A critical step in the case management for a client participating in a rehabilitation program is regular and timely reviewing and monitoring. Regular progress reporting by the rehabilitation service provider for all VVRS, MRCA and DRCA clients is mandated.
The key tool for progress reporting is the Rehabilitation Progress Report which is DVA form D1330 and can be accessed through the DVA forms portal [2] (this form applies for VVRS, MRCA and DRCA clients).
Rehabilitation Coordinators may agree on a reporting period that is most appropriate to the client's circumstances. The maximum reporting period must not be more than every 6 months. It is essential that if significant issues arise, such as deterioration in a client's symptoms or conditions, or life changes that will impact on a client's rehabilitation progress, that rehabilitation providers are pro-active in contacting the client's Rehabilitation Coordinator and informing them. The agreed reporting period must be recorded in the client's R&C ISH case.
Rehabilitation service providers are required to provide the Rehabilitation Coordinator with Rehabilitation progress reports that.
Note: See Goal Attainment Scaling in chapter 15 [3] of this Guide for "how to steps" on completing a rehabilitation progress report.
Progress reports should be uploaded by the Rehabilitation Provider electronically to R&C ISH. Documents uploaded to R&C ISH will be saved in the client’s TRIM file and flagged as new info in R&C ISH.
To upload to R&C ISH, the DVA Rehabilitation Coordinator will need to send the Rehabilitation Provider an email with information about how to upload to R&C ISH and the Transaction Reference Number (TRN) to be used for the individual client. Any follow-up items or recommendations from the progress report need to be recorded and actioned in R&C ISH.
The Rehabilitation Provider is required to sign the progress report to authenticate the information provided in it. There is no requirement for the Rehabilitation Coordinator to sign the progress report.
All parties involved in implementing any aspect of a client’s rehabilitation, including pre and post plan activities, have a responsibility to monitor those activities, provide feedback and ensure the activities are progressing. This team input helps to provide the best possible opportunity for the client to reach their rehabilitation goals.
The Rehabilitation Coordinator has overarching responsibility for the progress and the direction a rehabilitation case takes. Input is sourced from all parties including client interviews, client files and reports, assessment reports, medical and allied health reports, case correspondence, rehabilitation progress reports, phone calls or conversations.
Effective monitoring by the Rehabilitation Coordinator involves:
The client is the key player in the process of reporting and providing feedback on whether the approved rehabilitation activities are helping them to progress towards their rehabilitation goals. They are also an important feedback source on the accuracy of events occurring and reported on by other stakeholders. Ongoing contact with the client by the Rehabilitation Coordinator is vital to make certain that changes in the client circumstances are acknowledged and where necessary are addressed by appropriate interventions as quickly as possible.
Rehabilitation service providers play the critical role of case manager in the rehabilitation process, providing ongoing and proactive support to the client, management and implementation of recommended and approved rehabilitation interventions, and the close monitoring of the client’s responses and progress. They are expected to regularly document and report progress to the Rehabilitation Coordinator (with timing as agreed to following negotiations with the Rehabilitation Coordinator). Providers are expected to maintain regular contact with the client, the Rehabilitation Coordinator and key service providers. The intensity of this contact will be determined by the complexity of the case or as discussed and agreed with the Rehabilitation Coordinator.
Specialist, treating practitioners and allied health providers contribute to the rehabilitation of the client by providing crucial information such as a diagnosis or prognosis regarding the client’s medical condition(s). Their reporting guides the client through the recovery process, with recommended treatment pathways, clarifying functional restrictions and limitations and suggesting appropriate aids, appliances or modifications which can help maximise potential functioning. They are significant contributors to the process providing regular medical reviews and reports. They also provide important input on a client’s psychosocial circumstances.
Other contracted service providers who are delivering services for the client can provide reports on progress or on the results relating to specific services being provided such as progress with training courses or work preparation activities.
In order to ensure timely progress of a referral through to the completion of a rehabilitation assessment or an assessment for a specific rehabilitation service, it is essential that the Rehabilitation Coordinator maintains close monitoring of the service providers’ actions through ISH and those of the client. All parties will need to be adequately prepared to begin the process and be informed of prescribed deadlines and input required.
This is the most involved phase in the rehabilitation process. Unless the process moves without delay, immediate and urgent needs can not be addressed nor can early interventions be implemented. Close monitoring ensures providers meet prescribed deadlines and clients are aware of what is expected of them.
Links
[1] https://clik.dva.gov.au/user/login?destination=comment/reply/21037%23comment-form
[2] https://www.dva.gov.au/get-support/find-forms
[3] https://clik.dva.gov.au/rehabilitation-policy-library/15-goal-attainment-scaling