Digital Mental Health Model of Care Standard

The service provider has a model of care for each digital mental health service that enables and supports the delivery of care to service users.

• How does the service provider document the model of care for each service, including outlining the intended users?
• What processes are in place to monitor and evaluate whether the models of care for each service are effective?
• What actions does the service provider take to update and improve the models of care of its services?

• Documents that outline the model of care for each service, including the purpose of the service, the intended users, the outcomes expected, and the way in which the service is to work to achieve the stated purpose and outcomes for the intended audience
• An audit of the adherence of the services delivered to the models of care
• Analysis of variance data on the outcomes from use of each service against expected outcomes
• Feedback from service users about whether the service met their expectations
• Position descriptions that indicate accountability for the model of care of each service
• Evidence of changes to the models of care of services based on an analysis of outcomes and feedback
• Committee or meeting minutes that detail discussion about the models of care and any evaluation of or changes to the models of care.

The effectiveness of the digital mental health service is enhanced when the model of care reflects the best available evidence and best practice.

• How does the service provider ensure the models of care for each service are based on evidence and reflect best practice?
• What processes are in place to ensure the models of care of its services are updated when the evidence base changes?

• Literature searches that show the evidence relied upon by the model of care at the time of development of each service
• Clinical guidelines that set out best practice for the services being delivered
• An audit of the alignment of the model of care for a service with the available evidence and best practice
• Research trials or other scientific endeavours that evaluate a service and comment on its evidence base or practice
• Consumer-led research and evaluation of the experience and outcomes of the model of care
• Endorsement by professional associations or academic institutions that the model of care of a service reflects the evidence base or contemporary practice
• Systems to periodically review and update the evidence base that underpins the model of care and to report on the implications of new evidence for the model of care
• Expert opinions about the contemporary nature of the model of service and any required changes
• Committee or meeting minutes that detail discussions about updates to the model of care based on updated evidence.

The service user has the information they need to make an informed choice about whether to use a digital mental health service.

• Does the service provider provide concise and easy-to-understand product information about each service to service users?
• How does the service provider assess whether the information in the product information meets the needs of diverse service users?

• A policy on the development and provision of product information to be provided to service users; the policy should:
  • align with the current template
  • set out the requirements for different languages and formats, consistent with the intended users
• Product information for each service
• Feedback from (or survey of) service users on the product information provided for a service, especially on whether it is easy to understand and meets their needs
• Evidence of updates to product information in line with changes to the model of care or changes in legislation.

Safe and effective care is delivered in line with the model of care and the service user’s needs and preferences, and the outcomes of care are reviewed regularly to ensure that the goals of care are being met.

• How does the service provider monitor the delivery of services?
• What processes does the service provider have to ensure that there is one person with overall accountability for the care of each service user?
• What processes are in place for when the service user stops receiving care from a service?

• Policy documents that outline processes for the delivery of the service that are consistent with the model of care and also require that overall accountability for each service user be assigned to a designated member of the workforce
• Audits of the fidelity to the model of care of the service delivered
• An audit of healthcare records that indicates that each service user has a designated individual with overall accountability for their care
• A survey of service users about their experience of the service, including whether goals of care and actions for treatment were developed in partnership and clearly communicated to them
• A policy document that outlines the processes that support the involvement of service users’ support people in communications and decision-making
• Healthcare records that document the involvement of support people in communications and decision-making
• A standardised template for referral to follow-up services or evidence of completed referrals.

Service users receive prompt screening and, when indicated, assessment and identification of risk.

• How does the service provider identify service users who are at risk?
• What are the potential risks that users of this service are most likely to face?

• Policy documents that outline processes for how services can conduct screening, including:
  • when routine screening of service users will occur
  • the roles and responsibilities of members of the workforce when service users are routinely screened
  • the process for taking action when risks are identified
  • indications for repeating the screening process
• Observation of practice that shows use of relevant screening processes
• Records of interviews with the workforce that show that they understand the service provider’s screening processes and their responsibilities
• Training documents about screening processes
• Communication with the workforce about updates to screening processes
• Results of audits of healthcare records of screening
• Feedback from service users about screening
• Assessment of the risks relevant to the population serviced by the service
• Resources and tools developed by the service provider for screening and assessment of clinical conditions and risks that are relevant to the service provided
• Training documents about the identification and assessment of at-risk service users.

Adverse outcomes relating to service users who are distressed or have thoughts of self-harm or suicide or who have self-harmed are prevented through early recognition and effective response.

• How does the service provider respond to service users who are distressed, have expressed thoughts of self-harm or suicide, or have self-harmed?
• What referral processes does the service provider have in place?

• Policy documents that outline collaborative processes for identifying and treating service users at risk of self-harm or suicide, or who have self-harmed
• Risk assessment tools for service users at risk of self-harm or suicide
• Training documents about identifying and treating service users at risk of self-harm or suicide, or who have self-harmed
• Service user information packages or resources about strategies for managing self-harm, or risks of self-harm or suicide, and escalation protocols
• A clinical incident monitoring system that includes information on self-harm and suicide
• Resources for the workforce to help identify service users who require close monitoring
• Service user experience surveys, a complaints management system and a service user participation policy for service users at risk of self-harm or suicide
• Observations that information about referring service users to specialist mental health services is accessible to the workforce.

Service users are correctly identified and matched to their care, and their anonymity is preserved if applicable. Service users who identify as of Aboriginal and/or Torres Strait Islander origin and who wish to have their cultural identity recorded can do so to inform the development and delivery of culturally safe digital mental health care.

• What processes are in place to ask if service users wish to record that they identify as Aboriginal and/or Torres Strait Islander?
• How is this information recorded in administrative information systems and transferred to clinical information systems?
• What processes are in place to ensure that service users are correctly identified and matched to their care?
• If the service is provided anonymously, how does the service provider protect the anonymity of the service user?

• A policy document that describes the service provider’s requirements for the identification and authentication of service users (in line with the model of care) and includes:
  • processes for asking if service users are Aboriginal and/or Torres Strait Islander
  • processes for recording this information in administrative and clinical information systems
  • methods to match service users to their care following identification and authentication
  • approaches that protect the anonymity of service users when this is part of the model of care or requested by the service user
  • use of appropriate identifiers according to digital services best-practice guidelines
• A registration form on which service users can identify as being of Aboriginal or Torres Strait Islander origin
• Communication material that provides service users with information about why they will be asked if they are of Aboriginal or Torres Strait Islander origin
• Training or contract documents about obtaining information about Aboriginal and Torres Strait Islander service users
• Communication with the workforce about the importance of identifying Aboriginal and Torres Strait Islander service users
• Analysis of incidents relating to failure to correctly identify or authenticate service users or to match them to their care, and any associated actions to be implemented as a result
• Analysis of incidents about failure to protect the anonymity of service users and any associated actions to be implemented as a result
• Observation of system for using appropriate identifiers for service users.

Emerging or new critical information, alerts and risks are communicated in a timely manner, including by service users and their support people.

• How does the service provider communicate critical information to protect the safety of service users?
• Are service users able to communicate information about risks to the service provider?

• A review of process mapping that identifies the situations in which communication of emerging or changing critical information are required
• A risk register that includes identified risks for receipt and distribution of critical information to responsible clinicians
• Activities to manage identified risks with receipt and distribution of critical information
• Reports, investigations and feedback from the incident management and investigation system that identifies incidents relating to receipt and distribution of critical information
• Documented processes for communicating critical information when there is an unexpected change in a service user’s status or when new critical information becomes available
• Policy documents that outline the:
  • types of critical information that are likely to be received, and actions to be taken in response
  • method for communicating critical information to the responsible clinician
  • method for communicating critical information to the service user and their support people
  • time frames for communicating critical information
• Results of audits of workforce compliance with policies relating to communicating critical information
• Examples of information provided to patients, carers and families about processes for communicating concerns to the clinicians responsible for care.

Service users’ safety and care is maintained by accurate and relevant communication when care is transferred.

• What processes are in place to transfer the care of the service user at the end of their care?
• How does the service provider assess the service user’s needs and risk at the point of transfer of care and ensure effective communication occurs to support the transfer of care?

• A model of care that documents the options for transfer of care
• Policy documents that specify the risk assessment process and the minimum information to be communicated at transfer of care
• Evidence that clinicians were involved in specifying the minimum information to be communicated at transfer of care
• Feedback from the workforce on the use of transfer-of-care policies, procedures and protocols
• Observation of clinicians’ practice that shows use of structured risk assessment and communication processes and tools at transfer of care
• Records of interviews with clinicians that show that they understand the service provider’s structured processes for transfer of care
• Results of audits of completed documentation that show effective handover of responsibility for care; documents may include standardised transfer forms, completed transfer forms and standardised referral letters
• Results of audits of workforce compliance with transfer-of-care policies, procedures and protocols
• Training documents about responsibilities and processes for transfer of care
• Communication with the workforce about transfer-of-care processes
• Information provided to service users that outlines their role in the transfer of care, such as a charter of rights or service user information sheet
• Results of a service user experience survey, and service user feedback about transfer of care
• Results from workforce satisfaction surveys and feedback about referral and use of transfer-of-care processes.

Service users with acute deterioration are identified early and adverse outcomes relating to acute deterioration in a person’s mental state are prevented through early recognition and effective response.

• What processes are in place to detect deterioration in the service user’s mental state?

• Policy documents about recognising and documenting acute deterioration in mental state
• Screening and assessment policies and procedures for mental health in line with the model of care
• Training documents about recognising acute deterioration in mental state and how to deal with reports of deterioration from the service user or their support people
• Documentation of service user involvement in developing individualised monitoring plans
• Results of audits of compliance with the monitoring plan systems for mental state.

Care for service users whose mental state is deteriorating is escalated safely and effectively.

• What process is in place to call for emergency assistance when required?

• Policy documents about escalating care and calling for emergency assistance that identify the criteria to trigger this response and set out the nature of the emergency assistance to be sought
• Training documents about mechanisms for escalating care and calling for emergency assistance
• Results of audits of compliance with the mechanisms for escalating care and calling for emergency assistance
• Evidence of investigations into failures to escalate and call for emergency assistance, and associated quality improvement projects.

Systems are in place to respond to service users whose mental state is deteriorating.

• What processes are in place to respond to service users who show signs of acute deterioration in their mental state?

• Employment documents that describe roles and responsibilities in the event of episodes of acute deterioration
• Training documents about emergency interventions in the event of acute deterioration, including specialist training for responders, such as members of medical emergency teams
• Evidence of clinician competency assessment – for example, through simulation exercises, peer-review or formal assessments
• Information provided to service users about options to get urgent assistance from an alternative service, for example, 000, GP, emergency department.