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3.4 Rehabilitation Assessments
The rehabilitation assessment
The rehabilitation assessment requires the rehabilitation service provider to investigate and report on the client's whole-of-person needs, their current circumstances and their rehabilitation goals. As part of this process, the provider is expected to consult with all key parties including the client, treating medical and allied health professionals, and if appropriate, an employer, family and/or other support person/s.
A Life Satisfaction Indicators (LSI) form must be completed by the client during the rehabilitation assessment to indicate levels of life satisfaction. This questionnaire covers how an individual is coping across a range of domains including employment, finances, mental health, physical health and personal relationships. The LSI aids the provider in developing Goal Attainment Scaling measures by identifying areas of the client's life that require improvement.
The rehabilitation assessment provides evidence to support the development of a rehabilitation plan, tailored to the client's needs, circumstances and goals.
It is important that the rehabilitation assessment occurs in a setting which is safe, suitable and comfortable for both the client and the provider. In some cases, the rehabilitation referral may indicate that the client is experiencing issues that may create stress during the assessment. This may occur, for example, if the client is experiencing acute symptoms of post-traumatic stress disorder, anger management issues or substance or alcohol misuse disorder. Where this is highlighted, it is important that the rehabilitation provider considers their personal safety and organises for the rehabilitation assessment to be conducted in a neutral environment, away from the client's home.
Specific service assessments
Specific service assessments would normally be conducted separate to the whole-of-person rehabilitation assessment.
Specific service assessments require the service provider to investigate a specific need for the client and recommend services to be provided.
Service providers do not need to be DVA accredited rehabilitation service providers to undertake a specific service assessment. They must however, be Comcare accredited, appropriately qualified and experienced.
Types of specific service assessments include:
- Functional capacity evaluation
- Activities of daily living assessment
- Home assessment
- Medical management assessment
- Ergonomic assessment
- Workplace/workstation assessment
- Vocational assessment
- Job demands assessment
Functional capacity evaluation (FCE)
This is an objective assessment of the injured client’s physical abilities and limitations.
Activities of daily living (ADL) assessment
This is an assessment of the normal ADL routines of an individual and their capacity to perform these activities such as self-care, cooking, cleaning, and washing. Given that not all injuries are the same, the capacity of injured persons will differ, The ADL assessment analyses an injured individuals’ ability to carry out domestic and personal hygiene activities.
The assessment generates a report identifying the degree to which an individual is limited and makes recommendations for home alterations and/ or personal assistance. The principle underpinning an ADL assessment is that by knowing the person’s limitations and providing the right support at the right time, this will facilitate recovery and help the client develop confidence in managing their service related injury or illness as well as they can.
There are several evidence based ADL assessment tools available to rehabilitation service providers to complete this assessment type. The RUG-ADL and the Barthel Index for ADLS are but two examples.
This assessment is similar assessment to the ADL assessment and may be held at the same time by the same professional, usually an Occupational Therapist or Nurse. The focus of the Home Assessment is on normal home routines and the performance of such. This assessment may identify the need for aids and appliances.
Medical management assessment
This is an assessment of the client’s capacity to self manage their medical treatment, appointments and administration of medications. This assessment may be undertaken as part of a functional capacity or home assessment. The preceding assessment types may be undertaken individually or in combination to ensure a comprehensive and holistic assessment of the clients’ individual capacity and needs within these criteria.
This involves the assessment of how a client’s immediate physical work environment affects the client. This can involve providing training for the client and/or employer to increase their level of understanding of injury management and possible workplace alterations, aids and appliances.
This is an assessment undertaken to make recommendations for workplace alterations and/or job redesign to accommodate an injured workers return to work and/or promote a safe work environment.
This is an assessment of the client’s work capacity, interests, work history, training, experience and transferable skills.
Job demands assessment
This involves identifying the physical, cognitive, sensory and psychological demands of a job, i.e. the full range of requirements for a particular job. This assessment is usually included in a vocational assessment. However, the assessment may be undertaken as a standalone activity.
Specialist Medical Reviews
Generally Specialist Medical Reviews (SMRs) will be organised by a compensation delegate. If this is not possible for any reason, then a Rehabilitation Coordinator may do so. It is however important, that the SMR is tailored to include questions to inform initial liability, incapacity or permanent impairment decisions where this is required. A Rehabilitation Coordinator would therefore need to liaise with any relevant teams before organising the SMR.
Ensuring that a client's GP and/or treating specialist is provided with a copy of the SMR will help to ensure that they are aware of relevant information that they may need to address in treatment plans as part of helping the client to manage their health issues effectively.
It is important that rehabilitation providers are not asked to organise SMRs at any time. This is because a rehabilitation provider's role includes obtaining medical information and where appropriate, return to work guidance from a client's treating GP or specialist, rather than gathering informaton to inform decisions about a client's access to compensation or other entitlements from DVA.