Maintaining and enhancing the quality of life of clients by improving their physical and mental wellbeing.

Achievements in 2018–19

Support during transition to civilian life

In 2018–19 DVA continued to work closely with Defence to improve the transition process for veterans and their families, particularly where a member suffers a serious injury or illness or is going through medical separation from the ADF. This ensures that transitioning members and their families can access the right services and support to help them prepare for civilian life.

DVA and Defence use the Early Engagement Model (EEM) to coordinate their response to members who are transitioning to civilian life. Under the EEM, Defence notifies DVA of members who are transitioning for medical reasons. DVA’s On Base Advisory Service then uses the EEM information to ensure that we:

• contact (or attempt to contact) everyone who is transitioning out of the military
• send a White Card to eligible transitioned personnel to cover treatment for any mental health condition, regardless of whether it is service related
• give the transitioning member information about Non-Liability Health Care for all mental health conditions
• check that members with minimum one day of continual full-time service have received and understand how to use their White Card
• make referrals to higher level supports within DVA, such as Case Coordination and Case Management, including the Wellbeing and Support Program.

The Wellbeing and Support Program provides an intensive case management service for transitioning and ex-serving veterans who require additional support. Each veteran is supported by a contracted specialist case manager who coordinates clinical care and helps them to access DVA and community support services. The case manager works closely with DVA to ensure the veteran receives the right level of support from their treating practitioners and community supports.

In 2018–19 DVA continued to prioritise transitioning personnel under the EEM. We issued White Cards to 2,459 transitioning personnel who had not otherwise made DVA claims.

Reductions in claim processing times for medical, dental and allied health services

In 2018–19, as a result of payments and reimbursements business process improvements, DVA achieved a reduction in time taken to process (TTTP) from an average of 25 days as at 30 June 2018 to an average of 19 days as at 30 June 2019. We also increased the percentage of claims processed within 28 days to 85 per cent.

Also in 2018–19 we streamlined our business processes for the management of declined health entitlement requests. And as a result we have improved response times for more complex requests requiring further review.

DVA is undertaking a review of its pharmacy programs to ensure key programs, governance structures and processes are consistent with current industry standards and support the wellbeing of our veterans.

Improved use of medicines and health care services

The Veterans’ Medicines Advice and Therapeutic Education Services (Veterans’ MATES) program aims to improve the use of medicines and related health services in the veteran community. Veterans’ MATES uses DVA’s health claims data to identify emerging trends in health care and medicine and provide the latest evidence-based information to the veteran community, the veteran’s GP and allied health care providers.

In 2018–19 Veterans’ MATES focused on four topics:

• Topic 3, 2018—Proton Pump Inhibitors
• Topic 4, 2018—Dry mouth
• Topic 1, 2019—Cognitive impairment
• Topic 2, 2019—Insomnia.

Veterans’ MATES will be focusing on the following topics for the remainder of 2019:

• Topic 3—Renal impairment
• Topic 4—Diabetes.

Enhanced access to rehabilitation aids and appliances

In 2018–19 the Nous Group delivered a report on DVA’s rehabilitation appliance services. We will be implementing recommendations that will enhance veterans’ access to rehabilitation aids and extend eligibility for some items.

Additional items have also been included on the National Schedule, which has helped us to cater for the wellbeing of eligible clients and facilitate their greater participation in the community. Specifically, eligibility for electric mobility aids has been extended to all veterans who hold a Gold Card and have a medically assessed need for the item. To enable clients to remain independent in their own homes, rails and ramps will now be provided so that individuals can access many more areas of their house, including gardens and sheds.

Health provider compliance audit

DVA conducts assurance reviews of health provider compliance to ensure that veterans receive clinically necessary treatment. We also collaborate with the Department of Health and peak bodies to highlight and improve provider compliance.

In April 2019 DVA engaged Medibank Health Solutions to audit its hospital arrangements. The audit work will assess quality and appropriateness of hospital services, including data analysis for the Preventable Re-admissions Quality Initiative, as well as addressing payment integrity for hospital services.

New Veterans' Home Care assessment agencies

The Veterans’ Home Care (VHC) program provides home care services that help veterans to maintain their health, wellbeing and independence. It provides a small amount of practical help to assist veterans to continue to live at home. VHC assessment agencies assess veterans’ needs, approve services and arrange for those services to be carried out by a contracted service provider.

In February 2019 following an open tender process, DVA awarded contracts for a new panel of VHC assessment agencies.

Overall, the number of assessment agencies decreased from 12 to seven. This is because of the declining number of VHC clients and the need to maintain the veteran population for each assessment agency at an appropriate level so that VHC businesses can remain viable through the life of the contract.

New Patient Experience Survey

During 2018 DVA developed the new Patient Experience Survey designed to measure a veteran’s experience of care while they are an inpatient in a DVA contracted private hospital. The survey aims to improve private hospital care through ongoing feedback. The questionnaire focuses on the patient’s overall experience of care and reflects current hospital industry survey standards.

The updated Patient Experience Survey was launched on 1 July 2019 in all DVA contracted private hospitals.

Results of the survey will be presented in survey outcome reports which will assist DVA and hospital providers to better understand the experience of veteran patients during their hospital stay and drive service delivery and quality improvements in hospital services.

New mental and social health program review framework

In 2018–19 DVA established a new national framework to guide the development, delivery and evaluation of current and future mental and social health programs. The framework aims to ensure that we are investing in the right areas, that our investment is effective and that the mental and social health care model continues to appropriately support the health and wellbeing of veterans and their families. It will ensure a simplified and nationally consistent decision-making process for assessing the efficiency and effectiveness of current and new mental and social health initiatives.

The new framework was based on two reviews—the Carer and Volunteer Support review (2016) and the Mental and Social Health Branch programs review (2017). The program logic will be used to support DVA’s current and future mental and social health initiatives through the stages of program design and implementation, ensuring that program evaluation is embedded into design thinking.

Streamlined support for vulnerable and at-risk veterans

DVA’s Client Support Framework creates a streamlined pathway for timely and individually tailored supports for veterans and families who are identified as vulnerable or at risk. The framework is an enhancement of a number of complex client support initiatives that have been in place for some time—changes have been made incrementally in response to increased awareness of veterans’ needs and a number of reviews. The framework was developed as part of the DVA transformation agenda.

In 2018–19 we made several enhancements to the framework. We:

• recruited mental health clinicians and social workers to provide support and case management to veterans who are in complex circumstances and/or who are vulnerable
• developed a more evidence-based assessment of client complexity to ensure support services are provided to veterans across various areas of DVA
• established clearer pathways for referral and collaboration between DVA and Open Arms to ensure that a holistic support service can be provided to veterans who are vulnerable or in crisis.

The Wellbeing and Support Program (formerly the Case Management Pilot) has also been incorporated within the framework to provide intensive and supportive case management services for transitioning and former serving veterans and their families who require additional support.

Support for veterans who have taken anti-malarial medications

In 2018–19 DVA established several initiatives to assist veterans concerned about having taken the anti-malarial medications mefloquine and tafenoquine. The initiatives were implemented through an action plan with four priority areas: consultation forums; online publication of information, resources and points of contact; commissioning of research; and health assessment programs.

Between September and November 2018 DVA hosted a series of mefloquine and tafenoquine consultation forums across Australia. Approximately 110 veterans and members of the veteran community attended the forums.

As part of the 2019–20 Budget, the Government announced a $2.1 million initiative to provide a national program of comprehensive health assessments for veterans who are concerned about having taken these medications. The initiative is in response to the concerns heard at the forums, as well as during the Senate inquiry into the use of the anti-malarial drugs mefloquine and tafenoquine in the ADF, which reported in December 2018.

DVA and Defence are continuing to develop initiatives to ensure that current and former serving ADF personnel have access to information and support. We have published web-based information, resources and dedicated points of contact. We also have a webpage on supports and services (www.dva.gov.au/mefloquine) and a designated phone line—1800 MEFLOQUINE (1800 633 567).

In 2018–19 Open Arms continued to develop a Neurocognitive Health Assessment Program, which will provide access to screening, assessment and treatment for any veteran who has symptoms of a neurocognitive disorder or concerns about their cognitive functioning, including those concerned about anti-malarial use. It will commence in Townsville in the second half of 2019.

DVA and Defence commissioned the University of Queensland to use data from 2007–2008 studies of deployment to East Timor, Bougainville and the Solomon Islands to investigate the issue of anti-malarial drugs and long-term health. The final report was published in March 2019 and is available on the DVA website.

New approaches to mental and social health service delivery

In 2018–19 DVA progressed testing of several new approaches to mental and social health service delivery.

The Coordinated Veterans’ Care (CVC) Mental Health Pilot is one of two suicide prevention pilots announced in the 2017–18 Budget. The pilot has been operating since August 2018. It is testing whether the use of a digital coaching app can promote better health outcomes for veterans in conjunction with traditional treatment through a GP.

The pilot is leveraging the existing CVC Mental Health Pilot, which uses a team-based model of care, led by a GP and supported by a practice nurse, to provide overall clinical management planning and care coordination.

The pilot is available to eligible DVA White and Gold Card holders under 55 years of age with mild to moderate anxiety or depression and a musculoskeletal condition requiring pain management. The pilot is primarily targeting rural and remote regions where mental health services can be difficult to access, or are limited or unavailable.

During 2018–19 recruitment of eligible participants took place across selected Primary Health Networks in Queensland, New South Wales, Victoria, Tasmania and South Australia. Recruitment for the pilot ceased on 30 June 2019.

As at 30 June 2019, 53 GP practices had registered for the pilot. Of the 240 veterans that enrolled, 197 veterans participated in the pilot and 43 veterans opted out and did not participate.

Veterans enrolled in the pilot have access to coordinated care from their GP for up to 12 months and access to a digital coaching app. The app prompts various health messages along with ‘light touch’ cognitive behaviour therapy sessions over a six-to-eight-week period.

The pilot concludes in December 2019 and an independent evaluation is scheduled for completion in December 2020.

Veteran Suicide Prevention Pilot

The Veteran Suicide Prevention Pilot—also known as the Mental Health Clinical Management Pilot—is the second of two suicide prevention pilots announced in the 2017–18 Budget.

The pilot is evaluating the benefits of providing intensive, wrap-around support and non-clinical management services to address an ex-serving ADF member’s mental and social health needs on discharge from hospital. It is available to veterans who discharge from hospital following a suicide attempt or suicide ideation; or who have a mental health condition and have been clinically assessed as being at an increased risk of suicide. The pilot provides 90 days of support after hospital discharge.

Also, DVA has contracted Beyondblue to adapt its existing suicide prevention service, The Way Back Support Service, to the needs of ex-serving ADF personnel. The pilot is being delivered by Beyondblue, which has subcontracted Richmond Fellowship Queensland to provide services in the greater Brisbane region. As at 30 June 2019, 48 veterans have participated in the pilot.

An independent evaluation of the pilot is scheduled for completion in June 2021.

Reinvigorated veterans and families counselling service

In 2019 the Veterans and Veterans Families Counselling Service was rebranded as Open Arms—Veterans & Families Counselling.

This year, Open Arms completed an evaluation of the Community and Peer Program pilot completed in Townsville as part of Operation Compass—Townsville Veteran Community Suicide Prevention Trial. The key objective was to improve management and support of vulnerable veterans, especially those who are at risk of suicide. Under the pilot, the teams, which included veterans with lived experience of both the military and mental health issues, are employed as mental health peer workers to provide a bridge between clinical services and community-based health and ex-service community supports. The evaluation determined that the model enhanced the military awareness of all staff in Open Arms, reduced barriers to care for clients and improved mental health and wellbeing outcomes for clients and their families. The national rollout of the Community and Peer Program has now commenced.

Open Arms was the lead agency in the provision of mental health support to athletes and families at the 2018 Invictus Games in Sydney. Staff, including mental health peer workers, were on hand 24 hours a day offering individual counselling support, relaxation spaces and wellness activities.

Over the last year Open Arms has increased the number of staff available to provide case management and assertive reach-out to vulnerable individuals. Refreshed and new group treatment programs in the areas of trauma, anger, pain and anxiety have been introduced. The service has also increased its capacity to provide mental health training and is piloting new programs in the area of transition from the ADF.

Open Arms supports all of its mental health professionals to attend relevant mental health professional conferences, seminars and workshops. In 2018–19 it co-hosted the Centenary of Anzac Practitioners Forum conducted by the Phoenix Australia Centre for Posttraumatic Mental Health; and sponsored clinical staff to complete the APS Institute Foundation of Suicide Prevention online program.

Open Arms is currently working with Defence and Phoenix Australia on three innovative clinical research programs: the Rapid Exposure Supporting Trauma Recovery (RESTORE) Trial, focused on testing a more efficient approach for PTSD treatment; the Stepping Out: Attention Reset (SOAR) Trial, exploring whether a brief attention-training computer task improves wellbeing and adjustment to civilian life for transitioning military personnel; and international research to determine if it is possible to develop a measure of moral injury to be utilised in clinical settings.

For more information about the rebranding and launch of Open Arms, see the vignette Launch of refreshed Open Arms—Veterans & Families Counselling service.

New framework to prevent elder abuse of veterans

In 2018–19 DVA developed the Abuse of Older DVA Clients (elder abuse) Responding and Reporting Policy Framework to assist DVA staff to respond to and report allegations of abuse of older veterans.

The framework responds to the National Plan to Respond to the Abuse of Older Australians 2019–2023, released earlier this year—in particular, priority area 3.1, ‘Establish and evaluate front-line support services for older people experiencing abuse in a range of locations across the country’. DVA is not a mandatory reporting organisation, but we do have an opportunity to identify and support victims of abuse and work with our service providers to do the same. The framework will be implemented in 2019.

Expanded health and wellbeing online and digital services

AT-Ease portal

AT-Ease is a health and wellbeing online portal for veterans and their families. It provides tailored mental health and wellbeing resources for serving and veteran communities.

During 2018–19 AT-Ease successfully redesigned online services to be more client focused and expanded content to include a new family channel and wellness channel.

Specifically focusing on early intervention for at-risk populations, AT-Ease has increased its traffic by 60 per cent during 2018–19 and is servicing more than 60,000 users annually with self-help information and tools.

AT-Ease Professionals, designed for health providers, saw a significant increase in the use of the clinical tools and professional development opportunities.

AT-Ease is now in the process of merging with Open Arms to provide a single digital service offering allowing veterans and their families to easily find self-help information or be referred to appropriate person-based care such as counselling and group programs.

Mental health webinars

DVA’s professional development webinar series ‘Mental Health and the Military Experience’ aims to support practitioners to better respond to the mental health needs of veterans. The webinar series has been successful in engaging with health professionals who have an interest in treating veterans or who are currently treating veterans.

Over 4,100 health professionals attended the five webinars that took place in 2018–19. Topics of these webinars included pain, research, identity during/after transition, the military experience and mental health, and managing comorbid mental health conditions. This builds on the three webinars that took place in 2017–18 and the four webinars that took place in 2016–17. A further two webinars are scheduled for 2019–20.

Health professionals can access previous webinars and register for any upcoming webinars on the AT-Ease Professionals website.

Redeveloped PTSD Coach Australia mobile app

In 2017–18 DVA conducted an evaluation of the PTSD Coach Australia mobile app. In line with recommendations of the evaluation, in June 2019 we began to redevelop the app. Our work will address underlying technical issues that users are experiencing with the app but will not make any major changes to the tool.

Strategic research to improve our services

DVA commissions research to expand our understanding of the wellbeing of veterans and their families; build an evidence base of effective policy and services; provide actionable outcomes that can be translated into policy and program directions; and evaluate DVA programs.

Research programs

In 2018–19 the Applied Research Program (ARP) has been the primary mechanism of commissioning research. It has enabled our business areas to undertake research projects that contribute to DVA’s research priorities and outcomes. All ARP-funded research projects approved by the Research Board were undertaken in accordance with the ARP requirements and governance. From 2019–20 a new mechanism—the Strategic Research Framework—will guide departmental research and detail DVA’s analytical and research priorities.

Partnership with Australian Institute of Health and Welfare

In 2018–19 DVA and the Australian Institute of Health and Welfare completed the second year of a four-year strategic partnership. The partnership takes a coordinated, whole-of-population approach to monitoring and reporting on the status and future needs of veterans and their families. During 2018–19 a key output was the publication of A profile of Australia’s veterans 2018.

The publication draws on data from more than 25 sources to highlight health and welfare information of our veterans and identify data gaps together with opportunities to address these gaps. The report showed that 78 per cent of people who served in the ADF in 2014–15 rated their health as excellent, very good or good. However, the report also recognises that some veterans experience challenges above those of the Australian population due to the unique nature of military service. Supplementing this baseline report over time will allow a greater understanding of veterans and their families; assist in informing policy development; and ensure that services are targeted toward improving the health and welfare of Australia’s veterans.

Client consultation forums, workshops and interviews

Understanding the experiences and needs of veterans and their families is at the heart of DVA’s transformation agenda. To better understand these experiences and needs, DVA is engaging with a diverse range of veterans and veterans’ family members through consultation opportunities and co-design engagements, including new engagement forums, workshops and one-on-one interviews. These engagements focus on understanding the experiences of veterans and their families, discovering opportunities for improvement and developing innovative solutions. This work is ongoing. In 2018–19 DVA consulted and engaged with over 300 veterans and family members using co-design to create programs and services for the future.

Client Satisfaction Survey

The DVA Client Satisfaction Survey is a key activity to assist in measuring the experiences of veterans and their families when they engage with DVA and to track their satisfaction over time.

The 2018 Client Satisfaction Survey involved more than 3,000 randomly selected DVA clients, including current and ex-serving members of the ADF, war widows and widowers, carers and dependants, of all ages, across all Australian states and territories.

The 2018 survey found that DVA’s clients value our staff but are challenged by our processes. Overall, satisfaction with DVA’s services remains steady at 81 per cent, with older clients remaining more positive about DVA’s service delivery compared with younger veterans.

Satisfaction amongst DVA’s younger client cohort (aged 45 years and under) rose from 49 per cent in 2016 to 56 per cent in 2018, and dissatisfaction halved from 31 per cent in 2016 to 15 per cent in the 2018.

For clients aged 45 to 64 years, satisfaction has improved from 69 per cent in 2016 to 72 per cent in 2018. Dissatisfaction amongst this group (45 to 64 years) has also reduced, with 2018 results showing that approximately 9 per cent reported being dissatisfied as opposed to 14 per cent in 2016.

The results of this survey will continue to inform DVA’s efforts to transform delivery of services to veterans and their families.

Strategic research on a healthy ageing strategy for veterans

Strategic research on healthy ageing helps DVA to answer questions about whether veterans age well, whether the determinants of ageing well differ in veterans, and which interventions might promote healthy ageing in veterans.

In 2018–19 a Rapid Evidence Assessment entitled ‘Healthy and Active Ageing in the Veteran Population and Factors and Interventions that Achieve Positive Effect’, by La Trobe University, was published on DVA’s Evidence Compass.

The assessment sought to determine whether ageing veterans experience challenges and issues that differ from those of the general population and the factors and interventions that positively affect health and wellbeing outcomes for older people (particularly those from military backgrounds). The assessment relied heavily on studies from the United States, noting that there is scope for further Australian research. While the healthy soldier effect—the proposition that military populations are likely to be healthier than other populations—continued for the majority of veterans post-discharge, by the time veterans reach middle age (between 45 and 64) they have an increased risk of poor physical and mental health compared with non-veterans.

During 2018–19, informed by this research, DVA progressed its policy work on developing a healthy ageing strategy for veterans. This will now be considered in conjunction with the creation of a network of Veteran Wellbeing Centres. This work will also be informed by the refresh of the Veterans’ Mental Health and Wellbeing Strategy to support a holistic approach to client wellbeing, including prevention, promoting healthy living and social connections, early intervention, and best-practice treatment.

Research to counter homelessness in the veteran community

In 2018–19 we completed a research project, overseen by the Australian Housing and Urban Research Institute (AHURI), on homelessness among former ADF members. The reports from AHURI provide an understanding of the factors that cause homelessness and the experiences of homeless veterans.

In 2018–19 DVA began consultation with stakeholders and service providers to explore future policy settings for homeless veterans and reduce risk factors for veteran homelessness.

DVA also commissioned the Australian Institute of Health and Welfare to undertake further analysis on the use of specialist homelessness services by ex-serving ADF members. We expect this research to be published later in 2019.

Study on transition and wellbeing

The Transition and Wellbeing Research Programme is the most comprehensive study on the impact of military service on the mental, physical and social health of current and transitioned ADF members and their families.

During 2018–19 the program produced five further reports on:

• physical health status
• technology use and wellbeing
• the impact of combat
• family wellbeing
• mental health changes over time: a longitudinal perspective.