please specify) and/or further comments Top of page

  35. What is your training budget per staff member, and how is it funded?

  36. Does your service specialise in treatment of disorders associated with a particular substance?

    • no

    • yes

    • If yes, which substance(s)?

  37. If your service caters for clients with a mental illness, which disorders have been diagnosed in your clients? (select the top 5 most frequently diagnosed disorders)

    • Adjustment disorder

    • Anxiety disorder

    • Dissociative disorders

    • Eating disorders

    • Impulse-control disorders

    • Mood disorders

    • Personality disorders

    • Psychotic disorders

    • Sexual disorders and dysfunctions

    • Sleep disorders

    • Somatoform disorders

    • Substance use disorders

    • Not applicable

    • Other (please specify) Top of page

  38. Does your service specialise in treatment of a particular MH disorder?

    • no

    • yes

    • If yes, which MH disorder(s)?

  39. What percentage of your clients have both an AOD and a MH problem?

  40. There is no agreed classificatory framework for comorbidity in Australia. Do you use a framework or model to classify comorbidity?

    • Yes

    • No

    • Not sure whether we do

    • Not sure what you mean (if you tick this, you will be given further information)

  41. If you answered 'yes' to the previous question, what framework do you use to classify comorbidity?

  42. Please describe your current clients with comorbid problems according to the framework you use.

  43. If you are not sure what I mean by 'classificatory framework for comorbidity', this is an example:

    - substance use disorders co-occurring with high-prevalence, low-impact mental health disorders (such as anxiety and depression) – x % of all clients;
    - substance use disorders co-occurring with low-prevalence, high-impact mental health disorders (such as psychosis and major mood disorder) – x % of all clients;
    - any mental health disorder co-occurring with either substance abuse or substance dependence – x % of all clients.

    You can either go back and change your answer to the previous question, leave a comment in the textbox below, or go to the next question. Top of page

  44. Do clients and potential clients experience any barriers to accessing your treatment service? If so, what are the barriers and how could they be overcome? (Please list any barriers you can think of - those that are in your control to change and those that are not)

    • yes, there are barriers to access the service

    • no, there are no barriers

    • Other (please specify)

  45. What proportion of clients have completed treatment as planned during the last 12 months?

    • 20% or less

    • 21-30%

    • 31-40%

    • 41-50%

    • 51-60%

    • 61-70%

    • 71-80%

    • 81-90%

    • 91-100%

    • don't know

  46. How does your service deal with client privacy issues? (within your organisation/service and in regard to other services that your clients access) Top of page

  47. What formal and informal mechanisms do you have in place to receive feedback from your clients?

  48. During the last 12 months, what proportion of your clients achieved significant treatment goals?

    • 20% or less

    • 21-30%

    • 31-40%

    • 41-50%

    • 51-60%

    • 61-70%

    • 71-80%

    • 81-90%

    • 91-100%

    • don't know

  49. Please describe discharge planning at your service/program (for example, whether you have a written plan, collaborate with other team members and other services in the community, provide client education about diagnosis and symptom management, link clients with community supports).

  50. Do you support clients in self-management after discharge from your program/ service?

    • yes

    • no

    • Any additional comment

  51. If you support clients in self-management after treatment, how do you do this?Top of page

  52. What care is available for your clients after they have been discharged from your service/program?

  53. Do you think that this is sufficient?

    • yes

    • no

    • If no, what else is needed?

  54. This question deals with links between child, adolescent and adult services - Please describe your service's links (e.g. if your service is an adolescent service, describe your links with children's and adult services)

  55. Does your service have links with other services that address your clients' problems in addition to direct AOD or MH issues? If so, of what nature are these links – networking, coordinating, cooperating, or collaborating?

    Networking = exchanging information for mutual benefit; it does not require much time or trust nor the sharing of turf.

    Coordinating = exchanging information for mutual benefit and altering activities for a common purpose; it requires more time and trust but does not include the sharing of turf.

    Cooperating = exchanging information, altering activities, and sharing resources for mutual benefit and a common purpose; it requires significant amounts of time, high levels of trust, and a significant sharing of turf. Cooperating may require complex organisational processes and agreements in order to achieve the expanded benefits of mutual action.

    Collaborating = exchanging information, altering activities, sharing resources, and a willingness to enhance the capacity of another for mutual benefit and a common purpose; it requires the highest levels of trust, considerable amounts of time, and an extensive sharing of turf. Collaboration also involves sharing risks, resources, and rewards.

    Indicate the nature of links - if any - with the below services (more than one entry per service is possible; for example, a networking relationship with one housing service and a cooperating relationship with another housing service)

    • Hospital

    • GP

    • Community health service

    • Housing/supported accommodation

    • Employment

    • Centrelink

    • Child care

    • Financial counselling

    • AOD treatment service

    • MH service

    • Indigenous health service

    • Criminal justice system

    • Centrelink

    • Welfare

    • Other (please describe type of service and type of relationship)Top of page

  56. In your view, which partnerships/links are the most effective, and why?

  57. Where do most referrals to your service come from? Please select the three most common referral sources. (select up to three)

    • Hospital

    • GP

    • Community health service

    • Housing/supported accommodation

    • Employment

    • Centrelink

    • Child care

    • Financial counselling

    • AOD treatment service

    • MH service

    • Indigenous health service

    • Criminal justice system

    • Centrelink

    • Welfare

    • Self-referral

    • Other (please specify) Top of page

  58. Do you provide feedback about clients (such as client status and discharge planning) to referring services?

    • no

    • yes, always

    • yes, sometimes

    • Comment

  59. In your view, what are the main barriers to inter-agency communication and treatment coordination?

  60. Have you costed the work involved in linking or building partnerships with other organisations? If so, what does it cost and how is it funded?

  61. This is the end of Part II of the questionnaire. If you wish to make any additional comments, please do so in the box below.