Quality Framework Project
Identifying examples of innovation, good practice
and successful implementation for Evidence-based
client focused treatment provision within the draft
Quality Framework Model (DQFM)
Consultation for Discussion Paper 2
DQFM Discussion Paper 2
3/31/2014
DQFM Discussion Paper 2
Page 1
Contents
1
BACKGROUND ......................................................................................................................................... 3
2
CONTRIBUTING TO THE CONSULTATION ................................................................................................. 3
3
WHAT DO WE NEED FROM YOU? ............................................................................................................ 4
4
LEVEL 1: KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION ......... 5
4.1
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR ALL AOD INTERVENTIONS
(LEVEL 1)5
Evidence Based Practice ................................................................................................................................. 5
Workforce Development ................................................................................................................................ 7
Implementation and evaluation ..................................................................................................................... 8
Outcome monitoring .................................................................................................................................... 10
5
LEVEL 2: EXAMPLES SPECIFIC TO INTERVENTION TYPES ........................................................................ 12
5.1
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR RESIDENTIAL TREATMENT
(LEVEL 2)13
5.1.1 Residential rehabilitation ................................................................................................................ 14
5.1.2 Therapeutic communities ............................................................................................................... 15
5.2
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR WITHDRAWAL: INPATIENT AND
OUTPATIENT (LEVEL 2) ........................................................................................................................................... 16
5.3
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR PHARMACOTHERAPY (LEVEL 2)
17
Your suggestions of good practice that you use in your work ..................................................................... 17
5.4
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR COUNSELLING (LEVEL 2) .... 18
5.5
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR CARE COORDINATION (LEVEL
2)
19
5.6
KEY EXAMPLES OF INNOVATION, GOOD PRACTICE AND SUCCESSFUL IMPLEMENTATION FOR STRUCTURED DAY PROGRAMS
(LEVEL 2)20
APPENDIX 1: DEFINITIONS OF INDICATORS OF DQFM.................................................................................... 21
Thank you very much for your assistance with this process. We look forward to your
feedback.
Please feel free to provide your feedback in a separate document if you require more
space.
Return your feedback via one of the following:
Email:
qualityframework@turningpoint.org.au
Mail:
c/-Sarah Flynn
Treatment and Systems
Turning Point Eastern Health
54-62 Gertrude st
FITZROY VIC 3065
Fax:
Turning Point Eastern Health
Attention: Sarah Flynn
03 9416 3420
Please contact Sarah Flynn on 03 8413 8486 if you require additional support.
Discussion Paper 2: Quality Framework Project
Page 2
1
Background
Turning Point was commissioned as the lead agency in a consortium to develop a model for
quality assurance that could be applied to all Alcohol and other Drug (AOD) treatment
providers funded under two Commonwealth Department of Health initiatives:
- Non-Governmental Organisations Treatment Grants Program (NGOTGP)
- Substance Misuse Services Development Grant Fund (SMSDGF)
The project was designed around two phases of activity – a model development phase and a
consultation and feasibility phase (for further details, please read Discussion Paper 1 which
is included as part of the pack with this document). The aim of the project is to provide both
Commonwealth funded services with a model for delivering good practice in the AOD field
and guidance on how to implement and sustain evidence-based practice.
2
Contributing to the consultation
A key activity for Phase 2 is the identification of specific examples of indicators (Quality
Standards (QS), Evidence-Based Practice (EBP), Workforce Development (WFD),
Implementation and Evaluation (I&E), and Outcome Monitoring (OM) (definitions of
indicators are given in Appendix 1)). In line with this, we are seeking input from Expert
Advisory Group (EAG) experts to provide us with examples of innovation, good practice and
successful implementation for each of the five indicators of the DQFM at Levels 1 and 2 (i.e.
relevant to all AOD treatment interventions and specific to intervention type the
organisation delivers). Intervention types that are delivered by treatment providers are
classified as per Table 1, below1.
Level 1
Level 2
All AOD funded interventions
Residential treatment
- Residential rehabilitation
- Therapeutic communities
Withdrawal: in-patient and outpatient
Pharmacotherapy
Counselling
Care coordination
Structured day programs
AOD funded interventions refer to any structured intervention aimed specifically at
addressing an individual’s alcohol and other drug use (Gomez & Ritter, 2014) .
1
Ritter, A., Chalmers, J & Berends, L. (2014). The Non Government Organisation Treatment Grants Program (NGOTGP) and the
Substance Misuse Service Delivery Grants Fund (SMSDGF) – a descriptive overview. Sydney: Drug Policy Modelling Program,
National Drug and Alcohol Research centre, UNSW.
Discussion Paper 2: Quality Framework Project
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3
What do we need from you?
In order to build a resource for the sector we are asking EAG experts to assist us by:
(a) Identify key informants who we should speak to about good practice and innovation
in each of the areas specified
(b) Advising us on any further key examples of innovation, good practice and successful
implementation that we have not identified.
To illustrate how the process works, we have provided below our initial suggestions for
Level 1 (i.e., applicable to all funded treatment agencies) – and we are grateful for any
feedback you will provide us with about three areas:
(i)
(ii)
(iii)
Would this guidance be useful to your clinical practice?
Who else should we speak to as key informants in this area as part of our expert
advisory group process?
What existing frameworks or guides you use in your area of work?
Then – having commented on the Level 1 guidance that would be appropriate for all AOD
adult treatment interventions and services – we would like you to focus on the treatment
types that have you have knowledge and expertise in.
Six intervention types were identified (Level 2) and we are seeking information specific to
each of them. We would like you to provide recommendations of Australian National,
Australian State and International examples of good practice guidance for each of five
indicators only for the intervention type in which you have expertise. We would like you to
go to the specific area of your expertise to:
(i)
(ii)
offer examples that you use in your work
suggest other key informants we should speak to
Discussion Paper 2: Quality Framework Project
Page 4
Level 1 examples
4
Level 1: Key examples of innovation, good practice and successful
implementation
There are no examples of Quality Standards (Level 1) in this document. We are currently
partnering with Breaking New Ground (BNG) in this domain.
4.1 Key examples of innovation, good practice and successful implementation for
all AOD interventions (Level 1)
In this section, we present examples of good practice indicators that could apply across all
AOD treatment services.
Evidence Based Practice
Australian
(National)
Australian
(State)
Title: Guidelines on the management of co-occurring alcohol and other drug
and mental health conditions in alcohol and other drug treatment settings
(2009)
Source/Contents/Link: Mills KL, Deady M, Proudfoot H (et al.) National Drug &
Alcohol Research Centre
These guidelines provide the direction for alcohol and other drugs (AOD)
workers as they manage comorbid (occurring at the same time) AOD and
mental health conditions faced by clients. The guidelines are based on the best
available evidence, experience and knowledge of clinicians, researchers,
consumers and carers.
They aim to provide the AOD workforce with:
 Increased knowledge and awareness of mental health conditions
 Improved confidence and skills for working with clients with comorbid
mental health conditions
 Guiding values for working with clients with comorbid mental health
conditions
 Improved skills to enable them to identify mental health conditions
 Practical information on the management of comorbid mental health
conditions
 Information on the treatment of comorbid mental health conditions
 Information on how to refer clients to other health professionals
 Resources that may be helpful for the above.
http://www.healthinfonet.ecu.edu.au/key-resources/promotionresources?lid=17398
Title: A brief guide to the Assessment and Treatment of Alcohol Dependence
(2012)
Source/Contents/Link: Western Australian Drug and Alcohol Authority
These clinical guidelines have been developed for use by doctors and nurses
when assessing and treating a patient with alcohol dependence. They will also
be of interest to counsellors seeking detailed information about the medical
treatment of alcohol dependence.
http://www.dao.health.wa.gov.au/DesktopModules/Bring2mind/DMX/Downlo
ad.aspx?EntryId=713&Command=Core_Download&PortalId=0&TabId=211
DQFM Discussion Paper 2
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Level 1 examples
(Internati
onal)
Title: Drug misuse and dependence: UK guidelines on clinical management
(2007)
Source/Contents/Link: Department of Health (England)
Drug Misuse and Dependence: UK Guidelines on Clinical Management is
intended for all clinicians, especially those providing pharmacological
interventions for drug misusers as a component of drug misuse treatment. The
2007 Clinical Guidelines provide guidance on the treatment of drug misuse in
the UK. They are based on current evidence and professional consensus on how
to provide drug treatment for the majority of patients, in most instances.
http://www.nta.nhs.uk/uploads/clinical_guidelines_2007.pdf
Your comments on the example above:
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
Page 6
Level 1 examples
Workforce Development
Australian
(National)
Title: Theory into Practice Strategies (TIPS): A Resource Kit for the Alcohol
and Other Drugs Field (2005)
Source/Contents/Link: NCETA
The Workforce Development (WFD) 'TIPS' Kit provides a unique range of
user-friendly and practical WFD tools and resources for the AOD
workforce targeted at supervisors, managers, policy makers and other
key individuals within the AOD field who are likely to engage in WFD
activities and interventions. The kit is designed to assist with the
development of strategies to:
 Support frontline workers (e.g., mentoring, stress management)
 Ensure high levels of skill and knowledge (e.g., professional
development strategies, clinical supervision)
 Facilitate positive organisational change (e.g., change
management tools and resources)
 Support effective team work (e.g., approaches to improve
cohesion and communication)
 Optimise staff motivation and satisfaction (e.g., approaches to
effectively supporting and rewarding staff, effective methods of
providing feedback).
http://nceta.flinders.edu.au/index.php?cID=111
Australian
(State)
(International)
Your comments on the example above:
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 1 examples
Implementation and evaluation
Australian
(National)
Australian
(State)
(Internatio
nal)
Title: Effective Dissemination: A 3-part series on dissemination and
implementation strategies for the AOD field (2008).
Source/Contents/Link: Bywood, P; Lunnay, B; Terao, H & Roche, A. Australian
National Research Centre on AOD Workforce Development. NCETA
In this document, the theories and models of change underpinning the use of
dissemination strategies and the implications for the alcohol and other drugs
field were examined. This report provides a summary of key theories and
models that were used in the development of dissemination strategies for
facilitating uptake of innovations into practice, or to interpret the outcomes of
an evaluation of such strategies. This report examined some of the key
theories and models of change that may
Enhance understanding of the factors that facilitate change at a number of
different levels, including:
• Individual practitioners’ behaviour - specifically the behaviour of
Professionals who interact with clients with AOD-related problems;
• Health care groups or teams of people who treat / manage clients;
• Organisations providing care - e.g. AOD treatment centres, rehabilitation
facilities, hospitals;
• The larger health care system or environment in which individual
Organisations are embedded.
http://nceta.flinders.edu.au/files/5612/5548/2892/EN375.pdf
Title: The Effectiveness of Drug and Alcohol Treatment: A Review of the
Research Literature
Source/Contents/Link: Stein, DM
This paper summarizes recent research on the effectiveness of contemporary
treatments for alcohol and drug dependence. It primarily examines basic and
applied research conducted since 1990, although older research is discussed
when it is relevant to a topic. The paper addresses the treatment of specific
problems, and the efficacy of particular treatments and interventions for both
specific samples and populations. Major topics include 1) summaries of largescale, national studies, and major reviews of the literature; 2) efficacy of
treatment in particular settings (e.g., inpatient versus outpatient, residential
and therapeutic communities, treatment drug courts); 3) effective treatments
for particular drug problems (i.e., heroin/methadone treatment, cocaine
treatment); 4) effective treatment modalities and special treatment
populations (family/couples treatment, adolescents, Women’s’ issues,
Alcoholics Anonymous, controlled, vocational rehabilitation), and 5)
contemporary practice issues that determine treatment practices (possible
impact of managed care, patient placement criteria, multi diagnosis patients,
patient treatment matching, length of treatment and outcomes, cost
effectiveness).
http://www.utahcountyonline.org/apps/WebLink/Dept/HEALTHSUBST/SteinLi
teratureReview.pdf
Discussion Paper 2: Quality Framework Project
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Level 1 examples
Your comments on the example above:
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
Page 9
Level 1 examples
Outcome monitoring
Australian
(National)
Australian
(State)
(Internation
al)
Title: The Australian Alcohol Treatment Outcome Measure (AATOM-C):
Psychometric Properties. Technical Report No.288 (2007).
Source/Contents/Link: Simpson, M; Lawrinson, P; Copeland, J & Gates, P.
NDARC
The Australian Alcohol Treatment Outcome Measure (AATOM-C) was
developed for routine clinical use to monitor treatment outcomes for clients
receiving treatment for problems arising from their alcohol use. It was
designed to be a multi-dimensional, standardised, valid and reliable
instrument for use by health professionals within the Australian context. The
AATOM-C instrument is comprised of five sections assessing: client
demographic and treatment information; health and well being; alcohol use;
other drug use; and health service utilisation. As a clinical tool, the AATOM-C
was designed to be brief, easy to administer and flexible enough to be
incorporated into existing data collection and reporting practices across a
range of treatment settings. The AATOM Psychometrics project was
conducted in Sydney to determine reliability and validity of the AATOM-C in
the context of Australian alcohol and other drug treatment services. It was
concluded that the AATOM-C has the potential to be a very useful clinical
tool for those working within the alcohol treatment field. It can assist with
treatment planning and tracking client progress throughout the course of
treatment and after treatment completion.
http://ndarc.med.unsw.edu.au/resource/australian-alcohol-treatmentoutcome-measure-aatom-c-psychometric-properties
Title:A Review of Screening, Assessment and Outcome Measures for Drug
and Alcohol Settings (2009)
Source/Contents/Link: Deady, M. NADA. NSW Health Department
This review provides an overview of some useful standardised tools that can
be used to measure treatment outcomes and to screen and assess for mental
health symptoms and conditions, drug and alcohol use and disorders and
general functioning. Focus has been given to tools that require limited
training to use and are freely available. It should be noted that some of these
tools require specialist training, or else mislabelling, misinterpretation, or
inappropriate use may occur.
http://www.ntcoss.org.au/sites/www.ntcoss.org.au/files/Review_of_Measur
es_09.pdf
Title: Development of a Routine Outcome Monitoring Instrument for Use
with Clients in the New Zealand Alcohol and Other Drug Treatment Sector:
the Alcohol and Drug Outcome Measure (ADOM) (2010)
Source/Contents/Link: Pulford, J; Deering, DE; Robinson, G; Wheeler, A;
Adamson, SJ; Frampton, C; Dunbar, L & Paton-Simpson, G
This paper describes the development and evaluation of the Alcohol and
Drug Outcome Measure (ADOM), a brief 18-item, two part, outcome
monitoring instrument designed for routine use with clients in the New
Zealand Alcohol and Other Drug (AOD) treatment sector. The development
of the ADOM was informed by an expert panel of AOD clinicians (n = 6), key
Discussion Paper 2: Quality Framework Project
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Level 1 examples
informant interviews (n = 14) and a pilot with AOD treatment clients and
their respective clinicians (n = 25). The psychometric properties of the ADOM
were tested with clients (n = 63) across a range of AOD treatment services.
Testing involved clinicians administering the ADOM at treatment admission,
one-to-seven days post-admission, and four-to-six weeks post-admission.
Analyses of the test-retest reliability, concurrent validity and sensitivity to
change of Part A of the ADOM, covering type and frequency of substance
use, consistently produced excellent results. Comparable results for Part B of
the instrument, covering associated psychosocial issues, were generally
satisfactory. The ADOM has the potential to be used as a core AOD outcomes
monitoring instrument.
http://www.psychology.org.nz/cms_show_download.php?id=1003
Title: Global Appraisal of Individual Needs– Short Screener (GAIN-SS):
Administration and Scoring Manual. Version 2.0.1 (2007)
Source/Contents/Link: Dennis, M; Feeney, T; Stevens, L; Bedoya, L (2007).
Chestnut Health Systems (USA)
The GAIN is a series of measures (screener, standardized biopsychosocial
intake assessment battery, follow-up assessment battery) designed to
integrate research and clinical assessment. It is designed to measure the
recency, breadth, and frequency of problems and service utilization related
to substance use (including diagnosis and course, treatment motivation, and
relapse potential), physical health, risk/protective involvement, mental
health, environment and vocational situation.
https://www.assessments.com/assessments_documentation/gain_ss/GAINSS%20Manual.pdf
Your comments on the example above:
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5
Level 2: Examples specific to intervention types
The second task is to comment on your areas of expertise, and every 2 pages in the
remainder of the document refer to one treatment type.
As with the Level 1 outline above, we are interested in good practice guidance – ideally that
is free and available online or as a PDF – that you know about or have used. We would also
be interested in your suggestions about other key contacts we should speak to as part of
this project.
*** Remember: You can provide your feedback in a separate document if you require
more space ***
DQFM Discussion Paper 2
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Level 2 examples
5.1
Key examples of innovation, good practice and successful implementation for Residential Treatment (Level 2)
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
DQFM Discussion Paper 2
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Level 2 examples
5.1.1
Residential rehabilitation
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5.1.2
Therapeutic communities
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5.2 Key examples of innovation, good practice and successful implementation for Withdrawal: inpatient and
outpatient (Level 2)
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5.3
Key examples of innovation, good practice and successful implementation for Pharmacotherapy (Level 2)
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5.4 Key examples of innovation, good practice and successful implementation for Counselling (Level 2)
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5.5 Key examples of innovation, good practice and successful implementation for Care Coordination (Level 2)
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
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Level 2 examples
5.6 Key examples of innovation, good practice and successful implementation for Structured Day Programs
(Level 2)
Good practice
guidance
Australian (National)
Australian (State)
(International)
Quality Standards
Evidence-Based
Practice
Workforce
Development
Implementation and
Evaluation
Outcome monitoring
Your suggestions about key experts in this area that we should liaise with
Your suggestions of good practice that you use in your work
Discussion Paper 2: Quality Framework Project
Page 20
Appendix 1: Definitions of indicators of DQFM.
Quality standard is ‘an agreed attribute or process designed to ensure that a product,
service or method will perform consistently at a designated level’ (Australian Commission
on Safety and Quality in Healthcare, November 2006, p 5).
Evidence-based practice is “a process involving creating an answerable question based on a
client or organizational need, locating the best available evidence to answer the question,
evaluating the quality of the evidence as well as its applicability, applying the evidence, and
evaluating the effectiveness and efficiency of the solution.” (NASW, Evidence Based
Practice, 2014).
Implementation and evaluation involves ‘procedures for the ongoing review and evaluation
of the service delivered by an organisation’ (Australian Council for Safety and Quality in
Health Care, July 2003a, p 4).
Workforce development is “a multi-faceted approach which addresses the range of factors
impacting on the ability of the workforce to function with maximum effectiveness in
responding to alcohol and other drug related problems. Workforce development should
have a systems focus. Unlike traditional approaches, this is broad and comprehensive,
targeting individual, organisational and structural factors, rather than just addressing
education and training of individual mainstream workers.” (Roche & Pidd, 2010)
Outcome monitoring involves the systematic application of evaluation procedures to
address issues at system, program and client levels. At system level it includes penetration
of services into in-need populations, impact of substance abuse treatment on social and
health population indicators, cost-effectiveness of treatment and prevalence of substance
abuse problems. At program level, outcome monitoring focuses on accessibility of services,
clients’ engagement and retention, compliance with ‘best-practice’ guidelines and
accreditation. At client level, the aim of monitoring is on client improvement in substance
abuse, health, social and psychological functioning, harm reduction, client satisfaction, and
utilization of health and social services (Rush, Martin, Corea & Rotondi, 2012).
DQFM Discussion Paper 2
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