Hinapōuri ki Hīnātore Study: The development of integrated care measures for specialist mental health and addition services in New Zealand

Background: People accessing specialist mental health and addiction services (PA-SMHAS) have an increased risk of preventable comorbidities and premature mortality. There are calls for better integration within SMHAS in New Zealand (NZ), connecting PA-SMHAS with other parts of our health and social system. However, measures to track, benchmark and evaluate integrated care are lacking.

 

Approach: Our study addresses this gap by developing and testing two integrated care measures in partnership with people with lived experience of mental distress. This presentation describes the development of the measures (one each for PA-SMAHAS and Staff) and theoretical models underpinning these.

 

Our approach is founded on three models of integrated care. One, developed by Singer in inpatient medical care settings conceptualises integrated care as coordinated across professionals, services and support systems, over time, and focused on patient and family needs and preferences. This is important because it explicitly includes patients’ needs and preferences; not only coordination between service ‘siloes’.

 

The second, World Health Organization model, emphasises people-centredness in integration, rather than person-centredness, allowing for clear consideration of caregivers, family and communities. The third, People Centred Joined Up Care model (PCJUC), is deliberately based on PA-SMHAS’ perspectives of integration, from qualitative research by some of our team with key stakeholders, including Māori and people with lived experience.

 

Results: Prior to our study, members of our team, together with Singer and others, developed a measure of staff perspectives of integrated care in the US. A measure developed and tested in the US may not be appropriate in NZ, therefore we held workshops with Staff to modify the measure for NZ’s SMHAS. The resulting Joined Up Supports Tool-Staff (JUST-Staff) was tested for feasibility of administration within one SMHAS team in 2019, before inviting 695 SMHAS staff in one NZ health district to participate in a pilot in 2020; 319 (46%) staff participated. JUST-Staff comprises 21 items relevant to NZ’s SMHAS, with three questions related to each of Singer’s seven integrated care domains.

 

Staff perspectives are important because staff provide services to many people and are therefore well-placed to recognise integration – and its absence. However, Staff perspectives alone are insufficient; perspectives of PA-SMHAS are also required. Underpinned by the PCJUC model, an integrated care measure was developed for PA-SMHAS – the Joined Up Supports Tool (JUST). JUST was refined via focus groups and workshops with PA-SMHAS, reducing the number of items from 31 to 25, before inclusion in a postal feasibility study with 85 PA-SMHAS; 35 (39%) people participated.

 

Implications: JUST and JUST-Staff have now been used in surveys of PA-SMHAS (n=532) and Staff (n=481) and found to differentiate between services with ‘high’ and ‘low’ levels of integration as assessed by both PA-SMHAS and Staff. Models of care and performance indicators are often introduced without fully understanding their appropriateness for people they are intended to benefit – and without understanding appropriateness for Māori. Māori and people with lived experience have been involved at every stage of developing and planning our two measures of integrated care.