Housing and Support Program (HASP): Final Evaluation Report

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64 Section 8 Discussion The purpose of this study was to ‘undertake an evaluation of the Housing and Support Program (HASP) to determine delivery and outcome effectiveness and effi ciencies, as well as to identify and recommend opportunities for the future management of the program.’ The evaluation team was asked to focus on: the effectiveness of the collaborative process established across agencies the process of providing clinical, non-clinical and housing services to clients the opportunities available through the program for clients to maximise their recovery and participate in community life — the focus here will be on social, recreational, educational, and vocational activities in the community the ability of the program to maintain clinical functioning and provide an acceptable quality of life for those supported by the program. A degree of caution is required in attempting to generalise the results of this study to other settings or populations. The clients in our sample volunteered to participate when invited to do so. As such, they may be different from those who declined to participate in important ways that may have an impact on the fi ndings. Notwithstanding this, the 80 HASP clients who contributed to the evaluation from across Queensland are likely to represent the broader population of clients in the program. Final Evaluation Report 8.1 The effectiveness of the collaborative process established across agencies It was apparent from discussions with staff at the coalface that many were concerned about interagency collaboration and communication within the program. It was felt that a single point of contact for HASP was required within each district. Some aspects of this role have been provided by Supports Facilitators across the state. However, the reforms outlined in the Growing Stronger reforms indicate that the Supports Facilitator role is likely to change. Supports Facilitators will have less input into programs such as HASP. It has been suggested that the role of the current Service Integration Coordinator (SIC) position could be broadened to provide these functions. Indeed, many of the Service Integration Coordinators have been invaluable in improving coordination between the agencies involved in HASP. However, there is variation in the way in which the role has been interpreted and implemented. It is clear that some clarity is required around the role to be provided by Service Integration Coordinators and their involvement, if any, in programs such as HASP. Many people noted the arduous nature of completing the paperwork to nominate clients for HASP. The paperwork required and the quantity of supporting documentation made the application process cumbersome and time-consuming. It was noted that in smaller teams it can be extremely diffi cult to fi nd an occupational therapist to provide an assessment, or to obtain a report from a psychiatrist. As a consequence, many of the clinical staff interviewed suggested changes to the selection process at the district level. It was proposed that the Case Manager could complete a one/two-page summary for their nominated client/s and then present this to their District Review Team. The District Review Team could ask questions of the Case Manager and prioritise nominations. Once a client had been shortlisted to advance to the next level, the Case Manager would provide a more detailed written application, which could then be submitted formally to the statewide panel. This would increase the quality
of applications, increase Case Manager involvement with the process, improve the estimation of support needs, and may decrease the risk of inappropriate clients being nominated. Notwithstanding the above concerns, there was a general impression that the appropriateness of HASP referrals had improved in recent years. The information sessions provided across the state by members of the HASP Operational Partnership were seen as being useful for clinical staff in decision-making around client selection for HASP. Nonetheless, there was a perception among some support agencies that mental health staff were using the program to discharge their most diffi cult clients. Many of these clients were considered inappropriate for HASP as they required more support hours than could be provided through HASP. This is similar to fi ndings from earlier work carried out in New South Wales, which suggests that mental health services nominated their most disabled clients, many of which were inappropriate, for the housing and support program (Muir et al., 2006). A number of stakeholders noted that some clients have three care plans — a transition plan, a plan developed by clinical services and a plan developed by the support agency. It is diffi cult to see how a coordinated approach to service provision can be maintained when individual clients have up to three care plans. Each client should have a single care plan which has input from all stakeholders, including the client. This care plan should be used to guide interventions with the client and be reviewed and updated on a regular basis — at least every three months. Finally, communication at the local level can also be problematic when a range of staff is involved with the same client. We found that one agency was using a diary (kept in the homes of clients) to keep a record of appointments and other activities carried out for clients. All persons entering the home of the client were encouraged to make an entry in the diary so as a record of the visit was documented. The diary provides a record of visitors to the home (including staff), an audit trail of interventions carried out and the date the interventions were provided. It is suggested that all support agencies consider using a diary to improve communication between staff and staff, and staff and clients. 8.2 The process of providing clinical, non-clinical and housing services to clients Clinical Service Provision Clinical service provision within HASP is usually provided by Case Managers employed by Queensland Health. The primary role of Case Managers is to provide clinical interventions such as assessment, illness monitoring and treatment. Case Managers were held in high regard by clients. Many clients attributed improvements in their health to their Case Managers. Indeed, over 60% of clients believed that their Case Manager helped them with their symptoms. Most clients (89%) indicated that they could get in contact with their Case Manager if they had a problem. Both Case Managers and support workers expressed satisfaction with the collaborative working relationships they have developed. Ninety-fi ve percent of Case Managers outlined that they valued the support worker role and 92% felt that support workers had a valuable role to play in the treatment planning process. Despite this, some support workers felt that they could have greater involvement in decisions and planning around patient care. Support workers also raised concerns about Case Manager involvement in HASP and felt that Case Managers could play a greater role in the overall program. Reasons highlighted for the perceived lack of involvement included the high caseloads that some Case Managers were expected to carry and the presence of support workers in the lives of the clients. Case mangers were aware that support workers would contact them if they observed changes in client symptoms/behaviour. Muir and colleagues (2007), in a NSW study, found that Case Managers had less involvement with clients supported by NGOs due to the auxiliary services provided by support workers (Muir et al., 2006). Housing and Support Program (HASP) 65
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Department of Psychiatry (UQ) and S
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Final Evaluation Report of the Quee
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• Community integration While eig
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List of contents Executive summary
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Section 1 Introduction Since the 19
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1.1.1 HASP — Management Structure
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1.2 Housing and supports - previous
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Table 1.2.2 Outcomes for clients mo
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activities, while others tried to c
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1.2.6 Section summary It is clear f
Page 21 and 22: Section 2 Method 2.1 Design The stu
Page 23 and 24: 2.2.1.2 Clients unavailable to part
Page 25 and 26: 2.2.1.5 Clinical staff — sample F
Page 27 and 28: 4) Data collected from mental healt
Page 29 and 30: 2.4 Procedure 2.4.1 Clients - proce
Page 31 and 32: All focus group discussions and ind
Page 33 and 34: However, it was clear that the deve
Page 35 and 36: Importance of the Supports Facilita
Page 37 and 38: Accountability There was a percepti
Page 39 and 40: Support workers highlighted issues
Page 41 and 42: 4.1.2 Client perceptions of support
Page 43 and 44: In general, Case Managers expressed
Page 45 and 46: 4.2.2 Client perceptions of the amo
Page 47 and 48: Support workers felt, as a result o
Page 49 and 50: 4.2.8 Amount of support required in
Page 51 and 52: 4.3.2 Living arrangements The major
Page 53 and 54: 4.3.7 Housing in HASP — compariso
Page 55 and 56: The majority of HASP clients (76%)
Page 57 and 58: 5.2 Satisfaction with key life doma
Page 59 and 60: 5.7 Depth of friendships We explore
Page 61 and 62: 5.11 Community involvement Clients
Page 63 and 64: 5.13 Section summary During our int
Page 65 and 66: etter functioning). However, while
Page 67 and 68: 6.7 Physical and mental health Link
Page 69 and 70: 6.10 Section summary The average ti
Page 71: 7.2 Comparing HASP with inpatient/r
Page 75 and 76: available when and where needed by
Page 77 and 78: 8.4 The ability of the program to m
Page 79 and 80: Section 9 Recommendations 1. More i
Page 81 and 82: Section 10 Reference list Anthony,
Page 83 and 84: Shepherd, G., Murray, A. & Muijen,
Page 85 and 86: Housing and Support Program (HASP)
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