Our Model of Care FAQ - For Providers
What does Open Arms offer to veterans and families?
Who is eligible for Open Arms services?
When does Open Arms refer to another service?
Can my client see a psychiatrist?
Does Open Arms have a role in the care of a client who is referred externally for specialist care?
Does Open Arms provide court ordered counselling?
Do I need to provide reports for DVA claims or court?
What steps should I take if a client is seeking information from their clinical records?
What has happened before a client is referred to me?
Does Open Arms offer assessments for ADHD (attention deficit hyperactivity disorder) or ASD (autism spectrum disorder)?
How many sessions can my client have?
Can an Open Arms client I’ve seen before see me again?
Does Open Arms provide help with transport?
What if a client doesn’t want to work on a goal and just wants to talk?
Can I charge Open Arms clients a gap fee?
What happens when Open Arms is not a suitable service for an eligible child?
What gets reported to Defence/ADF?
What is the difference between Open Arms and DVA?
What is Open Arms care coordination?
Why does Open Arms have care plans?
Why does Open Arms have case reviews?
Can I use artificial intelligence (AI) tools in relation to an Open Arms setting?
How does Open Arms fit with NDIS?
What are the expectations to engage with a client’s GP?
What is my clinical scope of practice with my Open Arms clients?
How does Open Arms manage long-term clients?
Why does Open Arms employ a mix of mental health professions?
What does Open Arms offer to veterans and families?
Open Arms is a trauma informed, mental health and wellbeing service for current and former serving members of the Australian Defence Forces and their families. We are the only mental health service in Australia dedicated to veterans and their families and we have almost 45 years of experience in providing support to our client group. We provide primary level non-medical treatment and support for clients dealing with issues such as depression, anxiety, PTSD, stress and family and personal issues. We do this through one-on-one counselling, relationship counselling, Peer support, care coordination, group and online programs provided across Australia.
Who is eligible for Open Arms’ services?
Open Arms provides services to anyone who has served at least one day of continuous fulltime service (CFTS) in the Australian Defence Force (ADF) and their families. You are eligible if you are a current or former ADF member, or if you are the partner or child (of any age) of a current or former ADF member from the Vietnam War onward.
Reservists with CFTS and those without but who have rendered border protection or disaster relief service or been involved in or witnessed a serious training accident and their immediate families are also eligible. Most of these are summarised in the Eligibility_at_a_glance_matrix_2021. If you are unsure of your client’s eligibility, you can call Open Arms on 1800 011 046 to check.
When does Open Arms refer to another service?
Open Arms is not equipped or staffed to provide specialised or acute mental health services. For example:
- Individuals experiencing immediate and severe symptoms of mental illness may be best served in a medical setting such as a hospital or residential program. Open Arms can support individuals with serious mental health conditions if they are receiving appropriate treatment and their symptoms are stable.
- Open Arms is usually not be able to work one on one with children under 5 years, as this is a specialised field outside the scope of practice for most of our clinicians and Peers. If there is not a suitably qualified clinician available, Open Arms can assist parents of very young children to access the most appropriate treatment, including facilitating referrals to other services.
- Open Arms is not a family and domestic violence service and cannot provide specialised family and domestic violence support. People in crisis due to family violence, including families at imminent risk of harm, will be referred to specialised family and domestic violence services.
Can my client see a psychiatrist?
Open Arms does not provide psychiatric care or refer to psychiatrists. Your client’s GP can refer them to a psychiatrist. Open Arms can recommend and fund a psychiatric assessment for partners, former partners (within 5 years or while coparenting a minor) and children of any age of Vietnam veterans, where this is to inform Open Arms care planning. Open Arms will recommend an assessment, but your client’s GP needs to make the referral for this. An Open Arms clinical care coordinator can work with your client’s treating psychiatrist and assist them to navigate the mental health system.
Does Open Arms have a role in the care of a client who is referred externally for specialist care?
Yes. Open Arms supports integrated, multidisciplinary care and a client can receive services from Open Arms and a specialist service if it is clinically indicated and appropriate. With client consent, Open Arms will work with the specialist care provider to ensure an integrated approach to the client’s care. This will most often occur through a clinical care coordination service in conjunction with the GP.
The clinical care coordinator may be a different person from the client’s counsellor as not all counsellors provide this service. A clinical care coordinator will provide the client with an overview of multiple services, assisting with coordination and connection between services, depending on what the client needs.
Although Open Arms can continue to be involved while the client is actively engaged with other care providers, it is good clinical practice to avoid multiple providers of the same service (for example, two counsellors seeing the client for the same issues).
Does Open Arms provide court ordered counselling?
Open Arms does not provide court ordered counselling, including Family Court orders and counselling as a parole condition.
Do I need to provide reports for DVA claims or court?
Open Arms does not provide medicolegal reports, support letters or reports for DVA claims or court. Open Arms can provide your client with a Statement of Attendance if they make a Release of Information request by calling 1800 011 046. This is a letter on Open Arms letterhead indicating the number of sessions attended and the general nature of those sessions.
These requests are managed by the client’s Open Arms regional office and all requests are to be sent directly to the Regional Outreach Team.
What steps should I take if a client is seeking information from their clinical records?
Outreach Providers are not to respond to any requests for client information. All requests received, including requests for a Statement of Attendance (SOA), are to be sent directly to your Open Arms Regional Outreach Team.
What has happened before a client is referred to me?
When you see your new Open Arms client, they might mention that they have had an intake assessment. This is usually a telephone call during which we seek to understand the client’s concerns and whether they are worried about their own or another person’s safety. This process, often referred to as ‘intake’, is not just about asking questions – it is the first step to support the client.
During intake, we ask questions about the client’s current circumstances and needs. Information gathered at intake allows us to determine whether Open Arms is the most suitable service to support that client. This information also assists us to connect the client with the most appropriate program, counsellor/clinician or Peer worker. If it is identified at intake that Open Arms cannot provide a suitable service, we will aim to support the client to connect with the service they need.
The client’s details are sent to your regional Open Arms office, who review the intake information provided and allocate the client to a counsellor. This intake information is also available to you in VERA.
Does Open Arms offer assessments for ADHD (attention deficit hyperactivity disorder) or ASD (autism spectrum disorder)?
Open Arms is not able to provide ADHD or ASD assessments. Where appropriate, we can provide counselling for someone with an ADHD or ASD diagnosis, but we do not provide ADHD or ASD specific supports. If a client needs ADHD or ASD-specific support, their GP is best placed to refer them to a psychiatrist or other support. We can however link in with the National Disability Insurance Agency if required as part of our care coordination role. We can also refer the client, with their permission, to the Wellbeing and Support Program (WASP) managed by Coordinated Client Support Branch.
How many sessions can my client have?
Each time a client starts counselling, care coordination or Peer support at Open Arms, the new client and their counsellor, care coordinator or Peer worker will discuss their situation and needs and create a plan with agreed goals. The support outlined by this plan is provided in an Episode of Care that begins at the point the client is allocated to a counsellor, care coordinator or Peer worker and ends when that service is closed. The amount of counselling, care coordination or Peer support will be agreed based on what is required to meet the goals identified.
There is no limit to the number of sessions in an Episode of Care. However, Open Arms’ Episodes of Care are expected to be goal focused and time-limited, in accordance with the Model of Care.
Your client’s progress will be reviewed by you each session, and by an Open Arms senior clinician after ten sessions. If more sessions are required to reach their agreed goals, you can request further sessions in your case review report. In some circumstances a third set of 10 sessions may be approved. Any further extension beyond this would only be approved in exceptional circumstances, and with a strong clinical rationale. If you believe an extended episode of care is warranted it is advised that you discuss this with your Open Arms Regional Outreach Team prior to making such a request.
Can an Open Arms client I’ve seen before see me again?
If the client has asked to see you again, the continuity of care principle will apply, unless there is a substantial reason for this to not be relevant. The region will need to evaluate the client’s request taking account of several considerations including whether the requested counsellor is available. Although this can include video-counselling when you and the client are in different locations, it needs to be assessed as safe and appropriate and you and the client both need to consent to video-counselling.
Does Open Arms provide help with transport?
Open Arms does not provide help with transport. However, some veteran clients may have an entitlement to reimbursement of the cost of transport for treatment related journeys. This is handled by DVA, and any queries should be directed to DVA – phone 1800 VETERAN (1800 838 372) or email GeneralEnquiries@dva.gov.au.
What if a client doesn’t want to work on a goal and just wants to talk?
Some clients have relationships with Open Arms of long duration and have used the service for occasional support rather than specific goal-oriented counselling; space to talk helps them to feel better when they are struggling a little. However, providing clients with some space to talk is still within an outcome-focused approach.
Open Arms counselling and care coordination are clinically based services, with episodes of care which are goal focussed, and in some circumstances a client may have their needs met better by referral to a service that offers non-clinical support.
The client can be assisted to express more clearly what “feeling better” means for them, and this can in turn be defined and set as goals. Tangible progress towards identified goals supports a recovery focus and assists the client to measure their own progress which in itself has a therapeutic value.
In setting up an episode of care, it is important that the client is guided through a care plan based on clear goals that are relevant to them. Sometimes relevant, meaningful goals can be difficult to identify but it is important for both the clinician/Peer worker and the client to approach the episode of care with a clear focus rather than an open-ended support offering. This guides the direction of sessions and provides a point of reference to observe progress and improvement.
Can I charge Open Arms clients a gap fee?
Open Arms’ services are provided at no cost to current and former serving members of the Australian Defence Forces and their families who meet the eligibility criteria. Outreach and external providers cannot charge their Open Arms’ clients any fee. Only eligible clients can be provided with an Open Arms service.
What happens when Open Arms is not a suitable service for an eligible child?
Open Arms is primarily a service for adults that supports children as part of a family. Children of any age can be included in family counselling sessions with their parents so long as it is appropriate for them to participate.
Open Arms is not a specialist child service and is not a suitable service to provide individual counselling or treatment to children under 5 years of age. Open Arms is also not a suitable service to provide individual counselling or treatment to children over 5 years of age, where they do not have the competence to participate in the proposed counselling or treatment.
Open Arms can provide generalist individual counselling to children over 5 years of age, where they have the competence to participate in the proposed counselling. Open Arms generally requires the signed consent of a parent or legal guardian authorised to consent on their child’s behalf. However, the consent of a minor who is 16 years or older will usually be accepted. A younger minor who does not want parental consent to be obtained can be provided with an appropriate individual service, where a review of competence confirms that the minor is competent to consent.
In instances where Open Arms is not an appropriate provider for a young child, Open Arms will assist families to identify a more suitable, specialised provider and where appropriate, their GP may be able to refer them to a suitable service. Open Arms does not fund these referrals.
What gets reported to Defence/ADF?
It is good practice for the health services that support a client to liaise with other parts of their care team with regard to their progress. If the client is a current serving member Open Arms will only disclose information about them with their consent. If your client is self-referred to Open Arms, there is no routine reporting to Defence, but the client can request and consent to Open Arms liaising with their Garrison Health facility to support their care. If your client’s safety or the safety or others is at serious risk, we may inform their Garrison Health facility if doing so supports their safety and treatment.
If your client has agreed to be referred to Open Arms by their ADF Health facility, you must seek their consent to provide summary reports of their counselling to their referring Garrison Health facility. If your client does not consent, Open Arms can’t provide a service under that referral. We will inform their Garrison Health facility of this and offer them the opportunity to self-refer.
What is the difference between Open Arms and DVA?
Open Arms is DVA’s veterans and families counselling service. DVA provides range of veteran services (go to this link for an Overview of DVA benefits and services), including mental health services. Access to most DVA veteran services requires accepted entitlement to a DVA Veterans White or Gold Card.
Through Open Arms, DVA provides mental health, counselling and wellbeing support services to veterans and their families without requiring Open Arms clients to have a Veterans Card. It provides non-medical mental health services including counselling, group sessions, Peer support and complex care coordination.
What is Open Arms care coordination?
In accordance with the Open Arms’ Model of Care, care coordination is a service provided by clinical staff and encompasses a range of services. Care coordination is tailored and goal focused for each client. The level of care coordination varies with the needs of the client – from clinical oversight of a counselling service through to intensive support for a client with complex needs. This intensive support involves collaboration with other healthcare providers such as the client’s GP, other medical specialists, state and territory mental health services, alcohol and other drug services or family and intimate partner violence services with the client at the centre to address their physical, emotional and social needs.
Clinical care coordination is most likely to happen in addition to counselling or Peer support, but a client may receive clinical care coordination without being in active counselling. This may happen where an Open Arms client has become more unwell or is experiencing psychosocial challenges that impacts on their ability to access and engage in mental health care and wants assistance in working with their broader care team.
Why does Open Arms have care plans?
The Care Plan provides a structured format to ensure good clinical governance and alignment with the Model of Care. It must include a treatment plan outlining the client’s goals and strategies for the episode of care. The first 10 sessions are straightforward – the initial 3 to develop the care plan then, the next 7 sessions to implement the plan (this may vary in relation to Defence referrals). In most cases, this will be all the client needs. There will always be people who require longer episodes of care, and this is accommodated – however, regular clinical oversight of the progress of this is required.
Why does Open Arms have case reviews?
Open Arms is committed to delivering quality clinical services with sound governance arrangements. This requires us to monitor and report on the impacts and outcomes of our services, with a focus on quality of clinical information, risk assessment and outcome measurements. Case reviews ensure adherence to an evidence-based or evidence-informed therapeutic intervention and support the delivery of safe and effective counselling to clients. Case reviews are carried out after every 10 sessions via the Client Management System. If a counsellor assesses that a client needs additional sessions and demonstrates that this is clinically indicated, the case review should include a rationale describing what will be achieved and how many sessions are needed.
Can I use artificial intelligence (AI) tools in relation to an Open Arms setting?
Due to current external data processing arrangements with predominant AI language tools, use of AI is prohibited for Open Arms staff and providers conducting business activities to ensure client privacy and data security. Generative AI tools are not appropriate for use in performing clinical health assessments for Open Arms. There are significant, inherent privacy risks associated with storing and managing clinical data and client information within currently available generative AI tools. Mental health data is highly sensitive and personal, requiring strict confidentiality and adherence to privacy regulations.
How does Open Arms fit with NDIS?
It is possible that an Open Arms client also has an active plan with the NDIS. There is no set approach to working with NDIS clients. The main consideration is that services provided by DVA and NDIS should be coordinated and complementary and must not duplicate services. OPCs with queries can contact their OPC coordinator.
What are the expectations to engage with a client’s GP?
For many clients, their GP, or their General Practice Clinic, is at the centre of their health care and needs to be aware of the supports in place. The treating clinician will obtain and/or confirm GP details from the client during the first counselling session. Consent to liaise with the GP will also be obtained at this time and will be formalised when the client completes the consent forms. For clients engaged with a regular GP, and with the client’s consent, Open Arms will maintain communication with the client’s GP throughout the client’s engagement with Open Arms, to update them regularly on the progress of the client’s care and advise of planned case closures. This aims to promote sound engagement with the client’s GP to encourage a continuum of support.
What is my clinical scope of practice with my Open Arms’ clients?
The Open Arms Model of Care supports evidence-informed assessment, treatment and counselling interventions, acknowledging the role that the therapeutic relationship also plays in achieving treatment outcomes.
Clinicians may only use treatments in which they are competent, or where they are engaging with regular expert clinical supervision to support practice development. In addition, scope of clinical practice includes compliance with mandatory reporting obligations and assessment and management of client risk.
Open Arms is not able to provide some specialised services. In these cases, Open Arms will expect clinicians to refer clients to appropriate specialist services:
- Children of any age can be included in family counselling sessions with their parents so long as it is appropriate for them to participate. Open Arms is not a suitable service to provide individual counselling or treatment to children under five years of age.
- Assessment and/or treatment for developmental disorders in children or adults, such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are not within scope of Open Arms’ services.
- Open Arms does not provide specialist alcohol and other drugs treatment, although we can provide non-specialist support for clients with alcohol or other dependencies.
- Open Arms does not provide specialist family and domestic violence support.
The scope of practice for Open Arms’ clinical services aligns with discipline-specific standards of the professional bodies under which our clinical workforce practises, including the Australian Health Practitioner Regulation Agency (AHPRA), the National Boards and the professional associations such as the Australian Psychological Society (APS), Occupational Therapy Australia (OTAus), Australian College of Mental Health Nurses (ACMHN), the Australian Association of Social Workers (AASW), the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA).
How does Open Arms manage long-term clients?
The clinical approach of the Open Arms Model of Care aligns with mental health best practices, which emphasise goal-focused counselling and support. The aim is to promote client recovery and independence within a specified number of sessions. Goal focused therapy provides practical tools and coping strategies that individuals can apply in daily life. You can access the Model of Care via the Open Arms website.
You will have been advised of the intent of the Model of Care and provided templates to further support your understanding and implementation of the Model, including reporting requirements. This includes advising you that care plans and case reviews will be evaluated based on clinical presentations, a description of strategies and the anticipated outcomes across the episode of care.
An episode of care is focussed on agreed goals rather than a set episode length or number of sessions. The client’s progress is reviewed at 10 sessions and if more sessions are required to achieve the agreed goals, another 10 sessions can be requested as part of the case review report you submit to the Client Management System at 10 sessions. Further sessions must be approved before the 11th session takes place. In some circumstances, where a strong clinical reason is provided, a third set of 10 sessions may be approved if requested in the case review you submit at 20 sessions. Any further extension beyond this would only be approved in exceptional circumstances, and with a compelling clinical rationale included in your case review report at 30 sessions.
This clinical approach aligns with the Open Arms Model of Care, which emphasises goal-focused, time-limited counselling and support. The aim is to promote client recovery and independence, often achievable within 10 sessions.
Where the case review of a long-term client determines that the Episode of Care should end, the Open Arms clinical team will assist the counsellor to transition the client from Open Arms.
Why does Open Arms employ a mix of mental health professions?
Clients come to Open Arms with a wide range of mental health, counselling and wellbeing concerns. These can include recovery from trauma, depression, anxiety, anger, self-harm, grief and loss, managing chronic pain, sleep disorders, transition from the military, other adjustments to changed circumstances, health and wellness, relationship issues, and family issues. This list is indicative rather than exhaustive.
Mental health professionals and Peers with Lived Experience have diverse training, backgrounds, experience and skills, allowing Open Arms to match clients with a mental health professional whose skills and experience can best respond to the client’s needs and goals.
Open Arms provides treatment support through evidence-based, and evidence informed therapies which can be delivered by a range of mental health professionals and Peers with Lived experience to ensure a diverse and multidisciplinary workforce.