Comorbidity treatment service model evaluation

Project activities

Page last updated: August 2009

A program logic approach was adopted for the evaluation of the Comorbidity Treatment Service Model Evaluation project. The program logic proposes a theoretical causal pathway where desired outcomes such as improved client health and wellbeing are presumed to depend on the generation of certain impacts such as achievement of treatment goals. These impacts are presumed to be caused by certain processes or structures being in place within treatment services, such as clear policies, processes and practices for intake, treatment, and referral. In turn, the development of improved policies, processes and practices for intake are enabled by inputs, such as funding, workforce, and service links. These chains of inputs and effects occur within the wider geographical, social and political context in which treatment services are located.

A program logic map was developed (see figure 1 below) and used to determine the kind of information needed to reflect on the hypothesised effects of treatment service provision on the impacts and outcomes for clients.

Subsequently, a tool (i.e. a survey) was developed to measure the domains. The survey was divided into two parts and administered online. It was designed to collect quantitative and qualitative data.

Suggestions for treatment services to be included in the evaluation were sought from the ten key informants and staff of the Comorbidity and Strategic Directions Section, Drug Strategy Branch of DoHA. The list of services to be included was finalised in agreement with DoHA, taking a range of considerations into account. These included different treatment models, different client age groups (i.e. adult, child and adolescent), rural and metropolitan locations, residential and non-residential services, and different states/territories.

The survey was piloted with two treatment services in Melbourne. Following some small adjustments, the survey was made available online in late December 2008. It was completed by all participating treatment services by mid-February 2009.

Treatment services that were to be evaluated were all perceived as providing a good service. The evaluation did not focus on the performance of treatment services, but sought to identify elements of good practice. The Assistant Secretary of the Drug Strategy Branch of DoHA invited treatment services to participate in the evaluation. Seventeen treatment services accepted the invitation.

Apart from this report and the literature review, individual service reports for the 17 participating services were prepared. Further, a dissemination plan for the distribution of the report (in electronic format) to alcohol and other drug (AOD) and mental health (MH) treatment service delivery organisations nationally has been prepared as part of the project
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Figure 1: Program logic map

Text equivalent below for Figure 1: Program logic map
Larger image of figure 1 (GIF 262 KB)Top of page

Text version of Figure 1

What is good practice in comorbility treatment service provision?

The map flows sequentially along 6 key areas:
  1. Context
    1. urban, rural, demographics1
    2. density of service system & workforce
    3. State regulatory or other issues with funding

  2. Inputs
    1. service structure, e.g. stand-alone, or part of larger organisation, management structure
      • determines procedures
      • consumer participation
      • organisational philosophy
    2. funding sources/issues
    3. workforce
      • composition, qualifications
      • volunteers - skills & roles
    4. service promotion - service links & types of relationships & types of organisations & purpose
      • ways of advertising
      • cost
      • funding sources

  3. Service system elements I (policies & procedures)
    1. intake processes2
      • appropriate assessment of client need
      • comprehensive, incl. screening for comorbidity
    2. clear treatment protocols
      • ext. guidelines re treatment of specific condition, or
      • multiple internal guidelines
      • culturally & gender sensitive guidelines
    3. processes/procedures/protocols for referring on & communication with other providers
    4. staff are trained in service procedures
    5. staff have adequate & appropriate training, skills & supervision in assessment, treatment & specialisation

  4. Service system elements II (practices)
    1. 'appropriate' treatment is provided (evidence-based). timing of delivery:3
      • sequential
      • parallel
      • integrated
    2. clear care/treatment plans (communicating treatment)3
      • involves consumer/carer
      • involves all providers (internal & external)
    3. use of referral/communication/feedback for others involved in clients' care (or who should be)3 4
    4. service supports client self-management post treatment5
    5. cost - client episode of treatment

  5. Client impact
    1. completion of treatment3 6
    2. achievement of treatment goals3
    3. 'continuity of care discharge'/post-service planning (for episodic care)7
    4. client self-care - knowledge of
      • early intervention
      • services
    5. service - referring health professional aware of client status

  6. Outcomes
    1. improved client health and wellbeing
    2. improved social functioning
    3. reduced MH symptoms
    4. less/less harmful AOD use
    5. less need for services (incl. readmission rates)Top of page

Footnotes

11.1 relates to 1.2
2 3.1 relates to 3.2
3 4.1, 4.2, 4.3, 5.1 and 5.2 all relate to each other
4 4.3 relates to 5.5
5 4.4 relates to 4.5 and 5.4
6 5.1 relates to 5.2
7 5.3 relates to 5.4