WORKCOVER NSW SNA TRAINING

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1 Frequently Asked Questions About the SNA process How will SNA assessors be introduced and described to clients? SNA assessors will be introduced to clients by the referring insurer. A key message to clients will be that the focus of the SNA is on person centred planning not reducing services. A script will be provided for claims managers to use when discussing referral for an SNA with clients. It is expected that the claims manager will speak with the client about the SNA process before making a referral or sending a referral letter to the client. Will there still be external case managers? How will conflicts of interests be managed? Whether the case manager is an external or an internal provider, case management works best when providers are accountable for both participation and financial outcomes. It is anticipated that the majority of WorkCover clients will require an episodic service and that clients who require ongoing case management will be the exception. WorkCover case management also has a focus on setting client expectations reassessments and responses that can be funded. Is the SNA assessor role intermittent or ongoing? SNA assessments are conducted in response to recovery stages and claims management stages. For example, new clients are likely to need more frequent assessment such as post discharge or once goals are achieved. In the first couple of years assessment of older claims will occur more frequently to get better information on clients and their needs. Can SNA assessors be part of a treating team? No. Providers with a treatment or therapeutic relationship with a client (either as a treater or a case manager can not conduct SNAs. Some clients may be referred for an SNAs even if they are receiving ongoing case management. Is WorkCover NSW accrediting SNA assessors? Not at this stage although there is an expectation that assessors will have regard to their clinical expertise when deciding whether or not to accept a referral. Will clients receive a copy of the SNA? Clients may request a copy of their SNA. How will co-managed claims (LTCA & WorkCover) be handled? The memorandum of understanding between LTCA & WorkCover is currently being revised. The LTCA manages rehabilitation services. Vocational & Return to Work services are managed by agents. Please advise Mary Minns if you think you have a client who needs co-management.

2 Will individual SNA assessors get information on the quality of the reports? Aggregated data and individual performance data will be available to individual providers. The agents report rating scale on the SNA form captures their opinion but is not a criterion based assessment. A key driver of report quality is the usefulness of the information in enabling the agent to make decisions or whether there are information gaps. A Survey of assessor and agents on these issues may be considered in six months time. Will SNA assessors have access to the WorkCover agent mentors? Technical questions will be managed by Dyson Consulting Group. Please technical questions to sally@dysonconsultinggroup.com.au. Policy and legislation questions will be managed by WorkCover NSW. Please questions on these issues to Mary.Minns@workcover.nsw.gov.au. Will sample SNA reports be made available to SNA assessors? Sample SNA reports will be posted on the DCG website. What processes will be established to co-ordinate the timing of SNAs in regional and remote areas? Communication processes between agents will be facilitated to co-ordinate assessments in regional areas where this is possible. Are SNA referrals made to practice groups or to individual providers? This is determined by the insurer. The SNA training has been delivered to a train the trainer model so others in the practice who have been trained up by attendees are also possible SNA assessors. What information on providers is given to the agents? The information provided and updated by WorkCover is the assessor, name, contact details and areas serviced. In what timeframe do SNAs need to be completed? There is no specific timeframe. This is for negotiation with the insurer. The SNA is designed to be conducted in the person s home and community. Flights to remote communities and travel for multiple family/client visits need to be negotiated with the insurer on a case by case basis. When will SNA referrals commence? Some insurers are already geared up and ready to go while others are still establishing their processes. There will be some SNA referrals in the next two months. The process is expected to be fully operational by early 2012.

3 About completing the SNA How does the new SNA differ from the current process? Insurers have long term relationships with clients that need to be supported to optimise client outcomes. It is important to take a person centred approach in conducting the SNA and to move away from assessors talking to clients about benefits, entitlements and recommendations as these decisions are made by the agent. How does an assessor providing advice (rather than making recommendations) impact on Section 74 processes regarding denials of requests? This information will be provided by legal team consulting to the project. Who can be consulted when completing an SNA? WorkCover NSW recognises the importance of consulting existing stakeholders (client/family/carers/friends/treaters) during the assessment. What is the decision being made if WorkCover is not funding responses to all needs documented? The agent makes decisions based on SNA advice. There will be a consultation and negotiation process, but the definition of a denial needs to be refined. Further information will be provided by Mary Minns to clarify this issue. How does SNA fit into WorkCover funding of specific services for injury related needs? Using a person centred approach enables the SNA process to keep the focus on the person, their needs and wishes. Advice about responses including funded and unfunded options will facilitate agents in making decisions regarding funded responses. WorkCover acknowledges this conversation may need to happen after the assessment. Client goals are the starting point for acceptance by the client of accessing both funded and unfunded responses. Client views on supports needed can be included. These views can be documented in the Findings Summary section of the SNA report. Does the SNA have a similar declaration process to the assessor recommendations ( in the LTCA participant needs report)? A declaration is not formally required but is part of the conversation linking needs, capacities and advice. Who sets expectations with the client and what are these expectations regarding not all responses being funded by the WorkCover? Assessors need to know what expectations have been set with clients by insurers and need to set the expectation that not all support needs will be responses funded by WorkCover. What level of detail is required in describing care needs? The level of detail required is not as great as that required by ADHC high support needs assessment. The assessment needs to provide detail in the findings summary and evidence to support advice regarding key services.

4 How much observation is required during assessment? As much as possible but findings can also be inferred from observation. Assessors need to use their professional judgement to determine the extent to which observation is required. How should assessors detail child care hours in the SNA? DCG will advise of these requirements after the SNA training is complete. Where does the performance of caring roles get documented in the SNA. E.g. An adult, child or spouse with a disability or an elderly relative? Performance in these roles can be documented in the family and participation section of the findings summary. Documenting roles and new supports to respond to these needs does not necessarily mean that this support is funded by WorkCover. E.g. Elderly relatives may begin accessing HACC services. How will family carer issues be documented and managed in the SNA? It is important to document the care that is being provided by family members and any care payments received for that care including hourly attendant care payments to family members and gratuitous care payments. It is also important document whether the care or supervision provided is beyond the typical role of family member, and the extent to which performing care tasks and supervision is disruptive to the family carer s life. Where do anticipated improvements get reflected in the SNA? Anticipate improvements are noted in the Findings Summary section of the SNA. About the tools in the SNA How will the FIM inform the SNA process & advice of the assessor? The FIM assesses what the person actually does rather than what the person can do. (e.g. with training, equipment, etc.). The FIM is not the only measure being used, and measures status NOT outcomes. FIM results need to be considered in combination with clinical information. The FIM provides consistent data to enable consistent decision making and the identification of outliers (both over and under servicing). The LTCA has slightly different processes and use the FIM for ABI clients only. Do assessors need to be accredited to conduct the FAM? Accreditation is not needed for the FAM but AROC do offer training in its use. Please note that AROC training uses the more recent British model (as distinct from the older US FAM). WorkCover NSW is using the US version of the FAM because it includes employment. The FAM manual is no longer available online but DCG will find a copy of the manual and make it available to participants if possible. How are impact scores calculated in the OBS? Impact scores are not aggregated in the OBS.

5 What is the impact and relevance of context on OBS scores? E.g. choosing not to shower has minimal impact if staying at home, and a higher impact if needing to go to work. Severity is influenced by the impact of the behaviour and rated accordingly e.g. the difference between not monitoring hygiene and refusing to shower. Can the OBS be shortened? No, the report format must be the publisher s format. Changes are not permitted, although keywords may be highlighted to make use in the field easier. Can the OBS be used for all clients or only those with an ABI? Can the OBS be used by non- ABI specialised staff? The OBS does not record causes of behaviour and can be used with any client. It can be used by non-abi specialised staff. About the SNA & person centred practice What is the best way to describe to clients that the assessor provides advice rather than makes recommendations? By taking a person centred approach that focuses on client goals and responses identified rather than number of hours of funded services required. What is being done to enable Workcover clients to access disability & community services? WorkCover NSW is currently negotiating with state and federal departments regarding access to other forms of support, such as employment services. How do you balance holistic assessment with the requirements for supports to be reasonably necessary? Using a client centred approach with the client is the starting point. The SNA process is supported by agents who have established teams of skilled staff with allied health backgrounds to manage these claims. The agent s role is to determine if WorkCover funding of responses is reasonably necessary. Do assessors identify which needs/conditions are compensable? No, this is done by the agent. However assessors can start preparing clients for the fact that non-compensable needs are not funded by WorkCover. Does the SNA assessor identify goals and all responses (including unfunded responses)? SNA assessors should identify specific opportunities both funded and unfunded if these are known. WorkCover is currently working with state and federal agencies to enable clients to access other programs (whether or not WorkCover funds these options). How specific should identified response options be? Options should be identified to as specific a level as possible; for example the make and model of equipment. There is no need to list costs or suppliers in the SNA.