Clinical governance

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Clinical governance is needed within aftercare programs to ensure the safety of the workforce and consumers.

Aftercare services focus on psychosocial supports and empowering people to establish ongoing community supports, in a non-clinical setting.1 This allows aftercare providers to deliver a peer-led service that centralises lived and living experience, and the voice of the consumer.

However, strong clinical governance is still needed to ensure care remains effective, relevant and safe for the workforce and consumers.2

The key elements of effective clinical governance include:

  • responding to escalated suicide risk
  • consumer care review
  • reflective practice
  • group debriefing
  • internal team meetings, reviews and processes.

Responsibilities of primary health networks

Primary health networks (PHNs) are responsible for maintaining appropriate clinical governance and quality assurance arrangements for all components of an aftercare program, as per:

Responding to escalated suicide risk

Establish clear policies and procedures to respond to acute or escalating suicide risk, including:

  • under what circumstances emergency services are to be contacted, including against a person's wishes
  • agreed escalation pathways with local stakeholders
  • how different workforce roles are to respond when a person indicates they are currently suicidal
  • which roles have responsibility for conducting suicide risk assessments and making decisions about the need for additional immediate support
  • when, where and how discussions about current suicidality are documented
  • engaging with other supports if a person indicates they are actively considering suicide
  • under what circumstances family members, carers, friends and kin are contacted
  • follow-up and monitoring processes
  • short-term workforce debriefing mechanisms.

Postvention processes and support

Establish clear processes and guidelines on how to respond in the event of a death by suicide, and how to support staff, including:

  • protocols for notifying deaths and adverse events
  • identifying local postvention supports available to the workforce and community, such as StandBy; with consideration for culturally appropriate supports, such as Thirrili
  • connections to local response groups or escalate to PHN suicide prevention lead
  • guidance on how to support the workforce in the short-term (<24 hours to 1 week) and longer-term (6+ weeks and anniversaries)
  • respectful and sensitive acknowledgement of the death – articulate when it is and is not appropriate to share information in the workplace; and how to maintain privacy and confidentiality for the person and their family.

Maintaining effective and safe care

Undertake consumer care review and reflective practice each month to ensure care continues to be relevant, effective and safe for the person and aftercare provider.

Consumer care review

Consumer care review focuses on reviewing the support provided to a person, and how it is meeting their needs and safety.

This involves reviewing the care, progress and challenges of each person being supported by the peer worker and/or care coordinator.

This regular review ensures everyone receives effective and relevant care.

Facilitators

  • A peer worker and/or care coordinator will conduct the consumer care review in collaboration with an appropriately qualified mental health clinician.
  • A team leader or other staff member can also facilitate this if they meet the above qualification requirements.
  • If this is not available internally, identify an external resource to provide consumer care review or draw on local partnerships, e.g. the LHD and SHN workforce, as needed.

Frequency

  • Undertaken consumer care review monthly, at minimum. This means three review sessions throughout a person's care, based on a typical 12-week aftercare program. Conduct this more frequently, if required.
  • Any member of the team can request a review. Include guidance about when to conduct additional reviews in the policies and procedures on escalating suicide risk.

Reflective practice

Reflective practice provides space to discuss and explore the professional practices, needs and wellbeing of aftercare workers, including staff who have lived and living experience of suicide (disclosed or not).

Facilitators

  • Occurs between staff and an appropriately qualified practitioner.
  • May be facilitated internally or externally through local partners, such as the LHD and SHN workforce.

Frequency

Undertake reflective practice monthly, at minimum; and provide more frequent support, if needed.

Additional supports

Below are some additional supports the workforce may wish to access, as needed.

Peer workers may undertake additional reflective practice activities focused on how their work impacts on their lived and living experience; and how they draw on this experience in consumer engagement.

Facilitator: Provided by an appropriately trained person with lived or living experience.

Frequency: This is determined by the peer worker’s needs.

Aboriginal staff may choose to receive cultural supervision. This offers a space to reflect on a worker’s practice and provides cultural context, which is often a critical component that is not available in mainstream supervision.

Facilitator: Provided by an appropriately trained Aboriginal person.

Frequency: Determined by the worker’s needs.

Trauma-informed group debriefing is a structured group discussion that enables aftercare workers to talk about challenges, successes and stressors in relation to supporting people in their recovery. Ensure group debriefing is available; however, it is not mandatory to participate.

Facilitator: Must be led by someone trained in facilitating group debriefing. This may be an internal staff member or may be sourced externally.

Frequency: Determined by the teams’ needs.

Further reading

Australian Safety and Quality Framework for Health Care
This framework outlines a vision for safe, high-quality care for all consumers. It is based on the core principles of consumer-centred care, data-driven decisions and safety standards.
Source: Australian Commission on Safety and Quality in Health Care

National Safety and Quality Health Service (NSQHS) standards
Provides a nationally consistent standard for the level of care consumers should expect from health service organisations.
Source: Australian Commission on Safety and Quality in Health Care

References

  1. Suicide Aftercare Services: An Evidence Check Rapid Review Brokered by The Sax Institute for The Commonwealth Department of Health and Aged Care. Sydney (AU): Sax Institute; 2023 [cited 25 Sept 2024].
  2. Clinical Governance Standard. Sydney (AU): Australian Commission on Safety and Quality in Health Care; 2023 [cited 25 Sept 2024].
  3. Bilateral Schedule on Mental Health and Suicide Prevention New South Wales. ACT (AU): Federal Financial Relations, Commonwealth Government; 2022 [cited Sept 2024].
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