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Going the distance

Public health and private industry can work together to improve outcomes for mental health services, writes Kaye Knight and Tim Lenten.

Delivering and achieving consistent education outcomes can be a challenge when mental health clinicians are spread geographically. A collaborative partnership between private industry and a public mental health service has demonstrated how this challenge can be overcome and how private industry and public health can work together to improve outcomes for mental health services.

Two central Victorian organisations - LearnPRN and Psychiatric Services, Bendigo Health have worked together on two major projects that are now seeing service outcomes at a local and statewide level.

Based in central Victoria, LearnPRN has provided face-to-face education, eLearning and education consultancy Australia wide since 2003. An RCNA APEC provider since 2004, LearnPRN is best known for its education work in rural and private healthcare, the development and delivery of healthcare specific eLearning programs, and for their work in rural telephone triage education.

The region of Victoria serviced by Bendigo Health Psychiatric Services is defined by the Department of Human Services (DHS) as the Loddon-Campaspe/Southern Mallee Region. The region covers just over 37,000 sq. kilometres, extends over 200km from top to bottom and has a population of 242,000. While most clinical services are located in Bendigo, including all inpatient facilities, regional clinical teams are located in Swan Hill, Echuca, Castlemaine, Maryborough and Kyneton. Very few private psychiatrists are employed in the region and there are no private inpatient facilities, thus the workload is high. This further highlights the importance to establish a flexible and sustainable education program.

The collaborative projects
In 2010 the Mental Health Branch, Department of Health Victoria, selected LearnPRN, as the lead agent to provide the education for the statewide roll out of the mental health triage scale to all mental health services within Victoria. LearnPRN engaged the Psychiatric Services Professional Development Unit (PSDU) of Bendigo Health to provide the specialist mental health education services for the project. The timeframe for the mental health triage scale roll out was four months from project inception to completion. The project utilised a range of education strategies and focused teamwork to achieve the project outcomes.

The LearnPRN team provided the instructional design, curriculum development, education and multi-media design expertise, together with the ability to use their own learning management system, whilst the PSDU provided the specialist content knowledge for the Train the Trainer manual, the face-to-face education and the content for the eLearning program.

The roll out comprised of six face-to-face training programs delivered as 'train-the-trainer' programs equipping participants with the key messages and tools to on-deliver this training to staff within their organisation. During the roll out phase, 101 educators, clinicians and administrators from 15 Mental Health services attended the face-to-face training. The preparatory train-the-trainer activities and resources aimed to accommodate the diversity in training backgrounds of the participants.

Trainers were provided with a comprehensive 'Train the Trainer' manual to support the implementation of the local training, access to ongoing support from the collaborative implementation team and access to an optional eLearning program designed to support the delivery of the mental health triage theoretical component for clinicians requiring introductory or additional information regarding mental health triage and the application of the triage scale.

'Train-the-trainer' models are terrific in theory, however from past experience the team knew that the 'train-the-trainer' approach could fail if there was inadequate support for the local trainers. The mental health triage scale was being rolled out into metropolitan and rural based services and specialist mental health services. Some services were well supported with dedicated educators, where others relied on clinical peers or line managers to implement the local training.

With this in mind, the team put in a considerable amount of work to ensure that a range of resources was available for trainers to use. Resources included suggested session plans and activities, PowerPoint presentation that could be modified to suit the local context, learning needs assessment tool, theoretical and competency assessment tools, program evaluation, documentation audit tool and additional resources to support local implementation of the mental health triage scale.

An eLearning program was developed and offered to all mental health clinicians requiring detailed background information about mental health triage and further information regarding the mental health triage scale. The eLearning program was delivered via LearnPRN's web based learning management system. This meant that all the health services were required to provide clinician access to an internet connected computer. As the eLearning program included theoretical assessments, local trainers could use this resource as a theoretical based competency assessment strategy as well.

The education resources were designed to be 'trainer selectable' based on the specific needs of the individual mental health service. During the local roll out phase trainers were further supported by a telephone support service offered by the collaborative team. The LearnPRN educator was available to provide advice related to the education and local training elements of the roll out and the PSDU educator provided advice related to the clinical and administrative elements of implementing a new system.

The project timeframes were met with roll out achieved in September 2010. The project evaluation demonstrated consistently that the training strategies translated well to the workplace-based setting and the resources provided supported the local implementation of the roll out training. The eLearning program evaluations indicated that participants found the material easy to follow, relevant and delivered in an appropriate learning environment. Smaller services with limited capacity to conduct face-to-face sessions found the eLearning program particular useful for delivering the theory behind the mental health scale and to demonstrate completion outcomes via the reporting capacity of the learning management system. The mental health triage scale is now used in mental health services statewide and is generating interest from other mental health services in Australia.

As a direct result of the successful working relationship, the two organisations have collaborated to develop six mental health specific eLearning programs for the mental health clinicians within the Bendigo Health Psychiatric Service. This project has again utilized the specialist content knowledge of the mental health clinicians within the Professional Development Unit and the education development and eLearning expertise of LearnPRN. The programs are designed to meet the mandatory education requirements of the mental health clinicians.

With such an extensive geographical and specialist spread of mental health services within the region, providing the education and achieving compliance had been problematic. The four programs that have been developed to date and are in use include: Medication administration - mental health, MSE & Assessing Risk, Create Workplace Safety and most recently, Advanced Suicide Assessment Program. Data from the first year of implementation indicates that the introduction of the eLearning strategy has resulted in completion rates for mental health competency education increasing from 30 per cent to 70 per cent.

Success or failure of an eLearning strategy is dependent upon how the implementation phase is managed. As a health industry based education company, the LearnPRN team understands the context and the characteristics of the learners. This understanding provides insight into the issues that arise from introducing a new education strategy such as eLearning.

Local implementation has been successful because the PSDU Team has fully appreciated the requirements of successful eLearning implementation. eLearning is not a set and forget option.

The PSDU recognise and accommodate the different learning approaches. Clinicians who are confident with computers can complete units individually; whereas those clinicians that lack confidence with computers can attend a facilitated session with educators. The PSDU also has specific administrative support to manage the operational requirements of managing student enrolments in the learning management system. What has resulted is a successful implementation at Bendigo Health Psychiatric Services, using a blended model of learning and support.

To access a copy of the Mental Health Triage Scale 'Train the Trainer' manual go to: www.health.vic.gov.au/mentalhealth/triage/training.htm

Kaye Knight is nurse educator and managing director of LearnPRN, email [email protected]. Tim Lenten is senior psychiatric nurse consultant at Bendigo Health, email [email protected]

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