This report outlines findings from the Comorbidity Treatment Service Model Evaluation, which was funded by the Australian Government Department of Health and Ageing under the umbrella of the National Comorbidity Initiative. The Evaluation included a literature review, to determine the evidence base for different comorbidity treatment service delivery models, development of a treatment service model evaluation tool to gather information on the impact of service delivery models on treatment outcomes, and the evaluation of 17 comorbidity treatment service models with a focus on the service structure and diagnostic and treatment methods.
Elements of good practice
Elements of good practiceThe literature review found that numerous methodological problems are associated with comparing comorbidity research, that there is no agreed definition of comorbidity, a range of different comorbidity service delivery models, and a lack of evidence on the effectiveness of particular treatment approaches and models. Broadly, this is reflected in findings from the Comorbidity Treatment Service Model Evaluation. However, we identified elements of good practice. These related to policies, service structure, partnerships between relevant services, and workforce issues. Elements of good practice include the following:
- Guiding principles of harm reduction and flexible and holistic approach.
- Integrated treatment and the principle of a no wrong door approach.
- Continuous Quality Improvement (CQI) programs.
- Processes/procedures/protocols for intake and comorbidity screening, client privacy, discharge, and client feedback.
- Individual treatment plans developed jointly with the client.
- Collection of data on treatment success.
- Links/partnerships with other relevant services.
- Active service promotion and referrals from a range of sources.
- Feedback to referring professionals.
- Well-qualified staff and generous provision of supervision and professional training.
RecommendationsRecommendations arising from the evaluation can be grouped into those pertaining to definitions of relevant terms, policies, service structure, partnerships between services, and workforce issues. The following recommendations are made:
- That a consensus be developed in Australia on clinical, policy, and research appropriate definitions for comorbidity and integrated treatment.
- That following the development of an agreed definition of comorbidity, agreement on the use and type of screening tools be reached.
- That consensus be developed on classificatory models of comorbidity.
- That treatment services develop and implement clear and transparent policies and procedures for intake, comorbidity screening, client privacy, and client feedback. That staff are trained in these policies and procedures and that they are communicated to clients.
- That a no wrong door approach to the treatment of people with comorbid problems be promoted and supported.
- That the collection of data on treatment success be supported with tools and approaches.
- That partnership work continue to be promoted as an element of good practice and be made explicit in funding arrangements.
- That feedback to referring professionals be regarded as desirable, and that the development of agreed referral protocols that include feedback be promoted and supported.
- That the importance of formally qualified staff continues to be promoted and supported.
- That training in the screening and identification of comorbidity be considered good practice for all AOD and MH services.
- That in the AOD and MH sectors efforts on increasing awareness and understanding of comorbidity continue.