The Report on the Provision and Funding of Specialist Behaviour Support Services provides a comprehensive overview of these services to the Ministry, along with recommendations to improve services. The Ministry has carefully considered these recommendations, and the best way to engage with the sector about how to use the recommendations to make changes to the services.
In November 2010 Split Ridge Associates Ltd was contracted by the Ministry of Health to undertake a project to develop a:
- Behaviour Support Services strategy to be submitted to and approved by the Senior Management Team within three weeks of the contract commencement
- Funding impact assessment to inform implementation of the Behaviour Support Service delivery model
- New Behaviour Support Service delivery model.
This report is provides a comprehensive overview of this project. It builds on the Ministry of Health’s previous reviews of Behaviour Support Services (BSS), which occurred in 2005, 2007 and 2008.
Previous reviews highlighted concerns regarding the purchase and delivery of BSS and led, among other outcomes, to a common service specification regardless of service provider. Those reviews did not consider different models but looked more at the quality of existing services.
The project methodology involved structured interviews with identified stakeholders and providers, analysis of current funding mechanisms, and the development of a service model for Regional Specialist BSS with options for the organisation and governance arrangements.
The conclusions reached from the analysis of interviews clearly confirmed many of the observations from earlier reviews and projects. In summary, these were:
- variability around how people gain access to BSS and variable access in terms of waiting times
- inconsistent approach to BSS delivery
- clients and their families have little influence on the structures and service being provided
- reporting to Needs Assessment and Service Coordination (NASC) by providers is variable
- variable maturity of relationships among providers and also between providers and specialist clinical services within District Health Boards (DHBs)
- some beginning evidence of working together and joint work but not across all providers
- range of skills and qualifications, a number of which are not in line with the service specification
- little evidence of clinical leadership
- need for greater national quality approach, including action research.
These reaffirmed earlier observations which concluded the following.
- We don’t know who is getting Behaviour Support
- We don’t know how long people are getting Behaviour Support
- We don’t know how many "Eligibility Assessments" we are buying
- We don’t have confidence that the providers are prioritising referrals in a way that the NASC/Ministry of Health would want them to (they may just go on the end of the waitlist)
- We don’t have confidence that the right people are getting Behaviour Support (ie, people in residential care may be getting Behaviour Support over people in the community.
In initiating and conducting the project the following six principles were developed and adopted by the project team to underpin the findings, conclusion and recommendations of the project:
- nationally consistent access – equity for eligible referrals
- responsive but flexible – meeting client needs
- integrated across the service continuum – no gaps or delays
- evidence-based practice – best practice and outcomes orientated
- clinical leadership and engagement – clinician lead
- sustainable over the longer term – affordable and value for money.