Access to Allied Psychological Services (ATAPS)

ATAPS allows the arrangement of mental health services provided by allied health professionals to assist GPs in the support of their patients through evidence-based psychological therapies.

Background

ATAPS enables GPs to refer consumers to ATAPS mental health professionals who deliver focussed psychological strategies services.

Through ATAPS, patients are eligible for a maximum of 12 sessions per calendar year – six time-limited sessions with an option for a further six sessions following a mental health review by the referring GP. Sessions can be individual and/or group therapy sessions. ATAPS provides patients with assistance for short-term intervention.  If further sessions are required it may mean that the patient needs a longer term program to meet his/her needs.

In addition, the referring practitioner may consider that in exceptional circumstances the patient may require an additional six individual focussed psychological strategies services above those already provided (up to a maximum total of 18 individual services per patient per calendar year). Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services. It is up to the referring practitioner to determine that the patient meets these requirements. In these cases a new referral should be provided, and exceptional circumstances noted in that referral.

Through ATAPS, patients are also eligible for up to 12 separate group therapy services, within a calendar year, involving 6-10 patients. These group services are separate from the individual services and do not count towards the 12 individual mental health services in a calendar year.

Patients are not to be referred for treatment through Better Access to Psychiatrists, Psychologists and General Practitioners through the Medical Benefits Schedule (Better Access) Program and ATAPS at the same time or in the same calendar year unless their individual circumstances have changed. Changed circumstances include: changes in location where the person is no longer able to access Better Access services due to workforce constraints; or their financial circumstances change and they are no longer able to meet the co-payments associated with Better Access services. In deciding if ATAPS is more appropriate GPs should consider the focus and target of the ATAPS program.

Medicare Locals act as fundholders for ATAPS. The Australian Medicare Local Alliance is the peak national body representing 61 Medicare Locals. All 61 Medicare Locals are funded to provide mental health services across the country. The Australian Medicare Local Alliance provides an on-line Network Directory on its website which allows individuals to obtain information on Medicare Locals. The Australian Medicare Local Alliance also provides a number of training and support resources for Medicare Locals.

Appropriate mental health training can help GPs to further develop and improve their skills in diagnosing, treating and referring patients with mental disorders to appropriate services. It is strongly recommended that GPs participate in appropriate mental health training, such as that accredited by the General Practice Mental Health Standards Collaboration.

Access to Allied Psychological Services – Child Mental Health Service (ATAPS CMHS)

ATAPS allows the arrangement of mental health services provided by allied health professionals to assist GPs in the support of their patients through evidence-based psychological therapies. ATAPS complements the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative, by providing low cost services for hard to reach groups and in areas where private mental health services may not be readily accessible. Better Access is the main vehicle for providing government subsidised psychological services in Australia.

ATAPS targets services for people requiring primary mental health care who are not likely to be able to have their needs met through Medicare subsidised mental health services and addresses service gaps for people in particular geographical areas and population groups.

The ATAPS CMHS is primarily designed for children under 12 years of age, who have or are at risk of developing, a mild to moderate mental health, childhood behavioural or emotional disorder, and who could benefit from short term focussed psychological strategies. The short term, goal oriented focussed psychological strategies that ATAPS provides are of most therapeutic value to individuals with common disorders of mild to moderate severity.

However, individuals with a more severe illness whose conditions may benefit from short term focussed psychological strategies as part of their overall treatment process may also be provided with ATAPS services.

Eligibility Criteria

The eligibility criteria for services under the ATAPS Child Mental Health Service includes:

• a child assessed as having definite or substantial signs and symptoms of an emerging mental disorder (including conduct disorder), where this causes “significant dysfunction in everyday life”;
• a child at risk of developing a mental disorder, where the child shows one or more signs or symptoms (social-emotional-behavioural) of developing a mental disorder and/or
• a child’s developmental pathway considered to be disrupted by his/her mental health condition (i.e. not limited to disruptive disorders). Signs of disruption to functioning in one or more settings are necessary. That is, one setting is considered sufficient to warrant the child’s eligibility to receive services under ATAPS CMHS (e.g. home or school); and
• children between the ages of 12 and 15 who have the clinical need and no other suitable mental health services exist in the region for the child to access.

Mental Disorders and Contextual Factors

A mental disorder may be defined as a significant impairment of an individual’s cognitive, affective and/or relational abilities which may require intervention and may be a recognised, medically diagnosable illness or disorder – this definition is informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD – 10 Chapter V Primary Health Care Version.

The mental disorders and contextual factors relevant to children under 12 years of age that can be treated under ATAPS CMHS are outlined below.

Referrals

Infants and children can be referred to ATAPS – CMHS by their GP, paediatrician or psychiatrist. Infants and children do NOT need to have a mental or childhood behavioural or emotional disorder diagnosed in order to access the CMHS. However, if they do not have a diagnosed disorder, there needs to be clear clinical evidence that they are at significant risk of developing a disorder, in order to access the CMHS. In cases where there is no diagnosis, the referring GP, paediatrician or psychiatrist should record symptoms which indicate that the child is at significant risk of developing a mental disorder or childhood behavioural or emotional disorder.

Stakeholders and referring practitioners should be made aware that referrals to ATAPS-CMHS are only for children who require short term support. In some cases, children may be more appropriately referred to another local service, such as the Child Adolescent Mental Health Service (CAMHS) where available.

In some instances, a referral from a GP, paediatrician or psychiatrist may not be possible. A ‘provisional referral’ can be made by the following professions and clinicians:

• Allied health professionals who are eligible to provide services under ATAPS (appropriately trained occupational therapists, social workers, psychologists, mental health nurses and Aboriginal and Torres Strait Islander health workers). An allied health professional may not refer someone to themselves or to someone operating in the same practice;
• School psychologists/counsellors or Deputy Principals/Principals. Where the school or early childhood service does not have a qualified psychologist or counsellor, referrals need to be made via senior staff members (e.g. Directors or Principals/Deputy Principals) in consultation with the child’s parents/guardian.
• Directors of early childhood services; and
• Medical officers in non-government organisations (NGOs).

Child Treatment Plan

The term Child Treatment Plan (otherwise known as “GP Mental Health Treatment Plan-MHTP”), is used in light of issues around labelling/stigmatising young children that may hinder families from becoming engaged with ATAPS CMHS.

Clients must have an assessment conducted and an ATAPS Child Treatment Plan (ATAPS CTP) developed to be eligible for ATAPS CMHS. Provisional referrals do not require an ATAPS CTP to be provided at the time of referral to the Service. Where referrals are made by professions other than a GP, patients must have an ATAPS CTP prepared in consultation with a GP as soon as possible, preferably within two weeks of the first session or four weeks in a rural and remote area or as soon as practical where there is no ready access to GPs.

the Medicare Local encourages a high standard of communication between referring and treating providers. A team based approach to care involving the GP in care coordination is often crucial to effective whole-of-person care. It is recognised that in some communities or for some individuals a GP may not be the primary provider responsible for the overall care of the person.

Intervention Standards

Service delivery under ATAPS CMHS must be based on principles and standards which underpin good clinical practice. The 2012 ATAPS CMHS Purchasing Guidance contains principles and practice standards considered by mental health experts to underpin good clinical practice for clinicians working with children who are experiencing or are at a significant risk of developing, a mental, childhood behavioural or emotional disorder.

The interventions that can be provided through this Service should be consistent with the following treatments as these are considered to have a strong evidence base:

• Behavioural interventions;
• Parenting/family-based interventions; and
• Cognitive Behavioural Therapy (CBT) Interventions.

The specific interventions to be provided as part of the above treatments include:

• Attachment Intervention – family based intervention (where expertise is available);
• Behavioural interventions;
• CBT (including individual child and family/parent based);
• Family based interventions (Behaviour or CBT based intervention only); and
• Parent-Child Interaction Therapy (PCIT) -for attachment and behavioural disorders (where expertise is available).

The following interventions are NOT included under ATAPS CMHS:

• Art therapy;
• Mindfulness-Based Cognitive Therapy (MBCT);
• Play therapy; and
• Family therapy (other than behavioural/cognitive behavioural treatments including:  Psychodynamic;
  • Structural;
  • Constructivist approaches (e.g. Milan);
  • Narrative; and
  • Solution focused interventions.

Please refer to the attached 2012 ATAPS CMHS Purchasing Guidance which provides the evidence for the above treatment interventions for the relevant ATAPS CMHS mental, childhood behavioural or emotional disorders.

Intervention Period

The CMHS is designed to provide short term support for children and their families and others responsible for the child. The Service is not intended to provide long-term intensive support. However, individuals with more severe illness who may benefit from short-term, focused psychological strategies as part of their overall treatment, may also be provided with ATAPS CMHS.

The total number of sessions the client can access under the CMHS is up to 12 in a calendar year (up to 18 in exceptional circumstances), as outlined below. However, up to an additional 6 sessions may be accessed if ceasing treatment would lead to a detrimental outcome for the child (in exceptional circumstances and determined on a case by case basis).

Sessions with the individual

• 1-6 sessions. Sessions one to three may contribute to the initial assessment to identify if the ATAPS CMHS is appropriate for the individual or inform the most appropriate treatment. Sessions will be subject to appropriate referrals and ATAPS Child Treatment Plan (CTP) requirements and timeframes. Where there is no diagnosis of a mental disorder, the referring medical practitioner should document in the ATAPS CTP that the child is at a significant risk of developing a mental disorder/childhood behavioural or emotional disorder and record the presenting symptoms.
• 7-12 sessions. On completion of the initial course of 6 sessions, the allied health professional is to provide a written report to the referring medical practitioner. Following receipt of the report, the referring practitioner will consider the need for further treatment and if clinically required issue a referral for an additional 7-12 sessions.
• 13-18 sessions. In exceptional circumstances, the individual may require an additional six sessions above those already provided (up to a maximum total of 18 individual sessions per client per calendar year). Following receipt of the allied health professional’s report, the referring practitioner will consider the need for further treatment and issue a referral for an additional six sessions. Further allied mental health services may not be provided without a referral for additional services.

Sessions with parents, family members, guardians or other persons having responsibility for the child without the child present

Parents or relevant others can be present at all sessions where clinically appropriate. The total number of services remains up to 12 in a calendar year (or up to 18 in exceptional circumstances) and is inclusive of those with and without the child present. Clinicians can determine how many services to provide to parents or relevant others without a child being present, however they should ensure that the child receiving treatment must always be the focus of services and support and that there is maximum capacity for treatment of the child within the total available sessions.

Group Sessions

1-12 sessions. Up to 12 group therapy services within a calendar year involving 6-10 people, providing appropriate referrals have been made and ATAPS CTP are prepared. It is envisaged that children and their parents or other responsible adults may participate in such groups depending on the clinical appropriateness.

Service Provisions

The following core principles are considered essential for Providers in delivering an effective ATAPS CMHS system, achieving better health outcomes for children and ensuring the right services are delivered at the right time and right place.

The Applicant will:

• develop innovative approaches and service delivery models to provide allied mental health care services to children and groups who are hard to reach or who have been identified as needing a greater focus;
• support GPs to provide early intervention and contribute to the achievement of the best possible health outcomes for infants and children with mental disorder or those at significant risk of developing a mental disorder;
• promote evidence-based practice in the delivery of primary mental health care.

The Applicant must undertake the following ATAPS activities:

1. Identify and support GPs and other eligible referring practitioners who are managing a child with a mental disorder, or infants and children, those at significant risk of developing a mental disorder.
2. Assist participating GPs and other eligible referrers with the referral procedure to ensure the best possible outcome for clients;
3. Establish an intake process to enable review of referrals to the Program utilising a model that best suits local conditions to ensure children are referred to the most appropriate services, resources are effectively targeted, duplication is minimised and levels of unmet demand are managed;
4. Identify and engage appropriately qualified allied health professionals who are trained in the use of evidence-based psychological strategies, who meet the requirements set out in the ATAPS Operational Guidelines and who will be available to receive referrals from GPs and other eligible referring practitioners. The applicant is encouraged to engage a range of eligible allied health professionals to ensure services are delivered by the most appropriate allied health professional to best meet the needs of each individual;
5. Establish and maintain clinical governance arrangements including relevant clinical supervision, performance monitoring and review arrangements in place for all Providers and a monitoring system for the qualifications, registration status and verification of continuing professional development of allied health professionals engaged to deliver the ATAPS program;
6. Put in place a complaints mechanism for people who are provided with services under the Program in accordance with section 1.16 of the National Standards for Mental Health Services. This mechanism must be documented in a plain English brochure and, as appropriate, in other languages. All people who are provided with services under the ATAPS Program are to be provided with a copy of the complaints mechanism brochure;
7. Make reasonable attempts to ensure there is no negative impact on existing ATAPS service delivery where an allied health professional engaged for this Program is also engaged by the public sector (such as in State and Territory mental health services) or another Commonwealth funded program such as the Mental Health Nurse Incentive Program or Better Access;
8. Manage and monitor the funds expenditure and commitments;
9. Establish and implement an effective Demand Management Strategy according to the Annual Budget so that services are provided throughout the year and are effectively targeted at hard to reach groups;
10. Collect and record data and information on the program, including data and information about clients, GPs and other eligible referrers and allied health
11. professionals. The Applicant must contribute data to the National Minimum Dataset (MDS) on a regular basis. The Applicant must ensure that data containing client information, provided under the MDS is de-identified from any personal Information received and that such Personal Information (if any) is collected, used and stored as required by the Privacy Act 1988.
12. Adopt a suitable service delivery model/s that suits local arrangements according to identified need and workforce availability;
13. Improve the efficiency and effectiveness of ATAPS service delivery models, with regular review of performance measuring and activity indicators;
14. Monitor Co-payments that may be put in place, ensuring that the Aim of the Program, to provide low cost focussed psychological strategies to individuals, is met. It is recommended that Co-payments not exceed $30 per session. In this paragraph, ‘Co-payment’ means payments individuals may be required to pay when receiving services from allied health professionals under the Program;
15. Participate in evaluation activities for ATAPS; and
16. Provide information on the method by which the Participant implements the delivery of services from allied health professionals, such as direct employment of staff, direct referral, a voucher system or brokerage.

More specifically the ATAPS CMHS Provider must

(a)    provide clinically appropriate services for children (0-12 years), and delivered by appropriately qualified and trained allied health professionals;

(b)   provide family based therapies where clinically required to support the child’s ATAPS treatment;

(c)    provide parent training to support the child’s ATAPS treatment;

(d)   establish and maintain appropriate referral pathways and linkages with government and non-government stakeholders at the community level (including those outside of the clinical mental health system, including all early childhood centres and schools in the catchment area).

Reporting

The Provider will be required to submit the following reports to the Medicare Local via specified reporting templates which will be supplied by the Medicare Local.

Six Month Report

The Six Month Report must include the following:

(a)    notable achievements and key contributing factors;

(b)   notable challenges and key contributing factors and actions planned/taken to manage challenges;

(c)    key learnings from both achievements and challenges;

(d)   demand management strategies that are in place and their effectiveness;

(e)   a description of, and details about, how the community needs were met, with specific reference Tier 2 funding, ATAPS CMHS

(f)     a description of how the Provider has met the aims of the program during the relevant reporting period, in particular the performance of program activities and the delivery of the program deliverables;

(g)    a description of clinical governance and quality assurance mechanisms in place;

(h)   financial information (unaudited) prepared on an accrual basis against line items in the approved Annual Budget for: Tier 2 – Child Mental Health Services,  in a format specified by the Medicare Local;

(i)      financial information (unaudited) stipulating the amount of income derived from co-payments for the Provider and the total amount charged for Co-payments by subcontracted ATAPS service providers;

(j)     details of total amount paid for staff, contractors and subcontractors who have worked on the Program;

(k)    other expenses as agreed in the Annual Budget;

(l)      if a voucher system has been used, a voucher audit conducted by the Provider.

Twelve Month Report

The Twelve Month Report must include full statements covering:

(a)    notable achievements and key contributing factors encountered in the Program;

(b)   notable challenges and key contributing factors encountered in the Program;

(c)    key learnings from the Program;

(d)   demand management strategies that were used and their effectiveness;

(e)   a description of, and details about, how the community needs were met, with specific reference to Tier 2 funding, ATAPS CMHS;

(f)     a description of how the Provider has met the aim of the Program, in particular the performance of Program activities and a list of the Program deliverables;

(g)    a description of clinical governance and quality assurance mechanisms put in place;

(h)   audited Income Statement for the ATAPS funding and must report on:  Tier 2 – Child Mental Health Services in a format specified by the Medicare Local, including details of total amount paid for staff, contractors and subcontractors who have worked on the Program;

(i)      audited financial statements must also include and separately identify:  details of the amount of income derived from Co-payments for the Provider the total amount (unaudited) of Co-payments charged by subcontracted ATAPS service providers

Final Report

On 14 September 2014 or within 90 Days of the date of any early termination of any agreement, the Provider must provide to the Medicare Local a written Final Report which must include full statements covering the following:

(a)    a comprehensive report on actual performance against the Guidelines and Standards and the Aim of the Program and whether the Aim of the Program was achieved and, if not, why not;

(b)   an audited detailed statement of receipts and expenditure in respect of the Funds prepared by an Approved Auditor in compliance with the Australian Auditing Standards;

(c)    a statement of how much (if any) the Provider needs from the final payment to meet current liabilities under legal commitments entered into by the Provider;

(d)   a certificate provided by the Chief Executive Officer or Chief Financial Officer of the Provider, or a person authorised by the Provider to execute documents and legally bind it by their execution, confirming that:

(i) the Funds and Other Contributions received were spent for the purpose of the Program

(ii) salaries and allowances paid to persons involved in the Program are in accordance with any applicable award or agreement in force under any relevant Law on industrial or workplace relations

(iii) at the time the Final Report is provided to the the Medicare Local, the Provider is able to pay all its debts as and when they fall due;

(e)   notable achievements and key contributing factors encountered in the Program;

(f)     notable challenges and key contributing factors encountered in the Program;

(g)    key learnings from the Program;

(h)   demand management strategies that were used and their effectiveness;

(i)      a description of how the Provider has met the aim of the program, in particular the performance of Program activities and a list of the Program deliverables;

(j)     a description of clinical governance and quality assurance mechanisms put in place;

(k)    special purpose audited financial statements prepared on an accrual basis against line items in the approved Annual Budgets in one consolidated report for the ATAPS funding for Tier 2 – Child Mental Health Services;

(l)      if a voucher system has been used, a voucher audit audited by an approved auditor.