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Programme 2.5: Veterans’ Counselling and Other Health Services

Objective

Programme 2.5 provides a wide range of mental and allied health care services, including counselling and referral services for veterans, war widows and widowers, serving members, former Australian Defence Force members and their families. The programme also supports veterans with aids and appliances, and travel for treatment.

Overview

The provision of effective mental health support for veterans and their families continued as a high priority for the Government in 2013–14. DVA introduced a range of innovative mental health care resources for the veteran community, with a focus on modernising and streamlining services to improve access to early treatment, and ensuring a high standard of treatment.

Throughout 2013–14, the demand for allied health services continued to rise, largely due to the ageing of the DVA population. In addition, there was and will continue to be an increased demand for mental health services for the younger cohort of veterans and their families. DVA is committed to delivering allied health services that are meeting the needs of all veteran cohorts, across ages and experiences.

DVA supported veterans with a range of aids and appliances to help keep veterans in their homes longer.

Expenses

Administered and Departmental expenses – Programme outcomes against Budget
  2013–14 PBS ($m) Estimated actual 2013–14 ($m) Outcome 2013–14 ($m)
Administered 618.4 639.1 628.3
Departmental 49.4 47.7 33.0
Total resources 667.8 686.8 661.3

PBS = Portfolio Budget Statements

Deliverables

Deliverables – Programme outcomes against Budget projections
  2013–14 PBS Estimated actual 2013–14 Outcome 2013–14
Health Treatment Card Holder Population 211,000 215,900 217,562
Travel for Treatment      
Number of processed claims for reimbursement 137,258 156,253 159,905
Number of DVA arranged person trips 903,220 1,025,000 1,002,844
Veteran Counselling      
Number of unique clients receiving intake referral services 12,500 12,500 14,108
Number of unique clients in receipt of counselling 10,800 10,800 14,136
Number of counselling sessions delivered 63,000 63,000 89,513
Number of calls received by the After Hours Counselling service 6,700 6,700 7,050
Number of unique clients receiving group programme intervention 3,200 3,200 2,074

PBS = Portfolio Budget Statements

Key performance indicators

Key Performance Indicators – Programme outcomes against Budget target
  2013–14 PBS Estimated actual 2013–14 Outcome 2013–14
Price: Unit cost per cardholder 215 205 141
Travel for Treatment      
Target percentage of claims for reimbursement processed within the Service Charter timeframe (28 days) 100% 100% 93.18%
Degree of complaints about arranged travel relative to the quantity of bookings 0.05% 0.05% 0.03%
Rehabilitation Appliances      
Cost: Attributed across treatment population 718 664 790
Number of broad categories of aids and appliances available to the veteran community listed in the RAP Schedule 251 251 251
Percentage of aids and appliances listed may be prescribed by General Practitioners, Registered Nurses and Occupational Therapists 95% 95% 95%
Veteran Counselling      
Percentage of unique clients presenting for service who receive attention by an Outreach contracted Counsellor within two weeks of intake 64% 63% 69%
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% 82%
Level of veteran satisfaction High High High

PBS = Portfolio Budget Statements

Report on performance

Veterans and Veterans Families Counselling Service

Members of the veteran and ex-service community and their families who are experiencing service-related mental health and wellbeing conditions continue to seek help from the Veterans and Veterans Families Counselling Service (VVCS).

The service is free and confidential and offers a wide range of therapeutic options and programmes for war and service-related mental health conditions such as posttraumatic stress disorder, anxiety, depression, sleep disturbance and anger. VVCS also provides relationship and family counselling to address issues that can arise due to the unique nature of the military lifestyle. VVCS counsellors have an understanding of military culture and can work with clients to find effective solutions for improved mental health and wellbeing.

VVCS continues to undergo a period of change, with increasing client numbers, changing client demographics due to the drawdown of troops from the Middle East Area of Operations and an ageing Vietnam-era client cohort. Within this context, VVCS commenced a functional review in 2013–14 to identify potential enhancements to administrative and clinical efficacy in order to ensure that it is well positioned to provide the best possible client outcomes into the future. Review outcomes will be considered in 2014–15.

Business improvement has also been underpinned by the introduction of the VVCS Electronic Records Application (VERA), updates to internal clinical and governance policies and changes to the service delivery model in some locations in regional Australia.

VERA is a highly secure, electronic framework that is transforming the way clinical service providers interact with VVCS. It also has the capacity to interact with the Australian Government’s personally controlled electronic health record system, should a client elect to do so. VERA assists in empowering clients by providing them with greater control over their personal health information relating to VVCS services.

VVCS has also continued to enhance workforce capability in 2013–14, with an ongoing focus on embedding cognitive processing therapy and family inclusive practice in its service mix.

VVCS also prepared for an expansion of client eligibility on 1 July 2014. This has included development of training for centre-based and outreach clinicians, promotional work, facilitating legislative change and internal policy refinement. Part of this preparation has included the launch, by the Minister for Veterans’ Affairs, of a VVCS standalone website (www.vvcs.gov.au) and social media presence to provide additional pathways for younger members of the veteran community and their families to connect to VVCS.

Number of clients receiving VVCS services

In total, 14,136 clients received an episode of counselling from VVCS in 2013–14, with some clients receiving multiple care episodes during the year. This is an increase on the 11,687 counselling episodes provided by VVCS in 2012–13. In addition, 2,074 clients participated in group treatment or psycho-educational programmes and 5,526 clients had their concerns resolved during their initial contact with VVCS (during intake), or were referred to a more appropriate service. The VVCS after hours crisis line, Veterans Line, received 7,050 calls in 2014–15. Table 25 shows numbers of client contacts for each stream for the past five years (centre and outreach combined).

Table 25: Number of eligible persons receiving VVCS services by support stream 2009–10 to 2013–14
  2009–10 2010–11 2011–12 2012–13 2013–14
Counselling (Centre/Outreach) 9,063 9,456 10,314 11,687 14,136
Intake assessment not leading to counselling (including referral to alternative service) 2,348 2,972 3,354 4,232 5,526
Group programmes 3,181 3,395 2,897 2,488 2,074
Veterans Line 4,610 5,332 5,497 5,306 7,050

Timeliness of services

VVCS aims that all clients in crisis receive clinical intervention and/or referral to specialist services at the point of initial contact with VVCS (i.e. as part of the clinical intake process). The intake process, which is undertaken by a qualified VVCS centre-based counsellor, includes an initial assessment, support and advice, and a determination of the most appropriate ongoing support (or referral) for each client.

Allocation to VVCS counselling or group programmes is arranged for clients who need ongoing support. Allocation depends on the clinical needs of the individual client. 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.

During 2013–14, of those clients progressing to centre-based counselling, 82 per cent received their first counselling session within 14 days and 97 per cent within 21 days. Of those clients referred to outreach-based counsellors, 69 per cent received their first counselling session within 14 days and 82 per cent within 21 days. Table 26 compares 2013–14 time to receive the first counselling session against the past three years.

Table 26: Timeliness of first counselling session 2010–11 to 2013–14
  2010–11 2011–12 2012–13 2013–14
Within 14 days        
Centre based 71.5% 76.7% 76.5% 82%
Outreach 51% 64.8% 66.1% 69%
Within 21 days        
Centre based 84.4% 87% 86.8% 97%
Outreach 69% 79% 81.3% 82%

Quality

The quality of service provision across all counselling and group programmes delivered during 2013–14, as measured by client satisfaction levels, was high. This result was derived from 1,885 returned satisfaction surveys which showed that 75 per cent of clients were very satisfied and 18 per cent were moderately satisfied.

Complaints and compliments

VVCS records all formal complaints and compliments received. This information provides a valuable tool to identify inconsistencies in service delivery and is used to target improvement activities.

In 2013–14, VVCS received items of feedback (complaints and compliments) from clients and other stakeholders. This is separate to feedback received though the client satisfaction survey. Of this feedback, 45 per cent were compliments. Complaints centred primarily around the responsiveness or accessibility of VVCS services. Table 27 shows the total number of complaints and compliments in 2013–14 compared to previous years.

Table 27: VVCS complaints and compliments 2011–12 to 2013–14
  2011–12 2012–13 2013–14
Complaints 45 24 30
Compliments 35 36 25
Total 80 60 55

VVCS services

Centre counselling

The 67 full-time equivalent VVCS staff counsellors (including programme managers) provided 19,401 counselling sessions to 3,513 clients, compared with 21,780 sessions to 4,366 clients in 2012–13.

The average number of sessions per client was 5.5. In addition, centre counsellors provided intake counselling, case management for clients with complex needs and coordination and clinical oversight of outreach programme clients and management of group programmes.

Outreach counselling

At the end of June 2014, VVCS had a network of 921 outreach counsellors located throughout Australia, of whom 722 provided services in 2013–14. Outreach counsellors are qualified psychologists (84 per cent) and mental health accredited social workers (16 per cent), with an understanding of military culture and the veteran experience. VVCS outreach counsellors deliver services to clients unable to access a VVCS centre.

During 2013–14, VVCS outreach counsellors delivered 71,852 counselling sessions to 10,623 clients. This compares with 51,283 counselling sessions to 8,520 clients in the preceding year. The average number of outreach sessions per client was 6.9, compared to 6 in previous two years.

Group programmes

In 2013–14, VVCS facilitated 247 group treatment and psycho-educational programmes, to 2,074 clients nationally (detailed in Table 28). This was a decrease from 2013–14, when 2,488 clients participated in 308 group programmes.

Noting the ongoing decline in group programme participation, VVCS has completed a review of its group programmes and will look to more effectively tailor these services for contemporary clients over coming years.

In addition, noting its social health content, in 2013–14 ongoing policy development for the Heart Health and Stepping Out programmes were transferred to the Department’s Health and Community Services Division. VVCS continued to operate Stepping Out programmes nationally.

Table 28: Group programmes delivered in 2013–14
Group programme Active groups
Health and wellbeing (including anxiety, depression and sleep programmes) 56
ADF transition (Stepping Out Program) 32
Operation Life 11
Residential Lifestyle (including two F-111 programmes) 23
Partners Groups 12
Anger management 17
Stress management 25
Posttraumatic stress disorder transition 14
Relationships and communication 14
Pain management 15
Sons and daughters 1
Other (including Ageing, Parenting and Resilience groups) 27
Total 247

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 2013–14, the service managed 126 cases nationally (compared to 57 in 2012–13).

Veterans Line

Veterans Line is VVCS’s after-hours crisis counselling service. It is designed to assist veterans and their families in coping with crisis situations outside VVCS office hours. It is delivered through a national contracted provider, On the Line Pty Ltd.

During 2013–14, Veterans Line received 7,050 calls, compared with 5,306 calls in 2012–13. Average call duration was 12 minutes.

The call-back service for clients at significant risk of suicide or self-harm allows for more systematic risk assessment, management and referral for after hours, weekends and public holiday periods. It allows coordinated management of high-risk clients and aims to provide a seamless risk management response. In 2013–14, the service made 122 call-backs to VVCS clients, compared to 52 call-backs in 2012–13.

Australian Defence Force services

The VVCS provides mental health support services to Australian Defence Force (ADF) personnel under an agreement between DVA and the Department of Defence.

In 2013–14, 911 referrals were made to VVCS under this agreement, compared with 1,181 in 2012–13. In addition, 2,815 currently serving members, self-referred to VVCS for assistance during 2013–14 compared with 3,566 self-referrals in 2012–13.

VVCS also continues to deliver the two-day Stepping Out Program for members separating from the ADF. This programme aims to increase awareness of psycho-social skills and behaviours that may assist during the transition from military to civilian life. In 2013–14, 32 programmes were run nationally with 308 participants, most of whom were current serving members from all ranks and services. These numbers are similar to 2011–12.

Supporting sons and daughters

VVCS seeks to support the mental health of the sons and daughters of Australia’s serving men and women and to reduce their suicide risk by establishing partnerships with local services to ensure that they receive appropriate care and by supporting self-help initiatives and projects that aim to increase their personal strength, resilience and coping skills.

VVCS services are available to the sons and daughters of Vietnam veterans of any age, and the dependent children of other veterans up to the age of 26. Services include intake and assessment, counselling, referral, psychiatric assessments (for the children of Vietnam veterans), group programmes and information sessions.

In 2013–14, 1,859 sons and daughters received support through VVCS, including 1,502 sons and daughters who received 11,282 counselling sessions, and 77 sons and daughters of Vietnam veterans were referred for psychiatric assessment. In addition, VVCS delivered one targeted group programme to eight sons and daughters.

Communication and marketing

VVCS continued to facilitate clear, regular communication with its clients and stakeholders throughout 2013–14. VVCS centres continued to hold a range of regional consultative forums and meetings to capture the views of clients, stakeholders and advocacy groups.

VVCS is aware of the need to maintain current high levels of support to Vietnam veterans and their families, as well as the need to ensure that VVCS services, and how information about them is communicated, address the needs of, and encourage participation by, contemporary veterans and their families. The relevance of communication channels, and their content, will continue to be reviewed on a regular basis and updated as appropriate.

Operation Life workshops

Operation Life provides a framework for action to prevent suicide and promote mental health and resilience across the veteran community. Its major components include a set of three suicide prevention workshops, along with support services for the veteran community.

Operation Life workshops delivered in 2013–14 were:

  • five Safe Talk half-day introductory workshops, with a total of 40 attendees (seven workshops and 62 attendees in 2012–13)
  • five Applied Suicide Intervention Skills Training two-day workshops, with 49 attendees (five workshops and 46 attendees in 2012–13)
  • one Tune Up workshop, with two attendees who had previously attended an Operation Life workshop (two workshops and seven attendees in 2012–13).

Noting the continued decline in participation rates, VVCS will work to identify opportunities to expand penetration of this programme.

Crisis Assistance Program

The Crisis Assistance Program provides assistance to Vietnam veterans who are experiencing a family crisis. Accessed through Veterans Line, 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 programmes conducted through the VVCS. In 2013–14, four clients accessed this programme. This compares to three clients in 2012–13 and four clients who had accessed the programme in the previous two years.

F-111 Deseal/Reseal Support Program

In response to the 2009 parliamentary inquiry report Sealing a Just Outcome: Report from the Inquiry into RAAF F-111 Deseal/Reseal Workers and their Families, VVCS delivers residential lifestyle management programmes designed to meet the specific needs of former F-111 personnel and partners, who are also eligible for the full range of VVCS counselling and group programme services.

In 2013–14, VVCS delivered three F-111 lifestyle management programmes (two in south-east Queensland and one in Sydney) for 69 participants comprising 40 former F-111 personnel and 29 partners. This compares with five programmes that were held in 2012–13 accommodating 34 former F-111 personnel and 24 partners.

Mental health support

The Veteran Mental Health Strategy 2013–23 continues to provide a framework for the delivery of mental health services to the ex-service community. This includes the development of online mental health educational resources and self-help tools to assist in the prevention and early identification of mental health issues. These tools seek to promote mental health and wellbeing, remove barriers to help-seeking behaviour, and reduce the stigma associated with mental illness.

An enhanced version of the ON TRACK with The Right Mix alcohol management mobile phone application was released in 2013–14. It enables users to get a visual depiction in graph form of how their drinking behaviour is impacting their wellbeing and fitness over time. It is based on data collected by users on the number and types of drinks they consume, and when, and the amount of money they spend.

Other online resources developed in 2013–14 included the Operation Life Online website to raise awareness and help prevent suicide in the veteran community and a mobile-compatible version of the At Ease website.

The new and existing online products were well received, as indicated by the number of website visits and mobile application downloads.

Website visits for 2013–14:

  • At Ease – 89,537
  • The Right Mix – 14,073
  • Operation Life Online – 4,768.

Mobile app downloads for 2013–14:

  • PTSD Coach Australia – 10,237
  • ON TRACK with The Right Mix – 5,453.

Online resources for mental health providers

The Department continues to use online technology as a sustainable delivery method for training mental health providers to support their care for the veteran community.

In 2013–14, DVA developed a new online e-learning programme for clinicians to address the complexities involved in veterans’ mental health. Veterans commonly present with comorbid disorders and complex needs that require careful treatment planning. The new programme assists health providers to set priorities for patient care.

DVA also created two new YouTube videos to improve providers’ understanding of how veterans can be affected by their military experience and ways to include evidence-based treatments in their consultations.

One video demonstrates how to effectively incorporate DVA’s PTSD Coach Australia mobile device application into treatment for PTSD, to help the client manage their symptoms on a day-to-day basis. In the other video, Mental Health Professionals – Delivering Positive Health Outcomes for Veterans, veteran mental health specialists discuss understanding and engaging effectively with veterans.

Social media

Social media is an effective mechanism for engagement and early intervention, and communicating positive mental health messages.

During May–June 2014, DVA ran a social media campaign on Facebook. It promoted the stories of serving and ex-serving personnel, veterans and their families that are an important aspect of the At Ease website. The aim was to raise awareness of mental health issues among veterans and families and to increase awareness of the At Ease website as a support tool. As at 30 June 2014, the campaign had received wide interest with over 5.8 million views and generated 24,428 clicks through to the At Ease website.

Social health programmes

In 2013–14, DVA further revised the Men’s Health Peer Education (MHPE) programme’s resource material for volunteers. A national workshop was held in March 2014 and a survey of volunteer activities was undertaken during the year. The findings indicated that volunteers were undertaking between 15 and 20 hours of MHPE programme activities each month. The main activities were one-on-one talks with men and specific activities during Veterans’ Health Week.

Veterans’ Health Week was held in October 2013, with a theme of physical activity. The number of events held increased to 189, up from 172 in 2012. Attendance also increased to around 14,000, up from 13,000 in 2012.

Allied health services

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

Payments to allied health providers are made through the Department of Human Services on behalf of DVA.

Number of allied health services

During the 2013–14 reporting period, there were 3.1 million allied health services provided to eligible clients compared to 3.07 million as at the same time in 2012–13. The estimate for the full 2013–14 year is approximately 3.2 million, a slight increase on the previous year. This is largely due to the growing demand for allied health services from the ageing population, who have chronic conditions and more complex care needs. It is also due to the addition of new cardholders who previously accessed services under the Safety, Rehabilitation and Compensation Act 1988 arrangements.

Average cost per allied health service

The average cost per allied health service increased slightly to $66.88 in 2013–14, from $65.46 in 2012–13. This reflected the broader range of services provided and indexation of fees paid to providers. The 2013–14 average is expected to increase slightly as payment for further claims for services are processed before the end of 2013–14.

Administered expenditure for allied health

Administered expenditure for the provision of allied health services in 2013–14 was $240 million compared with $225 million in 2012–13, an increase of 6.7 per cent. This was largely due to the increased demand for allied health services for an aging population together with fee increases.

Percentage of veteran population using allied health services

In 2013–14, 67.5 per cent of the veteran population accessed allied health services compared with 68.3 per cent in 2012–13. Table 29 shows the number of allied health services provided and average cost over the past five years.

Table 29: Number of, and average cost for, allied health services 2009–10 to 2013–14
  2009–10 2010–11 2011–12 2012–13 2013–14
Number of services 2,807,413 2,960,881 3,132,355 3,202,633 3,107,334
Average fee paid $61.21 $62.33 $63.62 $65.46 $66.88
Proportion of treatment population1 68.4% 69.1% 69.7% 68.3% 67.5%

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

Exercise physiology

A review of exercise physiology usage in 2013 found exercise physiology expenditure had increased substantially since the inception of the programme in 2007. Significant factors in the rising cost of exercise physiology services are the increasing number of clients accessing treatment and the growing number of treatments per client. Most exercise physiologists are compliant with DVA arrangements, however, instances of inappropriate practices and over-servicing were found among a small number of providers.

In July 2013, the Repatriation and Military Rehabilitation and Compensation Commissions agreed to a revised fee schedule for exercise physiology treatment to align more closely with comparable DVA allied health provider arrangements.

These changes, which provide clarity on existing services, came into effect on 1 November 2013, following consultation with Exercise and Sports Science Australia (ESSA), the national accreditation body for exercise physiologists.

DVA and ESSA are undertaking an education campaign for providers to increase their understanding of DVA’s arrangements for exercise physiology services.

Travel for treatment

In 2013–14, DVA processed 159,905 travel for treatment reimbursement claims under the Repatriation Transport Scheme, a decrease of 3.2 per cent compared to 2012–13 when 165,137 claims were processed.

There was a slight decline in processing times, with 93.18 per cent of claims being processed within 28 days this year, compared to 99.1 per cent last year. DVA has worked hard to identify ways to process claims more quickly to reduce waiting times for reimbursement. This is expected to further improve processing times over the next financial year.

DVA has made it easier for clients to lodge travel claims online through MyAccount, including expanding the type of claims that can be lodged. This has increased acceptance of online travel reimbursement under all of the Acts (VEA, MRCA and SRCA), and increased the number of online claims submitted to DVA.

Arranged travel through the Booked Car with Driver Scheme is an important service for the aged and frail veteran community, as evidenced by the 1,002,844 person trips completed in 2013–14. This represents a 4.9 per cent increase compared to 2012–13 where 955,954 trips were completed, and is commensurate with the ageing veteran population.

Table 30: Claims for reimbursement and arranged transport processed by DVA 2009–10 to 2013–14
  2009–10 2010–11 2011–12 2012–13 2013–14
Claims for reimbursement 168,991 156,854 145,880 165,137 159,905
Person trips 827,682 790,114 877,521 955,954 1,002,844
Cost (million) $151.5 $152.5 $158.3 $163.6 $175.8

Note: Figures for the number of DVA-arranged person trips for 2010–11 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 $171.8 million in 2013–14 (including Rehabilitation Appliances Program (RAP) expenditure of $154.27 million; HomeFront expenditure of $13.5 million; and Medical Grade Footwear expenditure of $3.58 million). A total of 142,353 beneficiaries received aids and appliances in 2013–14.

Medical grade footwear

The Medical Grade Footwear programme provides eligible beneficiaries with clinically approved modified footwear. In 2013–14, the programme assisted 7,357 beneficiaries with 6,955 pairs of ready-made medical grade footwear and 2,878 pairs of custom-made medical grade footwear. Expenditure for this year totalled $3.58 million.

Essential Medical Equipment Payment

The Essential Medical Equipment Payment covers the additional costs of running essential medical equipment or medically required heating/cooling. In 2013–14, approximately 3,900 claims were paid, with a total expenditure of $513,323.

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