Cross-sector collaboration case studies
The benefits of cross-sector collaboration are explored in more detail in the Cross-sector collaboration: Implications for Gambler's Help background paper.
To print the practical examples of successful collaboration listed below, download our publication: Practice guidelines for cross-sector collaboration.
Principle 1: Case examples
Begin by creating an authorising environment
Case example: Victorian Responsible Gambling Foundation
Government, organisational and clinical leadership is needed to promote and reward collaborative practice and establish incentives to facilitate integrated care.
- Consistent with a 'no wrong door' approach to service delivery, this initiative included funding clinicians to provide problem gambling outreach, secondary consultation and specialist clinical interventions such as single session and co-counselling to agencies already engaged with clients.
- The program recognises that gamblers are more likely to present at other health services for their gambling related problems.
- A reference group was established to support the implementation of the new program, including senior managers from Gambler's Help services and senior representatives from the Department of Health and the Department of Justice (now the Victorian Responsible Gambling Foundation) to ensure authorisation took place at the inter-agency and inter-government levels.
- Program included funding of The Bouverie Centre and The Victorian Statewide Problem Gambling and Mental Health Partnership to assist in building better connections between Gambler's Help services and the mental health, alcohol and drug, and family services sectors.
- To address initial difficulties experienced by Gambler's Help services in gaining traction with other service sectors, the reference group recommended developing a Memorandum of Understanding (MOU) between the Department of Justice and the Department of Health for collaborative work between problem gambling, mental health, and alcohol and other drug (AOD) service sectors to be authorised at the highest level.
- Cross-sector training initiatives and resources were allocated through government funding.
Case Example: Eastern Allied Community Health (EACH)
Creating an authorising environment between the Ringwood Magistrates' Court and a Gambler's Help agency
A clear rationale for collaborative work needs to include how it will benefit clients, workers and organisations as well as identifying what challenges are likely to arise.
- Research shows as many as 33 per cent of prisoners may experience problems with gambling. To address such high rates of problem gambling, this initiative involved placinga Gambler's Help practitioner from EACH in the Ringwood Magistrates' Court to promote and create a client pathway to gambling and financial counselling services.
- A detailed plan outlining the benefits for both parties was presented to the Chief Magistrate. This included interventions to prevent repeated court appearances by problem gamblers attending the court and to work alongside other practitioners to address the multiple issues that can affect a client's involvement with the justice system.
- The partnership made clear how all parties stood to benefit from the collaboration rather than being seen as an impost or complication in an already busy and demanding environment.
- The Gambler's Help practitioner was able to engage and network with court staff to establish collaborative relationships, a consistency in the professional services provided, initiate referrals and brief interventions, and provide consultation and feedback to other practitioners.
- A log was kept to record interactions with court staff which provided a means to account for the practitioner's time at the court, build on the knowledge and information being accrued, track the levels of contact with other practitioners, and how relationships translated into secondary consultations, co-working arrangements and referrals.
- Prior to the commencement of this strategy, there were no regular referrals from the court. In the first seven months of operation, there were 12 single session counselling appointments, 30 secondary consults, and 8 referrals for ongoing problem gambling and financial counselling, co-work and case planning discussions.
- The success of this initiative suggests the broader needs of the client in relation to problem gambling issues are now being considered.
Principle 2: Case examples
System integration is an essential element of collaboration
Case Example: St Luke's Anglicare
System Integration working for an individual client
A 'no wrong door' approach provides people with access to appropriate services regardless of where they enter the system of care.
The material in this case study has been de-identified.
- Judith, 46, had participated in the Care Coordination Program at St Luke's since September 2011. As part of the program, she identified her main issues, set goals and nominated which service providers and support people she wished to participate in her care. At this stage, gambling had not been reported as an issue.
- After participating in the program for one year, Judith was experiencing difficulty with her mental health, and struggling to manage her diabetes and finances. It came to the attention of her mental health support worker that Judith's financial situation was being severely affected by her use of electronic gaming machines (EGMs).
- Initially, Judith was ambivalent about the issue. However, when the State Trustees threatened to take over management of her finances, Judith decided to 'just have a meeting' with a Gambler's Help counsellor. During the meeting, with the mental health worker in attendance, Judith decided to self-exclude from the venue where she regularly played EGMs and asked the Gambler's Help counsellor to participate in her care coordination meetings.
- After two months of self-exclusion and fortnightly Gambler's Help counselling sessions, all of the care coordination partners reported sudden progress by Judith, such as:
- Reduced stress and anxiety
- Stabilisation of her diabetes as a result of making better food choices
- Access to finances to buy the necessary equipment to manage her diabetes
- Rent was paid on time with a payment plan to address the accrued arrears
- The State Trustees became satisfied that Judith could manage her own finances.
- A year later, Judith's progress continued with Gambler's Help counselling as part of her care coordination. She was discharged from the Area Mental Health Services after 16 years involvement and is currently in the exit phase of the Care Coordination program as a result of her sustained recovery.
- Though Judith had not identified gambling as a primary issue, the financial impact of her problem gambling undermined her ability to address the range of issues she was experiencing.
Case example: Banyule Community Health Service
Collaborative service delivery for an individual client
A collaborative model of care includes both inter-agency and intra-agency approaches to working together.
- Beth, 45, made contact with Banyule Community Health Service (BCH) to help her deal with issues associated with her gambling behaviour including binge drinking, depression and anxiety. During her assessment, Beth disclosed a history of severe childhood neglect and emotional abuse, and explained that both of her parents were problem gamblers.
- She felt she had learnt from her parents to use gambling as a coping mechanism to escape her feelings of grief and loss, abandonment and sense of worthlessness. Over her 20 year history of gambling, she had found that electronic gaming machines (EGMs) could provide her with feelings of excitement as well as deflecting negative feeling states.
- Through the recommendation and support of her Gambler's Help counsellor, Beth was referred to Neami mental health service for assessment and on-going case management services. Her Gambler's Help counsellor accompanied her to the appointment and collaborated with the Neami practitioner to extend Beth's support options to maintain positive behaviour post-counselling with Gambler's Help. A supported referral was also made to the Psychiatric Registrar (Austin Health) who specialised in dual diagnosis and was located at BCH one day per week.
- Beth was provided with education on the connection between depression, anxiety, binge drinking and gambling together with information on the contra-indication of drinking alcohol (depressant) and taking anti-depressants.
- Relapse prevention and harm minimisation strategies for her drinking and gambling patterns were also offered. The problem gambling counsellor also worked with Beth to regulate her emotions and to recognise her catastrophic thinking and negative belief systems.
- After six weeks, Beth had stopped gambling and was successfully managing her impulses to gamble through utilising the self-management techniques she had developed.
- In Beth's care plan, it was identified that a primary motivation for her to stop gambling was so that she could save money and be able to afford to move out of the bungalow in her parent's backyard. However, she also had a fear of living on her own without a partner, which she addressed by gambling. Once these ambivalent feelings were explored, Beth's motivation to change increased and she began to look at alternative housing options and employment.
- After a lapse surrounding Beth's gambling behaviour, the Neami caseworker negotiated with Beth to attend an appointment with the Gambler's Help counsellor as a relapse prevention strategy. Further support was also facilitated through Beth's attendance at the eight week Getting Even Group and the Peer Connection Program which provided weekly telephone contact and peer support.
- The Gambler's Help counsellor facilitated a total of five referrals including North East Housing, Neami, the Austin Health Psychiatric Registrar, the Peer Connection Program and the eight week Getting Even Group. The coordination of these referrals and the collaborative work across services enabled Beth to address a range of inter-related issues associated with her gambling.
Case example: Working with the Karen community
Centre for Culture, Ethnicity and Health, Gambler's Help Western, Health West Partnership and New Hope Foundation, with funding from Victorian Responsible Gambling Foundation
Flexible service delivery to meet the needs of different population groups with acceptance and respect for cultural diversity
Acceptance and respect for cultural diversity is demonstrated through flexible service delivery that is reviewed and adjusted to meet the needs of different population groups.
- In 2010, a new partnership was formed between the Centre for Culture Ethnicity and Health, Gambler's Help Western at IPC Health, Health West Partnership and New Hope Foundation to the risk of gambling-related harm in the Karen community, Wyndham municipality.
- With funding from the Victorian Responsible Gambling Foundation, the three year project provided a community specific response to raise awareness about problem gambling to more than 1,000 community members.
- To identify and address issues such as stigma and to build rapport and trust with the Karen community, a number of meetings took place before substantive project planning began. A service mapping exercise was also undertaken to identify the relevant agencies and key organisations who had direct relationships with the Karen community.
- A community advisory group was established, and a skilled bilingual worker was employed to support the project and help facilitate the group. A skills assessment of the advisory group members was conducted to identify the levels of support needed for them to participate fully. Some advisory group members did not have an understanding of what was expected of them so the lead agency developed plain language documents and the role of the advisory group was clarified regularly.
- As the awareness and capacity of the community grew, so too did the project. The first year focused on community education and raising awareness. The second year of the project focused on developing and disseminating a Karen problem gambling DVD, and reaching disengaged men.
Principle 3: Case Examples
Social Capital provides the fuel for the machinery to run
Case Example: The Alfred Victorian Statewide Problem Gambling and Mental Health Partnership
Building social capital - Collaborative care pathways for clients with mental illness and problem gambling
Clinicians can find working in multi-disciplinary teams highly satisfying as they create a more collegiate atmosphere where the burden (and opportunities) of complexity are shared.
- The financial and social consequences of problem gambling can increase the vulnerability of people developing mental health issues, and mental illness can also exacerbate problem gambling behaviour.
- The inter-related nature of these concerns means that practitioners from both the mental health and gambling fields need to have the capacity to respond to co-occurring conditions.
- A barrier to this has been that many gambling practitioners have had little experience treating severe mental illness, and many mental health clinicians have had little experience treating problem gambling.
- The Victorian Statewide Problem Gambling and Mental Health Partnership (the partnership) was developed in 2010 to provide training and assessment, brief intervention and a secondary consultation service for co-morbid problem gambling and mental illness.
- Collaboration between Gambler's Help and mental health services was enhanced througha co-training model that provided education on co-morbid mental illness and problem gambling to Victorian mental health services.
- Co-facilitated by a local Gambler's Help service, this approach enabled mental health workers and gambling help professionals to gain a greater understanding of their respective expertise and an opportunity for workers to learn and share information across professional boundaries.
- A visiting assessment clinic was established where mental health clinicians travel to regional Gambler's Help services to assess clients in consultation with Gambler's Help counsellors. This enables a sharing of assessment information and a discussion about recommendations for interventions.
- Case conferences are also hosted during these visits to consider strategies to assess or intervene with clients who have more complex issues. This aims to effectively build the local service's capacity to respond to serious mental health issues, and involve local mental health services wherever possible.
- The program was evaluated through questionnaires. Mental health clinicians who participated in co-facilitated education sessions reported being better equipped to deal with clients experiencing co-occurring mental health and gambling issues and were more likely through their training experience to contact the Gambler's Help worker for referral and consultation.
- Gambler's Help counsellors reported an appreciation for collaborating with the partnership clinicians to provide a collaborative model of care and found the ability to access psychiatric and neuropsychological assessments in a timely way of great benefit.
- Through consultations with partnership staff, a greater range of interventions are available to Gambler's Help workers which generates a sense of empowerment and confidence in their work with clients who have complex needs.
- Developing an understanding of the culture and challenges of each other's particular work environment, helped develop trust, respect and a common language for communication.
Case example: Latrobe Community Health Service and Turning Point
Improving client pathways through communication, meetings and team-building
Regular communication, project team-building events, project team meetings as well as whole cross-sector team visits promote relationships between individuals and services.
- With a service area spanning a 500km in Gippsland and low referral rates from the Gambler's Help phone line, Latrobe Community Health Service Gambler's Help decided to explore referral pathways to see how they could improve the number of clients.
- By tracking the pathway of clients to the Gambler's Help services in the region, it was found that clients could speak to as many as five separate people before accessing a Gambler's Help counsellor. This most likely meant that clients may `fall though the cracks' and not receive the service they needed in a timely way.
- The intake and counselling team manager was contacted by Service Access at Turning Point to discuss how the services could work together to improve referral pathways for clients. Given they were using two different databases, working together would enable a better understanding of each service's processes and help determine funding requirements.
- Practitioners from Latrobe Community Health travelled to meet with Turning Point staff and took time to review the information on the database used for referring clients.
- In order to improve his knowledge of the region, the Turning Point manager also visited Latrobe Community Health Service and gained a better sense of the geography and location of the available Gambler's Help services.
- Together, they identified that a more accurate method of gauging service delivery points and client location could be achieved by sharing information through online communications. Email pathways were established and information sharing information was streamlined.
- By visiting each other's services, staff developed a greater understanding of culture, processes and the types of services that could be provided. To further build relationships and build confidence in the referral process, staff profiles were shared across the services so that the interests, skills and expertise.
- As a result, information sharing across services improved and structures were instituted to review service information quarterly which translated into a more efficient and responsive intake system.
- The two agencies also identified the need for a faster turnaround in providing referrals and care to clients in the region. This involved providing an immediate telephone response from a Gamblers Help counsellor, and offering a `walk-in' service. The Gambling Information and Support Team was introduced to respond to all Gamblers Help referrals and queries, from basic information through to single session work.
- With a service area spanning a 500km in Gippsland and low referral rates from the Gambler's Help phone line, Latrobe Community Health Service Gambler's Help decided to explore referral pathways to see how they could improve the number of clients.
Principle 4: Case examples
Co-location can be a useful mechanism for facilitating collaborative work
Case Example: Primary Care Connect
Integration within a multidisciplinary agency
- In November 2012, Primary Care Connect sought to capitalise on a major building project at their Shepparton location by bringing together practitioners from a range of sectors into a newly built office area.
- By facilitating informal contact between practitioners from different disciplines they aimed to strengthen inter-personal relationships, increase knowledge of surrounding areas of practice, and ultimately improve client pathways and integration of services.
- Managers from three areas of operation proposed the institution of integrated agency pods where members of diverse teams including Gambler's Help, alcohol and other drugs, parenting, youth, financial counselling and family violence staff, would be seated together in groups of three or four.
- To begin with, some practitioners were sceptical. However, once they had trialled the integrated seating pods they reported preferring the new arrangement over the old.
- Initially, practitioners felt a degree of disconnection from their program area. This was addressed by establishing regular program meetings and encouraging staff to walk to each other's new seating location to communicate directly rather than by electronic means.
- Management have noted an increase in cross-program referrals and information sharing along with an improved capacity to respond to a range of inter-related issues.
- Practitioners have found their interpersonal relationships have improved through a decrease in isolation, a sense of teamwork and co-operation across the agency, and an ease in accessing information outside of speciality areas.
- Although changes cannot be solely attributed to the strategy, the number of secondary consultations to the program increased from eight in the year the strategy was implemented, to 24 in the following year.
Case example: Gambler's Help City (Melbourne Counselling Service) and the Neighbourhood Justice Centre
Co-location generates mutual understanding, sharing of information and a sense of trust on an inter-personal and cross-sectoral level
Both formal and informal contacts promoted through co-location can generate mutual understanding, sharing of information and a sense of trust on an inter-personal and cross-sectoral level.
- The Neighbourhood Justice Centre in Collingwood is the only community justice centre in Victoria where a court, support services and a community facility are all co-located.
- A number of people attending the centre have come into contact with the justice system due to gambling related issues. Although many of these clients are compelled to participate in formal counselling, they don't necessarily perceive the need to receive help with their gambling behaviour.
- Gambler's Help City at Melbourne Counselling Service therefore sought to work with staff at the Neighbourhood Justice Centre to engage clients with court orders in problem gambling treatment, and to provide support for people with gambling issues prior to their hearing.
- Despite counsellors spending considerable time following-up clients, there was a high rate of 'no-shows' at individual counselling appointments. This led to a complex relationship with Corrective Services staff who were primarily concerned with a client's compliance to their court orders, while Gambler's Help counsellors were more attentive to the therapeutic process and client privacy. The clash between legal and therapeutic cultures made it difficult for either service to achieve good client outcomes.
- To overcome these issues, the Problem Gambling Counselling Group was established to provide psycho-education for mandated clients who were not ready or willing to take part in counselling, while also meeting the needs Community Corrections Services and the courts.
- The two-hour group sessions run for six consecutive weeks. Intake into the group begins with a referral from Community Corrections staff. Clients are then contacted by the group facilitators to discuss expectations and to assess their suitability for the program.
- In the group sessions, participants are encouraged to explore their own gambling behaviour through a series of educative activities, including sessions on identifying triggers and de-bunking gambling myths. At the end of the six-week period, participants receive a certificate of participation that can be used to satisfy their court orders. All participants are also able to access individual counselling throughout the group program or after its completion.
- Although new programs can take time to gain momentum, the outcomes of this group have been encouraging from the outset. In a notable contrast to the poor attendance at individual sessions, all clients who attended have completed the program. Participation within the group sessions has been strong with initially ambivalent attendees becoming active group members over time.
- After witnessing the effectiveness of the group, Community Corrections liaised with Gambler's Help practitioners to expand the group to include other clients with gambling issues as well as those mandated to attend. The group is now also able to cater for people who wish to revoke their self-exclusion from Crown Casino.
- The benefits of locating the group program at the centre, has resulted in increasing the profile of Gambler's Help, raising awareness about problem gambling, and the strengthening the relationship between Gambler's Help practitioners and other co-located services.
Principle 5: Case example
Joint training can help develop staff commitment to collaboration
Case Example: Bethany Community Support, Barwon Health and the Bouverie Centre
Joint training in family inclusive practice
Staff training programs can create a common language between services.
- In recent years, the needs of families and vulnerable children have been given greater priority in the strategic directions of services and government policies.
- Delivered by The Bouverie Centre, the Beacon Strategy provides training and implementation support to Gambler's Help, alcohol and other drug and mental health sector organisations how to implement family inclusive approaches in single session family consultations.
- The single session family consultation model is a readily accessible means of building confidence for staff to include families in their work. It also has the dual benefit of providing staff from different disciplines to come together in a common language and bridge divisions in service delivery.
- By its nature, family work involves a range of needs and concerns so it is well suited to the endeavour of promoting collaboration across services as well as opportunities for co-work and the sharing of expertise.
- In 2011/12, the Bouverie Centre provided training in single session family work for Bethany Gambler's Help and Barwon Health, mental health and drug and alcohol services. Once staff had completed the training, they were encouraged to attend practice enquiry groups where they could build on successes and overcome barriers to implementation.
- The training sessions helped to increase awareness of Gambler's Help services as well as foster a collegial atmosphere where clinicians could confer around complex clients with whose issues traversed multiple programs.
- The success of the program was evaluated through questionnaires prior to training, and again six months afterwards. There was significant uptake of family centred practice within both organisations including enhanced knowledge, skills and confidence of staff and improvements in the way they engaged families.
- Importantly, a problem gambling screening question was introduced into the assessment used by Barwon Health that meant problem gambling was more likely to be detected when clients presented for other concerns.
- Through the identification of clients experiencing problems with gambling, referrals and secondary consultations could be made to Bethany Gambler's Help. Over a 10 month period, there were an additional 12 referrals and 15 secondary consultations.
- These successful outcomes were a result of providing practitioners with an opportunity to get to know each other, share a common language, and develop an appreciation for the culture and expertise of other disciplines.