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6.3 Psychosocial rehabilitation and accepted conditions
The concept of "accepted conditions" is central to the determination of a client's eligibility for supports and services from DVA. "Accepted conditions" means those illnesses or injuries that DVA has accepted liability for. These conditions are then used to determine the level and type of compensation and other payments that the client may be able to access. Once liability has been accepted for a service injury or disease, and the Rehabilitation Coordinator is satisfied that that the person has an impairment as a result a service injury or disease, the rehabilitation process, and an investigation of the person’s psychosocial needs can commence. This process starts with a referral to a rehabilitation provider for a whole-of-person rehabilitation assessment.
It is expected that a whole-of-person rehabilitation assessment will examine the client’s rehabilitation needs and their life circumstances in a holistic way. This means that the assessment can investigate any barrier to recovery that may impact on the person being able to achieve their rehabilitation goals. This can include an assessment of the impact of any conditions that are not related to the client's Defence service, but may be preventing them from being able to focus on their recovery and reaching their goals.
It is important to note that treatment needs cannot be met through a psychosocial rehabilitation plan. This includes for example, physiotherapy, massage, occupational therapy or other similar treatment provided by allied or other health providers. Therefore, if the rehabilitation assessment identifies treatment needs, the rehabilitation provider is expected to discuss this with the client’s DVA Rehabilitation Coordinator as a first step. It is important to manage the client’s expectations appropriately, and to ensure that they understand the types of supports that can be provided through a whole-of-person rehabilitation plan. It should also be made clear to the veteran how the health care card system works, particularly the requirements to access allied health services.
DVA’s whole-of-person approach means that there is some flexibility in being able to include psychosocial rehabilitation activities to address needs that may not be related to an accepted condition, on an approved rehabilitation plan. Activities such as brief intervention counselling to assist the person to learn strategies to manage their pain more effectively, or to adjust to a new normal of living with a disability, are good examples of activities that may be included on a psychosocial rehabilitation plan, to address non-accepted conditions.
Where a client has a diagnosed mental health condition and is receiving treatment through the Non Liability Health Care Arrangements, then it is recommended that the provider note DVA’s acknowledgement of this condition, when recommending psychosocial rehabilitation activities. This can be done under criteria 10 of the psychosocial rehabilitation decision making framework. If the condition is creating major and ongoing barriers to the client being able to progress their rehabilitation, then it is recommended that the client lodge a claim for acceptance of liability for that condition.
The following case study may help guide decision making about the reasonableness of including activities to address non accepted conditions.
Jackie has a back and knee condition accepted under the MRCA. She has become quite socially isolated and has just moved to a new town. Jackie has been provided with a DVA Health Card for specific conditions (white card) which enables her to access treatment for her accepted conditions. Her rehabilitation goals include finding a physiotherapist and GP in her new town and to start accessing treatment for her back and knee conditions; starting to establish a social network in her new location; and exploring employment options as a first step towards returning to work. Jackie has become quite anxious in social situations, but anxiety is not a condition for which DVA has accepted liability.
The rehabilitation provider recommends that attending a singing workshop be included as a psychosocial rehabilitation activity to assist Jackie to overcome her anxiety in making contacts in her new community. Jackie hopes that if she enjoys the workshop, she will be able to join the local choir. They also recommend a range of other vocational and medical management activities to help her to work towards her other rehabilitation goals.
The rehabilitation provider uses the decision making framework to support their recommendation regarding the singing workshop. They identify that starting to establish a social network in her community is likely to help boost Jackie’s confidence in identifying potential job opportunities in her new town, and to help address the risk of social isolation. The provider also includes recommendations about vocational and medical management rehabilitation activities for approval. The DVA Rehabilitation Coordinator considers the recommendations and approves the workshop and the payment of fees to enable Jackie to attend. He also approves the other rehabilitation activities.
If there is any doubt about providing psychosocial or other services not directly related to a person's accepted conditions, Rehabilitation Coordinators are requested to please discuss this with their team leader or contact the Rehabilitation policy team at firstname.lastname@example.org
As a general principle, psychosocial rehabilitation interventions should be time-limited and be closely monitored and reported on. It is expected that before any of these interventions can be extended, positive progress, including for example, regular participation in activities must be evident. The GAS process is an important tool for clients to be able to identify their psychosocial rehabilitation goals, and the track life changes, and changes in life satisfaction, through achieving their rehabilitation goals.