Post on 05-Aug-2020
Mental Health &
Wellbeing
Outcome Framework Work in progress – for discussion only at Reference and
Steering Group
1
Results for
people in New
Zealand
2
You can’t be
sure you will all
end up in the
same place
Creating a
unifying tool
Our Approach
“Our methodology
is designed to
reveal the
strengths and
wisdom that exist
within the system
whilst creating
spaces for new
things.”
3
Information as a flashlight4
Turning
information into
intelligence
Create a
shared
performance
storyCreating
evidence about
what works
Summarised overview of
development to date5
6
‘He Tangata’
Everyone in New Zealand is thriving
‘Reducing the impact of mental distress, illness and addiction
contributing to people in New Zealand to participate in their
community ensuring equity and improved life outcomes’
Macro target populations
Life stage and cultural identity
Attribute clusters
Cluster Cluster Cluster Cluster Cluster Cluster
Cluster Cluster Cluster Cluster Cluster Cluster
Cluster Cluster Cluster Cluster Cluster Cluster
Healthy, safe and secure
homes
Security of tenure
Healthy homes
Safe homes
Quality residential care
Financial security
Income security
Financial stressors
Living in hardship
Employment, education & participation
Paid & unpaid work
Education & training
Social, cultural and
spiritual connection
Friends & social networks
Cultural connection
Spiritual wellbeing
Wellbeing and respect
Reported wellbeing
Stigma, discrimination &
racism
Mental distress, illness & addiction
Suicide & self harm
Mental health
Mental health & LTC
Physical health
Physical health
Hazardous behaviour
Life expectancy
Outcome
Goal
Key result
areas
Population
groups
Services and activities for population groups
Structural measures
Process measures
Impact measures
Service
activity
The outcome framework
The Goal – the reason for creating this outcome framework
The ‘Quality of Life Outcome’
The key result areas that matter to achieve the goal
The indicators in each result area that measure success
The target populations so we can create equity and support the right people
Activities matrix – to organise existing service interventions and plan for new ones
Service performance measures to ensure we measure the things that matter
7
W/shop 1
W/shop 2
W/shop 2
W/shop 2
W/shop 3
W/shop 3
Definition for a health and
wellbeing outcome
framework8
Scope and definition9
Incorporation of the health promotion and prevention strategies
Mental distress and mental illness – the medicalisation
Tangata whaiora – people seeking wellbeing.
Protect - to defend or guard
Promote mental health and wellbeing for people in New
Zealand
Prevent the onset and development of mental distress, illness &
addiction
Protect life outcomes for tangata whaiora
Protect the well-being of family, friends & whanau of tangata
whaiora
Social
Equity of
outcome
Social & Economic
Policy Setting
Personal &
Community
Factors
Participation &
Contribution
Housing
Education
Health services
Alcohol& drug policy
DebtRacism
Dysfunctional family life
Social isolation
Failing education
Child incare
Pregnancy
Communityresources
LGBT
Discrimi-nation
Parents unwell or addicted
GenderEmployment
Poverty
Welfaresupport
WorkTraining
Poor healthDisability
Aged care
Mental Health Act
Strategic Alignment Framework
The proposed Goal and the Outcome11
‘He Tangata’
Everyone in New Zealand is thriving
‘Reducing the impact of mental distress, illness and
addiction contributing to people in New Zealand
being able to participate in their community,
ensuring equity and improving life outcomes’
Key result areas for
populations12
Organise the:
population level indicators of the
outcome
the focus of interventions for target
population groups
Key result areas
Healthy, safe and secure homes
Financial security
Employment, education & participation
Social, cultural and spiritual connection
Wellbeing and respect
Physical health
Mental distress, illness & addiction
13
Healthy, safe and secure homes
Security of tenure
• Emergency housing support required
• Lengths of tenancy/Home ownership
• Homelessness and temporary accommodation
Healthy homes
• Levels of crowding
• Quality of homes - star rating
Safe Homes
• Interpersonal violence and domestic assaults
• Reported child abuse
Quality residential care
• CYF care
• Prisons
• Residential care
14
Financial security and living standards15
Income enables
• Individual income levels
• Household income levels
• Benefit & subsidy utilisation & time on benefit
Financial stresses
• Households able to meet every day needs
• People requiring emergency assistance grant
• Sources of debt greater than 3
Hardship measures
• Living in hardship (ELSI metrics)
• Ability to meet bills
• Proportion of children living in a household dependent on a main benefit
Education, employment and
participation16
Meaningful work
• Working age people in employment
• Households with at least one person employed
• Volunteering and whanau support
Education/Training
• Children leave school able to read and write – national standards
• 18 year-olds with NCEA Level 2, Level 3
• Literacy and numeracy rates at Level 2 or above
• Qualifications at level 5-7 in the working age population
Healthy work environments
• To be developed
Social, cultural and spiritual connection17
Family, friend and whanau networks
• Access to support
• Participation in social networks
Cultural connection
• Language skills
• Cultural participation & support
Spirituality
• Yet to be determined
Wellbeing & respect
Reported wellbeing
• National health survey
• Self reported wellbeing
Suicide and self harm
• Suicide rate
• Self harm /suicide behaviour rate
Stigma, discrimination and racism
• Knowledge in community
• Experience of discrimination
18
Physical health19
Physical health
• People within each household with average or above physical health self-rating overall life satisfaction
• People with good/very good/excellent health rating
• Reported levels of physical activity and nutrition
• Obesity rates
• Smoking rates
• Incidence of long term conditions
Life expectancy
• Low prevalence (serious) mental health conditions
• High prevalence mental health conditions
Mental distress, illness and addiction
Mental distress, illness and addiction
• Incidents and rates of illness and addiction
• Compulsory treatment orders?
Mental health of those with long term conditions & disability
• Incidence of mental distress, illness and addiction
Hazardous behaviour
• Drug & alcohol misuse
20
Knowing the
peopleDeveloping target populations
21
Population Filters22
Major target population segments
• These are the four groups linked to the purpose of the outcome framework
Life course and cultural identity
• Within the target populations life course, and cultural identity influence the distribution of need within the target populations
Clusters of attributes
• These are the social determinants and personal stressors that can cluster in groups of people generating greater challenges to
resilience
Macro target populations
People experiencing challenges to
their wellbeing.
Family, friends and whanau of tangata whaiora.
People who are
experiencing ill-health and, or addictions.
23
People with
challenges to
wellbeing
Tangata
Whaiora
Family, friends
and whanau
All people in New Zealand
Life course and cultural identity
Families with young
children
Children Tamariki
Young adults
Rangatahi
Adults Pākeke
Older adults
Kaumatua
24
Māori
Pacific Island
Asian
European
Other
Inclusion of children
as a life course group
Ethnicities can
be sub-setted
Locality
Geocoding
quality
Attribute clusters25
Attribute clusters that create
challenges to wellbeing
Examples of attributes only
Experiencing distress
Social determinantsIsolation
Low incomeEducation levels
Housing stressCrowding
Discrimination
Individual stressorsAdverse childhood
events
Poor health
Death of a
loved one
Relationship
breakdown
Job loss
Trauma RefugeePersonal debt
Representing populations26
Tangata whaioraTangata
whaiora
Challenges to
wellbeing
All people
in New Zealand
Family, friends and whānau
Young adultsRangatahi
AdultsPākeke
ChildrenTamariki
Whānau with
tamariki
Older adultsKaumatua
Cultural identity
within each wedge
Population GroupsHow we find target groups
27
Why segment our populations
To understand who we are planning service / Are we designing services that:
• Contribute to the outcome
• Provide population coverage
• Change the result
To measure population indicators to know that it works creating knowledge about
• Life outcomes for people
• The impact services may be having on these key result areas
• The gaps and opportunities in service delivery
28
Tangata WhaioraThese populations are likely to be service users, or
should be service users.
29
Who are the clusters of
people we are planning
services for in addiction?30
Tangata Whaiora development
•Chronic poor health
•Alcohol and drug addictions
•High prevalence and low need conditions also known as the ‘Big 5’
•Low prevalence and high need conditions
•Forensic youth
•Youth with emerging mental ill-health & addictions
•Youth with early onset low prevalence disorders
•Forensic adults
•Drug & alcohol addictions
•Co-morbid with chronic and serious ill health
•Low prevalence and high need conditions
•High prevalence and low need conditions also known as the ‘Big 5’
•Pregnancy related
•Child related with emergent conditions
•Infant and child attachment
•Child with high prevalence disorders
Families with
young children
Adults Pakeke
Older adults
Kaumatua
Young adults
Rangatahi
31
Populations with
Challenges to Wellbeing32
Who are the clusters of
people we understand are
at greater risk of addiction?33
Challenges to wellbeing34
Organising and
understanding activities and
servicesThinking about activities and services
35
Key concepts36
The activity matrices are for clearly defined people groups within a cluster:
Challenges to wellbeing
Tangata whaiora
Family, friends and whanau
Activities could be supplied by anyone:
Other Agencies
DHBs
NGOs/PHOs
Community organisations
Information (natural) supports
It is all about contribution not attribution
Is it likely to contribute to the key result area
At what level do interventions occur
Interventions designed to work with the individual and their whanau
Interventions for social groupsthat individuals may be connected
Interventions that occur within community / hāpu that people live
The whole of society / Iwiinterventions such as policy or public health strategies
37
Quit
smoking
services
Smokefree
sports
sponsorship
Smokefree
public
spaces
Cigarette
tax
Service activity matrix38
Healthy, safe
& secure
homes
Financial
security
Participation
in society
Social &
cultural
connection
Physical
health
Mental health
Individual & whanau
Social groups
Community
& Hapu
Society & Iwi
For a population group e.g. Maori Rangatahi engaged with justice
The matrix is
populated by services
and activities
designed to
contribute to the ley
result area for target
populations
Service performance measurement
Structural measures
Inputs
Competence & compliance
Process measures
Evidence markers
Quality & completion
Impact measures
Change in circumstance
People impact
Coverage
Change of circumstance
Person/community experience
39
Service performance measurement
Nationwide consistent service performance measurement requires:
Consistent service description
Consistent service performance measurement
Know the target population
Understand eligibility
Consider coverage
Stream-lined contracting requires
Agreement on service user population
Agreement on service purpose
Contribution to key result areas
Performance measurement
How much?
How well?
Did it work?
40
41
‘He Tangata’
Everyone in New Zealand is thriving
‘Reducing the impact of mental distress, illness and addiction
contributing to people in New Zealand to participate in their
community ensuring equity and improved life outcomes’
Macro target populations
Life stage and cultural identity
Attribute clusters
Cluster Cluster Cluster Cluster Cluster Cluster
Cluster Cluster Cluster Cluster Cluster Cluster
Cluster Cluster Cluster Cluster Cluster Cluster
Healthy, safe and secure
homes
Security of tenure
Healthy homes
Safe homes
Quality residential care
Financial security
Income security
Financial stressors
Living in hardship
Employment, education & participation
Paid & unpaid work
Education & training
Social, cultural and
spiritual connection
Friends & social networks
Cultural connection
Spiritual wellbeing
Wellbeing and respect
Reported wellbeing
Stigma, discrimination &
racism
Mental distress, illness & addiction
Suicide & self harm
Mental health
Mental health & LTC
Physical health
Physical health
Hazardous behaviour
Life expectancy
Outcome
Goal
Key result
areas
Population
groups
Services and activities for population groups
Structural measures
Process measures
Impact measures
Service
activity