1. DASWest NP AOD Model Mental Health and AOD Nurse Practitioner Collaborative Meeting December 2010

2. Footer Text2 About DASWest  One of the largest AOD services in Victoria  Largest AOD service provider in the West  Programs encompassing: -Home Based Withdrawal -Homeless Dual Diagnosis -Outreach -Post Withdrawal Linkages -Specialist Pharmacotherapy -Women’s and Children’s Program -Forensic Counselling Program -Community Residential Withdrawal Unit (Adult) -Community Residential Withdrawal Unit (Youth ) -Youth and Family Services -Addiction Medicine Beds

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4. 4 About DASWest  Western Health auspiced  6 Sites in Footscray and Sunshine  60+ EFT (~ 90 individual staff members) -Registered Nurses, Psychologists, Social Workers, Addiction Medicine Physicians, Community Development Workers, Welfare Workers, Admin.  Funders:  DH  ACSO COATS  MBS

5. Footer Text5 2009-10 Service Activity Data  In 2009-10, DASWest delivered: o 1,200 Outreach contacts o 2,163 Episodes of Care, with Significant Treatment Goals attained for clients. The Episodes of Care were delivered from the following programs: Client EOC 2009-10 Adult888 CRWU Adult551 Youth585 CRWU Youth94 Women's45 Total2163

6. Footer Text6 2009-10 Client Profile  Demographics: o In 2009-10, 64% of DASWest clients were Male, and 36% female o 80% of clients were born in Australia, and 3.70% identified as ATSI o 39% of clients were aged under 24 years of age o 25% of DASWest clients in 2009-10 were aged 40 years or over

7. Footer Text7 2009-10 Client Profile  Primary Drug Use: o Alcohol 31% o Cannabis 27% o Heroin 23% o Reflects DH NWMR data

8. Footer Text8 NP AOD Model development - 2009 - Various Gaps identified throughout DAS re NP applicability - Research and Models investigated - 2009 Victorian Nurse Practitioner Project -Funding Round Phase 4 Round 4.6

9. Footer Text9 Refining the Model – 2010 -High level support at WH and DASWest for the NP initiative; including Executive, Nursing and DASWest Medical Director - 2010 New Management at DASWest - Lots of options canvassed - Consultants engaged - DASWest NP AOD Model Development Steering Group established: DAS Ops Manager, Adult Services Manager, CRWU NUM, Medical Director, PNPC, DON Footscray, Director Pharmacy - Focus Group Sessions re Priority Areas and Service Gaps

10. Footer Text10 Refining the Model – Narrowing the scope  Out of Scope: - Youth Services - General Drug and Alcohol in Primary Health Care settings - Community Residential Withdrawal Unit  Potential In-scope for the NP role:  NP to work within the Adult Services Team for support, access & influence  Home Based Withdrawal (lack of community prescribers)  Potential role in specialist out-patient clinics, esp. re withdrawal  Pharmacotherapies; especially Bridging Pharmacotherapy post Actue discharge  Need to be cautious re Acute Consultation and Liaison Services across WH campuses

11. Footer Text11 Considerations 1. Is there a service gap? 2. Which service? Which patients / clients? 3. What part(s) of the care continuum will the proposed NP role address? 4. What is the estimated value add? Can we measure it? 5. Where will the NP be physically located? 6. What will the NP relationship be with other WH clinicians including FAChAMs and medical specialists, and with Community based medicos (GPs)? 7. What formulary will be utilised? 8. What diagnostics will be available? 9. How will clients access the NP? 10. What are the reporting and accountability lines for the NP?

12. Footer Text12 Three Models Model OnePharmacotherapy Prescriber (Clinic Based) NP AOD Service LocationServices Provided DASWest Clinic Or Community based clinic (e.g. GP Practice / Community Health Centre) Alcohol pharmacotherapy Opioid substitution program Co-morbidty management Dual diagnosis Stabilisation Referral to appropriate ongoing care and/or GP management Hep C testing Consult & liaison with GPs & referral co-management of complex Pharmacotherapy clients Transitional Pharmacotherapy / Bridging pharmacotherapy from acute to community / primary care sectors

13. Footer Text13 Three Models Model TwoWestern Region Area based NP AOD Service LocationServices Provided May operate from various locations, such as: Outpatient AOD Clinics Community Health Centres Mental Health Services Western Health Hospital campuses Other Hospitals Home visiting Assessment and Intake Specialist Pharmacotherapy Home Based Withdrawal

14. Footer Text14 Three Models Model ThreeWithdrawal and Transitional Pharmacotherapy NP AOD Service LocationServices Provided Home based - Detox In-patient - Detox CRWU Detox (Adult) Outpatient clinic - Pharmacotherapies Advanced Assessment and Intake triage role Withdrawal management (home - based / inpatient/ outpatient) Therapeutic and educational programs Linkage to community based programs and support Conduit to the GP community for D&A clinical advice Transitional Pharmacotherapy / Bridging pharmacotherapy from acute to com1010munity / primary care sectors

15. Footer Text15 Testing the models  Each of the models allowed for integration of the NP into MDTs and capitalises on the NP's ability to prescribe from an agreed formulary and to order diagnostics.  10 key questions  Plus:  Work load manageability: Is the work do-able? Is it satisfying? What can be achieved? Will it be a satisfying role for a NP?  Influence: Is the NP part of a team and to influence a team? How can the NP influence DASWest AOD nursing practice and AOD directions in the larger health service and the NWM region?  Integration: How easy will it be to support and supervise the NP? How will the NP interface with Western Health?

16. Footer Text16 Withdrawal and Bridging Pharmacotherapy Model  Key features Located at DASWest in Adult Services Team Withdrawal management (home - based / outpatient / ? Inpatient CRWU) Transitional Pharmacotherapy / Bridging pharmacotherapy from acute to community / primary care sectors Advanced Assessment and Intake triage role Prescriber role Therapeutic and educational programs Discharge Linkages to community based programs and support Conduit to the GP community for D&A clinical advice Clinical Leadership, Quality, Education and Research,

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18. Footer Text18 Governance - DASWest NP AOD Steering Group established: DAS Ops Manager, Adult Services Manager, CRWU NUM, Medical Director, PNPC, DON Footscray, Director Pharmacy - Western Health NP framework -ICU Liaison NP -Adult Emergency NP -Paediatric Emergency NP - Western Health Scope of Practice Committee

19. Footer Text19 Terms Of Reference

20. Footer Text20 Accountability

21. Footer Text21 Recent discussions:  Recent NP AOD Steering Committee Topics of discussion: -Formulary (Mental Health and Primary Care) -Opportunities for Integration with Western Health -WH Scope of Practice requirements

22. Footer Text22 Integration Opportunities with WH -Provision of expert AOD clinical nursing advice to: -WH 1 East Addiction Medicine Beds -WH Emergency Departments (Footscray, Sunshine, Williamstown) -AOD clinical education to acute / sub acute staff via formal forums -Presentation at Grand Rounds -Representation on relevant WH Steering Committees re advanced level nursing opinion and advanced clinical nursing practice -Participation in Western Health’s Teaching, Training and Research portfolio -Participation in Western Health’s Accreditation and CQI portfolio -Case Conference opportunities for shared clients -Provision

23. Footer Text23 Next Steps -Final Model sign off via Western Health -Advertise and appoint NPC -Commence