The development of a rehabilitation plan must be a collaborative process between the client and the rehabilitation provider. Where appropriate, the client's family, the client's treating medical practitioner, allied health professionals and employers/work colleagues should also be involved.
This is consistent with an enablement approach [NSW Agency for Clinical Innovation, Rehabilitation Goal Training, 2013], veteran and family centric service provision and systematic review evidence which supports the value of shared decision making within goal setting for rehabilitation [Rose A, Rosewilliam S and Soundy A, Shared decision making within goal setting in rehabilitation settings: A systematic review, Patient Education and Counselling, 2017;Sivaraman Nair, K.P. (2003). Life goals: The concept and its relevance to rehabilitation. Clinical Rehabilitation, 17, 192-202.]. This will enable a shared understanding of a client’s priorities and motivations, their expectations and their understanding of the rehabilitation process, and the roles and responsibilities within this.
The Delegate will ensure that Providers receive adequate referral information to enable a comprehensive assessment of the person’s whole-of-person needs, to better inform their rehabilitation program.
All parties – the Client, Provider and Delegate should work constructively and proactively work with to manage any arising issues or concerns. Effective communication is required to ensure that, where possible and reasonable, goals (and the activities to support the achievement of these) reflect the client’s priorities while managing expectations of what may be relevant or reasonable within a rehabilitation context.
It is important that the roles and responsibilities of the Provider and the Delegate are clearly defined and maintained during the rehabilitation process to maintain the integrity of the relationship between the client and provider. Delegates remain responsible for communication of any concerns they have or decisions or determinations made with regard to the client and their rehabilitation plan (eg: client’s attitude, costs or alternative programs). The Provider should not be asked to communicate this information, nor should they initiate communication with the client around these matters.
Authority for expenditure of money is only provided when a delegate approves an individual’s rehabilitation plan.
Rehabilitation plan approval
When considering a rehabilitation plan for approval, the Delegate is required to consider a range of factors (MRCA section 51(2), or DRCA section 37(3).
If significant variation exists between the client’s expectations or requested goals or activities from that of the Providers’ recommendations, or if the Delegate has a concern that they may not approve the proposed plan, the Delegate may seek appropriate and reasonable adjustments to the proposed plan be made after discussion and negotiation between all parties.
If, having considered all factors, the delegate is satisfied the rehabilitation plan will support the aim of rehabilitation for the client, their approval determination will provide the authority for the rehabilitation program.
DVA’s whole-of-person approach to rehabilitation must always be used to guide decision making, and to ensure that a client’s rehabilitation plan is tailored to their current needs and circumstances. This approach reinforces that vocational rehabilitation must not be the only, and may not be the first priority, in assisting a person to re-establish themselves within a civillian context after a service related injury.
In addition, the delegate is to have regard to the minimum standards of documentation and service required of providers by DVA with regard to the development of a rehabilitation plan.
Documentation standards must be met by both the provider and delegate, with all required information documented within DVA systems. This information provides the baseline outcome measure for the client, provides a comprehensive overview of a client’s rehabilitation experience and contributes to DVA data for the purpose of analysis of performance, policy and future services.
The Delegate must make a determination regarding the rehabilitation plan in a timely fashion to ensure rehabilitation activities can commence as soon as possible, supporting a ‘future focussed’ approach for the client.
Following delegate approval (by signing the rehabilitation plan), the Provider is required to sign the rehabilitation plan, and the client is requested to do so. While ideal that the client provides a tangible indication of their agreement to participate in the rehabilitation program, they may choose not to sign the rehabilitation plan.
Authority to proceed with the rehabilitation plan occurs with the Delegate’s determination. The determination must be advised in writing to the veteran, along with information regarding the client’s rights and obligations.
The determination letter, the relevant and the approved rehabilitation plan constitute a formal determination that a person is undertake a rehabilitation plan under section 37 of DRCA, section 51 of MRCA or section 13.2 of the VVRS Instrument. This determination is a reviewable decision.