C7. Service Delivery – Oral Paper Session

Friday, 31 March 2017

Securing our sector: embedding outcomes evaluation centre wide

Torture and trauma rehabilitation centres are under increasing pressure to demonstrate outcomes in order to secure public and private funding. In Australia, some sources of government funding had previously only required output level results. With limited time and resources for evaluation, embedding outcomes evaluation in internal practices ensures results are demonstrated and lessons learned.

Taking a centre wide approach ensures consistency and demonstrates professionalism. At ASeTTS, programs had grown organically in response to clients’ needs and funding availability. As such program documentation and evaluation had varied. ASeTTS management and staff sought to tackle this problem as a whole centre. ASeTTS staff drew on best practice program management techniques from the not for profit, public and private sectors.

The ‘ASeTTS Program Management and Evaluation Toolkit’ was developed with templates for five key documents to be completed across the life cycle of a program.

The documents include; a Concept Proposal (for programs at the idea stage), a Program Document (for the program design stage), an Evaluation Report and a Lesson Learned Document. The same templates were used across the centre, including different programmes and disciplines. Staff received training and Individual drafting sessions were conducted with staff for each program with evaluation expertise support available.

ASeTTS staff completed Program Documents for 22 programs across the centre (including all direct and capacity building services). As a result, corporate memory has been captured to improve staff induction and handover. Staff were up-skilled in project management and outcomes. Taking a centre wide approach has helped to build buy-in from staff as they can see they are not alone in learning something new and completing the documentation. Evaluation reports have been used to support funding applications and improve programs, positioning ASeTTS well in a competitive environment.

April Pearman (ASeTTS)

Obtaining informed consent in evaluating trauma and recovery and settlement services

One of the challenging areas in the provision of trauma recovery services and indeed in the provision of settlement services to newly arrived refugees and humanitarian entrants is effective evaluation of services. Evaluation of services involves, among other things, finding out from clients whether they found the services useful and whether their needs were met. Obtaining informed consent from clients to participate in research evaluation is an important principle in the evaluation of services. How do we know that a client has given informed consent? Do clients really understand informed consent? Drawing on my experience carrying out fieldwork for my PhD, I reflect on the challenges I faced in obtaining informed consent and argue that for some client groups it is difficult to tell whether informed consent is obtained. What is usually considered as informed consent is a form of consent given under the impression that one is obliged to give consent to reciprocate the fact that a service has been received for free.

Atem Atem (Australian National University)

Presenation currently unavailable

Clinical Information Systems: the gadget that turns data into evidence based decisions

New generation clinical information systems use cutting-edge technology by collecting data at its source allowing clinicians to focus on service delivery enhancing clinical outcomes for clients whilst providing enriched data for evidence based service management decisions, provide an abundant supply of data for research purposes and establish undeniable evidence of the importance for the existence of the service to funding bodies.

Such a system has been implemented at STARTTS since January 2016 and has assisted clinicians in making better decisions for their clients, management to make better decisions for the service, researchers to establish evident trends and it supports the agency’s fundraising efforts to acknowledge obvious evidence of the importance of the existence of the service.

The client information system at STARTTS enables optimised service delivery from the moment a client is referred with a waitlist prioritisation system alarming the service when a client has exceeded their recommended waiting time.

Information is also amassed pertaining to both the client’s attributes as well as approaches and techniques used by clinicians in each episode of intervention. The clinician is recommended pathways to combat triggers such as suicidal ideation and domestic violence.
Trends of symptomatology between clients with similar demographics are established and the evaluation of interventions and their impact on those symptoms is supported.

Statistical reports can also be provided to attract and retain funding ensuring the survival of STARTTS as a torture and trauma service.
Client information systems vary due to different service needs but the value of developing situationally appropriate data collection systems to ensure the survival and thriving of torture and trauma services is universal.

Carlena Tu (STARTTS)

The Treatment and Research Integrated Model, TRIM – how make the most of your clinical data in a refugee health setting

Although more treatment outcome studies for trauma-affected refugees have been published in recent years, most are limited in design and quality. The paucity of data possibly reflect a combination of methodological challenges in performing research in a transcultural setting, problems in collaboration between researchers and clinical staff as well as a lack of resources for undertaking larger research projects.

The Treatment and Research Integrated Model (TRIM) is invented at Competence Centre for Transcultural Psychiatry (CTP) in Denmark and has gained international interest due to its simple, yet structured approach of optimising the use of clinical data for research purposes. The aim of the TRIM model is to involve all personnel in generating research data of high quality with minimal impost in terms of additional costs and time commitment.

The rationale behind the model is presented, demonstrating the feasibility of integrating outcome research into real-life clinical practice settings. While challenges remain in carrying out treatment outcome studies among trauma-affected refugees, they can be overcome by careful consultation and negotiation in a setting where there is an established ethos of commitment to the scientific endeavour. Ultimately, identifying the most effective interventions will provide better treatment and quality of life for the large number of trauma-affected refugees seeking assistance for mental health problems.

Through this presentation, different elements of the model are discussed with examples of implementation in various kinds of studies. Focus will be on providing practical advice and guidance towards integrating research in clinical facilities that are working with mental health among trauma-affected refugees.

Charlotte Sonne (Competence Centre for Transcultural Psychiatry, Denmark)