Current Research Impacting on Rehabilitation: A Study into Barriers to Rehabilitation

1. Current Research Impacting on Rehabilitation: A Study into Barriers to Rehabilitation Associate Professor Virginia Lewis

2. Study Aims • Position DVA for the future in relation to: • Determining whether rehabilitation is being delivered by DVA in the way DVA intends AND to the highest possible standard • Whether processes DVA has “on paper” are what happens in reality • Whether rehab providers are delivering “best practice” biopsychosocial rehabilitation • First step is to be sure that what is “on paper” represents the system that DVA is aiming for • The “essential” elements from last 2 days should be there

3. Step 1: Developing an acceptable description of the DVA Rehabilitation Model

4. Overview of DVA Model of Rehabilitation

5. Overview of DVA Model of Rehabilitation • DVA claim • Appropriate application of DVA principles for determining liability in a timely manner • Appropriate communication with claimant +/or advocate Former ADF member or DVA client injured (physically +/or psychologically) OR Develops health or mental health problem • Health provider for treatment of physical or mental illness • Appropriate holistic assessment identifying all needs • Appropriate communication with DVA • Knowledge of available services • Referral to appropriate services

6. Overview of DVA Model of Rehabilitation • DVA needs assessment • Appropriate Needs Assessment for medical treatment, income support, rehabilitation and other needs (using NA Recording Sheet) • Appropriate referral to Incapacity Payments processing staff; Medical treatment cards staff; Rehab providers; other health or allied health service providers DVA claim Appropriate application of DVA principles for determining liability in a timely manner Appropriate communication with claimant +/or advocate • DVA Rehabilitation Coordinator • Appoints rehabilitation provider and takes ongoing case management role Former ADF member or DVA client injured (physically +/or psychologically) OR Develops health or mental health problem Health provider for treatment of physical or mental illness

7. DVA Contracted Rehab providers • Appropriate assessment for client’s capacity to undertake rehabilitation (includes psychosocial needs) using Assessment Report DVA Rehabilitation Coordinator • DVA plan approval • Staff have knowledge of available and appropriate service and treatment options (required to assess plan) • Appropriate high quality plan developed (where required) including identification of providers and treatment options – kinds of rehab services planned for which kinds of problems (RTW, Other – specified) • Client actively engaged in development of plan • Timely communication with DVA claims/case managers (using Reports) Overview of DVA Model of Rehabilitation

8. Model implemented = “Best Practice in Rehabilitation” DVA Rehabilitation Coordinator • DVA Contracted Rehab providers • Appropriate assessment for client’s capacity to undertake rehabilitation (includes psychosocial needs) using Assessment Report • Appropriate high quality plan developed (where required) including identification of providers and treatment options – kinds of rehab services planned for which kinds of problems (RTW, Other – specified) • Client actively engaged in development of plan • Timely communication with DVA claims/case managers (using Reports) • DVA plan approval • Knowledge of available and appropriate service and treatment options (required to assess plan) • Implementation of Plan (to satisfaction of client and provider) • Appropriate monitoring of outcomes (at key time points) • Appropriate quality reports provided to DVA as required • Appropriate communication with other health providers • Reassessment and new plan if required after prescribed period (and through process again) • DVA ongoing monitoring • Review of progress reports Overview of DVA Model of Rehabilitation

9. Overview of DVA Model of Rehabilitation Biopsychosocial client outcomes • Implementation of Plan (to satisfaction of client and provider) • Appropriate monitoring of outcomes (at key time points) • Appropriate quality reports provided to DVA as required • Appropriate communication with other health providers • Reassessment and new plan if required after prescribed period (and through process again) (Increased) Connectedness to education +/or employment (Increased) Connectedness to social support (family, friends +/or community) Minimize risk factors and enhance protective factors for General Wellbeing and functioning. Increased positive outcomes/ reduced negative effects of targeted associated problems. • Quality closure report provided in a timely manner • DVA ongoing monitoring Reduced negative effects of mental or physical illness. Health provider/s providing treatment of physical or mental illness Reduced symptoms of mental or physical illness.

10. Overview of DVA Model of Rehabilitation Biopsychosocial client outcomes • Implementation of Plan (to satisfaction of client and provider) • Appropriate monitoring of outcomes (at key time points) • Appropriate quality reports provided to DVA as required • Appropriate communication with other health providers • Reassessment and new plan if required after prescribed period (and through process again) (Increased) Connectedness to education +/or employment (Increased) Connectedness to social support (family, friends +/or community) • DVA ongoing monitoring • Appropriate post-closure monitoring Minimize risk factors and enhance protective factors for General Wellbeing and functioning. Increased positive outcomes/ reduced negative effects of targeted associated problems. • Quality closure report provided in a timely manner Ongoing care coordination and management of health and wellbeing. (Self-management with appropriate professional support) Reduced negative effects of mental or physical illness. Health provider/s providing treatment of physical or mental illness Reduced symptoms of mental or physical illness.

11. Overview of DVA Model of Rehabilitation

12. Step 2a: Develop potential indicators for each element of the model

13. Developing potential indicators • Theoretically • Based on the map of rehabilitation • Literature review • Through consultations with: • DVA Staff from key business groups • Expert opinion • Rehabilitation providers • Consumers – with varied experiences

14. DVA claim • Appropriate application of DVA principles for determining liability in a timely manner • Appropriate communication with claimant +/or advocate Time to lodge claim Former ADF member or DVA client injured (physically +/or psychologically) OR Develops health or mental health problem Time to lodge claim • Health provider for treatment of physical or mental illness • Appropriate holistic assessment identifying all needs • Appropriate communication with DVA • Knowledge of available services • Referral to appropriate services Time to seek help

15. Example: “Appropriate Needs Assessment” • Number of Needs Assessments undertaken quarterly/ annually (Distinguish between new clients and reassessment) • Quality of Needs Assessments (consider cases not referred when indicated and referred when not indicated) • Referrals arising from Needs Assessments (number and as a proportion of total claims) (Distinguish between new clients and reassessment)

16. Example: “Psychological and self-care needs met” • Relationships and Socialisation: Increased connectedness to social support (family, friends +/or community) • Number with improved social connectedness +/or quality of relationships • Total cost for number with improved social connectedness • Self-care • Increased capacity to manage own condition (physical or mental health) (including chronic pain management, stress reduction, etc.) • Behaviours & Attitudes • Reduced risk factors (associated with health and wellbeing) (e.g. decreased substance use; anger management; etc.) • Enhanced protective factors (associated with health and wellbeing) (e.g. SNAP)

17. Consultations • Focus groups with clients of DVA Rehabilitation • Groups with positive experiences • Groups whose outcomes were not as expected • As part of a compatible research project (ACPMH and Lynda Matthews): • Interviews with key stakeholders (experts/DVA staff) • On-line survey of contracted rehabilitation providers (companies re policy and practices)

18. Step 2b: Determine usefulness of potential indicators

19. Determining usefulness of potential indicators • Consultation (e.g. workshop) with: • DVA Barriers to Rehabilitation Reference Group • DVA Rehabilitation Technical Advisory Committee (TAC) • Purpose: To refine the set of descriptors / indicators to ensure that • They are adequately comprehensive and balanced • The set is manageable / realistic in its size and scope • They meet the criteria for use as performance indicators

20. Step 3: Trial use of indicators: study of barriers to rehabilitation

21. Trialling use of indicators • Collect agreed indicators – in one area/office for a defined period of time • Analyse data for evidence of barriers to rehabilitation including those at: • the individual client level • DVA systems (including staff) level • Rehabilitation provider level • Report on findings

22. Step 4: Support DVA to implement systematic ongoing monitoring

23. Developing ongoing monitoring system • Develop guidelines for DVA to implement systematic, inexpensive, easy means of collecting indicators for ongoing monitoring of quality of Rehabilitation • In consultation with Reference Group & TAC • Compatible with Cúram Business Application Suite

24. www.acpmh.unimelb.edu.au A Centre of Excellence Supported by the Australian Government