The National Disability Insurance Scheme (NDIS) and Mental Health in NSW
Guideline for Establishing a
Local NDIS Community of
Practice to Enhance Learning
and Sector Reform
July 2016
MENTAL HEALTH COMMISSION OF NSW AND MENTAL HEALTH COORDINATING COUNCIL
NDIS AND MENTAL HEALTH ANALYSIS PARTNERSHIP PROJECT
Acronyms
For any further information please contact: ADHC Ageing, Disability and Homecare (Department of FaCS)Mental Health Coordinating Council
Building 125, Corner of Church & Glover Streets
Lilyfield NSW 2040 CMO Community managed organisation
PO Box 668
Rozelle NSW 2039 DSS Department of Social Services
02 9555 8388 (Commonwealth government department) info@mhcc.org.au
www.mhcc.org.au FaCS Family and Community Services (NSW government department)
When referencing this paper please cite as follows:
Mental Health Coordinating Council (2016). The National HASI Housing and Accommodation Support Initiative
Disability Insurance Scheme (NDIS) and Mental Health in NSW:
Guideline for Establishing a Local NDIS Community of Practice HNELHD Hunter New England Local Health District
to Enhance Learning and Sector Reform. MHCC, Sydney.
Author: Tina Smith HNEMHS Hunter New England Mental Health Service
© Copyright Mental Health Coordinating Council (July 2016).
Disclaimer and limitations of liability LHD Local Health District
MHCC provides the information contained in this report in
good faith. The report derives information from sources
believed to be accurate and current as at the date of MHCC Mental Health Coordinating Council
publication.
Acknowledgments NDIA National Disability Insurance Agency
MHCC respects and promotes people’s fundamental human
rights. We acknowledge the traditional custodians of the land NDIS National Disability Insurance Scheme
and value the lived experience of people recovering from
mental health related conditions – both past and present. NDS National Disability Services
We also acknowledge the contributions of mental health
consumers, their families and carers, and service providers to NMHCCF National Mental Health Consumer and Carer Forum
the consultative processes conducted during the course of
the NDIS and Mental Health Analysis Partnership Project. NSW New South Wales
MHCC developed this guideline, supported by the Mental
Health Commission of NSW. PIR Partners in Recovery
PIRO Partners in Recovery organisation (consortium that deliver PIR)
PHN Primary Health Network
UNCRPD United Nations Convention on the Rights of Persons
with Disabilities
Table of Contents
1. Introduction 2
2. What is a Community of Practice? 4
3. Establish a Community of Practice to enhance NDIS learning 7
4. Guidelines for thinking about qualities of a Community of Practice 10
Leadership 10
Size 11
Membership 12
Frequency 12
Format 12
Content 13
Documentation 13
Evaluation 15
Lifespan 15
5. Guidelines for next steps to establish a Community of Practice 18
Audit existing mental health consultative structures 18
Consult with key stakeholders 19
Convene a regional meeting 19
Seek agreement to establish a Community of Practice 19
Identify a leadership structure 20
Develop agreements regarding the running of a Community of Practice 20
Develop a plan to evaluate the success of a Community of Practice 20
6. Concluding remarks 21
7. References 22
- Introduction
The Mental Health Commission of New
South Wales collaborated with the NSW HUNTER NDIS TRIAL IN HDELHD
Mental Health Coordinating Council
(MHCC) between June 2013 and 2016 to undertake a National Disability Insurance Scheme (NDIS) and Mental Health Analysis Partnership Project. This activity supported directions of
Living Well: A Strategic Plan for Mental
Health in NSW 2014 – 2024, adopted by the Government in December 2014.1
The project focused on the three communities within the Hunter
New England Local Health District
(HNELHD) chosen to trial the NDIS:
Newcastle, Lake Macquarie and
Maitland.
The scaling up of the NDIS in NSW over the next three years will be a massive undertaking, and the project has helped to inform this journey from a mental health perspective.
A major achievement of the project was the establishment of the Hunter
NDIS and Mental Health Community
of Practice. The Community of Practice enhanced learning, increased opportunities and reduced challenges associated with implementation of the NDIS in NSW from a mental health perspective. The experience, learning, activity and outcomes of the Hunter
NDIS and Mental Health Community of
Practice has informed this Guideline.
The Guideline is about how to establish a Community of Practice. It also considers the purpose, benefits, qualities and next steps to establish a Community of Practice.
NSW Potential increase in NSW NDIS participants with pyschosocial disability
UP TO 19,000
participants in NSW with a psychosocial disability by the end of June 2019
1022 participants in the Hunter trail site with psychosocial disability at the end of June 2016’
1 NSW Mental Health Commission (2014). Living Well: A
Strategic Plan for Mental Health in NSW 2014-2024. Sydney, NSW Mental Health Commission.
2 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
The Future of the NDIS in NSW Why did we develop this Guideline? The NDIS will be rolled-out within NSW Local Health District MHCC developed this Guideline to encourage local (LHD) catchments between July 2016 and June 2018 communities in NSW to establish a NDIS and Mental Health according to the timetable summarised below. Community of Practice. Organisations that provide services
to people affected by mental health conditions, and their From 1 July 2016 From 1 July 2017
carers and families, will find the Guideline useful. We
the remaining population llawarra Shoalhaven encourage you to consider establishing a local Community
of the HNELHD (i.e., other Mid North Coast of Practice to enhance learning arising from NDIS
than the three trial site
implementation and other mental health sector reforms. Murrumbidgee LGAs)
The Guideline encourages inter-sectoral innovation, the remaining population Northern NSW
learning, leadership and local level action to maximise of Nepean-Blue South Eastern Sydney
opportunities presenting through the NDIS and to Mountains (i.e., other than Sydney
strengthen reform capability of mental health in NSW. the early start from 1 July
Western NSW
2015 for young people)
Far West
Central Coast
Following this introduction, some basic knowledge and an illustration is provided about what a Community of Practice Northern Sydney is (Section 2). We then think about how establishing a South Western Sydney Community of Practice can enhance learning arising from Southern NSW the NDIS and related mental health sector reform (Section Western Sydney 3). Aspects of the scope and logistics of establishing a Community of Practice, starting with the important role of leadership, is then considered (Section 4). The Guideline From 1 July 2016, the NDIS will begin to roll out across NSW. then considers some next steps to establish a Community of In the first year, seven districts will transition to the NDIS
Practice (Section 5). including Central Coast, Northern Sydney, South Western
Sydney, Southern NSW, Western Sydney, and the remaining The establishment of regional and/or local level NDIS and populations of Hunter New England and Nepean-Blue Mental Health Communities of Practice across NSW will help Mountains. to ensure that our understanding of, and responses to, people with psychosocial disability are enhanced. The National Mental From 1 July 2017, the NDIS will be begin to be available Health Consumer and Carer Forum (NMHCCF) originally in the districts of Illawarra Shoalhaven, Mid North Coast, identified the need for a greater understanding of the concept Murrumbidgee, Northern NSW, South Eastern Sydney, Sydney, of psychosocial disability and the experiences of people Western NSW, and Far West NSW. living with it.2 The NMHCCF developed a position statement People currently receiving supports through the NSW in response to the inclusion of people with psychosocial Government Department of Family and Community Services disability in the United Nations Convention on the Rights of (FaCS) Department of Ageing and Disability (ADHC) specialist Persons with Disabilities (UNCRPD).3 disability services program will be moving to the NDIS first. This is because the NSW Government plans to stop Unravelling Psychosocial Disability delivering ADHC funded services by July 2018 and following this will withdraw from the delivery of specialist disability
[The] Position Statement
support services in NSW (i.e., and close ADHC). Existing developed by the NMHCCF, Commonwealth and state based supports will continue until seeks to identify the needs of people are covered by the NDIS. people with a psychosocial disability, and describe the The NDIS will provide support to more than 140,000 people issues that affect their capacity in NSW by July 2018. This will include around 19,000 people to participate in the community. with psychosocial disability. A NSW Government website The voice of people with provides more information about how and when people will psychosocial disability must be move to the NDIS.6 heard.
Graeme Innes,
Disability Discrimination
Commissioner, Foreword, p. 8
A complimentary report summarising the experiences and lessons learned in the Hunter through the NDIS and Mental 2 National Mental Health Consumer and Carer Forum (2011). Unravelling Psychosocial
A Position Statement by the National Mental Health Consumer and Carer Forum Health Analysis Partnership Project during the three year NSW Disability: NMHCCF, Canberra. on Psychosocial Disability Associated with Mental Health Conditions,
NDIS trial accompanies this guideline. 4 MHCC published a 3 United Nations General Assembly (2006). Convention on the Rights of Persons with more detailed report on the first two years of the project from Disabilities. Resolution adopted by the General Assembly, 24 January 2007, A/RES/61/106, a community managed mental health sector perspective in United Nations, Geneva. August 2015.5 4 Mental(NDIS) Healthand MentalCoordinatingHealth in CouncilNSW: Navigating(2016). ThetheNationalNDIS - DisabilityLessons LearnedInsurancethroughSchemethe Hunter Trial. MHCC, Sydney.
5 Mental Health Coordinating Council (2015). Further Unravelling Psychosocial Disability –
Experiences of the National Disability Insurance Scheme in the NSW Trial Site: A Mental Health Analysis. MHCC, Sydney. 6 NSW Government (2015 a). NDIS website: http://www.ndis.gov.au/nsw
GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016] 3
- What is a Community of Practice? A Community of Practice is …
A group of people who share a concern, a set of problems, or a passion about a topic and who deepen their knowledge and expertise in this area by interacting on an ongoing basis. 7
A Community of Practice is a group of people who share Three characteristics are crucial - a domain (i.e., area) of a concern or interest. Lave and Wenger first proposed the knowledge, a notion of community and a practice. concept in 1991.8 A Community of Practice can evolve naturally Domain - A domain of knowledge creates common ground, because of the members’ common knowledge, interest or inspires members to participate, guides their learning and connections. They can also evolve deliberately with the goal of gives meaning to their actions. gaining knowledge related to a specific field. It is through the process of sharing created information and experiences with Community - The notion of a community creates the the group that the members learn from each other, and have social fabric for that learning. A strong community fosters an opportunity to develop themselves. interactions and encourages a willingness to share ideas.
Members of a Community of Practice have the opportunity Practice - While the domain provides the general area to develop both personally and professionally, while working of interest for the community, the practice is the specific towards solving problems facing the group. Group knowledge focus around which the community develops, shares and passes from novice to expert, and between peers. maintains its core knowledge.
The combination of these three things constitutes a Learning through Participation Community of Practice. By developing these together you cultivate a community.
Jean Lave (anthropologist) and Etienne Wenger
Examples of characteristics of the Hunter NDIS and Mental (computer scientist) first suggested the idea of ‘situated Health Community of Practice follow: learning’. This means that learning is a social process and not just something that happens in the learner’s head. Domain - The NSW trial of the NDIS and mental health/ Lave and Wenger say that learning as a social activity is psychosocial disability about participation. Learners participate in communities of practitioners, moving toward full participation in the Community - The Hunter NDIS and Mental Health Community of Practice Forum sociocultural practices of a community. Participation provides a way to speak about crucial relations between Practice - Enhancing learning and opportunities arising newcomers and old-timers and about their activities, from NSW NDIS trial. identities, interests, tools, knowledge and practice. The brief description of the reasons (‘why’?) and process (‘how’?) of establishing the Hunter NDIS and Mental Health Community of Practice are described next. A rationale for the need to establish Communities of Practice to enhance learning in the context of local, state and national NDIS implementation and mental health reform then follows (Section 3). This includes thinking about the important contribution of lived experience and consumer ‘co-design’ in all aspects of service delivery.
7 Wenger, McDermott and Snyder (2002). Cultivating Communities of Practice: A guide to managing knowledge. Boston, MA: Harvard Business School.
8 Lave & Wenger (1991). Situated Learning: Legitimate Peripheral Participation. Cambridge
University Press, Cambridge, USA.
4 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
Why we established the Hunter NDIS
and Mental Health Community of Practice
When the NDIS started in the Hunter trial site People wanting to access new disability/recovery mental health service providers (i.e., practitioners) support services included people/patients unable in both the government and non-government to leave psychiatric hospitals due to lack of sectors – and also consumers and their families adequate community care. and carers – began to have a lot of contact with NDIA notions of ‘choice and control’ initially
the National Disability Insurance Agency (NDIA),
prevented community managed service providers as summarised below. However, much of this to support people to access the NDIS. That is, the contact was occurring in isolation for workers, NDIA did not want service providers making or programs, organisations and their clients and unduly influencing decisions for people. The need families and carers. for agreed collaborative practice approaches Most people with psychosocial disability related was identified in the early stages of NDIS to a mental health condition needed a lot of implementation and adopted over time. support to explore their eligibility/access for NDIS By the end of March 2016, there were 616 people funded services and supports. NDIS/NDIA contact with psychosocial disability able to access NDIS included people with mental health conditions: funded services and supports in NSW and 1,602 Receiving Commonwealth funded mental nationally. 9 Many more people with physical, health program services, including sensory and/or intellectual disability also living with a mental health condition/psychosocial Partners in Recovery disability also access the NDIS. The NDIS trial has resulted in considerable growth for community- Personal Helpers and Mentors Service managed organisations (CMOs) that provide Day to Day Living Program services to people affected by mental health conditions. This also resulted in closer working
Living in Assisted Boarding Houses
relationships between government departments Funded through the NSW Department of FaCS/ and CMOs providing treatment, rehabilitation and ADHC (primarily current and ex-boarding house support to people with mental health conditions. residents), and MHCC is now sharing the NSW Hunter trial site Who wanted to access new disability/recovery experience with others so it can be more widely support services. understood and hopefully benefit others.
9 National Disability Insurance Agency (2016). 11th Quarterly Report to the Disability Reform Council.
GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016] 55
How the Hunter NDIS and Mental Health
Community of Practice was established
From initial experience with the NDIS/NDIA Many other consumers and carers attended we saw that learning was occurring in silos; for the forums as paid Peer Workers. Participants individuals, programs and organisations. For this came from a wide range of mental health/health, reason, the Mental Health Commission of NSW disability, drug and alcohol, homeless, housing, and MHCC convened a meeting of community emergency services, education, university and sector organisations in October 2013 where advocacy services. service providers could discuss their early Each meeting featured a discussion about a topic experiences of the NDIS. At this meeting it was of interest as identified by participants, p. 13 agreed to meet every three months to share provides suggestions for NDIS and Mental Health experiences and learning and for meetings to be Community of Practice topics and content. open to anyone with an interest in the NDIS and mental health/psychosocial disability. There were also regular updates related to NDIS implementation from the HNEMHS and the NDIA. Meeting participant’s identified and considered A consumer perspective was included in the existing mental health and/or disability program over time as NDIS participants became interagency, networking and consultation comfortable speaking about their experiences. structures but none were in a position to host the proposed NDIS and Mental Health Community of Information about the Hunter NDIS and Mental
Practice. Health Community of Practice Forum meetings
can be found at the MHCC website (scroll down
The Mental Health Commission of NSW and
to the link that says ‘With the Mental Health MHCC hosted the Hunter NDIS and Mental Health Commission of NSW’’). 10 The MHCC website also Community of Practice Forum to meet ten times includes a six-monthly newsletter used to share across the three-year trial (eleven if the initial learning, and other opportunities presenting meeting is included). Around 70 people attended through the NDIS. each event. At the end of June 2016, the forum had engaged with 555 participants in total. A Evaluation of the Community of Practice Forum breakdown of forum participation across all occurred regularly to identify both topics of events is below: interest for future forums and event quality improvements. Participants discussed and 249 community sector workers from the trial reflected upon evaluation findings. site
106 community sector workers from outside the trial site
122 other people from the trial site (these are
mostly Hunter New England Mental Health
Service/HNEMHS staff)
60 other people from outside the trial site
18 consumers and carers.
10 MHCC website NDIS: http://www.mhcc.org.au/policy-advocacy-reform/influence-and reform/ndis-and-mental-healthpsychosocial-disability.aspx
66 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
-
Establish a Community of Practice to enhance NDIS learning State implementation Enhance learning, maximise opportunities and reduce challenges As the NDIS scales up in NSW, the opportunities and challenges likely to arise from a mental health perspective The experience of the Hunter NDIS and Mental Health will intensify. This is because the volume of contact between Community of Practice taught us that while there were the NDIS/NDIA and people with mental health conditions will initially no experts on the NDIS and psychosocial disability increase rapidly in NSW over the next two to three years. The that in an implementation environment, this quickly NSW Government needs greater understanding of people’s changes. Through the individual and shared experience NDIS experience to guide and refine implementation that is of the NDIS, people affected by mental health conditions responsive to local level needs. learned together with those that provide services and Benchmarks for NDIS access for people with psychosocial supports to them about the opportunities and challenges disability are not yet established. The increase in local presenting through the NDIS. Local Communities of experiences and strengthened NSW learning of the Practice are important activities to enhance learning, opportunities and challenges arising will help to establish maximise opportunities and reduce challenges associated future benchmarks and practices. with NDIS implementation from a mental health perspective. NSW experience will continue to shape the NDIS and including through the work of MHCC and the Mental Health Commission of NSW. This must include discussion and learning shared by National leadership and local approaches for both NDIS/ people with mental health conditions, their families and carers disability and health/mental health reform will be increasingly and those that provide services and supports to them. The important from 2016/17 onwards. The government’s response important roles of PHNs and LHDs in NSW are critical. to the National Mental Health Commission’s Review of Mental Health Programme and Services describes reforms
11 Primary Health Networks (10) Local Health Districts (15) that commenced in 2016. As the NDIS scales up the new
Primary Health Networks (PHNs) will take on a greater role in North Coast NSW Northern NSW
local implementation of national mental health reform. PHNs
Mid North Coast
will work with LHDs, GPs, other health care providers and hospitals to improve and better coordinate care across the Hunter, New England & Central Hunter New England
local health system for people requiring care from multiple Coast Central Coast
providers or at risk of poor health outcomes. The way in
which PHNs will interface with social care providers and the Sydney North Northern Sydney
NDIS will become important in addressing both individual and Central & Eastern Sydney Sydney population mental health needs.
South Eastern Sydney
Local approaches Western Sydney Western Sydney
(WentWest) The experience of the NDIS trial in the Hunter from a mental
health perspective has been profound. 11 Much learning South Western Sydney South Western Sydney
occurred across the three years of the NDIS trial. The learning
influenced approaches during the trial. The learning about Nepean Blue Mountains Nepean Blue Mountains
mental health/psychosocial disability will continue as the NDIS
South Eastern NSW Illawarra Shoalhaven
grows and is further refined on the basis of the experience of
(Coordinare) Southern NSW
other communities.
The trial site experience found that much of NDIS Murrumbidgee Murrumbidgee
implementation was shaped by local communities for Western NSW Western NSW
Individual Funded Packages (previously known as ‘Tier 3’). (Marathon Health) Far West NSW
This is because individuals, families and their communities have different services available to help address their needs. While directions for ‘commissioning’ Information, Linkages and Capacity Building (previously known as ‘Tier 2’) activity/s are only becoming clearer now local and community-based approaches will also likely be required.
It is local communities, through national leadership and state/ territory implementation, which will lead the way in shaping both the NDIS and related mental health reform. This is why establishing local NDIS and Mental Health Communities of Practice is so important.
11 Australian Government Department of Health (2015). Australian Government Response
to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and
Services. Canberra: Commonwealth of Australia.
12 MHCC (2016 & 2015). Op. cit.
GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016] 7
National leadership Learning through co-design
Taken together with national and state mental health reform, CMOs, PHNs and LHDs are required to including the imminent arrival of the 5th National Mental engage with consumers, their families Health Plan, this is an unprecedented time for achieving and carers, and local communities in coordinated and integrated health and social services for undertaking mental health reforms. people affected by mental health conditions. Ensuring access Many LHDs have mental health to NDIS funded services and supports that are both disability interagency/s and/or advisory focussed and recovery oriented – along with a range of other committees for this to occur. PHN health and social services - is a critical component of mental Community Advisory Councils are one health reform. avenue for community consultation but more inclusive approaches are The NDIA have recognised that a Community of Practice required to achieve good practice in can be useful for enhancing shared learning. In 2014, they the ‘commissioning’ (i.e., co-design/co established a National NDIA Community of Practice to share production) of services aligned to what ways of working with people with a psychosocial disability people say they want and need, and to
(i.e., the NDIA Mental Health Community of Practice: 13, 14 build mental ‘wealth’.
Enhancing Practice for People with Psychosocial Disability). NDIA trial site staff meet to share local issues and solutions In time, new ways of working and emerging innovations arising from helping people with psychosocial disability. They in service delivery will contribute to the scaling up of the are also developing knowledge of good NDIS and mental NDIS. Co-design and consumer led approaches are central health/psychosocial disability practice. The group expanded to this. Communities of Practice provide a place to reflect during 2015 to include people from the NDIA’s national office on the evolving service delivery environment and to pursue (e.g., the National Access Team and the Communications opportunities for further innovation and reform. and Engagement Team). The establishment of local and/or The Mental Health Commission of NSW is progressing regional Community of Practice initiatives will be useful to important work to encourage consumer-led innovation and maximising learning about the NDIS and mental health. reform. This includes the new Peer Work Hub that aims Other meetings, projects and activities have occurred to support growth of the peer workforce resulting in both nationally to better understand how the NDIS will work for cultural and service delivery reform. 15 people with mental health issues. This includes activities undertaken by the:
Commonwealth Department of Social Services (DSS; who develop NDIS policy)
NDIA (who are responsible along with state and Commonwealth governments for implementing NDIS policy)
NDIA Mental Health Sector Reference Group
NDIS Independent Advisory Council
Mental Health Australia NDIS Capacity Building Project
(2013 to 2016).
13 Australia Government (Department of Health; 2016). PHN Primary Mental Health Care
Flexible Funding Pool Implementation Guidance: Consumer and Carer Engagement and
Participation.
14 Co-design Initiative (2016). Co-design: Shared Perspectives on Authentic Co-design – Putting Consumers and Carers at the Centre of Mental Health Reform.
15 Mental Health Commission of NSW (2015 a): http://peerworkhub.com.au/what-is-peer work/
8 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
The Commission’s work also includes a rapid review of Reflections on consumer participation the evidence supporting the There were challenges for the Hunter NDIS and Mental effectiveness of services led Health Community of Practice in including consumers or run by consumers in mental who are and/or are potential NDIS participants or their health undertaken through
16 families/carers. There were large numbers of service the Sax Institute.
providers and policy makers present and a complexity The establishment of local of topics discussed. While the number of consumers and level NDIS and Mental Health carers attending forums increased over time this appeared Community of Practice will to be a place where they were not always comfortable. help the sharing of local The reason for this may relate to the newness of the NDIS knowledge and experience and the significant social, cognitive and communication to facilitate the learning, difficulties that are frequently associated with high levels opportunities and challenges/ of psychosocial disability. risks that will present during Where there was success in meeting with, and NDIS implementation; and to supporting the NDIS experiences of people with mental help identify local innovations health conditions/psychosocial disability, this was in www.saxinstitute.org.au and solutions to unmet mental environments where they are most comfortable (e.g., CMO health needs. This means that centre based programs). Through a series of meetings at it will be important to be aware of, and build upon, existing a centre based program, and with peer support – both and/or emerging structures for interagency mental health paid and unpaid - the number of NDIS participants, and discussion and reflective practice, both locally and at the NSW their families and carers, attending forums grew over time. level. You are encouraged to give thought to this important State-wide structures for NDIS implementation across NSW lesson learned at the Hunter NDIS trial and to have began to emerge in late 2015. These include the establishment conversations about this in advance of establishing of both a NSW NDIS Bilateral Steering Committee and a your local Community of Practice activities. We need
monthly NSW NDIS Implementation Steering Committee. As
to ask how we can create spaces for service providers there is no consumer, carer or community representation to and planners to reflect on their practices that are also these groups it will be increasingly important that there are welcoming and inclusive of service user experiences and avenues for local communities to share their experience of contributions? NDIS implementation as this relates to people with mental health conditions. Local level NDIS and Mental Health Community of Practice provide a pathway for this to occur.
16 Grey, F. and O’Hagan M. (2015). The Effectiveness of Services Led or Run by Consumers in
Mental Health: Rapid Review of Evidence for Recovery Oriented Outcomes: An Evidence
Check Rapid Review Brokered by the Sax Institute for the Mental Health Commission of NSW.
GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016] 9
- Guidelines for thinking about qualities of a Community of Practice Consumer and carer participation at the Hunter NDIS and Mental Health Community of Practice Forum in June 2016
Communities of Practice: Getting people to be creative and take responsibility 17
A 2016 review of Communities of Practice as a tool for control of learning increases the motivation of members of getting people to take responsibility for their own learning a Community of Practice. and developing creativity and innovation found that The review advises that successful Communities of Practice successful groups are a story of autonomy and control. require seeding in their initial stages until the group can Members need autonomy in both in running and managing take over responsibility and run the community themselves. the Community of Practice and the content and direction This is one of the aims of a Community of Practice. of the topics it focuses on. The review found that being in
There are many ways to establish a Community of Practice. The NSW Mental Health Strategic Plan 2014-2024 promotes Approaches will vary according to the interests, needs, innovation, learning and leadership to strengthen the reform resources and preferences of local communities. Some capability of mental health in NSW through: guidelines to consider the scope and logistics of establishing a Knowledge exchange Community of Practice follow. The resources available to work with will limited establishment of an NDIS and Mental Health Innovation sharing Community of Practice. This includes the level of leadership commitment within your local community. Strong and active Transfer and adaption of successful policy and service leadership is required at all levels of our sector to improve design outcomes for people using services and their families. Use of comparative data to drive service improvement
Problem solving
Leadership
Support for change management, and Any new activity requires thinking about leadership approaches. This guideline acknowledges the importance of Leadership and networking. 18 leadership in establishing a Community of Practice. It does The empowerment of leadership at a local level is an essential
not propose a preferred model for NDIS and Mental Health 19 action of taking the Strategic Plan 2014-2024 forward.
Community of Practice leadership. It is mostly a myth that Communities of Practice are one way of achieving this. there are no leaders in a true Community of Practice (see ‘Myths about Community of Practice’ on p. 17).
17 Oxford Review (2016). Research Intelligence Brief: Getting people to be creative and take responsibility.
18 NSW Mental Health Commission (2014). Op. cit.
19 Mental Health Commission of NSW (2015 b). One Year On: Progress Report on the implementation of Living Well: A Strategic Plan for Mental Health in NSW 2014-2024.
10 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
MHCC and the Mental Health Commission of NSW considered the following leadership options for establishing a NDIS and A preferred model for Community of Practice Mental Health Community of Practice: leadership?
Consumer/carer – a consideration for this option is the There is no preferred model for hosting an NDIS and Mental availability of local/regional level resourced options Health Community of Practice. This is because the needs, for consumer and carer engagement, participation, resources and preferences of local communities will vary. representation and/or co-design/co-production LHD mental health services have a long history of Community sector service provider – a consideration for relationships with people affected by mental health this option is perceived to represent a conflict of interest conditions that are living with high levels of psychosocial where the organisation is also an NDIS service provider disability. Some LHDs have strong inter-agencies and other and/or the added demands of NDIS readiness and consultative structures that would lend themselves well to providing information in support of NDIS access hosting COP events. The number of public mental health service clients that may access NDIS individual funded Partners in Recovery Organisations (PIR/Os; these are the packages over the next three years and beyond is unknown consortium that deliver PIR) – for the next two to three at present. years PIR is well placed in terms of their key areas of interest and activity, including their local and/or regional PIRO consortiums have now been working for three years level presence and relationships, to consider hosting a NDIS to engage and assist up to 7,000 people in NSW with and Mental Health Community of Practice. Some PIROs are ‘severe and enduring’ mental illnesses. The number of better placed to do this than others (e.g., one NSW area current PIR clients that may transition to NDIS individual does not have a PIR). funded packages over the next two to three years is unknown at present. It is important that other key stakeholders with NDIS and/ or mental health leadership roles including the NDIA, LHDs Both LHDs and PIROs have a very high level of interest in and PHNs contribute to discussions about establishing a NDIS the NDIS and mental health interface and this lends them and Mental Health Community of Practice. This is important to being a preferred option for hosting a Community of because of the role that: Practice. Organisations delivering services to the 7,000 PHaMHS programs clients in NSW due to transition to the NDIA has in implementing the NDIS the NDIS over the next two to three years also have high public mental health services have in working with people interest in CoP activities. who are acutely unwell and needing treatment, and The ambitious targets for transition of Commonwealth PHNs have and/or will have in local level implementation funded mental health program clients to the NDIS will of health/mental health reform including GP engagement, stretch organisations delivering these programs to consider stepped care approaches to mental health and the hosting an NDIS and Mental Health Community of Practice. ‘commissioning’ of services for individuals, families and The current plan is for both PIR and PHaMS to cease communities affected by mental health issues. operations by July 2019.
Medicare Local organisations that predated PHNs established Some LHDs and PIR programs have strong structures in most PIR consortiums in NSW in 2013. Some PHNs are still place to ensure systemic consumer and carer engagement, the lead organisations for PIR initiatives that are in-scope to representation, participation and co-design. Where these transition to the NDIS. are identified they may be an asset is establishing an NDIS and Mental Health Community of Practice. Community of Practice leadership consideration needs should explore the capacity of existing local and/or regional networks, inter-agencies and other inter-sectoral structures Size that may lend themselves to hosting (see p. 18). Options A Community of Practice can be of any size depending on a for leadership in establishing a NDIS and Mental Health number of factors. They can be large and they can be small. Community of Practice will vary against the needs and For some communities a small group may be preferred and/or preferences of local communities. the only option. Some examples of this are:
A small rural area with few health and community services
An area that decides to place deep thinking in the hand of a select few people initially (this approach could work for communities not entering the NDIS environment until 1 July 2017).
Instances where a large group may work better are:
Metropolitan areas that have a large number of organisations and/or programs assisting people with mental health conditions (as was the case with the Hunter trial site)
Communities that are committed to inclusiveness and have high levels of existing consumer and carer participation and established inter-agencies and mechanisms for cross sector collaboration.
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Another consideration for group size is whether you want the Community of Practice to be open or closed: Community of Practice membership participation Open groups (as was the case with the Hunter trial site) allow anyone with an interest in the knowledge area to Wenger (2002) identifies three main levels of participation join. They can, however, become very large and sometimes for Community of Practice members: unwieldy to manage
-
The core group who participate intensely in the Closed groups limit membership to people with certain community through discussions and projects. This group characteristics and tend to be smaller but this is not always typically takes on leadership roles in guiding the group the case (an example of this might be a group just for NDIS
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The active group who attend and participate regularly, participants with psychosocial disability where the number but not to the level of the leaders of interested participants would to grow over time).
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The peripheral group 20 who, while they are passive There are other pros and cons for small/large and open/closed participants in the community, still learn from their level groups. Undertaking an activity to understand pros and cons of involvement. Wenger notes the third group typically might help to identify what will work best for your community. represents the majority of the community.
For the Hunter NDIS and Mental Health Community of Practice
For the Hunter NDIS and Mental Health Community of we decided to be open and large. This was to optimise the Practice: learning arising from the trial of the NDIS. A downside to this is that the large meetings of what were mostly service - The core group was the Mental Health Commission of providers may not have been as welcoming of consumer/NDIS NSW, MHCC, HNEMHS and the NDIA participant and family/carer participation that would have benefitted our learning. - The active group was the core group plus many large CMO representatives from the trial site providing and/or wanting to provide NDIS services to people with mental Frequency health conditions, and a growing group of mental health consumer/NDIS participants emerging to share their lived There does not have to be a set frequency for Community of experience – these people attended most forums Practice activities. The frequency of activities can considered and established through core/leadership group consultation - The peripheral group were mostly other service providers with members. However, anticipation of regular activities can from within and outside of the trial site with an interest help with group cohesiveness and the member’s sense of in the NDIS and mental health – these people attended belonging and their contributions being valued. occasional forums.
Membership Format
There are other membership considerations to group size (i.e., A Community of Practice can take many formats. This might whether you want similar or diverse members to participate). include: An example of this is if you want the group to be mental Forums health specific (i.e., that is for consumers, carers and mental health specific service providers only. There are many other Workshops people interested in the NDIS and mental health. After all, Speakers mental health is everybody’s business! Consultations People with mental health issues usually experience diverse health and social difficulties and you will want to anticipate Newsletters service users and workers from the following sectors also keen E-group/s (e.g., internet websites/blogs, Facebook, Twitter, to be involved: etc.). Housing and homeless services The interests and resources of members will inform the blend Emergency services of formats offered.
Drug and alcohol services For example, the main format for the Hunter NDIS and Mental Health Community of Practice was the forum that met Physical health care providers quarterly for four hours (10:00 AM to 1:00 PM). The Hunter Other disabilities (e.g., intellectual, physical, sensory, forum was also supported through a six-monthly newsletter, acquired brain injury etc.) other documents/publications and website hosted by MHCC.21 And many more.
The Hunter NDIS and Mental Health Community of Practice
was large, open and diverse. This was to enhance the learning opportunities of the trial from the perspectives of many people.
20 Wenger, Etienne; McDermott, Richard; Snyder, William M. (2002). Op. cit.
21 MHCC NDIS website: http://mhcc.org.au/policy-advocacy-reform/influence-and-reform/ ndis-and-mental-healthpsychosocial-disability.aspx
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Content
Lived experience of the NDIS Content should be specific and relevant to the Community An excellent addition to the format of any Community of of Practice and strongly influenced by group member Practice is a short film developed by the Mental Health preferences. For a NDIS and Mental Health Community Commission of NSW featuring the experiences of mental of Practice this means including activities relevant to, for health consumer participants in the Hunter NDIS trial example: site. The film illustrates to policy-makers and the wider community the potential of NDIS to support people with psychosocial disability more effectively. You can view the Access NDIS Mental Health Perspectives video on YouTube. 22 outreach to, and engagement with, people with Also useful is the NDIA’s ‘Mental Health and the NDIS’ psychosocial disability webinar held during Mental Health Week, October 2015. 23 processes related to eligibility, access, planning, and review for people with psychosocial disability, their families and carers, and those that provide services and supports to them
appreciation of the experiences and perspectives of
consumers
carers
exploration of the experiences of organisations and workers that provide services and supports to NDIS participants
community managed mental health sector
public mental health services
NDIS - Mental Health Perspectives
Click to play, https://www.youtube.com/watch?v=9X-ea-O50Vg PHNs
private health/mental health service providers
other human services providers
the NDIA
engaging Aboriginal and Torres Strait Islander Peoples and other diverse groups of people with mental health issues with the NDIS
transition of Commonwealth funded mental health program clients to the NDIS
approaches to gathering evidence of psychosocial disability/impairment
Webinar: Mental Health and the NDIS
Click to play, http://webcast.viostream.com/?viocast=7837&auth= transition of NSW FaCS/ADHC funded mental health clients 09bf0e32-3eac-49c5-8cbc-337067bc65ad
Readiness
organisational readiness for the NDIS
NDIS pricing and the cost of psychosocial disability/ recovery support skills
becoming a registered provider
using the NDIA information portal
psychosocial disability workforce issues
the shift from block to individualised funding
individual funds management
customer service approaches
marketing approaches
22 Mental Health Commission of NSW (2015 c). Mental Health Perspectives video on You Tube: https://www.youtube.com/watch?v=9X-ea-O50Vg
23 National Disability Insurance Agency (2015). ‘Mental Health and the NDIS’: http://webcast. viostream.com/?viocast=7837&auth=09bf0e32-3eac-49c5-8cbc-337067bc65ad
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Impacts
Establish a familiar program for Community of people not eligible for NDIS funded services and supports Practice Forums internal and external NDIA eligibility review processes The Hunter NDIS and Mental Health Community of Practice (including the role of the Administrative Appeals Tribunal) Forum quickly developed a standard and familiar program. cessation of ADHC and mental health sector impacts This included a:
- Welcome, an Aboriginal and Torres Strait Islander NDIA interface with NSW Ministry of Health funded mental acknowledgment, a lived experience acknowledgement health programs (including but not limited to the Housing and opening remarks by a host (in this case, the Mental
and Accommodation Support Initiative/HASI and Pathways
Health Commission of NSW) to Community Living program)
-
NDIS and mental health update (information about recent coordination of supports activity provided by MHCC) Local area coordination roles and functions - Consumer update (this sometimes preceded the MHCC update) Quality and safeguarding framework
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Keynote speaker – on a topic of current relevance to the the commissioning of Information, Linkages and Capacity Community of Practice and/or NDIS and mental health Building quality and safeguards frameworks, including the environment role/s of both the NSW and Commonwealth Ombudsman - Consultation session – related to the keynote speaker topic Outcomes - NDIA update promoting choice and control – and supported decision - HNEMHS update making – when working with people with cognitive- - Next steps and concluding remarks. behavioural impairment MHCC and the Mental Health Commission of NSW wish to outcomes framework thank the following people for their participation and many evaluation. other contributions across the three-year trial:
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all Hunter NDIS and Mental Health Community of Practice Equally important to what NDIS and mental health issues are Forum participants discussed are how issues are talked about. This is because learning around the NDIS and mental health can at times be - Debbie Hamilton (NDIS participant and consumer overwhelming. Discussions, even when talking about difficult advocate/representative) things, should be respectful and welcoming to the sometimes- - the HNEMHS, and differing views of others. - the NDIA. To address people’s fears and anxieties about the NDIS MHCC worked to shape a shared learning culture where there were no experts in the mental health and NDIS space but rather we were working together to create that expertise. MHCC learned that each Community of Practice should have one key topic for consideration while also making space for discussion of a range of new information and experiences.
14 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
Documentation Lifespan
Decisions about documentation of Community of Practice A Community of Practice may have any given lifespan. activities are important. MHCC chose to fully document Hunter Members of the group usually decide this. As learning about NDIS and Mental Health Community of Practice activities (e.g., the NDIS and mental health is likely to continue for years, and 2016 and 2015 MHCC reports, forum programs, forum Minutes interface with state and national health and mental health PPT presentations, six monthly newsletter, conference and reform directions, one would expect the lifespan of a NDIS other meeting presentations). This is because of the nature of and Mental Health Community of Practice to be around three the NDIS trial and the need to benefit from this opportunity. years. A limit to the ability of a local community to document This three-year lifespan through to the end of June 2019 Community of Practice activities is resources available but would bridge the period of the national NDIS rollout, the is encouraged. This is because learning about the NDIS and planned cessation of ADHC in NSW, the transition of identified mental health/ psychosocial disability will continue for years Commonwealth mental health programs to the NDIS and also into the future. the initial trialling of mental health services commissioning by One advantage to documenting activities is an increased level PHNs. of accountability in responding to challenges/opportunities Ultimately, the life span of a Community of Practice will likely identified and requests for information. be in accordance with the preferences of core and active group members (p. 12).
Evaluation
Evaluation and continuous learning are essential underpinnings for a Community of Practice. A NDIS and Mental Health Community of Practice should undertake evaluation activity/s to consider if they are making a difference to the quality and effectiveness of our understanding of the NDIS and mental health space. A standard survey can be developed and routinely used to evaluate Community of Practice activities.
For the Hunter NDIS and Mental Health Community of Practice
Forums our evaluation forms collected information about:
Registrations
Attendance
Whether the participant
was from within or outside of the trial site
was service provider, consumer, carer or other
felt more informed after the event
Overall rating for each event
Overall rating for each speaker at events
Number of feedback forms completed
Whether the time allocated for the forums was appropriate
Whether the frequency of events was appropriate
Suggestions for improvements and/or general comments.
MHCC provided forum participants with de-identified evaluation feedback.
In addition, the consultation session at each event provided participants with the opportunity to share written feedback. Written feedback collection allowed everyone in the large group events to share. Written feedback collection also recognises that some participants preferred not to share verbally in front of others.
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Actions to Cultivate Success in a Community of Practice 24
What makes a Community of Practice succeed depends on the purpose and objective of the community as well as the interests and resources of the members of that community. Wenger (2002) identifies seven actions to cultivate success in a Community of Practice.
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Design for evolution 5. Focus on value Design the community to evolve naturally. Design Focus on the value of the community. Community of Practice activities to support Communities of Practice should create change as interests, goals and members are opportunities for participants to discuss the value dynamic and subject to change. and productivity of their participation in the group.
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Open dialogue between inside and outside perspectives 6. Combine familiarity and excitement
Create opportunities for open dialogue across Communities of Practice should offer the perspectives. While members and their expected learning opportunities as part of their knowledge are the Community of Practices’ most structure, and opportunities for members to valuable resource, it is also good to look outside shape their learning experience together by of the Community of Practice to understand the brainstorming and examining the conventional different possibilities for achieving learning. and radical wisdom related to their topic.
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Invite different levels of participation 7. Create a rhythm for the community Welcome and allow different levels of Find and nurture a regular rhythm for the participation (also see ‘Reflections on consumer community. Communities of Practice should participation’, p. 9). coordinate a thriving cycle of activities and events that allow members to meet, reflect, and
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Develop both public and private evolve. The rhythm, or pace, should maintain community spaces an anticipated level of engagement to sustain While Community of Practice typically operate in the vibrancy of the community, yet not be public spaces where all members share, discuss so fast-paced that it becomes unwieldy and and explore ideas, they should also offer private overwhelming in its intensity. exchanges. Different members of the Community … and to this list we would add the need to of Practice could coordinate relationships among evaluate the outcomes and impacts of activities members and resources in an individualised of your Community of Practice! approach based on specific needs.
24 Adapted from Wenger, Etienne; McDermott, Richard; Snyder, William M. (2002). Op. cit.
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Myths about Communities of Practice 25
The many types of Communities of Practice show that there is no one-size-fits-all. Here are some ‘myths’ about Community of Practice that you may want to reflect upon.
It is too difficult to evaluate a define new roles and functions, and develop a Community of Practice collective and strategic voice.
Mostly false. It may be difficult to associate with Good facilitation is all it takes to 100% certainty the activities of a Community of get members to participate Practice to a particular outcome. There is a good False. Good facilitation is important but there case using quantitative and qualitative data to are many other reasons why people may not measure different types of value created by a participate. The value of participation needs Community of Practice. Include how members recognition as being relevant otherwise members are changing their practice and improving will not participate. Members need to see results performance as a result. of their participation and have a sense that they Communities of Practice are always are getting something out of it. self-organising Communities of Practice are False. Some communities do self-organise and are harmonious places very effective but most need support to be sure Maybe. If a Community of Practice is totally that member’s benefit from their participation. conflict free, then be concerned that ‘groupthink’ There are no leaders in a true may be settling in or voices silenced. Respectfully Community of Practice discuss differences and ensure that this contributes to learning. Mostly false. Decisions about Community of Practice processes and planning need making. There is a technology that is best This includes decisions about strategic directions. for a Community of Practice Not all members see value in being involved in False. Online Communities of Practice exist even these processes. Whether or not you call them when no one is there! A tool or technology is only leaders someone needs to do it and it is as well to as good as it is useful to the people who use it recognise them for the role they play. and a forum is simply a forum until a Community True Communities of Practice of Practice occupies it. are informal Communities of Practice are the False. There are many informal Communities of solution to everything! Practice and there are many formal ones too. False. Communities of Practice do not replace A Community of Practice that is intentionally teams, networks, inter-agencies or other joint developed is more likely to have to go through activities. Each has its own place in a learning some formal process to be recognised as such. system. The role of a Community of Practice is to share existing knowledge
Partially true. The experience people have to share is clearly important. However, Communities of Practice also innovate and solve problems. They invent new practices, create new knowledge,
25 Adapted from Wenger-Trynor Introduction to communities of practice: http://wenger-trayner.com/introduction-to-communities-of-practice.
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- Guidelines for next steps to establish a Community of Practice
- Audit existing mental health Champion establishment of a NDIS and Mental consultative structures Health Community of Practice Map existing mental health related inter-agencies, networks Innovation, learning and leadership are critical to and other consultative structures of your local community. maximising opportunities for people with mental health Understand where these are situated against both LHD and conditions arising from the NDIS. PHN boundaries. Where such structures exist, explore the The Guidelines for next steps to establish a NDIS and pros and cons of these hosting a NDIS and Mental Health Mental Health Community of Practice presented in this Community of Practice. section are not necessarily linear. Leaders championing the Existing mental health consultative structures can host establishment of a Community of Practice need to know or an NDIS and Mental Health Community of Practice where learn about their local community’s preferred approaches well placed to do so. This may be because they are well to maximising opportunities presenting through the NDIS. established, have a history of inter-sectoral attendance and collaboration or have contributed well to other mental health A person’s NDIS journey commences by making contact with reform processes in the past. the NDIA to ask for an Access Request Form and in gathering evidence of psychosocial disability. The capacity for new Other areas may not have well developed consultative entrants to access the NDIS in NSW during 2016/17 is limited. structures or they may be restricted in their scope. In this case, Therefore, identifying and supporting those people most further developing them to include opportunities for NDIS disabled by their mental health condition first is important. It and mental health reflections may be an option. For LHDs is from these initial experiences that an understanding of the that cover a large geographic area, the consultative structures opportunities of the NDIS will grow. may not be optimal for considering/consolidating reflections upon local NDIS experiences. Consider a consultative ‘hub and Local discussion about the benefits of establishing an NDIS spoke’ approach within large geographic areas. and Mental Health Community of Practice - and what the leadership, scope and logistics of this might look like – is An NDIS and mental health consultative structure can be an important starting place for establishing a group. Some either short or long term. Consider what the immediate suggested next steps for establishing a Community of Practice outcome is that you seek to achieve (awareness, knowledge, follow. skill or capability).
Example of Hunter trial site consultative structures audit
Existing Hunter trial site structures considered to host a NDIS and Mental Health Community of Practice in late 2013 included:
HNEMHS Mental Health Interagency Meeting – this long standing and valued meeting’s scope is for informal discussion of sector developments and issues
HNEMHS Mental Health NGO Forum – this long standing and valued meeting’s scope is mostly for NSW Ministry of Health/HNELHD funded mental health program management
National Disability Services (NDS) NDIS Forum/s – the scope of leadership and frontline worker forums convened by NDS is all disabilities
NDIA Forums – the scope of forums convened by NDIA is all disabilities
HNELHD NDIS Operational Implementation Group (and
Mental Health Working Group) – the scope of these groups is government representatives.
18 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
- Consult with key stakeholders 3. Convene a regional meeting Speak with key stakeholders including any local consumer Convene a one-off regional meeting to discuss the pros and groups, carer groups, CMOs, and regional NDIA, LHD, PHN and cons of establishing a NDIS and Mental Health Community PIROs to understand their views and preferences to establish of Practice. Think about who you want to attend this initial a NDIS and Mental Health Community of Practice. These meeting. You may prefer a small or large group meeting for conversations can be with key individuals, groups and/or at this initial discussion. Considered the pros and cons of inviting existing consultative events. representatives from all key stakeholder groups should be regardless of group size. Conversations should include discussion of the pros and cons of existing or developing local/regional consultative structures While the initial one-off regional meeting convened by to enhance learning arising from the experience of the NDIS. the NDIS and Mental Health Analysis Partnership Project Be aware that different stakeholders may have different views was limited to CMOs this was because the NDIS was so about NDIS impacts and opportunities and the importance of new to MHCC’s membership. The potential identified for being respectful of these. strengthening coordinated, integrated and collaborative practice resulted in the decision to establish a recurrent forum During the first three months of the NDIS and Mental Health that was open to all interested people. Analysis Partnership Project the Project Officer met with numerous key stakeholders using the range of methods At this early stage of NDIS implementation in NSW it described above resulting in identification of the need to is recommended that initial meetings consider broad convene a one-off sector meeting. attendance. The involvement of service users and service providers - from both the government primary health care The importance of PHN and GP engagement and community sectors - will maximise opportunities for consumers, their families and carers, and sector reform. PHNs commenced operation in July 2015 and did not exist when the Hunter NDIS and Mental Health Community of Practice was established. The forum established a strong 4. Seek agreement to establish a and important connection with the Hunter Medicare Local Community of Practice that was the lead agency hosting the trial site PIR program. At your one-off meeting, seek agreement to establishing a The important role that PHNs are to undertake in local Community of Practice. If agreed, discussion could occur implementation of national and state mental health reform about whether this will be mental health/psychosocial is now better understood. This will include PHN related disability specific. During the Hunter NDIS trial, the volume of work in strengthening GP linkages; and in responding to potential mental health specific content was so great that this people with complex and diverse needs in areas such as was the agreed focus; this did not exclude consideration of youth mental health, suicide, substance misuse and the more generic content as the need arose. Examples of this are disadvantage experienced by Aboriginal Torres Strait discussion about how organisations become NDIS registered Islander and other marginalised groups of people. providers and NDIA IT reporting and financial claims arrangements. For these and other reasons PHNs, along with GPs and LHDs, are critical key stakeholders in moving forward with However, many discussions of seemingly generic content the scaling up of the NDIS as this relates to people with quickly identified unique elements from a mental health complex and diverse health and social needs including perspective. Examples of this are discussions about: mental health conditions. access and eligibility,
service planning and review, and
the centrality of ‘coordination of supports’ related activity to recovery-oriented and trauma-informed practice.
After establishing agreement to the existence and scope of a Community of Practice explore what its activities might look like (see Frequency, Format and Content of pp. 12 13). Consider options for securing in-kind and/or financial resources to establish the Community of Practice.
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- Identify a leadership structure 7. Develop a plan to evaluate the Explore options to establish a core group and/or other success of the Community of Practice leadership structure for your Community of Practice against Before undertaking Community of Practice activities, think available resources (see Leadership on p. 10). While a about the qualitative and quantitative measures that you will proposed leadership model has been put forward that, in the undertake to evaluate the quality and effectiveness of your short term, builds on the substantial social capital that has Community of Practice. been established by many PIROs and PIR program across NSW it is acknowledged that this may not be a preferred Opportunities to evaluate your Community of Practice will option for all communities. align with the level of resources that you have to measure impacts. For more information about the evaluation approach What is important is local communities having discussions taken by the Hunter NDIS and Mental Health Community of that result in an agreed and preferred leadership option that is Practice see p. 15. best situated against the needs, resources and preferences of any specific community and that encourages group autonomy over time. Evaluation Community of Practice 26
The NSW Government has established an Evaluation
- Develop agreements regarding the Community of Practice. It provides an opportunity for people from government and non-government running of the Community of Practice organisations to access relevant resources on evaluation. Following your one-off meeting, formalise agreements The Government developed an Evaluation Toolkit to related to undertaking your Community of Practice. Consider provide advice and resources for planning and conducting developing written Terms of Reference for your group a program evaluation. The toolkit supports public sector including consideration of group: managers commissioning or managing evaluation. It is Aims/objectives also a reference for non-government organisations and external evaluators involved in evaluations with the NSW Outcomes Government.
Values
Leadership
Membership
Strategies for strengthening group autonomy
Activities
Plans for review of the groups’ agreements and work.
26 NSW Government (2015 b). Evaluation Community of Practice: http://evaluation.dpc.nsw.gov.au/
20 GUIDELINE FOR ESTABLISHING A LOCAL NDIS COMMUNITY OF PRACTICE TO ENHANCE LEARNING AND SECTOR REFORM [MHCC 2016]
- Concluding remarks From a mental health perspective the NDIS ‘market’ is Additionally, the NDIA indicate that further development essentially the community managed mental health sector. The and implementation of a national Mental Health and NDIS community managed mental health sector has a rich history of Engagement Strategy is of high priority in their current mental working together – and with consumers, carers and the public health work plan. This work is to include an explanation mental health sector – to provide services and supports to of how the NDIS will work for people with psychosocial people affected by mental health conditions. disability, their families and carers. As many mental health conditions are ‘cyclic’, or vary in intensity, consumers are The opportunity of the NDIS means that the community the critical reference group regarding the development of managed mental health sector will grow as people with high personally meaningful and flexible plans. Thus, the inclusion levels of psychosocial disability access funded services and of consumers, and their families and carers, in both NDIS and supports. In the Hunter trial site, this has included growth Mental Health Community of Practice activities as well as NDIS of the peer workforce (i.e., people with lived experience of co-production opportunities is encouraged. recovery and skills to help others in their journey of recovery). A downside to this growth opportunity is the potential for This document provides guidance from the experience of the competition between organisations rather than collaboration. Hunter trial site and other local communities are encouraged Communities of Practice create a space where collaboration to contribute to the learning and opportunities arising from can thrive and reduce unhealthy competition, while the NDIS as this relates to their unique implementation encouraging innovation in service delivery and leadership in experiences. mental health reform. For further information The role of PHNs in ensuring joint planning and accountabilities in nationally led and locally implemented mental health reform are anticipated to grow over time. It is For background information important that while PHNs are growing into their new mental to this guide, you may be health roles and functions that the opportunity that is the interested to read: NDIS is not lost. Navigating the NDIS: Lessons Some important work will be undertaken over the next few Learned through the Hunter years related to clarification and refinement of the NDIA’s Trial operational approach to the early intervention gateway, and in Available at the context of mental health and the NDIS. This applies both www.mhcc.org.au for young people - given that 75% of mental difficulties begin before age 25 – but also for people of any age who develop a mental health condition with the potential to disrupt their economic and social participation. A NDIS and Mental Health Community of Practice provide a place for such conversations to occur. People’s NDIS experiences – consumers, carers and service providers - inform these conversations.
27 Community Mental Health Australia (CMHA: 2012). Taking Our Place — Community Mental
Health Australia: Working together to improve mental health in the community. Sydney: CMHA.
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Place — Community Mental Health Australia: Working together
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