RDNS/VAC Partnership agreement – A successful and innovative model
Liz Crock (Clinical Nurse Consultant HIV/AIDS Royal District Nursing Service and John Hall, Manager HIV Services Victorian AIDS Council)
Introduction
• RDNS employs 1,336 people across Melbourne. • VAC employs 47 people (many P/T or casual)
The Partnership Agreement
• Informal partnership began in 1985 to develop a strong community-based home care scheme • Pilot project began in 1987 which was evaluated in 1989-90 – arrangement was then formalised in a Memorandum of Understanding • Revised and renewed in 2006
RDNS catchment area
• Nurses work out of 23 centres across Greater Melbourne. • VAC covers similar catchment area
Target population
• People living with HIV/AIDS at home requiring district nursing support and additional community supports
Target population - 50% mutual clients
RDNS clients – 120 • 63% have mental health problems and/or drug and alcohol; • Up to 22% CALD background • 47.5% live alone • Most on DSP and live in public housing • 2/3 referred from hospital, some self-referred, 7 from VAC
VAC clients – 89 • 25 ‘significant others’ • 46 mental health issue • 6 CALD background • 52 live alone • most on DSP and in public housing • 20 self referred, 10 referred by RDNS.
Objectives of the Partnership agreement
• Ensure philosophies of VAC/RDNS upheld • Ensure access to RDNS and VAC services • Ensure provision of 24 hour nursing care home based trained volunteer support if needed • Facilitate access to other specialist services • Mutual input into educational programs of each service • Provide advocacy on behalf of clients of each service • Response to current and future changes in the epidemic
Services available
• • • • • • • Nursing care Allied health support Volunteer support Other VAC services Training and education Pastoral care/spiritual linkages Debriefing
How integration is done
• Collaborative approach for referral/assessment/care planning • Monthly team meetings • RDNS attendance at key CSP meetings and functions • Representatives of CSP and RDNS on interview panels • Documentation in home accessible • RDNS invited to VAC debriefing • RDNS facilitating education and training as needed
Challenges
Challenge for RDNS working with volunteers Communication Blurring roles Acute sector often doesn’t value what already exists • Ongoing education for workforce • Recruitment and maintenance • Chronic understaffing • • • •
Resource requirements
• RDNS – 3 CNCs cross regional. 2003 – 2 fulltime HIV Resource Nurses at 2 high case load centres. Liaison nurse. Other RDNS staff as needed. • RDNS - new role – Mental Health D and A CNC – pilot project • VAC - 3 Client Support Officers, Team Leader and 85 volunteers • Both organisations have Educator roles
Resource requirements - training
• Education for CNCs • Education for CSOs – have access to RDNS education
Outcomes
• Social determinants of health – i.e. people resourced, linked in, translates to better health • Client satisfaction high – trust and confidence • 468 transport to medical appointments not counting other transport • Lack of joint data on outcomes – need project
Why the program is successful/innovative
• Integrated service ensures better care coordination, quick response • Join representation on committees • Joint submissions • Regular meetings • After hours phone support • Timely feedback to clinical staff • Includes In Home Support Program
(continued)
• Interventions such as formal case conferences for ‘at risk’ clients to plan consistent and responsive care • Improves access to both services for marginalised clients • Can work collectively according to VAC charter around broad purposes such as social justice, social change – we are strategic partners in community based response • Together we have a stronger voice.
Translatability
• Would readily translate to other states/regions who have dedicated HIV team within a nursing service, and who have similar volunteer service for PLWHA • Some states have similar but informal arrangements • Makes sense to formalise arrangements – RDNS as VAC ‘clinical arm’ working collaboratively across a range of services