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Program 2.5: Veterans’ Counselling and Other Health Services

Objective

Program 2.5 provides a wide range of mental and allied health care services, including counselling and referral services for veterans, war widow/ers, serving members, former defence force members and their families. It also supports clients with aids and appliances and travel for treatment.

Overview

In 2012-13, mental health continued to be a priority for DVA, with the release of the new Veteran Mental Health Strategy and the development of mental health educational resources and self-help tools. Further mental health measures were also announced in the 2013-14 Budget to strengthen access to high quality mental health care.

During the year, demand for allied health services increased, reflecting the health needs of the ageing veteran population. DVA is committed to delivering allied health services that are meeting the needs of all the veteran cohorts, across age and service experiences.

DVA also supported veterans with a range of aids and appliances, and travel for health treatment. Travel reimbursement claims and travel through the Booked Car with Driver Scheme increased, reflecting improved claims processing and the needs of the ageing veteran population. Demand for aids and appliances increased in line with the growing complexity of health needs.

Expenses

Administered and Departmental expenses
  2012–13 PBS1 ($ million) Estimated actual22012–13 ($ million) Outcome 2012–13 ($ million)
Administered 555.3 589.0 593.3
Departmental 44.0 46.2 42.7
Total resources 599.3 635.2 636.0

1 PBS in performance reporting tables means Portfolio Budget Statements.

2 Estimated actual means the estimated expense or total for 2012–13 provided in the 2013–14 Portfolio Budget Statements. As the Budget is released in May each year but the financial year does not close off until 30 June, the current year numbers in the Budget can only be estimates.

Deliverables

Deliverables
  2012–13 PBS Estimated actual 2012–13 Outcome 2012–13
Treatment population 221 700 222 500 223 181
Travel for treatment      
Number of processed claims for reimbursement 143 997 143 997 165 137
Number of DVA arranged person trips 881 191 881 191 955 954
Veteran counselling      
Number of unique clients receiving intake referral services 12 400 12 400 15 804
Number of unique clients in receipt of counselling1 10 500 10 500 11 687
Number of counselling sessions delivered 62 000 62 000 73 063
Number of calls received by the after–hours counselling service 6300 6300 5306
Number of unique clients receiving group program intervention 3200 3200 2488

1 Some clients experience multiple episodes of care throughout the year, bringing the total number of (non–unique) clients seen in centres and by outreach counsellors for the period to 11 940.

Key performance indicators

Key Performance Indicators
  2012–13 PBS Estimated actual 2012–13 Outcome 2012–13
Price: Unit cost per cardholder $178 $190 $176
Travel for treatment      
Target percentage of claims for reimbursement processed within the Service Charter timeframe (28 days) 100% 100% 99.1%
Degree of complaints about arranged travel relative to the quantity of bookings 0.05% 0.05% 0.04%
Rehabilitation appliances      
Cost: Attributed across treatment population $664 $664 $743
Number of broad categories of aids and appliances available to the veteran community listed in the RAP Schedule 269 251 251
Percentage of aids and appliances listed that may be prescribed by GPs, registered nurses and occupational therapists 95% 95% 95%
Veteran counselling      
Percentage of unique clients presenting for service who receive attention by a outreach contracted counsellor within two weeks of intake 63% 63% 66.1%
Centre–based counselling –percentage of unique clients presenting for service who receive attention by a centre–based counsellor within two weeks of intake 73% 73% 76.5%
Level of veteran satisfaction High High High

Report on performance

Veterans and Veterans Families Counselling Service

As part of the 2013 Budget, the Australian Government announced a modest expansion of VVCS eligibility. From 1 July 2014, individuals from the Australian Defence Force (ADF) in the following groups will become eligible for VVCS services: border protection personnel; Australian and overseas disaster zone personnel; personnel involved in training accidents; members medically discharged; submariners; partners and dependent children up to the age of 26 of these groups; and partners, dependent children up to the age of 26, and parents of ADF members killed in service-related incidents. VVCS has commenced preparatory work to ensure the needs of this cohort are met.

Number of clients receiving VVCS services

In total, 22 662 unique clients received VVCS services during 2012-13, up 6.9 per cent on the 21 205 clients in the preceding year. Of these, 13 124 clients received counselling and/or participated in group treatment or psycho-educational programs. The remaining clients spoke to a crisis counsellor at Veterans Line, had their concerns resolved during their initial contact with VVCS (during intake), or were referred to a more appropriate service. Table 28 shows numbers of client contacts for each stream for the past five years.

Table 28: Number of clients receiving counselling services by counselling stream 2008-09 to 2012-13
  2008–09 2009–10 2010–11 2011–12 2012–13
Centre/outreach clients 9571 9063 9456 10 314 11 687
Intakes not leading to counselling or referred elsewhere 2971 2348 2972 3354 4232
Group programs 3480 3181 3395 2897 2488
Veterans Line 4005 4610 5332 5497 5306

Timeliness of services

VVCS seeks to have the majority of client needs identified and support systems in place within a fortnight of the initial intake process being conducted. Table 29 compares the time to receive the first counselling session over the past five years.

Table 29: Timeliness of first session for centre-based and outreach counselling 2008-09 to 2012-13
  2008–09 2009–10 2010–11 2011–12 2012–13
Within 14 days          
Centre based 64% 61.8% 71.5% 76.7% 76.5%
Outreach 51% 49.3% 51% 64.8% 66.1%
Within 21 days          
Centre based 82% 75% 84.4% 87% 86.8%

Quality

The quality of service provision across all counselling and group programs delivered during 2012-13, as measured by client satisfaction levels, was high. This result was derived from 2630 returned satisfaction surveys which showed that 76.6 per cent of clients were very satisfied and 17.6 per cent were moderately satisfied.

Complaints and compliments

In 2012-13, VVCS received 60 pieces of feedback (complaints and compliments) from clients and other stakeholders. This is separate to feedback received though the client satisfaction survey. Of this feedback 60 per cent was compliments. Complaints were primarily regarding the responsiveness of VVCS services. Table 30 shows the total number of complaints and compliments in 2012-13 compared to previous years.

Table 30: VVCS complaints and compliments 2010-11 to 2012-13
  2010–11 2011–12 2012–13
Complaints 32 45 24
Compliments 34 35 36
Total 66 80 60

VVCS services

Centre counselling

The 63 full-time equivalent VVCS staff counsellors (including program managers) provided 21 780 counselling sessions to 4366 clients, compared with 17 742 sessions and 3497 clients in 2011-12. The average number of sessions per client was five. In addition, centre counsellors provided intake counselling, case management for clients with complex needs and increased coordination of outreach program clients.

Outreach counselling

During 2012-13, VVCS outreach counsellors delivered 51 283 counselling sessions to 8520 clients. This compares with 45 909 counselling sessions delivered to 7604 clients in 2011-12. The average number of outreach sessions per client was six, unchanged from the previous two years.

Group programs

In 2012-13, VVCS facilitated 308 group treatment and psycho-educational programs, equating to 6361 hours, to 2488 clients nationally (detailed in Table 31). This was a decrease from 2011-12, when 2897 clients participated in 326 group programs, equating to 6580 hours.

Table 31: Group programs delivered in 2012-13
Group program Active groups
Health and wellbeing (including anxiety, depression and sleep programs) 126
ADF transition (Stepping Out Program) 33
Operation Life 14
Residential lifestyle (including three F–111 programs) 28
Heart Health Program (including Outreach Heart Health) 21
Women’s psycho–educational 26
Anger management 24
Men’s psycho–educational 22
Posttraumatic stress disorder transition 5
Couples 7
Sons and daughters 2
Total 308
Case management

VVCS supports a number of clients in complex situations who find it difficult to engage and manage the range of health and social care services they require. In 2012-13, there were 57 cases who started their case management episode of care. This compares with 53 complex care cases managed in 2011-12. However there were a further 2859 case management sessions provided to other case management and counselling clients in the same period. In total 3102 case management sessions were provided to VVCS clients.

Veterans Line

During 2012-13, Veterans Line, the after-hours crisis counselling service, received 5306 calls, compared with 5497 calls in 2011-12. Average call duration was 12.7 minutes, and 47.3 per cent of callers sought further VVCS assistance, with contact made by the nearest VVCS centre on the next business day.

In 2012-13, the call-back service for clients at significant risk of suicide or self-harm made 52 call-backs to VVCS clients, compared to 21 call-backs in 2011-12; this is reflective of a more robust application of call-back criteria.

Video counselling

Arrangements to access high quality, confidential local video-conferencing facilities allowed a total of 16 clients to receive 41 video-counselling sessions; this compares with eight clients who received 30 video-counselling sessions in 2011-12.

Text messaging

VVCS continues to use SMS text messaging to remind clients, who consented to being contacted in this way, of counselling appointments and group program sessions. During 2012-13, 14 284 text messages were sent to clients, nearly a 45 per cent increase on the 9872 text messages sent to clients in the previous year, in line with an increasing preference for mobile communication. Figure 20 shows text messaging activity by month during the year.

Text messaging activity by month for 2012-13 shown as number of messages over the last 12 month June 2012 to July 2013

Figure 20: Text messaging activity by month for 2012-13

Australian Defence Force services

In 2012-13, 1181 Defence referrals were made to VVCS, compared with 848 in 2011-12. In addition, 3566 serving members with VVCS eligibility self-referred for assistance during 2012-13 compared with 2417 self-referrals in 2011-12.

In addition, VVCS is contracted by Defence to deliver an all-hours support and information line to members and their families. The support line is outsourced to On the Line Pty Ltd, which also operates Veterans Line. The support line received 631 calls in 2012-13, compared with 528 calls in 2011-12.

VVCS services for veterans’ children

VVCS services are available to the children of both Vietnam veterans and F-111 fuel tank maintenance workers of any age, and the children of other veterans up to the age of 26. Services include counselling, support and referral, psychiatric assessments, the outreach program, group programs and information sessions.

In 2012-13, 2939 sons and daughters of veterans received VVCS support. 2653 sons and daughters of veterans received 19 802 counselling sessions and 84 sons and daughters were referred for psychiatric assessment. In addition, VVCS delivered two targeted group programs to 19 sons and daughters.

VVCS programs

Changing the Mix

In 2012-13, seven participants registered and received assistance from the Changing the Mix self-help program, compared with four participants in 2011-12. Noting the low annual participation rates, clients in need have, where appropriate, been linked into direct VVCS support and counselling. VVCS proposes to undertake an internal review of this program in 2013-14.

Crisis Assistance Program

The Crisis Assistance Program provides assistance to Vietnam veterans who may be experiencing a family crisis. Veterans may be offered ‘time out’ in short-term emergency accommodation and are offered counselling or other strategies such as access to residential lifestyle and coping skills programs conducted through the VVCS. In 2012-13, three clients accessed this program. This compares to four clients accessing the program in the previous two years.

Stepping Out Program

The program forms part of a suite of information seminars and assistance available to members separating from the ADF during the transition period. A review of Stepping Out was conducted in 2012-13, which identified opportunities to modernise the program and further integrate it with other transition services. Implementation of the review recommendations will commence in 2013-14.

In 2012-13, 33 programs were run nationally with 405 participants, the majority of whom were current serving members from all ranks and services. These numbers are similar to 2011-12.

Heart Health Program

The Heart Health Program is designed to assist veterans in establishing a healthier lifestyle. The program is based on the national cardiovascular health guidelines and incorporates structured physical activities, educational seminars and biometric screening. It is administered through the VVCS and delivered by a national contracted provider.

A total of 265 participants commenced the group version of this program during 2012-13, compared with 443 in 2011-12. In addition, 172 veterans participated in the outreach program during the year, compared to 111 participants in 2011-12.

F-111 Deseal/Reseal Support Program

In 2012-13, VVCS delivered five F-111 lifestyle management programs in Queensland, New South Wales and Victoria to 34 former F-111 personnel and 24 partners. In total, VVCS provided intake, counselling and group programs to 130 F-111 clients, of whom 69 per cent were former F-111 personnel and 31 per cent were family members.

Operation Life workshops

Operation Life workshops delivered in 2012-13 were:

  • seven Safe Talk half-day introductory workshops in five states and one territory, with a total of 62 attendees (compared to 16 workshops and 161 attendees in 2011-12)

  • five Applied Suicide Intervention Skills Training two-day workshops with 46 attendees (compared to 13 workshops and 120 attendees in 2011-12)

  • two Tune Up workshops with seven attendees who had previously attended an Operation Life workshop (compared to four workshops and 37 attendees in 2011-12).

Allied health

Allied health covers services accessed by veterans from a range of public and private sector health providers, including chiropractors, dietitians, occupational therapists, physiotherapists, podiatrists, optometrists, psychologists, social workers and speech pathologists.

Payments to allied health providers for services provided to entitled beneficiaries are made by the Department of Human Services on behalf of DVA.

Number of allied health services

There were 3.07 million allied health services provided and billed in 2012-13 compared with three million as at the time of reporting in 2011-12. Current estimates are for around 3.2 million services for the 2012-13 year, an increase on the actual number for 2011-12. This is due to growing demand for these services from the ageing veteran population, who are experiencing chronic and more complex health needs.

Average cost per allied health service

The average cost per allied health service has increased this financial year. This reflects the broader range of services provided and increases in fees paid to providers. The 2012-13 average is expected to increase slightly as further billing is received for services provided within the financial year but not processed at the time of reporting.

Administered expenditure for allied health

Administered expenditure for allied health services provided in 2012-13 was $225 million compared with $210 million in 2011-12, a seven per cent increase. Whereas the veteran population is declining, the overall allied health expenditure is greater due to the fee increases and the higher demand for services per veteran.

Percentage of veteran population using allied health services

In 2012–13, 68.3 per cent of the veteran population used allied health services compared with 68.6 per cent as reported in 2011–12.

Table 32 shows the number of allied health services provided and average cost over the past five years.

Table 32: Number and average cost for allied health services 2008-09 to 2012-13
  2008–09 2009–10 2010–11 2011–12 2012–13
Number of services 2 723 333 2 807 156 2 959 429 3 127 946 3 073 287
Average fee paid $59.91 $61.21 $62.33 $63.62 $65.38
Proportion of treatment population1 67.8% 68.3% 69.1% 69.6% 68.3%

1 Treatment population is measured at 30 June for each financial year.

Travel for treatment

In 2012–13, DVA processed 165 137 travel reimbursement claims, which is an increase of 13 per cent compared to 2011–12, when 145 880 claims were processed. Efficient processing practices have seen an improvement in processing times, with 99.1 per cent of claims being processed within 28 days this year compared to 89.2 per cent last year. The introduction and simplification of online travel claim lodgement through MyAccount has contributed to an increase in the number of claims submitted to DVA.

Arranged travel through the Booked Car with Driver Scheme is an important service for the veteran community. This is evidenced by the 955 954 person trips completed in 2012–13. This represents an 8.9 per cent increase compared to 2011–12, when 877 521 trips were completed, and is commensurate with the ageing veteran population. Table 33 provides further details of travel arrangements.

Table 33: Claims for reimbursement and arranged transport processd by DVA 2008-09 to 2012-13
  2008–09 2009–10 2010–11 2011–12 2012–13
Claims for reimbursement 193 280 168 991 156 854 145 880 165 137
Person trips 798 222 827 682 790 114 877 521 955 954
Cost (million) $146.4 $151.5 $152.5 $158.3 $163.6

Figures for the number of DVA-arranged person trips for 2010-11 onwards are not directly comparable with earlier years due to the introduction of the transport booking and invoicing system that uses a different method for handling trips that have been booked but not taken.

Aids and appliances

Expenditure for aids and appliances totalled $165.8 million in 2012-13 (including Rehabilitation Appliances Program (RAP) expenditure of $148.3 million; HomeFront expenditure of $13.9 million; and Medical Grade Footwear expenditure of $3.6 million). A total of 144 637 beneficiaries received aids and appliances. Table 34 provides further details of RAP items.

Table 34: Top 10 RAP items and expenditure 2012-13
RAP item Expenditure (million) Percentage of expenditure
Continence $17.7 10.7%
Chairs –electric and high/low back $16.7 10.1%
Home modifications –rails/ramps/bathroom modifications $16.3 9.8%
Personal response systems $12.6 7.6%
Oxygen therapy and CPAP1 $9.8 5.9%
Bedding for rehab purposes $8.9 5.4%
Assistive listening devices $8.2 5.0%
Minor mobility equipment –walkers etc $5.6 3.4%

1 Continuous positive airway pressure machines.

Medical grade footwear

Medical grade footwear (MGF) is provided to beneficiaries to replace everyday footwear of eligible persons with clinically approved modified footwear. In 2012–13, the program assisted 6801 beneficiaries with 7131 pairs of ready–made MGF and 2507 pairs of custom–made MGF. Expenditure for this year totalled $3.6 million.

Essential Medical Equipment Payment

The Essential Medical Equipment Payment covers the additional costs of running essential medical equipment, or medically required heating/cooling, that arise from the introduction of a carbon price. In 2012–13, approximately 3600 claims were paid with a total expenditure of approximately $490 000.

Men’s Health Peer Education Program

The Men’s Health Peer Education Program continued to help promote healthy lifestyle choices within the veteran community and encourage members of that community to share responsibility for managing their own health and wellbeing.

In 2012–13, 376 active volunteers were provided with ongoing training. Major activities included:

  • a national workshop in Adelaide in November 2012

  • a complete revision of the program training resources, including posters and brochures

  • significant volunteer activities during International Men’s Health Week and Veterans’ Health Week.

Veterans’ Health Week

Held in October 2012, there were 172 events conducted across Australia, an increase of 28 on the previous year. Attendance was also up, from around 10000 in 2011 to nearly 13000 in 2012. The theme for 2012 was ‘ Social Inclusion –participate, connect, and influence’.

Feedback from event participants was very positive, with most very happy with their event and a very high percentage indicating that they would participate again.

Vietnam Veterans’ Sons and Daughters Support Program

The Vietnam Veterans’ Sons and Daughters Support Program, which currently has 88 clients, assists Vietnam veterans’ children who have certain medical conditions with costs for medical treatment; aids and appliances; travel and accommodation related to medical treatment; allied health services; home and respite care; modifications; and rehabilitation.

Assistance is limited to out–of–pocket expenses after the receipt of any Medicare, private health insurance or other benefits for one or more of acute myeloid leukaemia; adrenal gland cancer; spina bifida manifesta; cleft lip; and/or cleft palate. In 2012–13, the total expenditure for the program was $47 593.

Study of Health Outcomes in Aircraft Maintenance Personnel Health Care Scheme

The scheme has 879 Group 1 participants and 563 Group 2 participants. Treatment costs for 2012–13 were $48 988 compared with $81 357 in 2011–12. The SHOAMP Health Care Scheme previously paid for counselling costs; however, this is now covered by VVCS. Since its inception in September 2005, the scheme has spent approximately $1.39 million on treatment and counselling services.

The Better Health Program is a voluntary GP–based program providing participants with access to screening for colorectal cancer and melanoma, and information on erectile dysfunction, depression and anxiety.

The program is open to SHOAMP Health Care Scheme Group 1 participants, and recipients of all three F–111 tiers. In 2012–13, there were 731 registered participants, and screening costs totalled $35 891.

Implementation of 2010 Government Response to the F–111 Parliamentary Inquiry

During 2012–13, the F–111 compensation team continued to determine new tier applications and compensation claims. Since May 2010, 759 tier applications have been accepted, allowing some 233 F–111 clients with compensation claims to receive compensation or health care under the Safety, Rehabilitation and Compensation Act 1988.

A performance audit on compensating F–111 fuel tank workers was conducted by the Australian National Audit Office (ANAO) with the final Audit Report No 46 of 2012–13 tabled in Parliament on 18 June 2013. DVA appreciates the ANAO’s recognition that, overall, the implementation of the F–111 support package has been administered effectively, with all 11 recommendations for DVA implemented or substantially implemented.

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