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Program 2.5: Veterans' Counselling and Other Health Services

Description

To provide a wide range of mental and allied healthcare services, including counselling and referral services for veterans, war widow/ers, serving members, former defence force members and their families.

Delivery

Ensure arrangements are in place to assist veterans to reach treatment locations through a variety of systems and transport modes. This includes reimbursing travel costs privately incurred (including financial assistance towards the costs for meals and accommodation), arranging taxi/hire car and air travel, and purchasing ambulance services from public and private sector providers.

Ensure arrangements are in place to provide an extensive range of rehabilitation aids which assist independent living and which are provided through a comprehensive system of prescribers and contracted suppliers.

Maintain arrangements with allied health providers in both the public and private sectors for the delivery of a comprehensive range of allied health services to entitled beneficiaries in order to meet their healthcare needs.

Ensure effective payment arrangements are in place for allied health providers.

Provide access to counselling services through the VVCS including use of outreach counsellors and through relevant providers in the public and private health sectors:

  • intake and referral services
  • counselling services
  • after-hours counselling
  • group program intervention.

Veterans and Veterans Families Counselling Service

A nationally accredited mental health service, VVCS provides free and confidential counselling and mental health support to current and former ADF members with at least one day of service, along with their partners and children.

Through its national, integrated, 24-hour service delivery system, VVCS continues to offer a wide range of treatment options and programs for military related mental health conditions. The service also provides relationship and family counselling and group programs to address issues that can arise due to the unique nature of military service.

The service offering includes:

  • counselling for individuals, couples and families
  • case coordination for clients with complex needs
  • group programs to develop skills and enhance support
  • an after-hours telephone counselling service
  • information, education and self-help resources, including social media and a website
  • referrals to other services or specialist treatment programs.

The VVCS clinical service delivery model recognises that military trauma from service rarely impacts on an individual in isolation; partners and children often are clients of VVCS. This family-inclusive approach enables therapeutic interventions to address the broader mental health impacts on the family that can stem from ADF service. It also supports long-term, positive family functioning.

VVCS client eligibility expanded in 2016–17. Notably, the extension of non-liability health care to cover any mental health condition greatly increased access to this important service for current and former serving members.

Over the last 12 months, treatment within the service has had an increasing focus on coordinated care for clients identified as at risk. VVCS has commenced a community coordination pilot in Townsville, the goal of which is to enhance the management of complex and/or high-risk clients; this is especially applicable to clients considered at risk of suicide. The pilot will explore whether the establishment of a care coordination team within the region, comprising a skilled VVCS clinician and a lived experience peer, who will work collaboratively within the local community, will enhance the clinical service experience of clients with complex needs. Learnings from this pilot will seek to enhance VVCS's ability to support clients to access a more holistic model of care that promotes recovery.

The 2016–17 period also saw VVCS continue to harness enabling technologies to improve the client experience. This included an upgrade to its secure, online client information system, enhancing VVCS's capacity to interact with its 1,200 clinicians nationally. Additionally, VVCS is in the design phase of a trial of a new digital platform, Synergy, which is intended to bring together integrated and interoperable applications, e-mental health tools and other resources that will enhance clinical care, as well as helping clients and their families be part of the management of their mental health.

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Number of clients receiving services

In total, 15,132 unique clients received VVCS counselling during 2016–17, down 0.15 percent on the 15,154 clients in the preceding year. A further 2,070 clients received intake support and had their concerns resolved during their initial contact with VVCS or were referred to other appropriate services; 832 clients participated in VVCS group programs. VVCS After Hours also supported clients outside centre business hours (6,622 calls were answered, an increase of 5.6 percent from 2015–16). Table 24 shows numbers of client contacts for each stream for the past five years (centre and outreach combined).

Table 24—Number of eligible persons receiving VVCS services by support stream 2012–13 to 2016–17
  2012–13 2013–14 2014–15 2015–16 2016–17
Counselling (centre and outreach) 11,687 14,136 14,627 15,154 15,132
Intake assessment not leading to counselling (including referral to alternative service) 4,232 5,526 5,350 4,783 2,070
Group programs 2,488 2,074 1,610 1,182 832
VVCS After Hours 5,306 7,050 6,571 6,269 6,622

VVCS = Veterans and Veterans Families Counselling Service

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Timeliness

VVCS aims to ensure 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 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 programs 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. Table 25 shows figures for the timeliness of the first counselling session for the past five years.

Table 25—Timeliness of first counselling session 2012–13 to 2016–17 (%)
  2012–13 2013–14 2014–15 2015–16 2016–17
Within 14 days
Centre-based 76.5 82.0 84.0 77.3 78.05
Outreach 66.1 69.0 73.0 66.3 67.67
Within 21 days
Centre-based 86.8 97.0 92.0 89.0 89.71
Outreach 81.3 82.0 86.0 81.3 82.09

Quality

The quality of service provision was high across centre-based and outreach counselling delivered during 2016–17, as measured by client satisfaction levels. This result was derived from 656 returned satisfaction surveys, which showed that 74.1 percent of clients were very satisfied and 19.2 percent were moderately satisfied (i.e. a total of 93.3 percent of clients were satisfied or very satisfied).

Complaints and compliments

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

In 2016–17, VVCS received 50 items of feedback (complaints and compliments) from clients and other stakeholders. This is separate from feedback received through the client satisfaction survey. Of the 50 items of feedback, 40 percent were compliments. Complaints centred primarily on the responsiveness of VVCS services. Table 26 shows the total number of complaints and compliments in 2016–17, compared to previous years.

Table 26—VVCS complaints and compliments 2012–13 to 2016–17
  2012–13 2013–14 2014–15 2015–16 2016–17
Complaints 24 30 35 45 30
Compliments 36 25 18 24 20
Total 60 55 53 69 50

VVCS = Veterans and Veterans Families Counselling Service

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Centre counselling

The 74 full-time equivalent VVCS staff counsellors (including program managers) provided 25,621 counselling sessions to 4,680 clients in 2016–17, compared to 25,114 sessions for 4,697 clients in 2015–16. 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 program clients.

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Outreach counselling

At the end of June 2017, VVCS had a network of 1,240 outreach counsellors located throughout Australia, of whom 797 provided services to VVCS clients in 2016–17. Outreach counsellors are qualified psychologists (83 percent) and mental health accredited social workers (17 percent), with an understanding of military culture and the veteran experience. VVCS outreach counsellors deliver services to clients who are unable to access a VVCS centre.

During 2016–17, VVCS outreach counsellors delivered 69,105 counselling sessions to 11,081 clients. This compares with 72,661 counselling sessions for 11,181 clients in 2015–16. The average number of outreach sessions per client was 6.2.

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Group programs

In 2016–17, VVCS facilitated 103 group treatment and psycho-educational programs, to 832 clients nationally (detailed in Table 27). This was a decrease from 2015–16, when 1,182 clients participated in 148 group programs.

Table 27—Group programs delivered in 2016–17
Group program Active groups
Health and wellbeing (including anxiety, depression and sleep programs) 19
Australian Defence Force transition (Stepping Out Program) 14
Operation Life 11
Residential lifestyle (including two F-111 programs) 7
Pain management 1
Anger management 14
Stress management 13
Posttraumatic stress disorder transition 2
Relationships and communication 10
Partners 5
Other (including grief and loss, parenting and resilience groups) 7
Total 103

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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 2016–17, the service managed 317 sessions nationally, compared to 293 in 2015–16.

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Veterans Line

VVCS's telephone-based counselling service, Veterans Line, is designed to assist veterans and their families outside VVCS office hours. It is delivered through a national contracted provider, On the Line Pty Ltd. During 2016–17, this service provided counselling support on 6,622 calls, compared to 6,269 calls in 2015–16.

Australian Defence Force Services

Client referrals under the Agreement between the Department of Defence and the Department of Veterans' Affairs for the Provision of Mental Health Support Services by the Veterans and Veterans Families Counselling Service (VVCS) to Australian Defence Force Personnel increased during the period, particularly in states with a large Defence presence, such as Queensland.

In 2016–17, 1,635 referrals were made to VVCS under this agreement, compared to 1,451 in 2015–16. In addition, 3,329 currently serving members self-referred to VVCS for assistance during 2016–17, compared to 2,968 self-referrals in 2015–16.

VVCS also continued to deliver the two-day Stepping Out Program for members separating from the ADF. This program aims to increase awareness of psychosocial skills and behaviours that may assist during the transition from military to civilian life. In 2016–17, 14 programs were run nationally with a total of 152 participants, the majority of whom were current serving members, from all ranks and services.

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Supporting families

In recognition of the important role of families in an ADF member's mental health recovery, client eligibility was expanded in April 2017 to include family members of current and former ADF members who died by suicide or reported suicide; siblings of ADF members killed in service-related incidents; and adult sons and daughters (over 26) of post-Vietnam War veterans. The adult children of Vietnam veterans have had unlimited access to the service since the 1999 release of the Vietnam Veterans Health Study. Additionally, in this expansion the service was made accessible to all Defence Force Abuse Taskforce complainants and their families.

In 2016–17, 2,644 children of veterans received counselling support (a total of 18,262 counselling sessions) and 47 children of Vietnam veterans were referred for psychiatric assessment.

In the 2017–18 Budget, the Government has further extended access to VVCS to partners, dependants, immediate family members and former partners of ADF personnel. The partners, children and immediate family members of veterans who have had one day of full-time service will have access to the services and support provided by VVCS, including counselling and group programs. Former partners of ADF personnel will also be able to access VVCS up to five years after a couple separates or while co-parenting a child under the age of 18.

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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.

The following workshops were delivered in 2015–16:

  • five Safe Talk half-day introductory workshops, with a total of 36 attendees (two workshops
    and 17 attendees in 2015–16)
  • six Applied Suicide Intervention Skills Training (ASIST) two-day workshops, with 60 attendees
    (15 workshops and 142 attendees in 2015–16).

In the 2017–18 Budget, the Government committed to trialling alternative suicide prevention initiatives, as well as continuing to deliver ASIST programs. VVCS will be central to rolling out these innovations over the coming year.

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Crisis assistance program

In addition to counselling support, VVCS delivers the Crisis Assistance (Time Out) Program, which provides short-term emergency accommodation for eligible Vietnam veterans (five nights maximum). The program aims to help reduce stress that might lead to family violence or family break-up. It links the client with VVCS services such as counselling, case management, and group programs that assist with managing stress.

In 2016–17, five clients accessed this program (two clients in 2015–16).

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VVCS research agenda

VVCS is committed to continually improving the service it provides and ensuring that the services are accessible and evidence based. In addition to the RESTORE trial, in 2016–17 VVCS partnered with Swinburne University to examine whether online video counselling is as effective as face-to-face counselling. VVCS also continues to collaborate with Phoenix Australia to examine the sustainability of cognitive processing therapy for clients presenting with PTSD symptomology.

Moving forward, VVCS will: collaborate with international colleagues to develop a Moral Injury Outcome Scale for currently serving members and veterans; continue to progress a trial (in the New South Wales region) to determine whether the Synergy ICT technology can augment existing veteran-centric e-mental health resources and integrate with VVCS clinical practice; modernise its suite of group
psycho-educational programs; and continue to deliver its online video counselling trial.

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Communication and marketing

VVCS continued to enhance its social media presence in 2016–17, establishing Twitter and LinkedIn accounts to complement its Facebook account and website. It also commenced a series of community mental health webinars that draw on the lived experience of members of the veteran and ex-service community, coupled with the expertise of clinical professionals, to start a community discussion on the identification, treatment and recovery from military trauma. The first webinar, ‘Military PTSD—thriving not surviving', was held in April 2017, with over 160 community members registering to attend online. Since then the video of the webinar and supporting elements (i.e. video snapshots) have been viewed over 5,000 times.

Future webinars will consider the impact of sleep disturbance on mental wellbeing and the role of families in recovery. Webinars will be accessible via the VVCS website and advertised on VVCS social media (Facebook, Twitter and LinkedIn).

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Allied health services

Allied health services are accessed by DVA clients from a range of health providers, including chiropractors, dieticians, exercise physiologists, occupational therapists, physiotherapists, podiatrists, optometrists, psychologists, social workers and speech pathologists.

At the time of reporting, 3.2 million services had been provided and billed for 2016–17, compared to 3.09 million at the time of reporting in 2015–16. Current estimates are for 3.3 million services for the full year, a 3.5 percent increase compared to 3.19 million for 2015–16. The proportion of the DVA treatment population accessing allied health services decreased to 65.0 percent in 2016–17 from 66.7 percent in 2015–16.

The average cost per allied health service increased slightly, to $68.50 in 2016–17 from $68.31 in 2015–16.

Administered expenditure for the provision of allied health services in 2016–17 was $238 million, compared to $225 million in 2015–16, an increase of 5.8 percent.

Table 28 shows the number of allied health services provided and the average cost over the past five years.

Table 28—Number of, and average cost for, allied health services 2012–13 to 2016–17
  2012–13 2013–14 2014–15 2015–16 2016–17
Number of services 3,210,538 3,216,654 3,160,972 3,181,143 3,199,855
Average fee paid ($) 65.48 66.96 67.82 68.31 68.50
Proportion of treatment population1 (%) 69.4 68.4 67.8 66.7 65.0
  1. Treatment population is measured at 30 June each financial year.

Note: Figures for previous years have been updated to reflect latest available claims data.

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Mental and social health support

In 2016–17, DVA continued to develop and provide mental and social health programs focused on the needs of serving and ex-serving ADF personnel and their families to improve their health and wellbeing.

DVA recognises that clients need access to a range of services and programs at various stages of life: from social health programs that provide general health and wellbeing information and encourage social engagement, to the provision of more intensive support, such as mental health treatment.

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Social health programs

DVA partnered with ex-service and community organisations to hold the annual Veterans' Health Week in 2016–17. This year's theme of ‘Social Connection' recognised the importance of relationships with family, friends, colleagues and neighbours to an individual's health and wellbeing, as well as the positive social connections fostered through community groups like ESOs. Approximately 15,000 people attended 300 events across the nation.

Over 250 active Men's Health Peer Education volunteers provided health information to members of the veteran and ex-service community. DVA also supported the popular 10K Steps National Walking Challenge, with 159 teams from the serving and ex-service communities completing the four-week challenge.

DVA continued to provide the Heart Health program, a structured 12-month physical activity and health education program aimed at improving the general wellbeing of participants. In 2016–17, 896 participants enrolled and completed the Heart Health program.

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Mental health programs and services

DVA is committed to supporting veterans experiencing a mental health condition and this year concluded a 12-month Peer to Peer Support Network Program pilot in Sydney and Townsville. Following five successful peer mentor workshops conducted in pilot locations, 35 mentor relationships were established during the life of the pilot. The pilot is being evaluated to inform the future of this program.

DVA's digital self-management products continued to attract licensing requests from national and international organisations for adaptation to specific populations in 2016–17. In late 2016, DVA released updates to the High Res resilience website to help serving and ex-serving ADF members cope better with stress and build resilience. DVA continued to use social media to promote the digital self-management support options available to the serving and ex-serving community. Social media continued to prove to be an effective way to reach a younger demographic of the ex-service community who may wish to access support online.

DVA funded trauma recovery programs in hospitals across Australia for the treatment of PTSD. During 2016–17, there were 13 hospitals contracted to DVA that were providing these services. In July 2016, DVA introduced national accreditation standards for trauma recovery programs for the treatment of PTSD. The standards provide a framework for improving the quality of services to veterans and draw upon evidence-based interventions for PTSD and its common comorbidities.

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Provider services and training

In 2016–17, DVA continued to strengthen the capabilities of health professionals to deliver quality care for veterans. DVA commenced a pilot webinar series offering health professionals an opportunity to participate in expert panel discussions on issues commonly arising from their veteran mental health clinical practice. The pilot seeks to test whether this delivery method assists health professionals to better support the needs of veterans, deliver evidence-based treatment and develop collaborative care practices. In 2016–17, four webinars occurred on the topics of understanding the military experience, PTSD, sleep disorders and substance use disorder. An average of approximately 1,000 participants attended each webinar. The pilot is expected to continue in 2017–18.

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Travel for treatment

In 2016–17, DVA processed 143,256 travel for treatment reimbursement claims under the Repatriation Transport Scheme, a decrease of 2.24 percent compared to 146,537 claims in 2015–16. There was a reduction in overall processing times with 99 percent of claims processed within 28 days, compared to 97.2 percent in 2015–16.

The ability for clients to lodge travel claims online through MyAccount continued to make it easier for clients to do business with DVA and has increased acceptance of online travel reimbursement under all three Acts. The number of online claims submitted to DVA in 2016–17 increased by 8.79 percent to 91,831, compared to 84,414 claims in 2015–16.

Arranged travel through the Booked Car with Driver scheme continued to be an important service for the aged and frail veteran community, as evidenced by the 1,323,956 person trips completed in 2016–17. This represents a 9.25 percent increase compared to 1,211,805 trips in 2015–16.

Table 29 shows activity under the two travel schemes over the past five years.

Table 29—Claims for reimbursement and arranged transport 2012–13 to 2016–17
  2012–13 2013–14 2014–15 2015–16 2016–17
Claims for reimbursement 165,137 159,905 150,871 146,537 143,256
Arranged transport trips (BCWD) 955,954 1,002,844 1,273,128 1,211,805 1,323,956

BCWD = Booked Car with Driver

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Aids and appliances

Expenditure for aids and appliances totalled $145.6 million in 2016–17 (including Rehabilitation Appliances Program expenditure of $142.7 million and Medical Grade Footwear program expenditure of $2.91 million). Approximately 82,500 DVA clients received aids and appliances in 2016–17.

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Medical Grade Footwear

The Medical Grade Footwear program provides eligible DVA clients with clinically approved modified footwear. In 2016–17, the program assisted 5,756 clients with 5,486 pairs of ready-made medical-grade footwear and 270 pairs of custom-made medical-grade footwear.

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Essential Medical Equipment Payment

The Essential Medical Equipment Payment covers the additional costs of running essential medical equipment or medically required heating and cooling. In 2016–17, approximately 3,327 claims were paid, with total expenditure of $549,000.

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