28th June 2018
FUNDING INFORMATION FOR GENERAL PRACTICE - 2018: RE: CPO MENTAL HEALTH PROGRAMME – STEPPED CARE MODEL AND E-REFERRALS FUNDING: Stepped Care Model: In July 2013 the WBOP PHO entered into a new Coordinated Primary Options (CPO) Mental Health Service Agreement with the DHB. The service is based on a stepped care model for service provision. Stepped care is a system of delivering and monitoring treatments so the treatment that is most effective, yet least resource intensive is delivered first. Adopting this model will help provide the most effective mental health care for the greatest number of people. The age range for referrals to the programme is 12 years and over. Youth under 18 years must have parental/guardian consent. In a stepped care model, there are interventions of different levels of intensity available, and the client’s needs are matched to the level of intensity required. In accordance with the new service agreement, the PHO has divided the available funding to be used for the following interventions: Extended GP/Nurse consultations (maximum of 2 per client per year) - $70+GST (practice to invoice PHO for extended consultation). The extended consultation is for specific interventions only, for selfmanagement. These are: • Medication Reviews (after initiating medication) • Registering clients for ‘Beating the Blues’ E-therapy • Linking clients with self-help resources to manage mood, anxiety, stress or alcohol and substance use issues. • Alcohol Brief Intervention using the ABC approach These extended consultations are to be used instead of referring for group programmes or individual counselling NOT as well as, however the client may be referred to a higher step if the outcome of the therapy prescribed at the extended consultation has not achieved a successful outcome (improvement). Brief Interventions (3 sessions individual counselling) - $30+GST (practice to invoice PHO for referral and Kessler 10 questionnaire). For clients with mild depression or anxiety or who have been referred previously and have already received PHO funded counselling.
Stepped Care Model 2018
Individual Counselling Therapy (6 sessions individual counselling) - $30+GST (practice to invoice PHO for referral and Kessler 10 questionnaire). This is for clients who have moderate depression or anxiety and/or have more complex presenting issues. No re-referrals. Group Programmes (6-8 sessions) - $30+GST (practice to invoice PHO for referral and Kessler 10 questionnaire) Group sessions are available as follows: •
Postnatal depression/anxiety – Wednesday afternoons, Tauranga. Can refer anytime as it is a rotating group with open entry.
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Positive Empowerment Programme (adult depression) – Monday mornings, Tauranga. Can refer anytime as it is a rotating group with open entry.
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FearLess Programme (adult anxiety) – Wednesday mornings, Tauranga. Closed group with definite start dates.
Please establish with the client that they wish to and are able to, attend a group programme before referring. These group courses/programmes are open to referrals from practices (there is no limit) and each group programme will be held once per term and dates for each group will be posted on the PHO website. This will need to be taken into consideration when referring as there may be a wait for the next available group to begin. This should not be a significant deterrent if clients are being referred appropriately as clients with mood and anxiety issues have usually had these problems for some time and will benefit from the strategies taught within these group programmes. The group programmes/courses are psycho-education sessions and are specifically targeted to improve mood, anxiety, coping ability and general well-being. Social Worker (individual brief intervention) - $30 + GST (practice to invoice PHO for referral and Kessler 10 questionnaire) The Social Worker is available to provide a range of therapeutic options that emphasise the importance of the social and psychological determinants of health to improve well-being. This includes navigating pathways to access services for clients. Clients who are experiencing a situational crisis who need acute mental health input should not be referred through the CPO Mental Health Programme. All steps have specific criteria attached and you will need to familiarise yourselves with this criteria in order to refer appropriately. The criteria are outlined in the e-referral and in the ‘Information Manual for General Practice Teams’ (attached) and can also be clarified by a phone call to the CPO Mental Health Coordinator. As for previous years, funding is limited and it is usual for clients wanting/requiring referral to exceed available funding so please give due consideration to all referrals. Funding should be prioritised for youth, high needs clients (Maori and Pacific Island people), and people referred to but declined from secondary mental health services. Funding is allocated to practices quarterly. If all available funding is used then clients will have to wait until the next quarter to be referred. A regular funding update (monthly) is sent to practice managers, to communicate to GP’s if there is no funding available. Clients will be declined if the referral is sent to the PHO and there is no funding available, however a discretionary fund is held at the PHO for the priority group above ONLY, if the practice has no funding.
Stepped Care Model 2018
E-Referral: All referrals are sent to the PHO via Best Practice e-referral. This referral form is to be used for all referrals to the programme and is found on Best Practice as below:
As before, the e-referral form and data base has been established to accommodate the changes of the stepped care model and the number system for funding allocations to practices has also changed. This system will allow easier tracking of referrals from our office and you will be updated regularly if you have numbers added due to client declines etc. You will still be advised if a client is declined and the outcome of any other clients referred. Invoices still need to be sent manually, however a new system is in the process of being developed that will result in the practice being paid automatically for any CPO Mental Health referrals or extended consultations. You will be notified when this process is complete.
Regards, Sylvia Donaldson CPO Mental Health Coordinator WBOP PHO Phone 571 7160 e-mail: sylviad@wboppho.org.nz
Stepped Care Model 2018