Collaborative Action Program
Assisting older people with complex mental health needs and challenging behaviours to access and receive appropriate community support. One program - three agencies.
Overview
The Collaborative Action Program (CAP) is for older people whose challenging behaviours associated with a psychiatric illness and/or dementia prevent them from accessing mainstream community support services. The program which commenced in July 1997 is run as a collaborative partnership between Adelaide Central Mission (ACM), Mental Health Services for Older People (MHSfOP) and Royal District Nursing Service of SA Inc. (RDNS).
On a day-to-day basis the program is managed by three CAP Program Co-ordinators (one from each agency) who meet on a weekly basis to assess new referrals, review individual care plans and monitor the program as a whole. Program Managers from each agency communicate with each other regularly, though less frequently.
The service delivery model is client driven with individual care plans determined by the clients’ and carers’ goals. Whether providing assistance with basic living or social or diversional activities, the program aims to build on people’s strengths to improve quality of life at the individual and community level. Typically the person is supported by a care worker, recruited, trained and employed by ACM who visits on a regular basis. The care worker builds a one-to-one relationship with client. There is a continuous feedback loop between the care worker, the MHSfOP key worker and the ACM Care Co-ordinator and the other CAP Co-ordinators.
Aggression is the most commonly reported challenging behaviour. Others include constant pacing, overt restlessness, sexual disinhibition, compulsive rituals and phobias. Common diagnoses of clients include bipolar affective disorder, depression, schizophrenia, personality and delusional disorders and dementia. In a number of instances clients have co-existing medical problems such as diabetes, hypertension and arthritis. Carer stress is a common reason for referral.
Where possible, integration with and support by mainstream services is encouraged. The complexity of issues, the vulnerability and fragility of many clients’ health status and support systems however means that longer term by support by CAP is necessary, as in these circumstances the program addresses a clear service delivery gap.
Innovation of service response is evident both at individual care planning level and at the service partnership model developed by the three in may ways disparate agencies.
Regular and continuing communication between the agencies provides for ongoing review and forward planning. A formal evaluation process ran alongside the initial phase of the program for its first 18 months. This provided independent observation and monitoring of the program’s development and implementation. The evaluation was similarly innovative with ongoing feedback from the evaluation providing valuable input to its continual improvement.
An independent economic evaluation by a health economist examined the total costs of the CAP program and compared these against evidence from some clients’ previous residential care with MHSfOP, a hypothetical comparison with aged residential care placement and with historical costs of Glandore Day Therapy Centre.
An in depth analysis of 16 randomly selected clients showed that the costs of the program together with the estimated costs of other community and residential care services provided to these clients, generated a savings of just over $2500 per client per month compared with an aged residential care alternative.
The Program is funded by the South Australian Department of Human Services.
Outcomes have shown client and carer satisfaction, improved quality of life for both client and carer, prevention or delay of institutional care and the cost-effectiveness of the program. The 1999 "Evaluation of the Collaborative Action Program" report attests to the programs achievements.
Eligibility
CAP provides a service to people (and their carers) who are eligible for mental health services and who:
- Are generally over 65 years of age
- Have a mental illness or a dementia with psychiatric complications
- Exhibit challenging behaviours
- Have multiple and complex needs.
People who meet these criteria may also:
- Have limited social connections or are at risk of losing those connections
- Be no longer able to access other community support services or to participate in activities available in the community
- Be at risk of having community services withdrawn or at risk of premature admission to institutional care.
Services
Services are developed with the user to ensure they are responsive, accessible and tailored to the individual’s needs and preferences. Services can be provided ‘in home’ or ‘out of home’ and may include such activities as:
- Assessment and care co-ordination
- Home respite
- Physical therapies
- Advocacy and assistance to access other programs
- Nursing services
- Practical assistance with daily needs
- Assistance to participate in local community groups and activities
- Group activities developed by CAP.
Referrals to CAP and Enquiries about program services can be made during working hours to:
Julie Adam
Project Officer - CAP Mental Health Services for Older People
Phone: 61 8 8357 6155
Fax: 61 8 8357 6177
Or:
Terry Wilson
Adelaide Central Mission,
Adelaide
South Australia
Phone: 61 8 8368 1512
Fax: 61 8 8262 3060
For information on other services visit our web site: www.rdns.org.au
