Transcript Introduction

Forensic Benchmarking Across
Australia: A Journey
Monica Taylor and Dale Owens
National Mental Health
Benchmarking Project
27 November 2008
A joint Australian, State and
Territory Government Initiative
Introduction
Four states participated in the Forensic National
Mental Health Benchmarking Project:
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New South Wales
Queensland
Victoria
Western Australia
All provide state-wide forensic mental health
services
Introduction
• We were the same yet different
• Found variability of service models due to differing
legislation and resources
• Acknowledgement of service differences but also
commonality of service aims
• Still had ability to compare clinical services and practices
Introduction
• Collected the 13 National KPI’s plus supplementary
ACHS Clinical indicators of seclusion and assault
• Collected,collated and reported 3 years of data:
• 2004-05
• 2005-06
• 2006-07
Site visits
• Site Visits
Site Visits
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6 States and 2 Territories
Site visits to all
inpatient facilities
assisted in
providing some
context to the
discussions
Immeasurable
opportunity for
networking
Evaluation of the 13 national KPI’s for
suitability in Forensic Mental Health Sevices
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1. What was learnt about the indicator?
2. Is the indicator relevant to the program area?
3. Does the indicator measure what is intended within the program area?
4. Is the national indicator definition appropriate to your program area?
5. Are the National data Specifications for the indicator appropriate to your program
area?
6. Can uniform targets be set for this indicator that apply across all program areas?
7. If targets are set for this indicator for your program area, are they on the basis of
relativities (who is the best of the group) or absolutes (based on some standard)
8. Can the indicator be interpreted and understood by people who need to act?
9. Can performance on the indicator be influenced by local decisions by people who
have power to act?
10. Is it feasible to collect the required data and report this indicator at an
organisational level, on a regular basis?
11. Is additional contextual information critical to the interpretation of an
organisation’s performance on this indicator?
12. Is the indicator relevant to understanding performance?
13. What are the recommendations of the consensus view of the forum?
Evaluation of the 13 national KPI’s for
suitability in Forensic Mental Health
Services
Is the indicator relevant to understanding
performance?
KPI
Service Unit
Individual clinician
28-day readmission rate
NO
NO
National Standards
compliance
NO
NO
Average LOS
NO
NO
Cost per acute inpatient
episode
NO
NO
Treatment days per 3month community care
YES
YES
Cost per 3-month
community care period
YES
NO
Population under care
NO
NO
Local access to inpatient
care
NO
NO
Evaluation of the 13 national KPI’s for
suitability in Forensic Mental Health
Services
Is the indicator relevant to understanding
performance?
KPI
Service Unit
Individual clinician
New client index
YES
NO
Comparative area
resources
YES
NO
Pre-admission community
care
YES
YES
Post-discharge community
care
YES
YES
Outcome readiness
YES
YES
Evaluation of the 13 national KPI’s for
suitability in Forensic Mental Health
Services
• Of the 13 National KPI’s only one indicator was found
not to be relevant to forensic mental health ‘Local access
to inpatient care’. This was due to difficulties with the
term ‘local’ as it pertains to state-wide services
• Of the 13 National KPI’s it was found that 7 had utility at
a service unit level and 4 had utility at the individual /
clinician level
Other projects undertaken
• Review of Court Liaison Services
• Census of Community Forensic Mental
Health Services
• Review of Prison Mental Health Services*
• Seclusion and Assault*
• Inpatient psychotropic medication audit
Review of Court Liaison
Services
A joint Australian,
State and Territory
Government Initiative
“ Sharing Information to
Improve Outcomes"
Areas reviewed
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1. Count of submitted records
2. Gender
3. Ethnicity
4. Diagnosis
5. Recommendations by court liaison
6. Activity of court liaison
7. Magistrates decisions
8. Source of referral
9. Custody / Access
10. Most serious offence
Outcomes
Count of records
Total records submitted:1305
Range from 97-510
Gender
Males:
Mean: 79.9% Range: 76.3 - 83.6%
Female:
Mean: 20.1% Range: 16.4 – 23.7%
Ethnicity
CALD:
Mean: 12.8% Range: 6.1 - 21.4%
ATSI:
Mean: 10.4% Range: 0.9 – 18.4%
Outcomes
Recommendations by court liaison:
Psychiatric: Care inpatient
Psychiatric: Care community
D&A
Other: NGO’s
No recommendations
4.55 – 17.84%
12.3 – 41.76%
4.12 – 14.51%
3.09 – 26.34%
20.4 – 40.45%
Outcomes
Magistrates decisions:
Refer to Psychiatric care: Inpatient
Refer to Psychiatric care: Community
D&A
Other: NGO’s
No recommendations
3.6 – 13.14%
1.26 – 32.55%
0.21 – 8.18%
0.21 – 6.82%
17.8 – 43.72%
Outcomes
Most serious offence:
B&E
3.3 – 6.25%
Theft
2.1 – 10.45%
Robbery
4.2 – 6.86%
Road / Traffic
0.00 – 7.32%
Property
2.93 – 5.19%
Homicide
0.59 – 5.21%
Sexual
2.2 – 4.60%
Acts intended to cause injury
25.1 – 32.29%
Against justice procedures
0.20 – 31.25%
Census of Community Forensic
Mental Health Services
A joint Australian,
State and Territory
Government Initiative
“ Sharing Information to
Improve Outcomes"
Areas reviewed
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1. Gender
2. Age group
3. Major index offence
4. Most serious known offence
5. Primary diagnosis
6. Legal status
7. Co-occurring mental illness
8. Co-occurring substance abuse
9. Previous episode of care
10. Models of care
Areas reviewed
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11. Referral source
12. Number of Indigenous clients
13. Country of birth
14. Main language spoken
15. Interpreter required
16. Days since episode start
17. Time since last contact
Areas reviewed
• 18. HoNOS collections
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Admission HoNOS profiles
Review HoNOS profiles
HoNOS Total Scores
Percentage clinically significant HoNOS ratings
Mean HoNOS organisational comparison
Lessons learnt
• Acceptance that benchmarking is a key process in
improving service quality
• That there is a need to continue and to further develop
the benchmarking of forensic mental health services
• That benchmarking can assist with the evaluation of
equivalence of forensic mental health service provision
• We have a greater awareness of service models used by
each of the benchmarking partners
• The importance of good baseline data collection
• The importance of adequate resource provision for
benchmarking processes
• That benchmarking is imperative to identifying ‘best
practice’ and for the progression of specialist mental
health services