Comorbidity treatment service model evaluation

Clear treatment protocols

Page last updated: August 2009

Nine services reported having treatment protocols and/or using guidelines and manuals. One of these noted specific attention to Indigenous populations, while another service reported having a 'comprehensive bill of rights and policy regarding discrimination'. One respondent referred to the service's 'normal policy around being sensitive to cultural practices'. One service reported allocating female staff to female clients and male staff to male clients. Further detail is outlined in Table 22 below.

When asked about how services deal with client privacy issues, all respondents referred to existing legislation and/or their organisation's privacy policies and procedures. The policies and procedures that were described involve confidentiality of client files, consent forms, informing clients about policies and procedures, and transparency. One service reported having policies in place for 'client request for access to client files'. Some services noted that staff are trained in privacy policies and guidelines, and that these are taken seriously. One respondent indicated that staff compliance with privacy policies is high and enforced. For example, in 2008 one staff member's employment was terminated due to lack of adherence to privacy policies. Overall, the responses to this question were very similar across services, with respondents reporting that clear policies and procedures are in place and being followed.

Respondents were also asked to describe the processes for monitoring quality of treatment. Sixteen services responded to this question and listed the following processes:

  • Supervision (internal, external, peer) and annual staff appraisal.
  • Case management reviews.
  • Case conferencing (inter-agency in one service).
  • Team meetings, review of consumer/client feedback.
  • External accreditation (Quality Management Services [QMS], Evaluation and Quality Improvement Program [EQuIP], quality framework involvement with peak body Western Australian Network of Alcohol and other Drug Agencies [WANADA]) or auditing.
  • 'Reports to funding bodies against agreed KPIs'.
One service noted that routine mandated treatment outcome measures, such as patient surveys, are used in mental health services, but that there is 'less rigor in AOD & PDRS26 services'. Another service reported having established a quality improvement committee.
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Table 22: Description of treatment protocols

Service size and typeTreatment Treating clinician Sensitivity to gender and particular population groups
Small AOD4 weekly treatment plans with standard tools used and program expectations incorporated in plans.

Small AODEach client is allocated an individual AOD Worker from the team. Female clients = female staff and male staff = male clients - appropriate to cultural needs.

That's what we do very, very well.
Small combinedVictoria has recently released Clinical Guidelines for AOD workers in regards to dual diagnosis/comorbidity. Mental health workers use a variety of guidelines and protocols.

Small combinedHave developed clinical pathways and guidelines as to services provided.

Medium AODCognitive Behavioural Therapy, motivational interviewing, behavioural technologies, counselling, group work, journaling.

Assessment devices for Indigenous populations and group work and mentoring.
Medium AODOperating manuals, organisational policies and procedures, client charter.

Employee Handbook. Agency Strategic Plan.
Medium combinedConfidentiality, comprehensive, best practice guidelines around treatment.Comprehensive staff and clinical policy and best practice guidelines for clinical staff; commitment to multidisciplinary team.

Comprehensive bill of rights and policy regarding discrimination. All policy in line with United Nations Charters on same.
Large AODThese are specific to particular programs but all use a case-management model.

Dependant upon role (i.e. nursing, outreach, residential).
Large combinedFollow DACAS23 guidelines and SAW manual for withdrawal management,24 MH services provided in accordance with directions of chief psychiatrist, some manualised treatment in groups for anxiety and depression (SHADES), MH required to follow up repetitive presentation to psych triage, mandatory risk assessments, 3- month care plan reviews, annual review of treatment orders by mental health review board, regular use of outcomes measures (service responses outlined in [service] assessment care and evaluation ACE guidelines).

Required to follow mandatory and minimum service requirements as outlined in ACE guidelines.25No specific protocols, normal policy around being sensitive to cultural practices.

Footnotes

23 Drug and Alcohol Clinical Advisory Service
24 Services for alcohol and drug withdrawal
25 Assessment Care & Evaluation
26 Psychiatric Disability Rehabilitation and Support program, Victoria

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