Memorandum of Understanding - Eastern Health...MEMORANDUM OF UNDERSTANDING THIS MEMORANDUM OF UNDERSTANDING is effective from 1 February 2013 (“commencement date”) BETWEEN Eastern

Memorandum of Understanding Eastern Mental Health Service Coordination Alliance Date: 30 October 2013

Memorandum of Understanding

BETWEEN

Eastern Health

Eastern Metropolitan Region (EMR) Psychiatric Disability and Rehabilitation

Support Services

EMR Drug & Alcohol Services

EMR Housing & Homelessness Services

EMR Primary Care Partnerships

EMR Primary Health Care Providers

Australian Government Department of Human Services

Endorsed by the Department of Health

Eastern Metropolitan Region


IN RESPECT OF

A Mental Health Service Coordination Collaboration between the Clinical Mental Health, Psychiatric Disability

Rehabilitation Support Service and Primary Health Sectors, Housing/Homelessness services and Alcohol & Other Drug

services

FOR

An Integrated Multi Sector Mental Health Service Coordination

Framework for People with Mental Health issues and co-occurring concerns and their Carers

February 2013

MEMORANDUM OF UNDERSTANDING

THIS MEMORANDUM OF UNDERSTANDING is effective from 1 February 2013

(“commencement date”)

BETWEEN Eastern Health, 5 Arnold Street, Box Hill, 3128

AND EMR Psychiatric Disability and Rehabilitation Support Services

ARAFEMI Victoria Inc. 270 Auburn Road, Hawthorn 3122

Anglicare Victoria, 666 Mountain Hwy, Bayswater

EACH, 46 Warrandyte Road, Ringwood, 3134

Mind Australia, 86-92 Mount Street, Heidelberg 3084

Mental Illness Fellowship, 276 Heidelberg Rd, Fairfield 3078

Neami Ltd, 305 Arthur Street, Fairfield 3078

AND Eastern Metropolitan Region Alcohol and Drug services

Eastern Health Alcohol & Drug Service, 43 Carrington Road,

Box Hill and Wellington House 31-33 Wellington Road Box Hill.

EDAS (EACH, MonashLink Community Health & Inner East

Community Health). Access through 1300 650 705

Knox Community Health Service, Alcohol, Tobacco & Other

Drug Team, 1063 Burwood Highway, Ferntree Gully


MIND 353 Whitehorse Road, Nunawading

AND EMR Homelessness & Housing services

Wesley Eastern Homeless Services, 291A Maroondah Hwy,

Ringwood

Salvation Army - Eastcare

AND EMR Primary Care Partnerships

Outer East Health & Community Support Alliance, 32

Greenwood Ave, Ringwood

Inner East Primary Care Partnership, 6 Lakeside Drive,

Burwood East

EMR Medicare Locals

Inner East Melbourne Medicare Local, 6 Lakeside Drive,

Burwood East

Eastern Melbourne Medicare Local, 21 – 23 Maroondah

Highway, Croydon

EMR Primary Health Care Providers

Knox Community Health Service, 1063 Burwood Hwy, Ferntree

Gully

AND Australian Government, Department of Human Services

Box Hill, Camberwell, Greensborough and Heidelberg Service Centres

AND

Endorsed by

Department of Health, Eastern Metropolitan Region


Glossary and Abbreviations

Abbreviations

The Agreement Memorandum of Understanding

AMHS Area Mental Health Service

AOD Alcohol and Other Drugs Services

PDRSS Psychiatric Disability Rehabilitation and Support Services

DH Department of Health

MST Mobile Support and Treatment Teams

CCT Continuing Care Teams

SECU Secure Extended Care Unit

CCU Community Care Unit

HBOS Home Based Outreach Services

RRS Residential Rehabilitation Services

Glossary

Target Group Refers to people with mental health concerns, that may be enduring a

serious mental illness with co-occurring concerns, and their carers

Consumers Refers to people with mental health concerns, that may be enduring a

serious mental illness with co-occurring concerns, who are eligible for

treatment and care from the public mental health and health service

system on the basis of assessed need

Service Sectors Refers to the following public mental health and health service sectors

Clinical Mental Health Service sector

Psychiatric Disability Rehabilitation and Support Services sector

Primary Health sector

Eastern Region Alcohol & Other Drug sector

Eastern Region Housing & Homelessness Sector


PREAMBLE

A review of the Eastern Mental Health Alliance Project and Action Plan was conducted in

January 2012 and it was determined that the Eastern Mental Health Alliance had achieved its

aim ‘to deliver more accessible, appropriate and coordinated mental health services to improve

the experience of consumers, carers and practitioners in the Eastern Region’ and that a stronger

focus on service coordination was required to build on the collaborative work already undertaken

that met the outcomes identified in the Eastern Mental Health Alliance Memorandum of

Understanding:

Improved trust, cooperation and understanding between services within each sector.

Improved health outcomes and continuity of care for the consumer target group.

More multi-disciplinary and integrated recovery, rehabilitation and care approaches

Optimisation of investment in public mental health services

Enhanced capacity for shared care

Improved clinical system throughput.

The realignment of the Eastern Mental Health Alliance Project to the Eastern Mental Health

Service Coordination Alliance Project will assist in achieving the service coordination goals as set

out in the EMR Mental Health Strategy Plan 2011-2013 and the Community Mental Health

Planning and Service Coordination Initiative 2011. It was also noted that the Victorian Dual

Diagnosis Initiative and the recent focus on physical health management for people with mental

health concerns were not well reflected within the Eastern Mental Health Alliance Project and

associated action plan despite significant work being undertaken by all partners in developing

dual diagnosis capable services and physical health being a priority for clinical, PDRSS and AOD

service partners. These initiatives require a stronger focus and will benefit from inclusion in the

Eastern Mental Health Service Coordination Project.

As part of the review is was noted that funding for the current Alliance and Service Coordination

Project Officer ceased in June 2012 but additional funding was made available from the

Department of Health to extend the Service Coordination aspects of the Project Officer role for

another 12 months commencing in July 2013.

PURPOSE

The purpose of this Memorandum of Understanding (MOU) is to provide a clear guiding

framework to bring together a number of different services within the clinical mental health and

Psychiatric Disability Rehabilitation and Support service (PDRSS), Housing/Homelessness,

Alcohol and Other Drug service (AOD) and Primary Health sectors to form an integrated multi

sector mental health service coordination model for people with mental health illness and co-

occurring concerns, and their carers (the target consumer group).

This MOU articulates the principles, protocols and structural/functional working arrangements,

which will facilitate effective communication, collaboration and integrated practice across the

mental health and health services operating within the Eastern Region.


STATEMENT OF INTENT

In signing this MOU each party agrees to:

Provide clear leadership and strategic direction in their respective organisations to

develop and promote an integrated multi sector mental health service coordination model

for people with mental health illness and co-occurring concerns, and their carers

Implement the agreed integrated multi sector mental health service coordination model

by working in a coordinated and collaborative manner to identify common issues and

solutions, and build and progress working alliances in the interests of people with mental

health illness and co-occurring concerns, and their carers

Achieve sustainable outcomes by embedding the agreed protocols and functional

arrangements into local work practice and providing ongoing support for the

implementation of practice reforms, cost effective innovation in service system delivery

and the structural changes necessary for the development and sustainability of an

integrated multi sector mental health service coordination model for people with mental

health illness and co-occurring concerns, and their carers

Monitoring the success of the mental health service coordination model and associated

action plan and their ongoing adaptation in response to changing needs of people with

mental health illness and co-occurring concerns, and their carers in the evolving nature

of the mental health and health service system reform.


IT IS HEREBY AGREED BETWEEN THE PARTIES

1. TERM

1.1 The term of this Memorandum of Understanding (MOU) shall be for three (3) years from

the commencement date.

1.2 This MOU acknowledges the provision of non recurrent project officer funding received in

the 2012/13 financial year from the Department of Health (DH).

2. Eastern Mental Health Service Coordination Alliance (EMHSCA)

2.1 The EMHSCA will oversee the implementation and monitoring of the MOU.

2.2 Members of the EMHSCA will include representatives from Clinical mental health,

Community Mental Health(PDRSS), Primary health, Housing services, Homelessness

services Social Support services and AOD services within the Eastern Metropolitan

Region.

2.3 The membership, role, frequency of meetings and coordination of the EMHSCA are set

out in the Terms of Reference for the EMHSCA, agreed between the parties, attached as

Appendix A.

2.4 Written minutes will be kept of all EMHSCA meetings.

2.5 Changes can only be made to the Terms of Reference of the EMHSCA by the designated

signatories to this MOU (or equivalent positions) or their nominated delegates.

2.6 The EMHSCA is accountable to the Chief Executives or their nominated delegates of the

relevant organisations that are party to this MOU.

2.7 The EMHSCA will be responsible for the development, implementation, monitoring and

review of the MOU and associated documents, including the Strategic Plan and associated

Action Task List.

3. REVIEW OF MEMORANDUM OF UNDERSTANDING

3.1 No review of the terms of this MOU is required during the three year term; however, at

any time any party to this MOU may request that proposed changes to the MOU be

considered. Amendments to the MOU will only be effective if made with the written

agreement of all parties to this MOU and signed by their designated signatories or

delegates.

3.2 To the extent that proposed amendments to this MOU substantively change the intent of

the MOU, the DH regional office shall be consulted about the proposed changes.


4. SCOPE

4.1 Within the scope of the MOU are all Federally and State funded mental health services

including specialist mental health services delivered through the Area Mental Health

Service model, Psychiatric Disability Rehabilitation and Support Services, Primary Health,

Housing Services, Homelessness Services, Family Services and Alcohol & Other Drug

Services, provided by the parties to this MOU.

5 OUTCOMES

5.1 The overall intent of the MOU is to foster and promote the development of robust

working mental health service coordination framework between clinical public mental

health services and non government PDRS services, Primary Health, Housing services,

Homelessness services, Family services and Drug & Alcohol services within the Eastern

Region in order to develop a integrated multi sector mental health service coordination

model for people with mental health illness and co-occurring concerns, and their carers.

5.2 The parties to this MOU will work together to create and strengthen working relationships

between the mental health (clinical and PDRS services), primary health, drug and alcohol

and homelessness service sectors to improve outcomes for consumers with multiple

needs.

5.3 The parties to this MOU will work together to achieve the following outcomes:

Improved collaborative mental health service coordination between services within

each sector and across sectors

Improved health outcomes and continuity of care for the consumer target group

To embed multi-disciplinary and integrated recovery, rehabilitation and strength

based pathways of care

Optimisation of investment in public mental health services

Enhance the capacity of the workforce to provide mental health service coordination.

6 ROLES AND RESPONSIBILITIES

6.1 The parties to the MOU agree to:

Nominate an appropriate officer to the EMHSCA. The nominated officer or their

delegate will be responsible for engaging their respective organisations/sector in all

processes and activities necessary to achieve the intent of the MOU

Encourage organisational/sector commitment (from senior management to the

worker level) to the sustained development of the mental health service coordination

arrangements and associated processes as articulated in the MOU and the Strategic

Plan.


7 GUIDING PRINCIPLES

7.1 The following principles encapsulate the critical features of the mental health service

coordination framework between all nominated service sectors:

I. Leadership – to promote and develop a clear shared framework for mental health

service coordination at all levels of the organisation/sector. This includes promoting a

spirit of cooperation and collaboration, and respect for each other’s philosophy,

priorities, knowledge, skills and experience

II. Authority – to implement the required changes in order to achieve the sustained

development of a integrated multi sector mental health service coordination model for

people with mental health concerns and their carers

III. Accountability – for quality service provision, achieving continuity of care and

optimal recovery and rehabilitation outcomes including strength-based approaches for

people with mental health concerns and their carers and for maximising the use of

available resources and minimising duplication of effort

IV. Ownership – of the change processes involved in developing and sustaining an

integrated multi sector mental health service coordination model for people with

mental health concerns and their carers

V. Sustainability – by embedding change activities and processes (including

coordination) within existing organisational/sector structures and service delivery

networks and models

VI. Adaptability/Flexibility – to enable the integrated multi sector mental health

service coordination model to respond to local needs, evolving service models,

emerging evidence based practice change and changing consumer needs.

8 PROTOCOLS

8.1 The parties to this MOU will develop, implement and monitor protocols between the

agreed scope of services (as per Clause 4) included in this MOU:

I. Monitor and review the development of the multi sector mental health service

coordination framework

II. Coordinate the development and maintenance of business issues for mental health

service coordination in the Eastern Region for people with mental health illness and

co-occurring concerns, and their carers, including review/development of MOU’s;

endorsement of cross sector operational protocols; review of resource allocation for

opportunities to address service gaps; consumer and carer collaboration and

participation frameworks

III. Make timely decisions that resolve any conflicts between the parties to this MOU;

monitor project risks; strengthen and embed consumer and carer collaboration and

participation; and issues in the development of mental health service coordination

in the Eastern Region.

8.2 The protocols will be consistent with existing standards and frameworks.


9 DELIVERABLES

9.1 A rolling annual Strategic Plan will be developed which will articulate the specific

processes and priority activities to be undertaken to give practical effect to the MOU. The

Strategic Plan will also articulate the review and development of mental health service

coordination arrangements and assist the parties to incorporate them within

organisational/sector structures and processes and consider how these can be sustained

over the long term.

9.2 The Strategic Plan is to be reviewed annually. This review will be carried out by, or

under the direction of, the EMHSCA.

10 FUNDING AND RESOURCES

10.1 The parties agree that Eastern Health will be the designated fund holder in respect of any

funds received from DH to facilitate the development/strengthening of mental health

service coordination arrangements between the parties to the MOU.

10.2 The parties to the MOU are expected to meet their respective management and

operational costs for the ongoing implementation of agreed activities and/or processes

related to the development and/or strengthening of mental health service coordination

arrangements.

10.3 Support ongoing education and training activities that support mental health service

coordination with an annual monetary donation to cover venue hire, equipment hire and

other associated costs.

11 EVALUATION AND REPORTING

11.1 Evaluation of progress in achieving the agreed outcomes, as well as any key performance

indicators (KPI) set by the EMHSCA, is to be undertaken annually by, or under the

direction of the EMHSCA.

11.2 The EMHSCA shall submit an annual written evaluation report to DH regional office on

the achievement of deliverables/actions articulated in the Strategic Plan.

12 WITHDRAWAL FROM MOU

12.1 Any party to this MOU may withdraw from the MOU at any time by giving the DH 3

months’ written notice.

13 DISPUTE RESOLUTION

13.1 If any question, difference or dispute arises between the parties, dispute resolution in the

first instance is the responsibility of relevant program managers, who will refer any

unresolved issue to their representative on the EMHSCA.

13.2 Where the matter cannot be resolved by the EMHSCA, the Chief Executives of the

organisations/sector representatives that are party to this MOU will agree on a method of

resolution to apply to the question, difference or dispute.


14 INTELLECTUAL PROPERTY

14.1 In respect to any methods, plans or guidelines jointly created by any two or more parties

to the MOU or the EMHSCA for the purposes of the MOU, all parties to the MOU shall be

entitled to the intellectual property in the product.

14.2 In respect to any methods, plans or guidelines created independently by a party to the

MOU, that party shall retain the intellectual property in the product, notwithstanding that

the EMHSCA may have approved the methods, plans or guidelines.


Appendix A

TERMS OF REFERENCE:

Eastern Mental Health Service Coordination Alliance

Acceptance Date: November 2012 Review Date: November 2013

1. ROLE

1.1 Oversee the development of an integrated multi sector service coordination framework

for people with mental illness and co-occurring concerns, and their carers across the

Eastern Region

2. REPORTING

2.1 Quarterly report to the Eastern Metropolitan Region Mental Health Planning and

Partnership Steering Committee

2.2 Service provider representatives will report progress and seek authorisation of service

coordination initiatives at relevant party’s internal governance and meeting structures

3. FUNCTION

3.1 Provide expert strategic direction for mental health service coordination in the Eastern

Region

3.2 Monitor and review the development of the multi sector mental health service

coordination framework

3.3 Coordinate the management of business issues for mental health service coordination

including review/development of MOU’s; endorsement of cross sector operational

protocols; review of resource allocation for opportunities to address service gaps;

consumer and carer collaboration and participation, etc

3.4 Raise awareness in the wider community and at government level for increased

services for mental health service delivery coordination in the Eastern Region

3.5 Make timely decisions that resolve conflicts between the parties; monitor project risks;

strengthen and embed consumer and carer collaboration and participation; and issues

in the development of mental health service coordination

3.6 Lead the development of a strong collaborative model in delivering mental health

service coordination

4. STRUCTURE & RELATIONSHIPS

4.1 Provide a structure to encourage collaboration and learning across all partner services

to deliver coordinated multi sector support to people with mental illness and co-

occurring concerns

4.2 The following Sub Committees will provide advice and recommendations to the

Alliance:

- Service Coordination Workforce Development Sub Committee

- Collaborative Partnerships & Implementation Sub Committee

- Physical Health Sub Committee

4.3 Membership of the sub committees will include representatives from within the

membership of the Eastern Mental Health Service Coordination Alliance and will co-

opt members from each party as required

5. COMPLIANCE & ACCOUNTABILITY

5.1 Decision making: It is acknowledged that the members of the Eastern Mental Health

Service Coordination Alliance are representatives of independent organisations and


that decisions made in the Alliance are ‘in principle’ agreements made by the

representatives. The member organisations’ governance structures are responsible for

reviewing the ‘in principle’ agreements for inclusion into local policy and procedure

and will either accept them or seek further clarification or suggest amendments via

their representatives at the next Alliance meeting. Once the ‘in principle’ agreement

has been accepted by the member organisations’ governance structures the agreement

will be ratified at the next Alliance meeting.

5.2 Communication: In general all discussions within the Eastern Mental Health Service

Coordination Alliance can be disseminated within partner agencies and other aligned

services to enhance the progress of the project

6. PERFORMANCE MONITORING

6.1 To create innovative strategies to address identified gaps across partner agencies in

achieving the implementation of a multi sector service framework for mental health

service coordination. This includes identifying service, business and clinical

improvement opportunities within available resources and in accordance with the

Strategic Work Plan as endorsed by the Eastern Mental Health Service Coordination

Alliance

6.2 Monitor Strategic Work Plan progress against projected timelines

6.3 Record service provider representative attendance

7. MEMBERSHIP

7.1 The Eastern Mental Health Service Coordination Alliance will include representatives

from following service providers:

Anglicare

ARAFEMI

Australian Government - Department of Human Services - Box Hill, Camberwell,

Greensborough and Heidelberg Service Centres

Consumer and Carer Representatives

Department of Health – Eastern Metro Region (EMR)

EACH

Eastern Health Alcohol and Other Drug (AOD) Services

Eastern Drug and Alcohol Services (EDAS)

Eastern Health Mental Health Services

Eastern Melbourne Medicare Local

Inner East Melbourne Medicare Local

Knox Community Health

Mental Illness Fellowship

MIND

NEAMI

Outer East Health and Community Support Allaince

Salvation Army – Eastcare

Wesley Homelessness Services (LASN)

Each service provider will send representatives who can attend regularly and have

seniority and appropriate decision making authority for their organisation.

8. MEETINGS

8.1 Chairperson: General Manager EACH

Deputy Chairperson: Area Manager NEAMI


8.2 Quorum: 50% (inclusive of Chair or Deputy Chair) plus 1

8.3 Frequency of meetings: Monthly on the 3rd

Monday of each month

8.4 Minutes are to be recorded by the allocated minute taker as per the roster. Minutes are

to be circulated no later than one week after each meeting.

8.5 STANDING AGENDA

Present

Apologies

Presentation

Consumer and Carer Updates

Service Sector Updates

- Community Mental Health

- Community Health

- Medicare Local

- Housing/Homelessness

- AOD

- Clinical Mental Health

- Family Services

- Department of Health

- Dual Diagnosis

Business Arising

Action Task List update

Sub Committee Updates

- Workforce Development

- Collaborative Partnerships and Implementation

- Physical Health

Other Business

Communication (letters/flyers/etc)

Next meeting date.


Appendix B

Eastern Mental Health Service Coordination Alliance February 2013 – February 2016

Alliance Members October 2013

ORGANISATION REPRESENTATIVE EMAIL

TELEPHONE

ADDRESS

Associate Program Director- Adult Mental Health, Eastern Health

Brad Wynne

[email protected]

9895 4845

1st floor Upton House

131 Thames Street Box Hill Vic 3128

EACH Service Manager CMHSS

Michael Janssen

[email protected]

9739 4722

7-9 John Street Lilydale Vic 3140

Eastern Regional Manager, NEAMI

Matthew Colledan

[email protected] 9481 1244

11 Malmsbury St Kew VIC 3101

Regional Manager Eastern and RTO Mental Illness Fellowship Victoria

Justin McKenzie

[email protected]

8873 2514

Suite 8 603 Whitehorse Road Mitcham Vic 3132

Area Manager MIND East, MIND Australia

Sally Corrigan

[email protected]

9872 2206

353 Whitehorse Road Nunawading Vic 3131

Senior Mental Health and AOD Program and Service Advisor, DoH ER

Trudy Parker

[email protected]

9843 1708

820 Whitehorse Road Box Hill Vic 3128

Eastern MHService Coordination Alliance Project Officer

Bronwyn Williams [email protected]

0434 608 544

Dept of Health 820 Whitehorse Rd Box Hill

Manager, Eastern Health Alcohol & Drug Specialist Services Eastern Health

Gavin Foster [email protected] 9843 5864 Level 3, 43 Carrington Rd Box Hill

Regional Manager, Specialist Support Services The Salvation Army Australia Southern Territory

Ann Smith

[email protected]

98517800 16 Church Street, Hawthorn

General Manager Primary Health Knox Community Health Service

Ann Elkins

[email protected]

9757 6281

1063 Burwood Hwy Ferntree Gully Vic 3156

Manager AOD services EACH/Eastern Drug and Alcohol Service (EDAS)

Ann-Maree Rogers [email protected] 9871 1800 46 Warrandyte Road Ringwood Vic 3134

Service Centre Manager – Box Hill and Camberwell – Australian Government

Scott O’Neil scott.o’[email protected]

03 99639830 3 Harrow Street BOX HILL VIC 3128

mailto:[email protected]












Department of Human Services

Senior Social Worker Australian Government – Department of Human Services

Jose Abalo [email protected] 9963 9882 3 Harrow Street BOX HILL VIC 3128

Director –Primary Care & Clinical Services - Inner East Medicare local

Martin Wilkinson [email protected] 8822 8444 6 Lakeside Dve, Burwood East Vic 3151

Clinical Services Manager, EACH

Heather McMinn

[email protected]

9837 3958

75 Patterson Street Ringwood East Vic 3135

Executive Officer, Outer East Health and Community Support Alliance

Jacky Close

[email protected]

9870 2725

Federation Estate 32 Greenwood Avenue, Ringwood

Program Manager Family & Community Serives Eastern Region, Anglicare Victoria

Amanda Exley

[email protected]

9721 3688

666 Mountain Hwy Bayswater Vic 3153

Service Manager Koonung, Doncaster & Waverly CCT, Eastern Health

Laurie Dusting

[email protected]

9843 5800

1

st Floor

43 Carrington Road Box Hill Vic 3128

Acting Manager Homelessness Services, Crisis and Homelessness Services, Eastern Region, Wesley Mission Victoria

Maidie Graham

[email protected]

8870 4022

291A Maroondah Hwy Ringwood Vic 3134

Manager Mental Health Triage & ED Response and Consultation Liaison Teams, Eastern Health

Robyn Jones

[email protected]

9847 4700

46b Laurence Grove Ringwood East Vic 3135

Service Manager Rehabilitation Services, Eastern Health

Ross Wood

[email protected]

9843 5800

1

st Floor

43 Carrington Road Box Hill Vic 3128

Service Manager Outer East Continuing Care Teams, Eastern Health

Tim Brewster

[email protected]

9871 3988

Murnong Clinic Cnr Bona & Patterson Streets Ringwood East Vic 3135

Director Health Services Eastern Melbourne Medicare Local

Craig Maloney

[email protected]

9871 1000 21-23 Maroondah Hwy Croydon Vic 3136

Executive Officer Inner East Primary Care Partnership

TBA 8822 8424 6 lakeside Drive, Burwood East Vic. 3151

Manager, ACE and Early Intervention, EHCYMHS

Jane Vane Tempest [email protected]

9895 4060 Upton House, 131 Thames Street, Box Hill 3128

Client Services Manager RDNS Knox/Lilydale

Tracey Easte [email protected]

1300 334 455 Royal District Nursing Service 7B, 841 Mountain Hwy, Bayswater 3153
















Appendix C

Eastern Mental Health Service Coordination Alliance Organisational Chart

Documents

Memorandum of Understanding - Eastern Health...MEMORANDUM OF UNDERSTANDING THIS MEMORANDUM OF UNDERSTANDING is effective from 1 February 2013 (“commencement date”) BETWEEN Eastern