Module 1: Introduction to DVA Whole-of-person ... · • DVA clients are usually former members of the Australian Defence Force (ADF), so returning to work can mean a new job and

WCAG Version Last updated on 3/4/17 Page 1 of 72

Module 1: Introduction to DVA Whole-of-person Rehabilitation and Goal Attainment Scaling

Welcome Welcome to Module 1: Introduction to DVA Whole-of-person Rehabilitation and Goal Attainment Scaling. Module Objectives: • Identify DVA’s whole-of-person rehabilitation philosophy • Locate the Rehabilitation Policy Library (CLIK) and DVA legislation • Identify Goal Attainment Scaling (GAS) Course Objectives • When you finish this course you will have completed one of the requirements for working with DVA rehabilitation clients. E-learning pre-requisites for this course: • Rehabilitation Online • Understanding the Military Experience • Non-Liability Health Care Module Completion Time: • Approximately 15 minutes. Consolidated Library of Information and Knowledge CLIK is your ‘go to’ source for rehabilitation reference material. All DVA Rehabilitation Providers are expected to use this source. You can access CLIK via the DVA website www.dva.gov.au or directly via http://clik.dva.gov.au/ There are links to the relevant rehabilitation policy in CLIK throughout this course. This will give you quick access to extra information. It will also familiarise you with using CLIK.


Click on the CLIK icon (across) for more information throughout this course. About CLIK The Consolidated Library of Information and Knowledge (CLIK) contains legislative, policy and reference material used by DVA staff in providing service to the clients of the Department of Veterans' Affairs.

The Rehabilitation Library http://clik.dva.gov.au/rehabilitation-policy-library is the section for rehabilitation policy, process and practice in DVA.

The Legislation Library http://clik.dva.gov.au/legislation-library is the section for links to relevant legislation provided on the Federal Register of Legislation https://www.legislation.gov.au/ website, such as Acts and legislative instruments.

DVA Rehabilitation vs Workers’ Compensation DVA rehabilitation has some key differences to other workers’ compensation arrangements in Australia. Some of the main differences are:

• DVA’s rehabilitation has a holistic and whole-of-person focus.

• DVA clients are usually former members of the Australian Defence Force (ADF), so returning to work can mean a new job and a new employer.

• DVA clients often have complex and multiple injuries resulting from their training and/or their service.

• Some DVA clients cannot return to the paid workforce.

• Depending on their needs, a DVA client could be on a rehabilitation program for a few months to a few years.

• DVA clients require you to work collaboratively with them and their other treating professionals to assist them to achieve mutually agreed upon goals.

Three Acts of Parliament There are three Acts of Parliament that apply to DVA’s rehabilitation assistance. Although you do not need to know everything in this legislation, you do need to understand the basics because there are some differences in the client’s entitlements under each Act. Military Rehabilitation and Compensation Act 2004 (MRCA) MRCA https://www.legislation.gov.au/Series/C2004A01285 provides for a holistic approach to screening, assessment, service provision and monitoring of rehabilitation. It aims to address the full range of issues that may impact on a client achieving their rehabilitation goals. Clients who have an accepted claim for liability under MRCA can receive rehabilitation under the provisions of this Act.

http://clik.dva.gov.au/rehabilitation-policy-library

http://clik.dva.gov.au/legislation-library

https://www.legislation.gov.au/Home

https://www.legislation.gov.au/

https://www.legislation.gov.au/Series/C2004A01285


The Safety, Rehabilitation and Compensation Act 1988 (SRCA) Rehabilitation under SRCA https://www.legislation.gov.au/Series/C2004A03668 has traditionally had a return-to-work focus. Some non-vocational services were provided if they supported a client's independent living needs or their general functioning. This has mainly been household and attendant care services, and alterations, modifications and aids and appliances, as set out in section 39 of SRCA. Even so, the rehabilitation provisions of SRCA cover the full range of rehabilitation services, including a client's medical, psychosocial and vocational needs. Clients who have an accepted claim for liability under SRCA can receive rehabilitation under the provisions of this Act. Veterans’ Entitlement Act 1986 (VEA) Section 115B of the VEA https://www.legislation.gov.au/Series/C2004A03268 provided the legislative authority for the establishment of the Veterans' Vocational Rehabilitation Scheme (VVRS). The VVRS is a voluntary rehabilitation scheme. Clients do not have to have an accepted claim to be eligible for VVRS but they do have to meet the eligibility requirements of the Act. Differences between the Acts DVA takes a ‘whole-of-person’ approach to rehabilitation, which includes vocational and psychosocial and medical management. DVA claims can be made under more than one Act.

Rehabilitation Provision

VEA (VVRS)

MRCA SRCA

Vocational

Psychosocial

Medical Management

Quick Fact Rehabilitation can be provided no matter which Act gives the person eligibility Stakeholders Involved in the Rehabilitation DVA clients have a wide variety of people are involved in their personal life, military experience and health and financial needs. Your DVA client might mention these people to you. You are encouraged to involve these people in the client’s rehabilitation if and when appropriate. Here are some of the stakeholders that can be involved in a DVA client’s rehabilitation.

• DVA rehabilitation coordinators • Medical and allied health providers • Families and significant others




• Advocates such as Ex-Service Organisations • Employers • Veterans and Veterans Families Counselling Service • Australian Defence Force (ADF) • Other areas of DVA such as Community Nursing, Income Support and Rehabilitation Appliances

Program. • Other agencies such as the Commonwealth Superannuation Corporation and Centrelink

DVA's Whole-of-person approach to Rehabilitation DVA uses a whole of person approach, which can be best explained by this definition of rehabilitation from the Australian Faculty of Rehabilitation Medicine: "The combined and coordinated use of medical, psychological, social, educational and vocational measures to restore function or achieve the highest possible level of function of persons physically, psychologically, socially and economically; to maximise quality of life and to minimise the person's long term health care needs and community support needs." To ensure DVA clients receive whole-of-person rehabilitation, it is your responsibility to know:

• what is important to them, • where they are at with their life • what motivates them.

This will ensure a client’s rehabilitation program is individually tailored meaning they are more likely to reach their rehabilitation goals. The ultimate goal for rehabilitation is a client being able to self-manage. To get clients to this point providers must encourage clients to be motivated. This involves case management and the client being focused on their goals. A person is considered to be ‘self-managing’ when they are able to make decision and take responsibility for their own needs and well-being, independently of DVA. FYI: Treatment and medical support is delivered separately to rehabilitation services. Please consult the DVA health factsheets which are located at http://www.dva.gov.au/about-dva/dva-factsheets

Meet your DVA Rehabilitation Case Studies Introducing Daniel, Karen and John They will help you understand what a client may experience, positive and negative, during a rehabilitation program. Karen, John and Daniel will pop up throughout the course. Just like in a real rehabilitation situation, you will be involved in their rehabilitation program and guide them towards recovery.

http://www.dva.gov.au/about-dva/dva-factsheets

http://clik.dva.gov.au/rehabilitation-library/1-introduction-rehabilitation/11-what-rehabilitation


Hi! My name is Karen and I’m 42 years old. I represent approximately 15% of the ADF who are women. I was medically discharged at 37 due to a stress fracture in my foot which I contracted during basic training. I was a late enlistee to the ADF. I stayed in the Navy for 12 months after my injury but ended up with chronic pain. My accepted condition is the stress fracture. I have a family and spend all my time looking after them. I do not have a job because I have a lot of pain. I’m very busy with household duties and running the kids around. I recently had a specialist medical report (SMR) completed and now I have been referred to DVA for rehabilitation. (Image by stockimages via FreeDigitalPhotos.net)

Hi! I’m John and I’m 45 years old. Over the course of a long military career I’ve had a number sprains of fractures, and I have lumbar spondylosis. These conditions have all been accepted under SRCA. I was discharged last month and am in no rush to return to work. I’ve always lived on base and I’m single. My friends told me I can get a DVA Gold Card, which sounds awesome. I would also like some household services. (Image by stockimages via FreeDigitalPhotos.net)

Hi! I’m Daniel. I have a knee injury but mostly need help coping with my depression in the work place. (Image by Artur84 via FreeDigitalPhotos.net)

Knowledge Check 1. How would you describe whole-of-person rehabilitation?

a. Rehabilitation that only focuses on getting a person back to work b. Rehabilitation that encompasses every part of the client’s wellbeing

2. Why is whole-of-person rehabilitation important?

a. Because it encompasses the clients physical, psychological and social needs to enable them to achieve their highest possible level of function

b. Because it’s a DVA requirement 3. Which of the following are considered stakeholders in a rehabilitation program?

a. Family b. Friends c. VVCS d. Advocates e. All of the above


4. Where is DVA’s rehabilitation policy for providers and staff located?

a. I don’t know b. The Rehabilitation Policy Library in CLIK c. From the coordinator d. I should use my internal policies

5. What are my responsibilities as a rehabilitation provider to DVA clients?

a. Ensure the client gets back to work as soon as possible b. Understand all aspects of the client’s current life and their rehabilitation needs c. Ensure the client does everything I tell them to do

Three Types of Rehabilitation for DVA Clients Often DVA clients present with multiple needs for rehabilitation. This can vary from physical injuries, feeling sociality isolated needing help to find a job. This is why whole-of-person rehabilitation is so important for DVA clients. There are 3 types of rehabilitation options that can be included in a rehabilitation program. DVA encourages providers to combine these rehabilitation options and expects providers to coordinate them to achieve whole-of-person results for their clients. Medical Management Medical management is the monitoring of treatment measures to restore or maximize a person's physical and psychological function. This may involve encouraging clients to attend and participate in medical and allied health services specifically aimed at treating their physical and/or mental health conditions to help achieve recovery and wellbeing. Normally these activities would be coordinated by the person's treating medical practitioner. However where the person, because of their specific injury or condition, is struggling to pursue treatment in a consistent way, a rehabilitation service provider can be engaged to coordinate a medical management rehabilitation plan. This may involve the rehabilitation provider facilitating attendance at necessary appointments and

assisting the person to manage their medical conditions more effectively. Psychosocial Psychosocial rehabilitation comprises a set of comprehensive, individually tailored rehabilitation interventions that help to promote recovery and an optimal level of functioning in people who have sustained a service related injury or disease. Examples of psychosocial rehabilitation interventions include pain management, adjustment to disability counselling, support to undertake activities to promote social connections within the client's community and family education programs to promote a better understanding of the client's accepted conditions. A client's rehabilitation program may focus solely on a package of psychosocial interventions. However, ideally a whole of person rehabilitation plan will be developed which will provide psychosocial rehabilitation interventions in conjunction with medical management and/or vocational rehabilitation

services.

http://clik.dva.gov.au/rehabilitation-library/5-medical-management-rehabilitation/51-what-medical-management-rehabilitation

http://clik.dva.gov.au/rehabilitation-policy-library/6-psychosocial-rehabilitation


Vocational Vocational rehabilitation is the managed process that provides an appropriate level of assistance, based on assessed needs, necessary to achieve a meaningful and sustainable employment outcome. The aim of a vocational rehabilitation program is to return a person to the workforce to at least the level of

their pre-injury employment. What is Goal Attainment Scaling? Goal Attainment Scaling (GAS) is used in a DVA rehabilitation plan to work with the client to set appropriate rehabilitation goals and to measure change and progress in the client’s functioning, employment, social and wellbeing outcomes.

Why does DVA use it? GAS is a best practice approach for measuring rehabilitation outcomes and for ensuring the client is actively engaged in planning and implementing their rehabilitation program What are DVA’s expectations? DVA expects you to work collaboratively with the client to develop rehabilitation

goals and a range of possible outcomes. Need more information? Guidelines can be found in Chapter 15 of the Rehabilitation Policy Library in CLIK and general information can be found on the rehabilitation provider webpage at http://www.dva.gov.au/health-and-wellbeing/rehabilitation/rehabilitation-service-providers How Goal Attainment Scaling will Help Your Case Studies GAS will be used to generate and measure goals for your case studies. This will give you a sense of how GAS benefits each client.

GAS will help Karen to keep on track during her complex rehabilitation program. The GAS scoring system will also aid her motivation to recover. GAS goals will help Karen focus on helping herself heal with the assistance of her family. It will also help her aim for future vocational direction.

http://www.dva.gov.au/health-and-wellbeing/rehabilitation/rehabilitation-service-providers

http://www.dva.gov.au/health-and-wellbeing/rehabilitation/rehabilitation-service-providers

http://clik.dva.gov.au/rehabilitation-library/9-vocational-rehabilitation/91-what-vocational-rehabilitation

http://clik.dva.gov.au/rehabilitation-policy-library/15-goal-attainment-scaling


GAS will help John identify his medical management needs and work capacity and motivate him to progress to a new job.

GAS will enable Daniel to identify ways to improve his employment opportunities and identify ways he can reduce/treat his depression.

Knowledge Check 6. What is Goal Attainment Scaling?

a. A way to determine appropriate goals for the client, measure outcomes against a standardised scale and measure change and progress in the client’s functioning, employment, social and wellbeing

b. A way to create goals for the client c. A way to measure goals developed for clients

7. Why does DVA use Goal Attainment Scaling?

a. To gather statistics on rehabilitation provider performance b. To improve rehabilitation outcomes

8. Why do I need to use Goal Attainment Scaling?

a. Because it is a process used by DVA to ensure client goals are whole-of-person focused b. It is an expectation of DVA c. All of the above

9. What are some of the benefits clients can achieve from the Goal Attainment Scaling method?

a. Identification of appropriate rehabilitation goal b. Helping clients focus on being motivated to achieve their goals c. Encourages communication between the provider and client d. Encompasses whole-of-person rehabilitation e. All of the above

10. Where can I find information, policy and guidelines about Goal Attainment Scaling?

a. CLIK b. This course c. The DVA rehabilitation provider webpage


d. All of the above Conclusion If your score is 80% or more correct then you have completed this module. If you did not get 80% or more answers correct please redo the assessment. You can now:

• Describe DVA’s whole-of-person rehabilitation philosophy • Locate the rehabilitation policy library (CLIK) and DVA legislation • Explain Goal Attainment Scaling (GAS)


Module 2: Referral and Initial Rehabilitation Assessment

Welcome Hello and welcome to Module 2: The Rehabilitation Assessment. Course objectives:

• When you finish this course you will have completed one of the requirements for working with DVA rehabilitation clients.

Module objectives:

• Organise and complete a rehabilitation assessment for DVA clients. • Build rapport with clients to ensure they fully engage in their rehabilitation program. • Recognise client barriers to successfully completing a rehabilitation program.

E-learning pre-requisites to this course:

• Module 1 of this course • Rehabilitation Online. • Understanding Military Experience. • Non-Liability Health Care.

Module completion time:

• Approximately 25 minutes


Receiving a Referral from DVA – What it will look like? Your first contact with DVA will be with a Rehabilitation Coordinator. They may refer to themselves as a delegate or coordinator. For the rest of this course, the Rehabilitation Coordinator will be referred to as “coordinator”. The coordinator will send you a referral to undertake a rehabilitation assessment or other type of assessment such as for home or vocational needs. The referral form looks like this. A case summary of the client and copies of relevant information such as medical reports will be included with the referral. Contact the coordinator if you need more information. The referral will also include a Defcare Case Id number. This is a unique client number which you should note and quote to the coordinator in all correspondence and conversations. Rehabilitation Providers must:

1. Acknowledge the referral by email to the coordinator within 24 hours.

2. Contact the client within 7 days to begin the assessment process.

3. Complete the assessment report and provide it to the coordinator (via email to the relevant DVA location) within 21 calendar days.

4. Note the Defcare Case Id on all reports. What you should know and consider? A coordinator may contact you prior to sending you a client referral, or they may provide further information in an email when they send you the referral. This information should contain an overview of the client and what is known about their situation. Before accepting the referral ask yourself: “Do I have the appropriate skills to match this client’s personality and rehabilitation needs?” If upon receiving the referral you decide that you do not have the skills to match the client’s personality or rehabilitation needs contact the coordinator immediately. They will organize another provider to undertake the rehabilitation assessment. EXAMPLE If the client has a psychological condition DVA expects you to have skills and experience in providing effective rehabilitation for clients with that condition. If you believe that your skills and experience do not match the client’s rehabilitation needs you should contact the coordinator immediately. They will organize a new provider with skills to match the client’s needs.

http://clik.dva.gov.au/rehabilitation-library/3-rehabilitation-process/33-rehabilitation-referral-process


It is very important for you and your client to connect and build rapport. This enables the client to achieve their best possible rehabilitation outcome. If you have the skills and experience to match your clients’ needs this best possible outcome is more likely to be reached. Did you know?

Veterans' Vocational Rehabilitation Scheme (VVRS) The Veterans' Vocational Rehabilitation Scheme (VVRS) is a free and voluntary rehabilitation program to help eligible veterans with vocational issues. It is slightly different to the rehabilitation provided under the SRCA* and MRCA** as it is voluntary. The VVRS can also help make the transition from military to civilian employment for members of the ADF, and members of peacekeeping forces, who may experience difficulty in obtaining and/or holding civilian employment. This includes those who have been out of the military for some time and who require income support and benefit protection while participating in a vocational rehabilitation scheme. Veterans who participate in a VVRS program can withdraw from

the program at any time. There is no penalty for a client if they do not complete their rehabilitation program. *Safety, Rehabilitation and Compensation Act 1988 **Military Rehabilitation and Compensation Act 2004 Barriers to Engagement in a Rehabilitation Program It is important to be aware that some DVA clients have barriers to engaging in a rehabilitation program. Barriers to rehabilitation can arise at any time during a rehabilitation program but are more likely to be expressed during the assessment. Some examples of these barriers are:

• The challenge of transitioning to civilian life. • The belief they will return to the ADF. • An ‘incapacity mindset’. • A focus on what they cannot do, which may have been reinforced by doctors. • Waiting for liability to be accepted or focusing on rejected conditions. • Avoidant behavior. • Mental health issues. • Other claims with DVA. • Anger with DVA. • Anger with ADF. • Family issues. • Long-term unemployment. • Waiting for a Comsuper decision. • Unrealistic goals. • Lack of motivation. • Difficulties in setting goals.

http://clik.dva.gov.au/rehabilitation-library/12-veterans-vocational-rehabilitation-scheme-guidelines/121-overview-vvrs


As a DVA rehabilitation provider you are expected to work through these barriers with the client to enable them to benefit from rehabilitation. One approach could be diverting the clients focus from the barrier to an unrelated positive activity. The Rehabilitation Assessment The Rehabilitation Assessment (assessment) provides evidence to support the development of a rehabilitation plan, tailored to the client's needs, circumstances and goals. You, as the provider, are expected to investigate and report on the client's whole-of-person needs, their current circumstances and their rehabilitation goals. You are also 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 assessment. This questionnaire asks the client to rank how they are coping across a range of domains including employment, finances, mental health, physical health and personal relationships. The LSI will help you develop Goal Attainment Scaling measures by identifying areas of the client's life that require improvement. Funding will be allocated by DVA to make initial contact with the client and complete the assessment. Note that these funds are for this stage only (e.g. not for plan activities) and are audited.

• Investigate & report on your client’s needs, circumstances and goals • Client must complete an LSI questionnaire • Funds for this assessment are approved on the referral form • Be flexible with timing of the assessment as it may take a couple of hours or a couple of sessions to

share their story with you Be flexible for the client The assessment can be completed in one or more sessions depending on the client’s needs. If you are unable to undertake the assessment within the required timeframe inform the coordinator of the reason for the delay. Case Studies and their Initial Barriers to Engagement Most clients will have at least one barrier towards engaging in a rehabilitation program. Click on each case study to see what their barrier is.

Karen’s family obligations, such as looking after her family, supporting her partner and keeping the house in order, are her barriers to rehabilitation. Karen spends her time and energy looking after her family which has taken precedence over getting treatment for her conditions. Another barrier for Karen is her GP diagnosis. The diagnosis was for long term incapacity with no ongoing treatment.

http://clik.dva.gov.au/rehabilitation-library/3-rehabilitation-process/34-rehabilitation-assessments


John has a number of barriers:

• He does not have a civilian GP which means he has no medical clearance for work.

• His main focus is on building his new house so he is not interested or motivated to look for work.

• He thinks of his incapacity payments as a pension and so he does not think he needs a job.

• John also believes he has reduced functional capacity so he cannot hold a job or do household duties.

• He also wants a DVA Health Card for All Conditions (Gold Card). For Daniel, once his initial enthusiasm for a new job wears off his depression sets in and he is unable to sustain job performance. He has few transferrable skills relevant to entry level jobs. Daniel is very keen to work to support his family but he is committing to jobs without considering his health restrictions.

Organising a Rehabilitation Assessment Once you have notified the coordinator that you will conduct the assessment, you will organise an appropriate time and meeting place with the client. You must complete the assessment within 21 days of receiving the referral. Take note of comments regarding the client’s demeanor, which the coordinator will write on the referral, before you set the location of the assessment. If you have concerns about you or your client’s safety, set the initial meeting in a neutral environment. This could be away from the client’s home. Take a colleague with you if you feel the need. Use your own judgment. The referral will provide you with guidance if the client will require a longer assessment. When contacting the client for the first time:

• Explain what the assessment will entail. • Organise an appropriate meeting place and time. • Ask if they would like a friend or family member to attend the assessment with them. • Explain they will need to complete a LSI questionnaire.

Hot Tips!

• Explain the LSI to the client prior to the meeting. This will save you and the client time during the assessment.

• Always follow your organisation’s safety protocols.


Meeting the Client When you meet a DVA client for their rehabilitation assessment it is important to emphasise:

• How whole-of-person rehabilitation can assist them in a variety of areas of their everyday life, wellbeing and employment.

• The discussion should be open and two way. During the assessment, the conversation should address the client’s:

• Rehabilitation expectations. • Health, wellbeing and employment needs/goals. • LSI score. • Lifestyle, addictions (if forthcoming), financial status and living status even if the issues are not

ADF/DVA related or caused. During the assessment you are expected to:

• Adhere to Comcare’s Professional Code of Conduct. http://www.comcare.gov.au/the_scheme/the_src_act/rehabilitation

• Start looking for client ‘buy in’ to rehabilitation. • Tailor the assessment to the client. Do not treat them as ‘just another case’; • Not overload the client with lots of information. • Use the DVA rehabilitation assessment report

(D1334 - http://www.dva.gov.au/sites/default/files/dvaforms/D1334.docx ) to guide your conversation with the client.

• Understand the client’s initial goals at the stage. • Discuss and agree upon a recommendation with the client. • Contact the coordinator before submitting the assessment report if the client’s expectations are

unrealistic. Employment Do not push employment during the assessment if the client appears to be reluctant. Employment can be discussed at a later date Rehabilitation Assessment Report Use the Keyword Search or form number search in the Forms Portal to find the form you need. E.g. Type D1334 in the number search to find the assessment report Initial Goals Goals can change throughout the program Unrealistic Such as 'To find myself', 'Astrophysicist', or 'Doctor'.

http://www.comcare.gov.au/the_scheme/the_src_act/rehabilitation

http://www.comcare.gov.au/the_scheme/the_src_act/rehabilitation

http://www.dva.gov.au/sites/default/files/dvaforms/D1334.docx


Case Studies and their Rehabilitation Assessment See below to gain an understanding of the type of information you will receive on a referral and what considerations you might have for a DVA client. Karen has been receiving DVA incapacity payments for a long time. As a result, she is not clear about the purpose of rehabilitation. Her current motivations are to continue receiving incapacity payments and maintain her life’s status quo. Karen’s GP is supporting this lack of action which has resulted in Karen’s family heavily relying on her and Karen not receiving treatment. Karen is experiencing a lot of pain in her previously stress fractured foot. Your concerns for Karen are that her stress fracture is the only accepted condition. This injury should have been resolved many years ago yet she is still experiencing pain and has not been receiving any treatment. Nor has the possibility of further conditions been explored.

When assessing John, you (a female provider) noted that he behaved inappropriately towards you and, in his recount of his personal history, clearly indicated that he lacked the appropriate social skills to interact with members of the opposite sex. You finalised the assessment with a recommendation for John to be transferred to a male provider within your company. Your assessment of John was that he is expecting to remain on incapacity payments as he believes it to be pension-like. Has no intention to work and wants a Gold Card. He also wants household services to be provided to him by DVA. His goals are building his house and continue with his current social activities which are associating with people

who are in a similar situation to him (ex-ADF). He did mention he has a passion for photography. Your clinical observations of his capacity to undertake physically demanding tasks by building his home demonstrates that he does not have any obvious limitations. You send the assessment and recommendation to DVA and then call the coordinator to discuss the issue of changing providers. It is mutually decided that the case will be handed over to a male provider within your company. Daniel wants a fantastic job that he can maintain. He is very motivated but does not have the appropriate coping strategies to manage the symptoms of his depression. He has a very supportive wife and a young family. Daniel is putting pressure on himself to provide for his family. Your recommendation for Daniel is to assist him in obtaining some coping strategies for his depression, determine his capacity for work and find him suitable employment.


Don’t Forget… The assessment is a two way conversation of you building a rapport with the client. Some clients may not be forthcoming with information so here are some questions you can ask during the assessment.

• What are the client’s expectations, motivations and barriers to rehabilitation?

• What is the client’s environment in which they are living, socializing and working?

• What does the client want to achieve? Knowledge Check 1. Is it important as a provider to have the right skill set for each individual client?

a. Yes b. No

2. What is the timeframe in which you should acknowledge the rehabilitation referral?

a. 21 days b. 7 days c. 24 hours

3. What is the timeframe in which you should contact the client to organise the rehabilitation assessment?

a. 21 days b. 7 days c. 24 hours

4. Is an LSI mandatory for a client to complete?

a. Yes b. No

5. How will the LSI help me as a provider during the rehabilitation assessment?

a. It will help me develop Goal Attainment Scaling measures by identifying areas of the client's life that require improvement

b. It will save time c. It ensures I have completed all the necessary steps DVA requires of a provider

6. What are some questions I should ask clients during the rehabilitation assessment? (Choose 3 options)

a. What are your expectations for rehabilitation? b. What do you want to achieve? c. What is your current home life like?


d. When do you want to go back to work? 7. What are some barriers a client could have in regards to engaging in a rehabilitation program?

a. Belief that they will return to the ADF b. Anger with the ADF or DVA c. Relationship problems d. Long term unemployment e. All of the above.

Did you know? Non-Liability Health Care DVA pays for treatment for certain mental and physical health conditions without the need for the conditions to be accepted as related to service. This is known as non-liability health care. Non-liability health care allows former and current ADF personnel, depending on their eligibility, to receive treatment for the following conditions:

• Posttraumatic Stress Disorder (PTSD) • Depressive disorder • Anxiety disorder • Alcohol use disorder • Substance use disorder

There is no need to establish that these conditions were caused by a person’s ADF service. DVA also provides Non-Liability Health Care for people with malignant neoplasm (cancer) and pulmonary tuberculosis if they meet a variety of eligibility criteria. Check out Factsheet HSV109 http://www.dva.gov.au/factsheet-hsv109-non-liability-health-care for more information. Mental Health Eligibility for mental health conditions has recently been expanded. Now anyone who has ever served in the permanent forces of the ADF may receive treatment for the mentioned mental health conditions, regardless of when they served, for how long, or the nature of the service. Image courtesy of phanlop88 at FreeDigitalPhotos.net The Rehabilitation Assessment Report Form The assessment report is a form you submit to the DVA coordinator with your findings and recommendations from your assessment meeting with a client. It is important that you gather all the information that this form requires.

http://www.dva.gov.au/factsheet-hsv109-non-liability-health-care


This is an excerpt of the Rehabilitation Assessment Report form. As you can see, DVA requires a lot of information about the client’s current status and expectations. Ensure you do the following:

• You must include all relevant information about the client and their LSI score (for GAS, see CLIK link).

• Avoid long narrative text with superfluous information.

• Make sure you follow the instructions provided on the form.

You are legislatively bound to use this form. Do not make any changes to this or any other DVA form. Do not save this form to your computer for later use. DVA forms are always being updated. For this reason, you should always use forms from the Forms Portal http://www.dva.gov.au/dvaforms on the DVA website to ensure you are using the most up to date version of the form. Failure to use the correct form could result in the coordinator instructing you to fill it out using the correct form. Click on this link D1334 - http://www.dva.gov.au/sites/default/files/dvaforms/D1334.docx to access the assessment form. Completing the Rehabilitation Assessment Report Form You must complete all areas of the report form. Include all relevant details about the client. For example, if the client has a gambling addiction you must include information about their current financial situation. Along with the report you also need to include relevant attachments. The attachments give evidence to your report and assist the coordinator in making decisions. Attachments include…

• Medical reports and clearances • Signed rehabilitation obligations form • Doctors certificates • Life Satisfaction Indicators

If the client has an immediate or urgent need you must telephone the coordinator immediately.

http://www.dva.gov.au/dvaforms


http://clik.dva.gov.au/rehabilitation-policy-library/15-goal-attainment-scaling/153-dvas-rehabilitation-process-goal-attainment-scaling/1532-rehabilitation-assessment-report


Completing the Rehabilitation Assessment Report Form Once you have filled out the report and gathered the attachments you then must submit the report within 21 calendar days of the referral date. Contact the coordinator if you cannot meet this date. You must email the report to the relevant DVA state inbox (see below). Do not mail the report via post. This is to ensure the report is received quickly for fast action by the coordinator.

• South Australia / Victoria [email protected]

• Northern Territory / Tasmania / Western Australia [email protected]

• South Queensland / NSW less postcodes [email protected] 2500-2699 and 2900-2999

• North Queensland / NSW and ACT postcodes [email protected] 2500-2699 and 2900-2999 The coordinator will notify you of their decision to proceed to a rehabilitation program or not via email. You must mail your invoice to the coordinator who is looking after your client. Knowledge Check 8. Where is the assessment form located?

a. DVA will send me a copy of the form b. On the Forms Portal on the DVA website

9. If a client has an immediate need what should I do?

a. Email the coordinator b. Call the coordinator c. Wait until I receive an email back from the coordinator approving a rehabilitation plan

10. What must I do after I complete the rehabilitation assessment report?

a. Add attachments to the report b. Send to the relevant state inbox c. All of the above

11. Where in DVA do I send invoices for payment?

a. To the coordinator b. Keep them until the end of the rehabilitation program.

http://clik.dva.gov.au/rehabilitation-library/3-rehabilitation-process/38-dva-rehabilitation-reporting-documents


Case Study Assessment 1. After reading the referral and supporting medical documents provided by the

coordinator, would you recommend Karen’s first rehabilitation priority be returning to work?

a. Yes b. No

2. What would be the primary focus of Daniel’s rehabilitation program?

a. Vocational b. Medical

3. What are some of the reasons for a change in provider?

a. John’s attitudes and behaviours towards the specific consultant. b. Provider did not have the level of skills and experience to match the

complexity of the case. c. The client wanted the provider changed for no apparent reason. d. The client did not want to do rehabilitation.

Conclusion If your score is 80% or more correct then you have completed this module. If you did not get 80% or more answers correct please redo the assessment. You can now:

• Organise and complete a rehabilitation assessment for DVA clients. • Build rapport with clients to ensure they fully engage in their rehabilitation program.


Module 3: The Rehabilitation Plan

Welcome Hello and welcome to Module 3: The Rehabilitation Plan Course objectives:


Module objectives:

• Explain the purpose of the rehabilitation plan and how to set goals for DVA clients. • Obtain evidence required to enable assessment of the plan. • Be able to score goals using the GAS scale. • Manage client expectations during their program.


• Module 1-2 of this course. • Rehabilitation Online. • Understanding Military Experience. • Non-Liability Health Care.


• Approximately 30 minutes. Difference Between a Plan and a Program The difference between a rehabilitation plan and rehabilitation program can often be confused. But it’s quite simple! Rehabilitation Plan + Case Management = Rehabilitation Program A rehabilitation program is a combination of the plan and case management.


This module will focus on the plan and all that it encompasses. Module 4 will focus on case management. What is Expected of a Rehabilitation Provider Before you are introduced to the rehabilitation plan, it is important you understand DVA’s expectations of DVA rehabilitation providers. These expectations go beyond formal training and Comcare approval to practice. They ensure DVA clients receive the best quality rehabilitation and achieve their best possible rehabilitation outcomes. Here are some expectations DVA has of you in relation to the rehabilitation plan:

• Ensure GAS is used to set and score goals. • Accountable for ensuring the client has a clear understanding of what is expected of them in regards

to activities and goals. • Ensure clients are actively seeking employment when it has been determined they are able to return

to work. • Considered and appropriate start and end dates for activities within the rehabilitation plan • Collaborating with the client to set appropriate goals and activities. • Ensure the plan is whole-of-person focused. • Contact the coordinator if the plan is taking longer than expected.

The Rehabilitation Plan (The Plan) It is likely, during your career, that you have generated a rehabilitation plan for a non-DVA client. However, you need to understand the DVA specific way in which you are required to generate a rehabilitation plan for its unique clients. Two types of plans can be drafted around the assessment report recommendations.

1. Whole-of-person plan 2. Specific Service(s) plan – Specific service(s) plans are for clients with short term needs. This

includes household or attendant care services. This e-learning will only focus on the whole-of-person plan. For information regarding specific service(s) plans click on the CLIK link. The Rehabilitation Plan (The Plan) A whole-of-person rehabilitation plan should address the client's combined medical management, psychosocial and vocational rehabilitation needs. The plan provides a structured series of individualised services agreed to by all relevant stakeholders. They aim to assist the client to live as full and meaningful life as possible, while still maintaining their independence and self-management. This includes, where possible, financial independence through employment.

http://clik.dva.gov.au/rehabilitation-library/7-household-services


Such plans may be complex in nature. They might involve multiple service providers and extend over a reasonable time period. Vocational, psychosocial and medical management activities may be provided in tandem rather than in sequence to ensure overall progress is maintained and the client remains focused. A plan must:

• Be goal and outcome focused • Clearly demonstrate a focus on the person's whole-

of-person needs • Clearly state the person's rehabilitation goals and

proposed activities • Clearly outline all case management activities to

be undertaken by the provider (you) • Specify your provider costs and third party costs

for all activities • Include a start and end date • Identify potential barriers to rehabilitation and recovery and include activities to address these • Be informed by medical evidence as to the appropriateness of proposed rehabilitation activities • Be realistic and achievable for the client • Incorporate GAS • Be agreed to by the client

A plan must not:

• Include activities that are not costed at the time of the plan • Include goals that are unmeasurable • Include unrelated activities such as internet use, holiday travel and petrol costs to take children to

school


The Rehabilitation Plan Form Just like the assessment form, you are legislatively bound to use this plan form http://www.dva.gov.au/sites/default/files/dvaforms/D1347.docx . Do not make any changes to this or any other DVA form.

Reminder! Do not save this form to your computer for later use. DVA forms are always being updated. For this reason, you should always use forms from the Forms Portal http://www.dva.gov.au/dvaforms on the DVA website to ensure you are using the most up to date version of the form. Failure to use the correct form could result in the coordinator instructing you to fill it out using the correct form. Tip: Use the keyword search to find ‘Rehabilitation’ forms. Knowledge Check 1. What is a plan?

a. A structured series of individualised activities agreed to by all stakeholders which aim to assist the client to live as full and meaningful life as possible

b. A DVA document that lists what the provider needs to do for the client c. A report on the client’s wellbeing

2. What should not be included in a plan? (Choose more than one answer)

a. Activities with costs that have not been approved or discussed with the coordinator b. Unmeasurable goals c. Unrelated expenses




3. What should be included in a plan? (Choose one answer)

a. Start and end dates b. Costings c. Goals and activities d. All of the above

4. Where is the plan from located?

a. The coordinator will send it to me b. I will use my organisation’s collection of forms c. The DVA forms portal on the DVA website

5. What does DVA expect of providers in regards to the plan?

a. Focus on the client’s whole-of-person needs b. Get the client back to work

What are Goals? Definition of ‘goal’ – an aim or purpose – Cambridge Dictionaries The plan requires clients and providers to collaborate and decide upon goals that the client will work towards. Goals must be developed using the GAS scale. Client goals will vary depending on their needs. A client who is debilitated with Post Traumatic Stress Disorder (PTSD) and can’t leave their house will have very different goals to a client who has an injured ankle and wants to go back to work as soon as possible. It is up to you as the provider to understand what your client needs and use that as a guide to set appropriate goals that will benefit their wellbeing. The timeframe you allocate to a goal will depend on what that goal is and how long you and the client believe it will take to achieve it. Goals must be:

• Appropriate - Appropriate for the client and their rehabilitation needs. Up to 4 goals per person. • Whole-of-person focused - This can include a variety of goals that are focused on medical

management, psychosocial or vocational • Not just return to work - Must meet the client’s needs and circumstances. • Developed using SMART – Specific, Measurable, Achievable, Realistic and Timeframe

Medical treatment cannot be provided as part of a plan. However, organisation of appointments and

support within a medical management goal can be included in a plan. If you believe the client’s treatment needs are not being met you must contact the coordinator. A case conference with the client’s treating professionals might be required.


Case Conferencing can be an extremely useful and cost effective mechanism for reaching agreement on moving matters forward and confirming goals or objectives for all players. You have learnt that DVA clients can have complex rehabilitation needs. These complex needs require factoring into the timeframe for goals. Keep in mind that new goals, including vocational, can be added at any time during the rehabilitation program. Example A client with a medical management goal might need to focus on that goal before changing their focus to returning to work. A vocational goal can be added to the plan but have a start date after the medical management goal is completed. While the client is working on their medical management goal you should still be working behind the scenes on their vocational or psychosocial goal. A vocational goal could include researching recognised prior learning. Match Up Goals Match up the goals to each case study Which goals belong to Karen?

a. Determine strategy to manage/improve depression symptoms b. Determine medical treatment regime c. Family and self-time management d. Determine vocational direction and source appropriate work e. Determine capacity for work per medical recommendation

Which goals belong to Daniel?


http://clik.dva.gov.au/rehabilitation-library/3-rehabilitation-process/38-dva-rehabilitation-reporting-documents/382-rehabilitation-plan


Which goals belong to John?


What are activities? Activities are small steps that are essential to fulfill goals. Each goal will have a number of activities associated with it. The development of activities happens between you and the client. Some examples of activities are:

• Supporting the client in accessing treatment • Training for future employment • Other assessments • Connecting to social activities to reduce social isolation • Introducing structure into the client’s life.

Some of these activities may require further approval by DVA i.e. Training. The plan should also include your activities that will assist the client in meeting their goals. Such as assistance with job seeking and case management. Here are some rules regarding activities:

• Costs o Activities must be costed before seeking approval. o Costs of activities must be discussed and agreed upon by the coordinator in advance of them

being undertaken. This excludes your provider costs. o Costs must be described at the back of the plan.

• Time frame o Timeframes must be appropriate and considered. o A goal can be added for the future. Example: A client may not have medical approval to

embark on that goal right now but adding it to the plan shows that it will be actioned when the client is ready.

• Commencement o Only activities listed on the plan will be considered for approval by the coordinator. o Activities can commence when you have received approval from the coordinator.

• Evidence o Evidence must be provided for activities. o Examples of evidence include, medical certificates, course information.


Match Up Activities Match up the activities you believe will enable your case studies to meet one of each of their goals.

Note: Further activities might arise later on and are not included in this exercise. Karen’s goal: Determine capacity for work per medical professional recommendation. Choose the activities you suggest Karen or yourself undertake for her to reach this goal.

a. Attend case conference with medical practitioner and coordinator b. Undertake Functional Capacity Evaluation c. Undertake Vocational Assessment d. Undertake time management counselling e. Facilitate the development of a family schedule and provide support to implement the schedule f. Establish a treatment plan

Daniel’s goal: Determine vocational direction and source appropriate employment.

Choose the activities you suggest Daniel or yourself undertake for him to reach this goal.

a. Obtain a GP referral to a psychologist to manage depression symptoms b. Undertake a Functional Capacity Evaluation c. Apply for a commission based sales position d. Provider to teach Daniel job seeking skills and injury disclosure methods e. Undertake a Vocational Assessment

John’s goal: Determine medical treatment regime.

Choose the activities you suggest John or yourself undertake for him to reach this goal.

a. Attend case conference with John’s GP and coordinator b. Undertake a Functional Capacity Evaluation c. Time management planning d. Connect with John’s GP and obtain relevant referral to allied health

professionals Meeting Your Client to Develop Their Plan Once you have received approval from the coordinator to formulate a rehabilitation plan for a client you can go ahead and plan a meeting. You must meet with the client face to face. This is the best way to build a rapport with the client, assess their presentation and get an understanding of their mood. If your client is remotely located or resides overseas click on the CLIK link for more information.


You are expected to do some research into activities before meeting the client. Use the assessment report as a starting point for your research. Each client’s goals will be different. Think outside the box for activities they could potentially do to help them reach their goal. Being prepared before the meeting shows the client your enthusiasm to help them. It is important your client trusts you and feels like you are engaged in their wellbeing. If an activity involves the client being physical and they have an injury you will need to obtain a medical certificate approving their capacity for the activity to attach to the plan. Case Study Example Daniel has an accepted condition of depression. You must go to the meeting prepared to discuss all potential resources available to help Daniel manage his depression through treatment paths and community support groups. Some community support groups that you could research are: Men’s Shed, Lifeline, VVCS, Mates4Mates and Soldier On.

Evidence for Plan Approval Evidence supports your claim that goals and activities will lead to a positive rehabilitation outcome for a client. DVA will not support activities or goals that cannot be proven to improve a client’s wellbeing, vocational opportunities or medical needs. It is very important that every goal, activity and cost is backed up by evidence. This enables the coordinator to make an informed decision when approving goals and activities within a plan. Evidence can also be examined during an audit so it’s imperative that you include it. If you do not include evidence with the clients plan, activities within that plan will not be approved. If the client has multiple injuries such as psychological and ankle, get both approvals/certificates from their doctor. If you have instructed the client to provide evidence, such as medical certificates, ensure you give strict instructions about when the information is to be provided by and follow up with the client regularly to ensure they do not forget to produce this information. A plan cannot be approved without evidence.

http://clik.dva.gov.au/rehabilitation-library/11-rehabilitation-service-providers/113-selecting-rehabilitation-service-providers-dva-clients-rural-or-remote-areas-or-residing-overseas


Types of Evidence

• Medical restrictions, current capacity for work and barriers to rehabilitation as perceived by their GP.

• Market labour research for jobs.

• Bridging course/course information for training.

• Assessments.

• Transferrable skills such as previous employment experience and dutie.

• Your professional opinion about their family circumstances. Include the clients motivation and willingness for the activity.

• The client's opinion. Did you know? There are other programs offered by DVA that can be utilized during a rehabilitation program. Community Nursing MRCA and SRCA clients who hold a DVA Health Card are able to access nursing services through DVA’s community nursing program. Rehabilitation Appliances Program (RAP) RAP provides access to aids and appliances according to assessed clinical need. Medical Treatment Support These are other types of support that may provide an adjunct to medical treatment. These can include:

• Some psychosocial goals that have clinical evidence. • Medically required home exercise equipment. • Independent living programs such as Veterans’ Home Care, Household Services and Attendant Care.

Medical treatment costs will not be covered under a rehabilitation plan however the DVA White Card assists clients who have injuries or illnesses as a result of their service in the ADF. This includes physiotherapy and psychological treatment. Image courtesy of phanlop88 at FreeDigitalPhotos.net Setting up initial Goal Attainment scores The GAS process includes taking each goal and setting potential scores against a potential outcome. The expected outcome 0 score is what the client should be aiming for. You should avoid setting goals and outcomes that could be too easily met or too difficult to achieve. Goals are scored on a scale of -2 to +2. Then proceed to converting those scores to an overall score using a conversion table provided with the plan form. Goals and expected outcomes should be described in such a way that the coordinator is able to determine whether the goals are achievable.

http://clik.dva.gov.au/rehabilitation-library/5-medical-management-rehabilitation/54-other-types-medical-treatment-support

http://clik.dva.gov.au/rehabilitation-library/10-alterations-modifications-aids-appliances/102-provision-aids-and-appliances-through-rap

http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/88-community-nursing-care


You will also need to complete the Importance of goal for the client and Challenge in achieving goal. Discuss this with the client before ticking the box. You will also need to complete the Importance of goal for the client and Challenge in achieving goal. Discuss this with the client before ticking the box. Formulating Gas Goals DVA expects each rehabilitation client to have their goal outcomes provided on their plan for each goal. It’s time to see some examples of GAS goal outcomes. One of Daniels goals is to determine strategy to manage/improve depression symptoms. His outcomes are:

+2: Self-managing depression symptoms with significant reduction in depression episodes +1: Self-managing depression symptoms with reduction in episodes 0: Self-managing depression symptoms -1: Managing symptoms with ongoing professional assistance -2: No improvement with managing symptoms

http://clik.dva.gov.au/rehabilitation-policy-library/15-goal-attainment-scaling/153-dvas-rehabilitation-process-goal-attainment-scaling/1533-rehabilitation-plan


One of John’s goals is to determine vocational direction. His outcomes are: +2: Obtained employment with increased capacity at full time in the area of his skills and expertise +1: Obtain employment within certified capacity in the targeted area of employment 0: Obtain employment within certified capacity -1: Working below capacity -2: Not employed.

One of Karen’s goals is to determine medical treatment regime. Her outcomes are:

+2: Significant improvement in symptomology and self-managing +1: Improvement in symptomology 0: Actively participating in a treatment regime -1: A treatment regime has been identified -2: No change

Knowledge Check 6. Why it is important that coordinators receive evidence about the activities of a plan? (Choose only one option)

a. DVA will not support activities or goals that cannot be proven to improve a client’s wellbeing, vocational opportunities or medical needs

b. Demonstrate costs of activities c. Auditing purposes d. All of the above

7. Goals must be….(Choose only one option)

a. Whole-of-person focused b. Appropriate c. Not just return to work d. Developed using SMART e. All of the above

8. In the case of Karen, do you believe that medical management activities should be completed before

starting vocational activities?

a. Yes b. No

9. Which activity/s could be considered as a psychosocial activity? (Multiple choice)

a. Adjustment to disability counselling


b. Guitar lessons c. Psychiatric treatment

10. What Goal Attainment Scaling goal score is a client expected to achieve?

a. +2 b. +1 c. 0

Did you know? Other Types of Assessments

Various other rehabilitation assessments can be completed before or during the plan (only if relevant to the client’s needs). Examples: • Activity of Daily Living Assessment (ADL) for household services. • Functional Capacity Evaluation • Ergonomic Assessment • Home Assessment • Workplace/Workstation Assessment

DVA Health Cards (Gold and White) Some DVA clients are eligible for a Gold or White Card. The cards enable clients to receive a reduced or nil amount for some or all of their treatment needs depending on which type of card they have. It is likely some DVA clients will talk to you about these cards and their expectations of obtaining one. Please read CLIK and the DVA factsheet IS160 http://www.dva.gov.au/factsheet-is160-overview-cards-available-veterans-and-their-dependants to familiarize yourself. Transport Costs Travel costs for a person may be covered by DVA if they have a clinical recommendation that an attendant or carer accompany them to a treatment program or have approved activities as part of a psychosocial goal. This should be discussed with your coordinator and not included on a rehabilitation plan. For more information please click the CLIK link below. Image courtesy of phanlop88 at FreeDigitalPhotos.net

Managing the Client’s Expectation of their Plan You required to manage the client’s expectations of their plan and their program. This ensures that the client understands their role and your role during the rehabilitation program. It is up to you to ensure the client understands the following:

• The client needs to be compliant with their rehabilitation plan and program. • What supplementary documentation the client might need to provide.

http://www.dva.gov.au/factsheet-is160-overview-cards-available-veterans-and-their-dependants

http://www.dva.gov.au/factsheet-is160-overview-cards-available-veterans-and-their-dependants

http://clik.dva.gov.au/rehabilitation-policy-library/3-rehabilitation-process/34-rehabilitation-assessments

http://clik.dva.gov.au/rehabilitation-library/8-attendant-care/87-travel-and-other-expenses-carers


• The plan should be signed by the provider and client before sending it to the coordinator. • Frequency of review meetings. • How long the rehabilitation program will take. • The client must take ownership of the plan. • Medical approval needs to be obtained before certain activities can proceed.

If a client is non-compliant with their plan you must warn them of the ramifications. These can include loss of incapacity payments. If the non-compliance continues advise the coordinator.

Once the Plan is completed… Once you have completed the plan you need to:

1. Obtain all signatures of those party to the plan excluding, the coordinator. 2. Ensure the client signs a Rights and Obligations form (located on the DVA forms portal). 3. Fill out the costs page at the back of the plan form. 4. Send the plan to the coordinator for consideration and approval. Note: A phone conversation with the

coordinator is not considered approval of a plan. Once you have obtained approval from the coordinator the client can start their plan! Note: Some coordinators may wish to review the plan before the client signs. In this situation follow their instructions. Knowledge Check 11. What must you do to manage your client’s rehabilitation expectations?

a. Ensure the client understands all aspects of their plan and program including what is expected of them and yourself as the provider

b. Explain the rules of rehabilitation and that they must comply regardless of their expectations. 12. What must you do once the plan is completed? (Select 4 options)

a. Obtain all signatures of those who are party to the plan b. Fill out the costs page at the back of the plan form c. Send the plan to the coordinator for consideration and approval. d. Give a copy of the plan to the client e. Start the activities straight away

13. What is the significance of activities?

a. They are small steps that help clients achieve their goals. b. They are for the provider only

14. Which activities do you believe require supporting evidence?


a. Case management b. Educational/employment training c. Psychosocial activity

Final If your score is 80% or more correct then you have completed this module. If you did not get 80% or more answers correct please redo the assessment. You can now:

• Explain the purpose of the rehabilitation plan and how to set goals for DVA clients. • Obtain evidence required to enable assessment of the plan. • Be able to score goals using the GAS scale. • Manage client expectations during their program.


Module 4: Case Management

Welcome Hello and welcome to Module 4: Case Management Course objectives:


Module objectives:

• Explain what case management is in regards to DVA rehabilitation clients. • Act in accordance with DVA’s expectations of you as a provider when case managing a DVA client. • Appropriately amend a plan. • Amend goals, objectives, timing and costs associated with the plan.




• Approximately 25 minutes. Case Management Case management is a collaborative process of assessment, planning, facilitation, care coordination and evalutation to meet an individuals comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. (Adaptation of the defintion of case management by cmsa.org)


DVA expects providers to case manage all clients. The level of case management each client will need to receive will depend on the individual. Clients who have complex illnesses, injuries or barriers will likely require more intensive case management. Case management ensures clients are receiving appropriate treatment and resources, complying with their rehabilitation program and making progress towards their rehabilitation goals. Top Tips for Case Management 1. Discuss with the client their progression, barriers and

achievements.

Example: If a client is studying they need approval for funding for the next module or semester of their course.

2. Ensure the progress reports* detail the client’s current barriers, progression, actions and

achievements. *Information about progress reports and amendments are coming up!

3. Ensure plan end dates and costs don’t lapse without first preparing an amendment. 4. Give the client clear guidance and instructions on their plan.

Example: If an activity is ‘ongoing job seeking’ you should specify the amount of applications a client is expected to submit and which potential employers they should engage with.

5. Case conferencing if appropriate. DVA encourages case conferencing as it can assist progress for the

client. If your client is not showing progression speak to your coordinator. 6. If you have regular/ongoing issues contacting your client notify the coordinator as soon as possible

with dates and time that you have attempted to contact the client. 7. Coordinate all activities with the client. This will help clients develop a direction for their

rehabilitation. 8. Understand and acknowledge the client’s dealings with DVA but do not become their advocate.

Example: It’s the client’s duty to follow up their claims not the provider. There are advocacy services available clients through the Returned and Services League (RSL’s) of Australia, Legal Aid, the Vietnam Veterans Association of Australia (VVAA) and Vietnam Veterans Federation to name a few.

As part of case management, you are expected to maintain a rapport with the client. If you are having any difficulties with your client, call the coordinator straight away. It is expected that the provider will keep up to date with other stakeholders that are involved in a client’s plan. This is to ensure the provider understands every aspect of the client’s health and vocational concerns.


These can include:

• Medical professionals • Advocates • Centrelink • Other areas of DVA such as community nursing and RAP.

All case management costs are required to be noted on the plan.

DVA asks providers to care for themselves. If you become emotionally or physically affected by your work with DVA clients, please talk to your manager.

Image: FreeDigitalPhotos – Master Isolated Images Case Managing our Case Studies To gain an understanding of the case management that would take place during a program, see the below case studies.

John has been working on his medical management rehabilitation goal for 3 months and is progressing well. To help John find treatment outside of the Australian Defence Force (ADF) you recommended to him some GP’s in his area. He chose one who has assisted him with treatment for his conditions. During your conversations with John you explained the difference between incapacity payments and a pension. When John’s conditions were accepted by DVA he was given a DVA White Card to assist him with treatment of those conditions. John was insistent that he wanted a

Gold Card like some of his ex-service friends. You researched eligibility for the Gold Card and spoke to your coordinator. You explain to John that he is not eligible for a Gold Card however his white card will cover treatment for all of his accepted conditions. John has asked for training to undertake a private pilot’s license course and photography course to become a drone operator and photographer. You have had many conversations with John about eventually finding employment and the benefits of going to work. John was initially very reluctant. However, John’s competitive streak has come out and he is working towards his +1 GAS goal. He has had a vocational assessment and Functional Capacity Evaluation (FCE) completed. The recommendation from the FCE (completed by an Occupational Therapist) is sedentary work for 20 hours per week. The vocational assessment has suggested John has technical skills, project management skills and leadership skills. Workplace Health and Safety and project management jobs have been suggested as possible employment options. However, John is focused on obtaining his private pilot’s license and is insisting that you send a request for this activity to his coordinator. Karen is 2 weeks into her rehabilitation program. While Karen’s future goal is to return to work, her first priority is managing her medical issues. You organise a medical case conference with Karen’s current treating GP about her current treatment regime, why the fracture is still causing pain and a possible change to the regime.

http://clik.dva.gov.au/rehabilitation-policy-library/3-rehabilitation-process/31-dva-rehabilitation-case-management-pathway


You have discussed with Karen the importance of her family members participating in the running of the household. Karen has spoken to her family, with a positive result, and now you are helping her design a household task schedule for her family members. You have also been counselling Karen to help her understand that she needs to actively participate in medical treatment. If she continues to put her treatment second her condition could get worse. This is most important for her recovery. Once Karen is engaged in her treatment, which could be a few months, you will start

to discuss her vocational goal. This goal may not be accomplished until her medical issues have improved. However, you make a note that when you and Karen both believe that she is ready to focus on getting a job, she will need to undertake a FCE and vocational assessment. Daniel is very keen to get his rehabilitation under way. The first thing you do is consult with John’s GP to identify a treatment pathway for his depression. Following this you organise vocational counselling which includes:

• Goal setting • Resume and cover letter development • Interview skills • Injury disclosure techniques • Job searching skills • Registering with job agencies and online job searching • Activating Daniels own networks to source work trial/hardening

opportunities • Monitoring and review of job seeking activities, including liaison with employers / follow up of

unsuccessful applications. One month into Daniels rehabilitation, he has shown great progress. Daniel is, and continues to be, very active in his vocational counselling and is responding well to his depression treatment plan. Case Study Assessment You want to have a conversation with John about vocational activities that would indicate his capacity to undertake employment. However, John has requested training for a private pilot’s license and photography course. This is his hobby and passion. Would you approach DVA with a request for a private pilot’s license and photography course for John? a. Yes b. No


Knowledge Check Which of the following are plan activities and which are case management activities? Options:

• Attend Psychologist review • Complete computer training course • Attend vocational assessment • Apply for appropriate jobs as identified in the vocational assessment • Assist the client in updating their resume • Fortnightly meetings/phone calls with rehabilitation coordinator • Provider to liaise with the client’s GP regarding job options • Prepare progress report to rehabilitation coordinator

Amending a Plan When do I amend a plan? At times it may be necessary to amend a plan in response to changes to a client's circumstances, or where rehabilitation goals have been achieved. To implement these changes the plan amendment form is used:

• When any changes to the short or long term activities of a plan are required. • If the time frames to complete activities need to be adjusted. • If additional activities or third party costs need to be included. • When the approved funding for the plan activities needs to be varied.

Start and end dates must be clear and realistic. The start date is the date that the coordinator signs off on the amendment. An amended activity or goal must not start beforehand. Speak to your coordinator about their local preferences.

The plan amendment form is located on the DVA Forms Portal http://www.dva.gov.au/about-dva/forms/dva-forms-keyword Amending Vs Closing a Plan A plan amendment is not used where the overall focus of a plan changes, for example where a client moves from a non-return to work plan to a return to work plan (a variation). When/if this occurs, the original plan should be closed and a new plan should be developed.

http://www.dva.gov.au/about-dva/forms/dva-forms-keyword



Case Study Assessment Providing evidence for an amendment to a goal or activity is very important. It enables a coordinator to assess each amendment against the evidence provided. Without evidence, an amendment will take longer to be accepted. This is because the coordinator will be required to contact you to request the evidence to support the amendment. This results in the client’s program being paused and can be very demotivating; something which you should avoid at all costs. Let’s look at John. The recommendation from the vocational assessment and FCE is sedentary work for 20 hour per week. The vocational assessment has suggested he has technical, project management and leadership skills. Workplace Health and Safety and project management positions have been suggested as possible employment options. What type of evidence would you submit with John’s plan amendment for Recognised Prior Learning (RPL) for project management?

a. Quote from a RPL company b. Vocational assessment c. ADF service record d. Records of other completed training e. Nothing f. Your recommendation including medical information to suggest that this option is medically

suitable Case Study Check In - Karen

It has been 6 weeks since your case conference with Karen’s GP about her treatment regime. Karen was referred to a pain management specialist and has been diagnosed with Somatoform Disorder, a psychological condition, which causes her chronic pain. This condition is linked to accepted stress fracture injury. You refer Karen to her local advocate for assistance in filling out her claim form for her new condition. While Karen’s claim is being processed she is undertaking a


computer course and seeing a psychologist for her condition. Karen’s plan amendment should include extra case management costs. Match Up Plan Activities - Karen Choose each possible plan amendment activity for Karen Karen

a. Job counselling b. Work trial c. Time extension d. Attend pain management session with psychologist e. Case management funding

Case Study Check In - John

John has undergone a vocational assessment which determined he has the capacity for sedentary work of 20 hours per week. You explained to John that as he has transferable skills in project management and workplace health and safety, and jobs are available in these fields, it is very unlikely DVA will agree to a private pilot course. John is not happy with this outcome. In addition, John is experiencing back pain after mowing his lawn. You suggest to John to take it easy when working on his house as he could be aggravating his

condition. However, you consider mowing assistance to help John reduce his back pain. Match Up Plan Activities - John Choose each possible plan amendment activity for John John

a. Job counselling b. Work trial c. Case management funding d. Job seeking activities e. Assessment of Daily Living in line with the FCE for Household Services.


Case Study Check In - Daniel Daniel has been progressing well through his rehabilitation plan.

He is attending psychology sessions and feeling the tools he is learning will help him manage his depression at home and at work You and Daniel have been working on his resume and job seeking activities. Daniel is keen to get back to work.

Match Up Plan Activities - Daniel Choose each possible plan amendment activity for Daniel Daniel

a. Psychology sessions b. Time extension c. Assessment of Daily Living d. Job counselling e. Case management funding

Knowledge Check 1. When should a plan be amended?

a. When any changes to the short or long term activities of a plan are required b. If the time frames to complete activities of the plan need to be adjusted c. If additional rehabilitation activities need to be included d. Where the approved funding for the plan activities needs to be varied e. All of the above

2. When should a plan be varied?

a. When the overall focus of the plan changes from return to work to non-return to work or vice versa

b. When an activity changes 3. What is the start date of a plan amendment?

a. From the date the provider signs the amendment form b. From the date the coordinator signs the amendment form

4. What should be included in the plan amendment?


a. Changes to costs b. Change to activities c. Change to goals d. All of the above e. B and C

5. Who do you send the completed amendment to?

a. My supervisor b. The DVA coordinator c. The client

6. Why is case management important?

a. It ensures clients are receiving appropriate treatment and resources, complying with their rehabilitation program and making progress towards their rehabilitation goals.

b. It ensures clients are on track to returning to work. 7. If a major development occurs in the client’s life what should you do? Choose one or more options.

a. Contact the coordinator to discuss this development. b. Wait until the next progress report period before adding it to the report. c. List it on the progress report.

8. Should you request funding from DVA for case management?

a. No b. Yes


• Explain what case management is in regards to DVA rehabilitation clients. • Act in accordance within DVA’s expectations of you as a provider when case managing a DVA

client. • Appropriate amend a plan. • Amend goals, objectives, timing and costs associated with the plan.


Module 5: The Progress Report

FreeDigitalPhotos.net-winnond Welcome Hello and welcome to Module 5: The Progress Report Course objectives:


Module objectives:

• Complete a progress report using Goal Attainment Scaling and the Life Satisfaction Indicators. E-learning pre-requisites to this course:



• Approximately 15 minutes. The Progress Report A critical step in the case management for a client participating in a rehabilitation program is regular and timely reviewing and monitoring. One key tool in this element of rehabilitation is the Progress Report. Progress reports are mandatory for all clients. The progress report form is located on the DVA forms portal. http://www.dva.gov.au/about-dva/forms/dva-forms-keyword You must follow the same rules with the progress report as you do with the assessment and plan forms.

http://www.dva.gov.au/about-dva/forms/dva-forms-keyword


1. Reassess the client’s life satisfaction every 6 months by having the client complete an LSI, and include these results on the progress report.

If on the rare occasion, a client finds the LSI distressing they do not have to complete it but please make sure you advise the coordinator. In this instance, you will complete the clients LSI to the best of your knowledge.

2. Document plan goals, activities and developments during a set period of time on the report. 3. Ensure reports are succinct, only provide necessary details and are not a record of all contact with the

client. NO SURPRISES OR QUESTIONS. 4. Ensure reports are not the coordinator’s sole source of information – major or significant

developments are to be communicated to the coordinator by you at the time of the incident or event. 5. Ensure reports are provided at a time period agreed following negotiations (recommended monthly)

between you and the coordinator. 6. Ensure reports are consecutively numbered. LSI and GAS score The progress report contains areas for you to enter the client’s achievements, issues, goal progression or outcomes and Life Satisfaction Indicators (LSI) information. Regardless of the timeframe you and the coordinator decide is best for progress report submission, you must submit the clients completed LSI and Goal Attainment Scaling (GAS) information every 6 months. For progress reports provided at more frequent intervals (e.g. monthly), the LSI section of the report should be left blank. The achievement of goals should be reported through the progress report regardless of when they occur. Here is an example of the progress report. To save you some time you can send the LSI to the client via email and get them to send it back to you via email. Do not repeat information already written on the report. Reporting on goals at this stage is straightforward. You only need to report on the client’s goal status at this point. If you want more information on GAS and the progress report click on the CLIK link below.


http://clik.dva.gov.au/rehabilitation-policy-library/15-goal-attainment-scaling/153-dvas-rehabilitation-process-goal-attainment-scaling/1535-progress-reports


Once the Progress Report is Completed… Once you have completed the progress report you must:

• Sign the progress report. • Send the progress report to the coordinator via email to the relevant DVA location inbox (not the

individual coordinator) which is detailed on the progress report form. • If directed by the coordinator give a copy of the report to the client.

Case Managing Your Case Studies Please note that progress reports are to be completed and sent to the coordinator at least every six months. For this purpose, each case study is at a different point in their rehabilitation program and more than one report is likely to have been lodged previously (especially Karen).

Over a period of 3 months, following a vocational assessment and FCE, you have been counselling John on appropriate and realistic employment options including jobs available in his location. John’s Recognized Prior Learning (RPL) has been completed and he has just commenced job seeking for a project management role. You have explained to John that he may explore completing a private pilot’s license under his own funding as a hobby.

John continues to see his physiotherapist regularly and GP as required. He has not experienced any further physical complications.

Karen’s new condition, somatoform disorder, has taken some months to be accepted by DVA. Karen was assisted by an advocate to fill out the claim form. In the meantime, Karen has been participating in her rehabilitation program. She has been attending an exercise physiologist to improve her functional tolerances. These sessions were covered by her DVA White Card. Karen has participated in a computer skills program to make her more competitive in the employment market. Since the acceptance of Karen’s somatoform disorder, she has been receiving

psychological treatment, over a 4 month period, which is helping her understand what the condition is. Her treating psychologist has also helped her manage her condition through Cognitive Behavior Therapy. Karen’s family are participating in the home schedule which is allowing Karen to access treatment and time for herself. It was difficult to get the family to participate, but once the family understood that it was helping their mum recover they began to help out more around the house. Once Karen’s conditions were adequately managed through proper diagnosis and treatment, Karen then undertook a Vocational Assessment and FCE. As a result, Karen’s GP established she had the work capacity of 20 hours per week of sedentary work. You provided Karen with vocational counselling and labor market research. As a result, Karen is now participating in a work trial with a local business as an administration officer.


Daniel has actively engaged in treatment for his depression with a Psychologist and is learning coping techniques. As a result, Daniel has seen a reduction in depression episodes. Daniel is actively engaging in job seeking activities and is applying for jobs with his newly developed CV and cover letter which you assisted him with. Daniel is very friendly and personable. As such, you are currently investigating work trial possibilities in customer service roles for him.

Knowledge Check 1. Where is the progress report form located?

a. On my internal computer system. b. On the Forms Portal c. I have to request it from the coordinator.

2. Is the progress report form mandatory to use?

a. Yes. b. No.

3. When should you complete a progress report?

a. At least every 6 months. b. As discussed with the coordinator. c. When I determine one is required. d. A and B.

4. What are some of DVA’s expectations of you when completing the report?

a. Document the client’s progression with their activities and goals. b. Ensure the client completes and LSI. c. Document the LSI on the report. d. The report does not contain any surprises or questions. e. All of the above.


• Complete a progress report using Goal Attainment Scaling and the Life Satisfaction Indicators; and • Explain why the progress report is an important part of the rehabilitation program.



Module 6: Closing a Rehabilitation Program

Welcome Hello and welcome to Module 6: Closing a Rehabilitation Program Course objectives:


Module objectives:

• Close a client’s plan in accordance with DVA’s expectation E-learning pre-requisites to this course:



• Approximately 15 minutes. Closing a Rehabilitation Program Here are some reasons for a plan closure.

• All rehabilitation goals have been achieved • A return to an optimum level of functioning has been achieved and the client does not require any

further support or services • A return to work with optimum hours and duties has been achieved • The client has withdrawn from the program • The client has ceased contact with their provider and/or coordinator • The provider advises that they consider that no further gains are likely


• The client is non-compliant with their rehabilitation program • The rehabilitation provider or their organisation can no longer continue to provide case management

services for the client. Therefore requiring a transition to a new provider. • Rehabilitation is no longer considered appropriate. Example: It is unlikely rehabilitation will provide

any further value to the recovery process and no aggravation of the injury is likely to occur. • A medical assessment indicates that further rehabilitation, at that point in time, is impractical.

If you believe a closure should occur, you must contact the rehabilitation coordinator to discuss as it could impact on other benefits the client is receiving from DVA. All closure reports are to be discussed with the client in advance and preferably face to face.

Determining and Reporting on Outcomes The process of going through DVA’s Closure Report is a 9 step process using the rehabilitation closure report form on the DVA forms portal http://www.dva.gov.au/dvaforms . Click on the CLIK link provided to view the 9 step process. For determining and reporting on the client’s outcomes there are a few key steps.

1. Transfer Life Satisfaction Indicators (LSI) scores into the Closure Report 2. Determine Goal Attainment Scaling scores and activities 3. Convert Goal Attainment Scaling scores

Complete Final Life Satisfaction Indicator (LSI) As provider, you will need to send the client a final LSI form to complete – this can be done via email. The client will complete the LSI and, once returned to you, the scores are then transferred to the relevant section on the Closure Report (see below). If the client won't complete the final LSI then you must complete it to the best of your knowledge.


http://clik.dva.gov.au/rehabilitation-policy-library/15-goal-attainment-scaling/153-dvas-rehabilitation-process-goal-attainment-scaling/1536-rehabilitation-closure-report


Goal Attainment Scaling Scores and Calculation As discussed in Module 3, GAS is scored on a 5 point scale from +2 through to -2 with a score of 0 being the expected outcome. Determining the goal scores requires working with the client to accurately rate the outcome of the prescribed goals. Once you and the client have agreed on the level of achieved outcome, the score number is to be applied and the complete scores transferred over to the relevant section of the Closure Report (below). If the client did not engage in their program and you are unable to contact them you still must score their goals. Don’t be afraid to score your client -2. Conversion Instructions

1. Add up the score(s) achieved for each goal

2. Convert the scores using the GAS Conversion Table attached to the Closure Report form.


Plan Sign-off Now that the client’s final outcomes have been determined through the LSI and GAS score, there are a few more steps to go to before completing the closure report. Closure Instructions

1. In your report, consider any post closure monitoring requirements. 2. Complete the agreement section of the Closure Report (this includes the final sign-off by both you and the client). 3. Ensure final costs are listed including your case management costs (not the invoice). 4. Submit the report to the rehabilitation coordinator who will then review and provide final sign-off

to the plan. 5. Send your final invoice to the coordinator.


Scoring the Case Studies using Goal Attainment Scaling Each case study how now completed all of their goals. Focusing on one goal each, determine which score you would give them on their closure report. One of John’s goals was to ‘Determine vocational direction and source appropriate work’. Since the establishment of his rehabilitation plan, John has obtained employment for 20 hours per week as a Workplace Health and Safety Officer, his target area of employment. What score do you and John give this goal?

a. +2: Gained employment with increased capacity at full time in the area of his skills and expertise. b. +1: Get a job within certified capacity in the targeted area of employment c. 0: Get a job within certified capacity d. -1: Working below capacity e. -2: Not employed

One of Karen’s goals was to ‘Determine treatment regime’. Since Karen began her rehabilitation plan she has been engaging in behavioural therapy regularly and her symptomology has improved. What score would you and Karen give this?

a. +2: Significant improvement in symptomology and self-managing b. +1: Improvement in symptomology c. 0: Actively participating in a treatment regime d. -1: A treatment regime has been identified e. -2: No change

One of Daniel’s initial goals was to ‘Determine a strategy to manage/improve depression symptoms’. Since the beginning of his rehabilitation plan, Daniel actively participated in his rehabilitation program and is now self-managing his depression, experiencing fewer depression episodes during work and is doing a 3 month work trial. What score do you and Daniel give this goal?

a. +2: Self-managing depression symptoms with significant reduction in depression episodes b. +1: Self-managing depression symptoms with reduction in episodes c. 0: Self-managing depression symptoms d. -1: Managing with ongoing professional assistance e. -2: No improvement with managing symptoms


Knowledge Check 1. When should you close a program? (Select two or more options)

a. When all goals have been achieved b. The client has ceased contact with their provider or coordinator c. You believe no further gains are likely d. The client is non-compliant with their program e. A medical assessment indicates that further rehabilitation, at this point in time, is impractical. f. If the client does not reach all of their goals.

2. Should final GAS scores be included on the closure report?

a. Yes b. No

3. Should you tell the client you are going to close their rehabilitation program?

a. Yes b. No

4. Should the goals have been achieved before closing the program?

a. Yes b. No c. It depends on the client’s individual circumstances.


• Close a client’s plan in accordance with DVA’s expectations.


Assessment 1

Welcome Hello and welcome to Module 7: Assessment One Course objective


Assessment Rules and Pass Rate

• You must pass this assessment with an 80% score before moving onto Module 8: Assessment Two. • If an 80% pass score is not obtained you will need to complete the assessment until you pass.

E-learning pre-requisites to this course


Module completion time

• Approximately 35 minutes. Assessment One: Question One You have received a referral for a DVA client named Mark. Here is the information you received on the referral for rehabilitation. Mark is 42 years old and was medically discharged from the Army two years ago. He served for 22 years and achieved the rank of Sergeant.


Mark’s accepted conditions are PTSD, depression disorder, adjustment disorder and lumbar spondylosis. Mark has received rehabilitation through Australian Defence Force Rehabilitation Program (ADFRP). Post discharge and ADFRP, Mark worked as a public servant for Defence as a security guard. He can no longer maintain this role as his mental health condition causes him to react negatively when seeing people in military uniforms. Question 1 Now that you have received the referral from DVA, arrange in chronological order the following tasks that you will complete.

a. Await confirmation to prepare a plan b. Contact client to organise an assessment c. Ensure client completes an LSI d. Acknowledge the referral e. Assess if your skills match the client’s needs f. Contact a rehabilitation assessment g. Complete and submit the assessment report

Freedigitalphotos.net - stockimages Assessment One: Question 2 During the rehabilitation assessment you discussed with Mark his expectations and barriers to rehabilitation. He spoke about his fearfulness when seeing people in military uniforms. He said he does not trust his ability to work with other people. The time he has spent standing up doing security guard work has aggravated his lumbar spondylosis. Driving his car also causes him pain. Mark is living alone with very little social contact. He goes to the gym frequently. He is seeing a GP but is receiving no psychological treatment. He also sees a chiropractor periodically. He feels like he wants to go back to work but is scared and feeling a bit lost. Question 2 What is your recommendation to the coordinator?

a. Develop a rehabilitation plan with a vocational focus. b. Develop a rehabilitation plan with a medical management focus.


Assessment One: Question 3 The submitted rehabilitation assessment has been approved by the coordinator. You organize a meeting with Mark to develop his rehab plan which will have a focus on medical management. Question 3 Choose which goals you would most likely discuss with Mark during the plan formulation meeting. Choose more than one option.

a. Obtain and maintain ongoing suitable employment. b. Participate and engage in a community activity. c. Access ongoing medical treatment to sustainably manage accepted condition/s. d. Obtain work/employment at his own capacity. Example: volunteering.

Assessment One: Question 4 Once you and Mark are both satisfied the goals are suitable, you will discuss the activities you both will carry out in association with these goals. Question 4.1 Choose the activities for Goal 1: Access ongoing medical treatment to sustainably manage accepted condition/s.

a. Attend a local Men’s Shed b. Identify and access a physiotherapist c. Research potential volunteering positions d. Investigate temporary modifications to Mark’s vehicle e. Consider accessing pain management program f. Connect with a social activity of interest g. Identify and seek a referral for an appropriate specialist

Question 4.2 Choose the activities for Goal 2: Participate and engage in a community activity.

a. Identify and access a psychologist b. Attend a local Men’s Shed in the future c. Golf lessons d. Contact a community service for ex-ADF and discuss social activities

in Mark’s local area e. Case conference with Mark’s GP about his mental health treatment

options f. Connect with a social activity of interest g. Purchase a tent for ‘going bush’


Question 4.3 Choose the activities for Goal 3: Obtain work/employment at his own capacity. Example: Volunteering.

a. Connect with a social activity of interest b. Attend a local Men’s Shed c. Research potential volunteering positions d. Obtain an independent report from a psychiatrist and psychologist about Mark’s capacity to work. e. Case conference with Mar’s GP about his mental health treatment options f. Identify an area of interest and skill and connect with a local community group.

Assessment One: Question 5.1 You have established Mark’s goals and associated activities. You now need to collaborate with Mark to set up the GAS scale for his goals. Focusing on Mark’s medical management goal, number each possible outcome with his appropriate GAS score (+2, +1, 0, -1 and -2). Outcome options:

a. Did not obtain referrals and received no treatment. b. Obtained physiotherapy referral and attended treatment but did not obtain psychologist referral. c. Attended physiotherapy and psychologist and is now self-managing both conditions d. Obtained both referrals and attended all physiotherapy and psychologist appointments. e. Attended physiotherapy and psychologist appointments and is self-managing his physiotherapy.

Assessment One: Question 5.2 Focusing only on Mark’s psychosocial goal, number each possible outcome with his appropriate GAS score (+2, +1, 0, -1 and -2). Outcome options:

a. Researched and participated in social activity of choice for 1 month. b. Did not research any social activities and therefore did not participate. c. Researched and participated in social activity of choice and has continued

to do so for more than 2 month with the view of continuing. d. Researched social activities but did not participate. e. Researched and participated in social activity of choice and has continued

to do so for more than 1 month.


Assessment One: Question 5.3 Focusing only on Mark’s vocational goal, number each possible outcome with his appropriate GAS score (+2, +1, 0, -1 and -2). Outcome options:

a. Obtain work at his capacity and maintain for 2 months. b. Did not obtain work at recommended capacity c. Obtain work at his capacity and maintain for 3 months. d. Obtain work at his capacity and maintain for 1-2 weeks e. Obtain work at his capacity and maintain for 1 month.

Assessment One: Question 6 Three months have passed since the approval of the rehabilitation plan. The current plan is about to end. Mark has been receiving physiotherapy treatment. Mark is having trouble sleeping. Mark has attended one meeting at a local ESO group but has not gone back. You have discussed this with Mark. Rather than attending an ESO group he expressed an interest in volunteering at the RSPCA. You discussed this option with the coordinator and decide that any volunteering satisfies Mark’s vocational and psychosocial goals. Mark is happy with this result. You have case conferenced with Mark’s GP and were informed that Mark’s back condition is not progressing and his physiotherapist has recommended a session with an exercise physiologist to ensure progression. Mark’s psychologist has determined that Mark’s capacity for work is 4 hours per week. Which of these additional assessments could you add to Mark’s plan amendment?

a. Activity of Daily Living assessment (ADL) b. Vocational assessment c. Functional capacity evaluation d. Medical management assessment e. Psychological assessment. f. Sleep Hygiene assessment.

Assessment One: Question 7 Choose the instance/s that would require a plan amendment:

a. A new anticipated plan end date (extension of time) b. Investigate treatment management options for poor sleep c. Investigate alternative groups for social engagement d. Request for additional funding e. Obtain funding for a case conference f. Obtain modification to a car seat upon recommendation from a OT Driving

Assessor


g. Request funding for treatment of an accepted condition h. Achieving a goal

Assessment One: Questions 8 and 8.1 Mark’s rehabilitation plan amendment was approved by the rehabilitation coordinator. All progress reports have been submitted and Mark has completed the six month LSI. The LSI shows an improvement in his physical health which you noted in his six month progress report. Mark has engaged in all mental health and community activities as per his plan. Mark is now self-managing his conditions but his capacity to work is unlikely to increase. On a positive note, Mark he is volunteering for four hours per week, and has been doing so for 2 months, at the RSPCA and is loving it. Mark has completed a sleep hygiene test. It was determined that he has sleep apnea. The coordinator connected you with an ESO who assisted Mark in completing his claim for his sleep condition. Mark was provided with a sleep apnea machine after his condition was accepted. Would you close or monitor Mark’s program at this stage?

a. Close b. Monitor for 3 months

Given Mark’s success with volunteering and sleep apnea assistance, would you recommend scheduling a visit with Mark’s GP and/or specialist to review the status of the his capacity to work?

a. Yes b. No

Assessment One: Question 9 You have been monitoring Mark for the past three months, checking in with him regularly. You have had a case conference with Mark’s GP who has determined that Mark’s capacity for work is unlikely to improve but his progress is impressive. You have determined that further rehabilitation intervention would not add further value. What should you consider before contacting the coordinator to recommend Mark’s rehabilitation program be closed:

a. Have all goals been reached satisfactorily? b. Is Mark self-managing his medical and psychosocial issues? c. Is Mark in a new relationship? d. Is Mark working/volunteering and/or has he improved his medical

capacity? e. Is it possible that Mark might reinjure himself? f. Have Mark’s LSI results improved since the initial LSI? g. Does Mark want to go overseas?


Assessment One: Questions 10.1 Choose the score and outcome (below) that is Mark’s final medical management goal outcome. Options:

a. +2 - Attended physiotherapy and psychologist and is now self-managing both conditions b. +1 - Attended physiotherapy and psychologist appointments and is self-managing his

physiotherapy c. 0 - Obtained both referrals and attended all physiotherapy and psychologist appointments d. -1 - Obtained physiotherapy referral and attended treatment but did not obtain psychologist referral e. -2 – Did not obtain referrals and received no treatment

Assessment One: Questions 10.2 Choose the score and outcome (below) that is Mark’s final psychosocial goal outcome. Options:

a. +2 – Researched and participated in social activity of choice and has continued to do so for more than 2 months

b. +1 – Researched and participated in social activity of choice and has continued to do so for more than 1 month

c. 0 – Researched and participated in social activity of choice for 1 month d. -1 – Researched activities but did not participate e. -2 – Did not research any social activities and therefore did not participate

Assessment One: Questions 10.3 Choose the score and outcome (below) that is Mark’s final vocational goal outcome. Options:

a. +2 – Obtain work at his capacity and maintain for 3 months b. +1 – Obtain work at his capacity and maintain for 2 months c. 0 – Obtain work at his capacity and maintain for 1 month d. -1 – Obtain work at his capacity and maintain for 1-2 weeks e. -2 – Did not obtain work at recommended capacity.

Assessment One: Questions 11 Calculate Mark’s converted GAS score using the Conversion Table and choose the correct answer below.


Instructions 1. Find the Total GAS score (TGASS) by summing all of Mark’s scores together. Mark’s score are +2,

0 and +1. 2. Convert the TGASS by finding its matching number in the left TGASS column. 3. Find the intersection between the TGASS and the number of goals in Mark’s plan. Mark had 3 goals. Question Options:

a. 75 b. 64 c. 62 d. 56 e. 50 f. 44

Conclusion You and Mark sign the completed Rehabilitation Closure Report form and submit it to the coordinator. Final If your score is 80% or more correct then you have completed this module. If you did not get 80% or more answers correct please redo the assessment. You can now:

• Move onto the final assessment


Assessment 2

Assessment Two Hello and welcome to Module 8: Assessment Two Course objective


Assessment Rules and Pass Rate

• You must pass this assessment with an 80% score. • If an 80% pass score is not obtained you will need to complete the assessment until you pass.

E-learning pre-requisites to this course


Module completion time

• Approximately 35 minutes.


Assessment Two – Questions 1 and 2 You have received a referral for a DVA client named Gemma. Gemma was a Commissioned Nursing Officer in the Navy. She achieved the rank of Lieutenant. Gemma is 32 years old and was medically discharged nine months ago. Gemma’s accepted conditions, under the MRCA, are right shoulder dislocation and Rotator Cuff Syndrome, internal derangement and chondromalacia patella of the left knee. Whilst still serving Gemma had surgery on her knee and shoulder.

Gemma has been working as a Registered Nurse at a nursing home since discharge. However, due to her conditions she has reduced her working hours from full-time to 20 hours per week. Prior to now, Gemma has been managing her conditions with intermittent appointments with her GP and physiotherapist. She pairs these with exercising regularly at the gym. Gemma lives in Sydney with her two school aged children and husband who is still serving in the Navy. She continues to go out with her old school and university friends. You carry out a rehabilitation assessment and Gemma completes an LSI. The assessment and LSI have brought a number of issues to your attention. Despite Gemma meeting with old friends, the assessments show that Gemma

has increasingly less in common with these friends. Paired reducing her working hours, chronic pain and physical limitations Gemma gets anxious about these catch-ups leading to her feeling socially isolated. Gemma’s states that her husband is very supportive. However, he is often away do to his ADF service. Fortunately, his parents are able to help out with children whilst he is away. Gemma mentioned that she is struggling with some of their household tasks, especially when her husband is away. Gemma wants to return to full time work. Your recommendation is for a rehabilitation plan. You recommend, as a first step, a case conference between yourself, Gemma’s GP and Physiotherapist to sure an appropriate treatment plan is organised, you also recommend some additional assessments. 1. What additional assessments would you recommend for Gemma as part of her rehabilitation plan?

a. Activity of Daily Living assessment b. Skills analysis c. Vocational assessment

2. What types of goals do you recommend for Gemma’s rehabilitation plan?

a. Psychosocial b. Medical management c. Vocational


Assessment Two – Question 3 The coordinator has agreed to your recommendation of establishing a rehabilitation plan. In developing the rehabilitation plan with Gemma you discuss your case conference with her GP and Physiotherapist. Gemma’s GP believes some more directed strength and conditioning training would be appropriate to improve her condition. Further, Gemma has identified that she is able to cycle without aggravating her left knee. Gemma’s goals are now developed in line with her abilities, skills and ambitions. The goals have been scored using GAS. Thinking about Gemma’s case as a whole, choose the most appropriate goals:

a. Obtain sustainable employment within medical restrictions b. Join a social/hobby group to increase social activities c. Attend all medical appointments, including physiotherapy appointments, and complete all exercises

at home to learn to self-manage conditions d. Join a gym

Assessment Two – Question 4 You recommend Gemma completes an Activities of Daily Living (ADL) assessment. The ADL assessment has identified a need for aids to assist Gemma around the home. As such, you seek approval for a stick vacuum; lightweight long reaching duster; and lightweight mop. Also, since her husband is often away for extended periods, mowing assistance for these time has been identified. Gemma attended a consultation with her GP. He referred her to an exercise physiologist. Gemma has attended her session with the exercise physiologist and they have recommended a gym program for Gemma to strengthen her knee and shoulder. Further, you recommend Gemma is to be provided with a three month hire of a home exercise bike. Gemma’s rehabilitation program has commenced. How do you request a change to this plan?

a. Email the coordinator b. Call the coordinator c. Submit a plan amendment d. Call or email the coordinator first to get their nominal approval before

submitting a plan amendment e. Change the plan without consulting the coordinator


Assessment Two – Question 5 In relation to Gemma’s medical management, which of the ADL recommendations are financially covered by rehabilitation and which are covered by the Rehabilitation Appliances Program (RAP)? http://clik.dva.gov.au/rehabilitation-library/10-alterations-modifications-aids-appliances/102-provision-aids-and-appliances-through-rap Options:

a. Strengthening program with exercise physiologist b. Home exercise bike c. Mowing assistance while husband is away. d. Modified cleaning tools

Assessment Two – Question 6 - 7 6. Are the cleaning aids and occasional mowing assistance likely to be approved for Gemma by DVA?

a. Yes b. No

7. Which of the following options would cleaning aids be approved under?

a. RAP b. Rehabilitation program

Assessment Two – Questions 8-12 Gemma doesn’t have any accepted mental health conditions. However, she feels her loss in confidence and social anxiety will interfere with her rehabilitation. Her husband, whilst having to travel frequently for his work in the Navy, is highly supportive of his wife. 8. Would you involve Gemma’s husband or parents in her rehabilitation?

a. Yes, if she agrees with the involvement. b. No, spouses and family should not be included in a person’s rehabilitation.

9. What would be the advantage of involving family members in Gemma’s

rehabilitation? (Choose one or more options)

a. Everyone is aware of Gemma’s rehabilitation goals and what she is working on and towards.




b. They understand how important Gemma’s goals are to her rehabilitation and getting her life back on track.

c. The meetings between you and Gemma can sometimes be overwhelming and a family member may have better retention of the discussion afterwards.

d. If a goal or activity is difficult for Gemma, a family member can be supportive and provide encouragement.

10. Are there any psychosocial activities you would recommend to Gemma?

a. Yes b. No

11. What psychosocial activities would you recommend or encourage Gemma to utilise?

a. Social interaction. b. Confidence programs. c. Mindfulness programs. d. Develop a new hobby. e. Join a social group.

12. Gemma does not have a DVA accepted mental health condition. Would DVA support psychosocial

activities mentioned in the previous question?

a. Yes if her mental health condition is a barrier to rehabilitation. b. N. If the condition is not accepted DVA will not support activities related to that condition.

Assessment Two – Questions 13-16 During the vocational assessment Gemma has shown an interest in health promotion and training work (i.e. Quit Smoking, Cancer Council or Wellbeing Officer). You conduct a jobs analysis of Gemma’s location and note there are six jobs, of this kind, available in her area. To obtain one of these roles, it will require Gemma to undertake a single semester Graduate Certificate to further build on her current qualifications. The course begins in three months. There is work available as a doctor’s surgery nurse. There are only are few jobs available and most of these require experience Gemma does not have. However, this type of role might be appropriate given her accepted conditions. Further, there are plenty of jobs available in health practice/hospital administration, but extra study is also required in business administration and a Certificate IV in Practice Management. After discussing all of the above with Gemma, health promotion and training interest her the most as she would be able to use her existing skills and knowledge. 13. What sort of information should you include in the plan amendment back to DVA

for them to consider funding and supporting Gemma through the one year course? (Choose multiple options)

a. Gemma’s return to work rehabilitation goal and a judgment of how realistic

this goal is given the labor market for jobs of this type in her location. b. Gemma’s current qualification and education history and how these may/may

not assist her in securing civilian employment.


c. Reasons why Gemma requires tertiary education to assist her to complete her vocational goal. d. Reasons why this course and university is most appropriate for Gemma. e. Gemma’s capacity and commitment to undertake retraining and study load. f. Medical evidence of Gemma’s capacity to undertake employment and study.

14. Gemma’s course starts in 3 months. Would there be advantages in Gemma doing a short work trial prior

to commencing the course?

a. Yes b. No

15. Would DVA provide funds for travel and parking if Gemma attended study?

a. No b. Yes

16. Would DVA consider funding after school care for Gemma’s children on the days when she is at

University?

a. Yes b. No

Assessment Two – Questions 17-18 You have spoken to the DVA rehabilitation coordinator and verbally recommended a Graduate Certificate course for Gemma. After some discussion the coordinator agrees to the course and asks you to submit a plan amendment. 17. You will complete a plan amendment with Gemma’s new course information. Will you change a current

goal or add a new one?

a. Amend a current goal b. Add a new goal

18. What would be the 0 score expected outcome for this goal?

a. Obtain at least a pass score throughout the course. b. Obtain anything above a credit throughout the course.

Assessment Two – Questions 19-20 Gemma has found a hobby group she is interested in joining. It’s called Cycle-Latte (social cycling on Sunday mornings, followed by coffee and cake). You have contacted the organizer and identified that many of the members are of a similar age and background to Gemma. The cost of joining is $25 and $15 per week (to cover coffee and cake).


You have not consulted with the rehabilitation coordinator as yet. 19. If DVA agrees, would the Cycle-Latte hobby group need to go on a plan amendment? If so, where would

it fit?

a. It should not go on a plan amendment. b. Yes, as an activity under the vocational goal. c. Yes, as an activity under the psychosocial goal. d. Yes, as an activity under the medical management goal.

20. What timeframe would you recommend DVA financially support Gemma attending Cycle-Latte before

you review the activity?

a. 6 weeks b. 3 months c. Until the end of her rehabilitation program

Assessment Two – Question 21 The plan amendment for the Graduate Certificate and Cycle-Latte has been approved by the DVA rehabilitation coordinator. Gemma’s course does not start for another 3 months. You and Gemma discuss a work trial. You explain the benefits of a work trial to Gemma and she is happy to go ahead with it as long as the work is within her area of interest. You are able to organise a 6 week trial with Heart Health. Gemma is enjoying the trial and is required to submit a work trial diary to her coordinator. 21. Why is it important for Gemma to submit the work trial diary to DVA?

a. So Gemma knows how many hours she has worked b. It’s not important. c. So DVA can monitor her work hours which can impact her incapacity payments

Assessment Two – Questions 22 and 23 Over the next 8 months Gemma completes her work trial with Heart Health and her Graduate Certificate. She has obtained full time employment at Heart Health. Gemma has been participating in Cycle-Latte and has made some good friends in the group who she socialises with outside of cycling. Gemma has reported a reduction in her social anxiety. The strength and conditioning Gemma has gained from cycling and physiotherapy sessions has resulted in a reduction of pain.


22. What are some of the indicators that would determine it is reasonable to close Gemma’s rehabilitation program?

a. Gemma is working to her full capacity b. Gemma is managing her job and not reporting any health issues c. There is no further support DVA can provide via rehabilitation. d. All of the above

23. When you are closing Gemma’s rehabilitation program what do you need to report on to DVA?

a. Goal Attainment Scaling scores b. Life Satisfaction Indicators c. Case management costs d. All of the above

Conclusion After discussion with Gemma and the coordinator it is decided that Gemma has had a successful rehabilitation program which has resulted in Gemma’s ability to self-manage her injuries, go to work and socialise. You score Gemma’s goals and convert them using the conversion table and submit the closure report to the coordinator. Gemma’s rehabilitation program will then be closed by the coordinator. Final If your score is 80% or more correct then you have completed this module and this course. CONGRATULATIONS! If you did not get 80% or more answers correct please redo the assessment.

Documents

Module 1: Introduction to DVA Whole-of-person ... · • DVA clients are usually former members of the Australian Defence Force (ADF), so returning to work can mean a new job and