Are we on the same side? Cooperation in Partnership - NCOSS

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Are we on the same side? Cooperation in Partnership - NCOSS

ong>Areong> ong>weong> on the same side

Co-operation in Partnership

The JGOS experience

Presented by Laurie Bassett, Team Leader, Mission Australia NSW.

Sunita Kotnala, Coordinator, Family Case Management, SWS

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A quick thought…

“Defeat is not the worst of failures. Not to have tried

is the true failure”.

George Edward Woodberry

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What is JGOS

Background: 1997 First Joint Guaranty of Service (JGOS1) signed betong>weong>en then Department

of Housing and Department of Health

Review of JGOS by Dept. of Health in 1999 led to the development of the new expanded JGOS

2 and establishment of multi-agency collaboration group. A broad “inclusive context”, “a

framework”, “a synthesis of best practice”.

Context: within background of homelessness, housing affordability and policy changes to social

housing and SAAP services

Policy Development: focus on partnership

• Reshaping Public Housing Reform

• Priority housing and the Accord

• Housing NSW initiative

• Expanding the Community Housing Sector

• HASI and COAG initiatives

Does it always work The difference betong>weong>en partnership and

collaboration evident from the 2 subsequent case studies.

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Partnership without collaboration

A relocated to HNSW unit from SHIPS property. As part of his recovery

provided with opportunity to manage medication by the team. Became

increasingly non- compliant and avoided contact with MH. Gradual deterioration

in MH and increasing psychosis saw aggression towards neighbours resulting in

complaints to HNSW. HNSW concerns raised with MH team not folloong>weong>d up/

responded to. The client service officer and MH case manager could not agree

on a suitable strategy. Increasing paranoia and further deterioration in Mental

State of client leading severe assault of neighbour leading to hospitalisation for

3 days. Client admitted to acute unit as non- voluntary patient.

Critical Issues for JGOS

Breakdown of communication betong>weong>en HNSW staff and MH staff . Limited

options of housing available for client due to assault.

Outcome:

To avoid eviction client provided group home accommodation with HASI low

level support. Loss of independent living option and work towards recovery

within the least restrictive environment.


What worked in NB JGOS

• Reinstated the committee after 5 year gap. Met every 2 months

• Re wrote the Terms of Reference and kept it as a live document

• Focus on resolution of issue and case planning

• Information share sessions to understand core business of all agencies and possible flexibility

• Case planning within realistic expectations and recovery focused

• Friendly yet formalised agenda with structured meeting format. Frank professional discussions

around contentious issues impacting monthly outcome measures for both agencies, including risk

factors to staff and clients

• The primary focus was on cooperation to achieve best outcomes for consumers

• Betong>weong>en 2007 and 2009 more than 30 cases ong>weong>re discussed at NB. At the ong>Areong>a level Housing

Coordinator position- a designated position led to strong outcomes for JGOS in the area

• NCSSAHS identifies JGOS on its FISCH database to identify clients

• Responsibility for JGOS particularly assigned to Housing and Health positions

• Participating in activities outside of JGOS eg. Development of NSCCAHS area guidelines for

collaborative management of MH clients in the community with multiple partners

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Organisational Support within HNSW & NSCCAHSMH

• At the ong>Areong>a level Housing Coordinator position- a designated position

led to strong outcomes for JGOS in the area

• NCSSAHS identifies JGOS on its FISCH database to identify clients

• Responsibility for JGOS particularly assigned to Housing and Health

positions

• Participating in activities outside of JGOS eg. Development of

NSCCAHS area guidelines for collaborative management of MH

clients in the community with multiple service partners

• HNSW commitment to joint process working across all area.

Willingness to make changes and adopt innovative practices

• Opportunity for resolution of area wide issues at ong>Areong>a JGOS


2009 NSW Ombudsman report on implementation of JGOS

• Case study not an isolated incident.

• The report details the findings of the implementation of the JGOS. The

agencies which ong>weong>re subject of investigation ong>weong>re Housing NSW and

NSW. What they found:

• Large number of individuals passionate about social outcomes for

people with Mental Illness

• This did not always translate into the JGOS committees being effective

or achieving systemic improvements.

• Weaknesses in JGOS agreements, governance structures, lack of

accountability mechanisms and systems to support effective

implementation.


Where it succeeded…

High level of support for the principles of JGOS and examples of

them being put to good use in some areas. What makes a good

committee

• a clear purpose for the meeting and agreed rules. Documentation (terms of reference, action

plan, agenda, minutes)

• an agreed process for recording activities and results and measuring performance

• consistent attendance, and representatives who have authority to make decisions

• identification of training needs for local partners

• a clear process for escalating issues that cannot be resolved

• a focus on identifying „local solutions to local problems‟

• feedback from the strategic committee to ensure broader systemic issues are addressed

• strong links betong>weong>en frontline staff and committee representatives

(The implementation of the Joint Guarantee of Service for People with Mental Health Problems

and Disorders Living in Aboriginal, Community and Public Housing – November 2009)

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How do ong>weong> measure success

• All clients discussed at JGOS appropriately in sustainably housed

• 0 evictions

• 0 nights homeless for JGOS clients in the area

• Clients discussed at JGOS did not go to CTTT

• Improved and collaborative discharge planning from MH services even

after case closed at JGOS.

• Improved access for MH patients for early hospitalization to stabilize

• Regular systems of information sharing set up outside of JGOS. HASI-

MH staff monthly updates on mutually case managed clients.

• Active collaboration in day to day operations with frontline staff

monitored by Managers

• Prioritizing of cases requiring hospitalization.

• Participation in development of new initiatives.

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HASI -Housing Accommodation Support Initiative

• NGO‟s work in partnership with Housing NSW, OCH providers &

NSW Health

• Works to promote mental health recovery and prevent

homelessness from public housing

• Keep client out of hospital-keep in tenancy

• Works with individual clients within a psychosocial framework

• Emphasis on developing skills, improving functioning and

connection with community

• Operational in North Sydney since 2006

• Low levels of experience of working in partnership

• Covers entire local health area


The key players, our perceptions and barriers…

The NGO‟s

• Volunteers & „do gooders‟

• Unqualified and inexperienced

• Unrealistic expectations of the system

• Can‟t handle difficult situations/complexity

• No under understanding of other agencies needs

• No clout

• Rely on charity/funding-can‟t provide new services

• Keep clients where they are with soup kitchens and vouchers

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The key players, our perceptions and barriers…

The Housing Providers

• Rigid policies and rules

• More interested in property than tenant

• Autocratic and insular

• Unrealistic expectations of other agencies

• Don‟t consult

• No understanding of clients and issues

• Responsible for numerous „bad calls‟

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The key players, our perceptions and barriers…

The Mental Health System

• Focus on illness and not other issues

• Overloaded

• Burnt out staff

• Don‟t respond-can‟t contact

• No timely intervention

• Hide behind legislation

• Poor community support

• Poor post discharge planning

• Prescriptive in approach-they know best

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The NGO experience -The Little Fish in a Big Pond

• Can compare today with 5 years ago and “stories of old”

• Seen as integral part of the solution

• Can see the situation from both perspectives

• Can link in other resources and initiatives

• NGO‟s sit on JGOS in 3 areas that cover the region and sit on

the area JGOS- a source of knowledge

• Close synergy of HASI with JGOS-one supports the other

Partnerships in place across area but attitudes and perceptions

do vary and have improved greatly

• Always challenges-more hopeful for solutions

• Increases knowledge and collaboration away from JGOS

• Increases response, accountability and transparency

• Helps us achieve our HASI objectives

• Aware of systemic issues/gaps to take back and fix


When Partnerships involve collaboration

• When ong>weong> actively collaborated in the JGOS partnership…

S had her a boyfriend stay in her DOH unit who takes advantage of her, shout, drinks

excessively, plays loud music and causes the neighbours distress-neighbours complain to

the landlord Housing NSW-they have to take action and take her to the Tenancy Tribunal.

Suzy becomes very unong>weong>ll and loses control of her unit during this time and enters hospital.

Discussed as high priority at Northern Beaches JGOS :

Case Planning Strategic joint plan with clearly articulated risk factors, client goals and

commitment from each agency to act.

Commitment by Managers of Housing NSW and MH to work with NGO and associated

clinicians/ stakeholders in working towards clients recovery in the community

Communication Plan communicated to case managers and community teams.

Organisational expectations/ restrictions exchanged to make the plan achievable.

Collaboration: Ongoing assessment and monitoring of client progress. Review of

organisational responsibilities and response of all players within parameters of Mental

Health Act 2007.

OUTCOME: Patient stabilised in the community post discharge. Tenancy retained. No

further hospitalisation in last 12 months. Risk of homelessness reduced. Quality of

life improved.


Our core elements of collaboration

1. Commitment

– Sending staff with the case information to work a solution

• A no-brainer but it does happen

• Respects and values the process and attendees

– Regular attendance at the meetings

• Allows for relationships and networks to develop

• Partners feel respected-better relationship

– Sending staff with the ability to make decisions

• Rapid decision making to create a joint plan-timely intervention

• Out of guideline decisions can be made

• Receive valuable feedback about barriers within our services

• Can mandate support to process

• Ensures accountability and transparency

• Feeds into systemic change

• Positive professional role models (resonates with key recommendations)

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Our core elements of collaboration

2. Honesty

• Builds integrity into partnership

• Builds trust in decisions and feedback of our partners

• Get to the heart of issue-timely intervention

• Builds respect and credibility into the partnership

• Allows us to disagree and still work together

• Allows us to get to know eachother


Our core elements of collaboration

3. Communication

• Allows us to share information-better agency response and client outcome

• Being aware of and not hiding behind privacy legislation-are your staff

trained

• Carrying on lengthier conversation offline-allows for better networking

• Feedback the joint plans with your teams to ensure it is understood and

folloong>weong>d

• Write up the plan and distribute so that it can be folloong>weong>d and everyone knows

their role

• Handle difficult feedback constructively-seek to improve by listening first

• Recognise great work and collaboration

• Report back to ong>Areong>a JGOS systemic issues


Our core elements of collaboration

4. Our people-who ong>weong> are.

– Flexible in our approach-open to new ways and styles to met client new

– Listen

– Respect eachother

– Value eachother‟s time, perspective and professional background

– Understand the big picture-ong>weong> are not the universe

– All busy

– Have common sense and common courtesy

– Believe in investing time to save time

– Empathise with the clients who are our Raison d'être

– Have similar levels of qualifications and experience and studies the same degrees


Our core elements of collaboration

5. Our Common Ground

– Solution Focused-best outcome for the client

– Work on common goals

• Keep out of hospital

• Keep in tenancy

• Improve quality of life

• Prevent homelessness

• Provide evidence for systemic advocacy and improvement

• Share resources, training and knowledge

• Enjoy working with eachother

• Know eachother roles and responsibilities and strengths


Available JGOS resources

The JGOS consists of a Memorandum of Understanding (MoU) betong>weong>en the

strategic partners and Guidelines for local implementation. The Guidelines

contain a sample local MoU. In 2007, some four years after the MoU and

Guidelines became operational, the SPC released additional resources

consisting of:

1. Making JGOS Work: Operations Manual – explains the JGOS and

provides information about its partners and clients and includes tips

and strategies for local committees

2. JGOS Reference Guide – provides information about mental health

issues, housing needs of people with mental health problems, relevant

legislation, and includes a „troubleshooting‟ section

3. JGOS Templates – provides examples of a local Memorandum of

Understanding, individual service plans, authority to disclose personal

and/or health information forms and JGOS meeting agenda

4. JGOS Quicklinks – provides a list of links to relevant ong>weong>bsites

See http://www.housing.nsw.gov.au


Some things to keep in mind…

1. Stronger client outcomes happen in partnerships with collaboration.

2. A Partnership is only as good as the level of collaboration that exists within it

3. A good partnership is worth more than the sum total of the parts

4. Remain client focussed-Always keep the client in the forefront of you minds and

in you discussions at every level of a partnership

5. Persevere and invest in relationships-this takes time-great collaborations doesn‟t

always happen overnight and require ongoing maintenance

6. See the people you collaborate with not the department/agency

7. As staff ong>weong> have the obligation to work under the legislative requirements. In this

case the Mental Health Act 2007, HNSW Tenancy related legislation

8. Respecting and valuing eachother enriches the partnership experience

9. Services achieve more with less and more quickly working in collaboration

10. Collaboration‟s foundation is respect

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We can end up with this…

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