Operational Guidelines. Vocational Rehabilitation Services

Transcription

1 Operational Guidelines Vocational Rehabilitation Services January 2012

2 Table of Contents 1 Introduction Purpose of this guidance document Background Purpose of vocational rehabilitation Service principles Service outcomes Service overview and high level design Service categories Overview diagram Relationships and communication Useful contact information Commencing services Client eligibility Service Delivery and Referral process Service requirements Certifying practitioners Supplier records Stand Alone Workplace Assessment Stay at Work Services Lead Supplier Co-ordination Work Readiness Services Job Placement service Sustained Employment Outcome payment Quality requirements Concurrent services Performance measurement, reporting and monitoring Key performance indicators and service monitoring

3 6.2 Supplier reporting to ACC Payment and Invoicing Electronic invoicing Purchase orders Pricing schedule explanation Timing of invoicing and payments Use of ACC logo Glossary Appendix case vignettes Case example, Stay at Work, Level Case example, Stay at Work, Level Case example, Stay at Work, Level Case example, Stay at Work, Level 4 Service Case example, Work Readiness Level Case example, Work Readiness, Level Case example, Job Brokerage

4 1 Introduction 1.1 Purpose of this guidance document These guidelines are designed to assist suppliers in implementing the requirements of the vocational rehabilitation (VR) Service Schedule. If there is a conflict or inconsistency between these operational guidelines and the Service Schedule, the Service Schedule takes precedence. If a supplier is in doubt as to the delivery of a service, please refer to the service schedule and not the operational guidelines. It is envisaged this document will be updated from time to time. 2 Background 2.1 Purpose of vocational rehabilitation The purpose of VR services is to help a client to maintain employment, obtain employment or regain or acquire vocational independence following an injury (Accident Compensation Act 2001 S80). VR services take into account the requirements of the Accident Compensation Act 2001 (the Act) and follow principles that are consistent with ACC s wider claims management systems and international best practice. 2.2 Service principles The services are based on the following areas of interest and principles for vocational rehabilitation: Area of interest Guiding principles and requirements Overarching strategy Recovery is best achieved at work Employers have a key role Early intervention leads to faster recovery Identification and removal of barriers to return to work is essential To meet a client s needs may require working with several stakeholders Solutions based on partnerships collaboration and communication Outcomes based service Minimise fragmentation of service delivery Suppliers positively represent ACC when dealing with clients, employers and other parties Claims management system requirements Rapid triage and streaming of client to the right level of claims management service delivery model Effective communication with all stakeholders including client, employer and GP Fast, high quality decision making and rapid/early referral (into correct bands) for vocational rehabilitation intervention Holistic claim management integrated approach to all of client s rehabilitation needs Ongoing risk assessment and management Timely and outcome focused claim management Claims management has capabilities, tools and training required Performance monitoring and management Clear accountabilities for ACC staff and vocational rehabilitation providers/suppliers Outcome, timeliness and cost measures in place for both claims managers and vocational rehabilitation suppliers E-support to monitor outcomes, allow analysis and provide feedback Benchmarking and regular performance feedback provided 4

5 Area of interest Guiding principles and requirements Pricing and payment framework Supplier market and procurement approach Performance management against outcomes Relationship with providers that engages over priorities, comparative results, areas for improvement and strategic direction Promotes provider/supplier accountability for achievement of milestones and return to work outcomes Promotes service solutions/provision tailored to individual client needs Encourages and rewards good performance Reduces and manages risks of under or over servicing Promotes capability development and innovation End to end procurement process Optimal number of suppliers: o Balancing needs for geographic cover, financial sustainability, and closer ACC-supplier relationships. o Who are able to meet clients needs and agreed outcome objectives consistent with the service strategy Both suppliers and claims managers have a role to play in ensuring that the services are delivered in accordance with these principles. 2.3 Service outcomes The outcomes sought under the service are focused on maintaining employment or alternative employment options shown in the figure below: Figure 1: ACC goals for vocational rehabilitation outcomes Same job, same employer Modified job, same employer New job, same employer Priority Similar job, new employer Modified job, new employer Work ready, vocationally independent New job, new employer Maximum employment participation 3 Service overview and high level design 3.1 Service categories VR services are based on the following service categories: Stand alone workplace assessment Stay at Work service to support clients in returning to their pre-injury job Work Readiness service to support clients in becoming ready to get a job Job Placement service to support clients to find employment where: o o they are assessed through the IOA/IMA process as immediately capable of working in specific suitable employment, and ready to target those occupations or they are assessed as vocationally independent 5

6 3.2 Overview diagram The following diagram depicts the services and their outcomes. Service Level Service & Timeframe Outcome Max Stay at Work Level 1 Service for clients 2 with simple rehab needs to return to preinjury employment or temporarily modified weeks job with their current employer Stay at Work Services Stay at Work Level 2 Service for clients with risk factors or barriers to achieving Max 6 an early return to work who requires weeks rehab to return to pre-injury employment or modified job with their current employer may require an integrated multidisciplinary team Same Job, Same Employer or Modified Job, Same Employer OR New Job, Same Employer or Maximum Employment Participation Stay at Work Level 3 Service as for Max 6 Level 2 service where a client requires weeks more extensive services within the same timeframe likely to require an integrated multidisciplinary team Stay at Work Level 4 - Tailored Service for clients with complex rehab needs with multiple risk factors & barriers to achieve an early return to work. Service elements & timeframes negotiated will require an integrated multidisciplinary team (each client case is individually costed) Neg Injured worker requires vocational rehabilitation Work Readiness Services Work Readiness Level 1 Service for clients who require rehab to reach a state of work readiness where the client is not Max 8 expected to return to their pre-injury job or weeks where the client cannot maintain their current employment as a result of their injury likely to require an integrated multidisciplinary team Work Readiness Level 2 Service as for Level 1 service where a client requires more extensive services within the same timeframe will require an integrated multidisciplinary team Max 8 weeks Work Ready and vocationally independent OR New Job, new employer or Maximum Employment Participation Work Readiness Level 3 - Tailored Service for clients with complex rehab needs with multiple risk factors & barriers who will require an integrated multidisciplinary team (each client case is individually costed) Neg Stand alone workplace assessment undertaken at client s workplace to gather information about pre-injury job but client does not need a SAW Service Job Placement Services Job Brokerage Services for clients without employment who are work ready with transferable skills Job Search Services for clients without employment who have been referred following a vocational independence assessment Max 6 weeks Max 10 weeks Similar Job, New Employer or Modified Job New Employer or New Job, New Employer 6

7 3.3 Relationships and communication Relationship expectations The rehabilitation partnership between the supplier and the claims manager is one of the most important tools for ensuring the client s rehabilitation outcomes are met. The client s rehabilitation will be enhanced by the supplier and claims manager working and communicating together in a coordinated way. To be effective this relationship needs to be based on mutual respect, open communication, and clear performance expectations. There is an expectation that: suppliers and ACC staff will work together to rehabilitate the client both parties will respect each other s area of expertise suppliers are experts in the rehabilitation of injured clients and are responsible for achieving the service outcome for the client within the context of VR services (as defined in the service schedule) claims managers are expert at managing the complex mix of rehabilitation, entitlements, and compliance relating to claims and monitoring outcomes ACC is responsible for funding rehabilitation services to the extent that they are costeffective, and likely to achieve the rehabilitation outcome The supplier will nominate a person to have contact with ACC. This person will: keep ACC informed of any issues with providing assessments or treatment raise any issues with the service and suggest solutions ensure all services are carried out in accordance with the service schedule represent the supplier in service performance discussions inform ACC promptly when any contact details change 3.4 Useful contact information The following people can be contacted for any questions about the contracting process: Provider Helpline, ph: or [email protected]. Relationship and Performance Manager for your region (contact the Provider Helpline to obtain contact details). Contracts Administrator and Health Procurement Facilitator, ph: or [email protected]. 4 Commencing services 4.1 Client eligibility Clients are eligible for VR services if: 7

8 They are eligible to receive weekly compensation 1 ; and They are determined by ACC as requiring a vocational rehabilitation service in order to achieve a specific agreed outcome (see Figure 1) The services are likely to be cost-effective 4.2 Service Delivery and Referral process Service Delivery Most clients return to work quickly and require no assistance or only a short term minor intervention such as arranging temporary adjusted duties with an employer to ensure a safe return to work. Where a short no touch intervention is required, this is supported by the Short Term Claims Centre. Clients requiring vocational rehabilitation are streamed based on the ACC Claims Management Service Delivery Model. Risk factors are assessed and where there are clients with: No significant risk factors requiring case management and an early intervention service is required, the client will be managed by the Short Term Claims Centre Few barriers or flags to returning to work and no significant risk preventing a return to work, the client will be managed by the Short Term Claims Centre (age of claim less than 70 days) or Branch (age of claim more than 70 days) Significant barriers to rehabilitation and return to work the client will be managed by the Branch Long term vocational rehabilitation needs, serious injury or sensitive claims, these will be managed through the respective specialised claims management offices Deciding on the client outcome and time frame Vocational rehabilitation services will be provided with urgency and intensity in order to achieve optimal rehabilitation outcomes. This relies on ACC assigning clients into the correct level of service at the earliest opportunity. As part of their rehabilitation planning process, claims managers will gather information and make a determination regarding the outcomes expected for the client, the complexity of the client s need for VR services and the expected duration of work incapacity. The ACC claims manager is responsible for working with the client to determine and agree the outcome objective under one of the four service categories. The determination of which service category that will be pursued i.e. Stand Alone Work place Assessment, Stay at Work, Work Readiness or Job Placement, will be guided by the client s medical certificate and obligations under the legislation and collation of relevant information. The claims manager then develops a plan 2 with the client and identifies whether or not VR services are needed in order to achieve the desired outcome. Copies of this plan should be sent to the client s GP and their employer (if applicable) to inform them of the proposed rehabilitation. 1 The AC Act also provides for VR services to be supplied to clients who are likely, unless they have VR services, to be entitled to weekly compensation. 2 This can be a formal individual rehabilitation plan as required by the AC Act or it can be an informal plan agreed with the client and documented as part of the claim record (e.g. an action plan). Work readiness and job placement service level decisions are a process set out in legislation, based on the results of the IOA/IMA, and the claims manager s followup with the client in agreeing the formal Individual Rehabilitation Plan (IRP). 8

9 Where the claims manager decides that a VR service is required to achieve the desired outcome the claims manager determines the level of service required based on the information available to them regarding the barriers to RTW and the duration and intensity of effort required for their rehabilitation. Services are not designed for clients to move through the process multiple times or receive any form of extension to the service pathway chosen 3. For example a client who should be referred to a SAW level 2 service (see table below) should not first be referred for a SAW level 1 service. All services beyond level 1 are inclusive of the lower level services Making the referral Once it has been determined which service category and service level a client needs to achieve their outcome, the claims manager makes a referral for the identified services by: Selecting an appropriate supplier from the list of available suppliers in the client s region. The following factors are taken into account: o o o o The geographic location of the client and supplier Any known associations between the client s employer and the supplier, e.g. where an employer may engage the services of a supplier for work-related injuries Any specific skills or competencies required by the client, e.g. cultural needs, experience with specific types of claim e.g. sensitive claims, traumatic brain injury The track record of the supplier in achieving results for similar types of client Contacting the supplier to ascertain capacity to accept a referral (often this can be by telephone or ) this is optional Making the referral in writing on the appropriate template and completing all relevant information. The referral will provide details of any specific service elements that the claims manager may have identified as being required for the client s rehabilitation needs and, if relevant, supporting documentation outlining this need. For example, literacy or computer skills or development of a Tailored Plan Supplier acceptance of the referral The supplier is responsible for: Checking their capacity to provide the service in the required time frame Checking that the referral information is complete and contains all relevant information if not, returning it to the claims manager Notifying the claims manager of their acceptance of the referral or otherwise within one working day of receiving the referral. Note all referrals are expected to be accepted unless the supplier can demonstrate that they don t have capacity, there is insufficient information or there is a conflict of interest. For accepted referrals, making an initial appointment with the client 3 Services should be provided with urgency and intensity. Maximum time periods are specified within the service schedule. The claims manager may agree to extend service durations in exceptional circumstances dependent upon individual client needs. 9

10 4.2.5 What if the supplier doesn t agree with the expected outcome, timeframe or level? If, following receipt of the referral, the supplier concludes from information available that the expected outcome and/or timeframe is not achievable they should make a request to the claims manager to reconsider. Such a request should include: What the supplier considers should be the client outcome, timeframe or level; Information that supports their opinion (this may be information provided with the referral or new information identified at the initial or subsequent appointments). Such requests must be made prior to completion of the referred service. Within two working days of receiving such a request the claims manager will advise whether or not they agree with the request. If they agree to change the expected outcome, timeframe or level the claims manager advises the supplier and amends the referral details and amends the previous purchase order by deleting the original service item code and replacing with the new code. The frequency and outcomes of such requests will be monitored. If the supplier is not satisfied with the claims manager s decision relating to such a request they may: Escalate their request to the claims manager s supervisor Decline the referral where an agreement has not been reached (within two working days as to the services required) What if the service needs to go on hold for a period? Some clients who commence a service may need to have the service suspended for a period of time due to factors such as a need for treatment that cannot be delivered concurrently or a change in social circumstance that makes it impracticable to continue with rehabilitation for a short period of time (e.g. bereavement). Where this is the case the claims manager has the ability to agree extended time frames for a client and amend the purchase order time period accordingly. Services cannot be put on hold for longer than 12 weeks from date of referral acceptance 4. Where services have been placed on hold, this is inclusive within the package price. Suppliers are unable to invoice for services until the service has been completed Confirmation of Service Plan The claims manager will confirm the receipt of the service plan developed by the supplier by contacting the supplier within 2 working days to: Indicate they have seen and agree with the plan, or Indicate that they need to discuss the plan further with the supplier. It is important that the commencement of services outlined in the service plan is not delayed. Therefore, the supplier should start delivering services as soon as possible and should not wait on confirmation of agreement from a claims manager before commencing services other than for any costed elements that are paid as a fee for service within Stay at Work Level 4 services or Work Readiness Level 3 services. 4 Note that an extension of services is by exception. It would be highly irregular for a service to be put on hold for its maximum possible duration. 10

11 5 Service requirements This section expands on the service requirements listed in the service schedule. 5.1 Certifying practitioners The supplier will liaise with the general practitioner or certifying practitioner to gain approval for: The Service Plan and confirm this clearance with the claims manager. Any proposed functional rehabilitation programme not covered by the current medical certificate before the client undertakes this. Any work trial or simulated work activities not covered by the current medical certificate before the client undertakes these. Refer to Work Readiness Work Trial clearance for GP and Certifying Practitioners section of this guidance document for more detailed information. 5.2 Supplier records The supplier is required to maintain their own records of client progress which represent a running record and are in addition to ACC reporting requirements. These records are to be made available to ACC upon request. The situations where records are likely to be requested are when: Further information is required by ACC for example, for a medical case review or vocational independence decision ACC has conflicting information and would like to review a supplier s source documents. 5.3 Stand Alone Workplace Assessment A Stand Alone Workplace assessment may be requested when the client does not require any other vocational rehabilitation service but the claims manager needs detailed information about the client s pre-injury job or workplace and work task requirements to assist them with onward decision making. It is not used to determine the entry requirements or level of a Stay at Work service. The workplace assessment is a process of conducting an on-site work place evaluation in order to document the range of employment tasks and activities and must be conducted at the pre-injury workplace of the client. The client is not required to be present at the assessment, but should have been advised by the claims manager that this assessment is to take place and can request to be present, but as an observer only. The assessment should be conducted using objective assessment tools and processes as far as possible and be conducted in a safe manner. The supplier will supply a report to the claims manager on a standard reporting template in the timeframe outlined in the referral. Information sought in regard to the assessment includes: The nature and type of the business; description of job tasks and corresponding physical demands for those tasks Classification of the activity of those physical demands - Never, Occasional; Frequent, Constant. Other activities (and the Classification of Activity where it applies) and any applicable information that may be relevant to those activities, for example : o Driving: whether it is long distance; public responsibility driving; type of licence; day or night work etc 11

12 o Cognitive activities: whether the role requires an ability to remember; focus and sustain attention; concentration; undertake structured work activities; undertake mentally demanding tasks ; requires multi-tasking; ability to divide one s attention; solve problems; control emotions; work autonomously; handle pressure of work or public demands, etc o Sensory activities: whether the role requires manually operating equipment at speed; fine hand/eye co-ordination; balance, etc o Psychosocial factors such as working alone and/or in isolated or rural area, etc o Cultural factors such as language barriers, etc. o Features of the Workplace environment indoors, outdoors, noisy, chemical exposure, etc. o Equipment required to be used or worn o Any additional information requested by ACC. On receipt of the report the claims manager will review it to ensure that it is complete and informative. If further information is required the claims manager will communicate this to the supplier within 2 working days of receipt of the report. The claims manager is responsible for forwarding the assessment to the client and obtaining confirmation that it is an accurate record of their work place and job tasks. 5.4 Stay at Work Services Stay at Work Level 1 The Stay at Work level 1 service is for those clients who require simple vocational support and will require: workplace visit negotiation or liaison with the employer/gp for an early return to work and whose return to work is expected to be within 2 weeks from the date of referral. The supplier is expected to: complete an initial face to face interview with the client within 2 working days of receiving the referral at the client s workplace liaise with the certifying medical practitioner and the employer and obtain agreement to a simple return to work (RTW) plan (including a partial RTW) that is consistent with the referral return to work date and medical certifier requirements identify the functional requirements of the client s work, and their current and expected functional limitations. Identify the obstacles or barriers currently preventing recovery at work in some capacity. Promote actions to address those obstacles or barriers so that recovery at work can begin provide a return to work plan on the Stay at Work Level 1 template to the claims manager within 2 working days of referral acceptance identify any additional support the client may need to support early RTW and report this to the claims manager keep the claims manager informed where progress is not as expected any non-compliance must be reported immediately provide a brief written completion report to the claims manager within two working days of completion of the service using a standard ACC template. The completion report should also 12

13 outline if there is any follow-up required by ACC. For example, if the client has returned to partial pre-injury duties on pre-injury hours i.e. there are one or two normal job tasks that they are unable to perform at this stage of their recovery e.g. lifting a particularly heavy object, but there is an expectation that they will be able to resume undertaking these tasks when they have fully recovered and a timeframe has been stated for resuming these full pre-injury work tasks enter information into an electronic database (or other reporting system) to record for each client the results achieved and services provided The claims manager will: acknowledge receipt of the return to work service plan within two working days of receipt and contact the supplier to discuss any suggested changes to the plan where appropriate arrange any additional support, e.g. transport, that is agreed as necessary to support the client s return to work maintain contact with the client and the supplier as appropriate Stay at Work levels 2 and 3 The Stay at Work levels 2 and 3 are for those clients that require: ongoing vocational support due to identified risk and barriers functional or vocational rehabilitation or job modification employment maintenance support or training or a combination of both; and whose return to work is expected to be within 6 weeks from the date of referral Note: Stay at Work Level 3 clients are expected to require a more extensive combination of function and/or vocational rehabilitation delivered by a multidisciplinary team. The supplier is expected to: Prepare a service plan using the Stay at Work Level 2 and 3 template that lists activities to be undertaken and timeframes to achieve the outcome specified in the referral. Provide all of the services described in section above. Provide any of the following services that may be required or requested for level 2 or 3 clients such as: o Additional vocational rehabilitation that may include further workplace visits and more extensive monitoring, modification of the workplace or job tasks, fitting or trialling equipment. o Rehabilitation services to address functional or psychosocial barriers to RTW such as low level pain issues and related fatigue, a physical reactivation programme to increase their general fitness and contact with other treatment providers e.g. physiotherapists to ensure treatment aligns with the RTW plan. o Job maintenance activities, where the client is not fit for selected duties or there are no other duties available and the client is at risk of disengaging from their employment, such as supporting the maintenance of contact with their employer and colleagues and could also include engaging in alternative work tasks such as working alongside colleagues, attending staff meetings; staff social activities o Obtaining agreement of the medical practitioner to any proposed functional rehabilitation programme before undertaking it and liaising with the treatment provider on progress, where applicable. 13

14 o Attendance at case conferences where required by the claims manager Report progress to the claims manager at the mid-point of the programme or more frequently if there are exceptions. Provide a brief written Completion Report to the claims manager within two working days of completion of the service using a standard ACC template o This report should also outline if there is any follow-up required by ACC. For example: if client has returned to Partial pre-injury duties on pre-injury hours i.e. there are one or two normal job tasks that they are unable to perform at this stage of their recovery e.g. lifting a particularly heavy object, but there is an expectation that they will be able to resume undertaking these tasks when they have fully recovered and a timeframe for resuming these full pre-injury work tasks. if there is any reason the client has not been able to return to work and any recommendations e.g. Functional capacity evaluation or medical assessment etc. Enter information into an electronic database or other reporting system to record for each client the results achieved and services provided. The claims manager is expected to: Undertake responsibilities listed in section above Review progress reports and provide any necessary feedback to the supplier Arrange any case conferences considered necessary Stay at Work Level 4 Tailored with or without Lead Supplier services The Stay at Work Level 4 (Tailored) service is for those clients who are not expected to return to work within the usual timeframes of the lower levels of the Stay at Work services due to a number of risk factors or barriers. These clients may also require other services, not normally provided within those lower level services, which are tailored to achieve the client s individual outcome and to meet any unique identified needs. The length of service is dependent on the needs and services and timeframes for achieving the client s specific vocational rehabilitation outcome. Tailored services are planned and managed through a collaborative process between the claims manager, the certifying medical practitioner, the supplier and other suppliers. The claims manager will work with the client and their certifying medical practitioner to develop and agree the client s Individual Rehabilitation Plan. The claims manager will then determine which services are required to meet the client s needs and outline these in the referral. Options for a referral for a Stay at Work Level 4 (tailored) service are: A Stay at Work Level 4 service without any additional fee for service components that is used for a client requiring an extended period of vocational rehabilitation past 12 weeks from the date of referral acceptance by the supplier (i.e. a slower programme of rehabilitation but not more services). A Stay at Work Level 4 service with additional services required that will be paid on a fee for service basis including where there may be additional hours to ensure liaison and monitoring of the progress of any activities the client may be undertaking or may be engaging in within the SAW return to work plan that extends the duration of services e.g. attending community funded computer courses. 14

15 A Stay at Work Level 4 service with or without additional services paid under a fee for service and a referral for the supplier to act as a Lead Supplier (Refer section 5.5.Lead Supplier Co-ordination) Development of the SAW Level 4, Tailored Plan The supplier will work collaboratively with the claims manager to agree the content of the tailored return to work plan as it applies to them as a supplier (including where the supplier is a lead supplier). This Tailored Plan should be developed and completed within 4 working days of the receipt of the referral. This will include specifying the additional services with timeframes and any fee for service costs that require approval by the claims manager including additional services and /or time required for lead supplier co-ordination. The Stay at Work Level 4 Tailored Plan will be completed using the ACC template and includes: other services that are reasonable and necessary relevant rationale, goals and activities related to those other services appropriate monitoring, milestones/ progress dates dates outcomes are to be achieved and measures of achievement any client specific activities linked to goal achievement any other service supports or activities that may be required e.g. case conferences any Lead Supplier Co-ordination to be undertaken, including the services to be co-ordinated, methods of co-ordination and frequency of progress reports/updates costing sheet that outlining any hours and costs (that are additional to those that are inclusive within a Stay at Work service package price) The supplier will: submit the Tailored Plan (on the standard ACC template) to the claims manager for approval ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome report progress to the claims manager as agreed in the Tailored Plan for Other Services and/or as a Lead Supplier SAW Level 4 Services Progress Reporting The supplier will submit Progress Reports for Stay at Work Level 4 services to the claims manager in the agreed timeframes and should outline: an overview of progress goals and outcomes achieved including any partial or full return to work any activities completed any new issues or barriers that have emerged The minimum progress reporting requirement is the mid-point of services, however, it is expected that more frequent progress reporting will be required for tailored services. This is outlined in the tailored plan to ensure ACC and the supplier have shared expectations around reporting. If the supplier is a Lead Supplier the progress report should also include any comments about the coordination of other services to date SAW Level 4 Plan Outcome Report. The supplier will submit a Service Outcome Report on the Stay at Work level 4 Tailored Plan Completion Report and submit it to the claims manager 2 working days after the service has been completed. The Service Outcome report will outline: 15

16 services provided goals and outcomes achieved whether the client has achieved the outcome of a full return to work in the same job and hours with the same employer as prior to injury and an explanation should this not be achieved general comments and whether there is any follow-up action required by ACC If the supplier is a Lead Supplier the report should also include any comments about the co-ordination that has been completed Other services for SAW Level 4 clients The supplier is responsible for the range of other services required within the tailored return to work plan. This may include contracting or subcontracting others to provide the range of services that are usually outside Stay at Work services but have been requested or agreed to by the claims manager to facilitate the client s vocational rehabilitation outcome. These additional services are designed to meet the client s unique identified needs and may include, for example: dietary support and/or advice cultural support social support Note: These services cannot include ACC contracted services. Those services that are normally provided by ACC contracted providers must be facilitated through the Claims Manager in the usual assessment and approval process. Consideration must also be given to whether the other services being considered for inclusion in a tailored service are of a type that can be provided under ACC legislation. There is no fee for service payable for clients who do not attend an appointment under the allowable fee for service billing. It is also important to consider community services that can provide free training/up-skilling for clients that they can complete independently as part of their Tailored Plan e.g. free community computer courses, literacy courses. 5.5 Lead Supplier Co-ordination The supplier of Stay at Work Level 4 services or Work Readiness Level 3 services may be appointed as a Lead Supplier where the claims manager may consider it is appropriate that the supplier is responsible for liaising between other ACC contracted suppliers and co-ordinating communication so that all parties are aware of the client s progress through their vocational rehabilitation. Communication by the Lead Supplier with other ACC contracted suppliers will include phone calls, s and or case conferences. Only those services that have been identified by the claims managers as relevant to and that may impact on the vocational outcome are to be included in the lead supplier arrangement. For example, a home help contracted service may not be relevant to the vocational rehabilitation supplier whereas a pain service may be. Note: The Lead Supplier is not responsible for co-ordinating the other suppliers contracted services themselves and their contractual obligations such as reports to ACC. These remain the responsibility of the other supplier. Case conferences need to be approved by the claims manager as part of the tailored plan. Case conferences attended by the VR supplier are usually inclusive within the package price and not a fee for service. Where extended timeframes for provision of services are required, then a fee for service may be applicable for additional case conferences. ACC will pay ACC contracted suppliers for their time when case conferencing. A Lead Supplier status finishes when the vocational rehabilitation service is complete, or when the claims manager determines the coordination service is no longer required. 16

17 The Lead Supplier is only responsible for the communication with these suppliers to ensure that all parties involved with the client are focused on the same outcome. In addition, any progress, lack of progress, barriers or needs can be identified in a timely way and managed to ensure a smooth and co-ordinated delivery of the client s vocationally relevant rehabilitation to ensure a return to independence. The claims manager is responsible for notifying the client s other service suppliers that there will be communication between them and the client s vocational supplier. 5.6 Work Readiness Services Determining work readiness Work ready means the client has capacity to obtain employment, or has regained or acquired vocational independence. Work readiness has a corresponding meaning. Documented evidence of the identification of barriers, activities addressing the barriers and of the client s response demonstrating work readiness is pivotal for this group of services. Currently, there is no standardised programme to facilitate work readiness. ACC would like to encourage suppliers to take a systematic, well documented approach to determining what rehabilitation is required to facilitate this goal. In the context of work readiness under vocational rehabilitation services, ACC needs to see how rehabilitation needs were identified (referring to the Initial Occupational Assessment (IOA), Initial Medical Assessment (IMA), individual rehabilitation plan and any additional assessments, client interview or clinical information). ACC needs to be able to see that activities undertaken address the rehabilitation needs and that barriers that emerge during rehabilitation are given appropriate attention and mitigated. In documenting the progress of the rehabilitation activities, the suppliers must show how barriers have been addressed and how work readiness is demonstrated. Some injury conditions for example leave clients with pain, psychological vulnerability and fatigability or suboptimal stamina. Rehabilitation therefore frequently involves helping clients to adjust, optimise stamina and manage ongoing symptoms. Suppliers should show how rehabilitation has facilitated the adjustment of these clients to be able to undertake work and complete a working week while managing residual symptoms. Similarly, rehabilitation to address loss of confidence in skill sets or the need to update skills should always be documented. In every instance, achieving work readiness requires motivating and engaging with the client and where barriers to motivation are encountered, the supplier must show how these have been addressed. Note that the goal of the work readiness service is to ensure the client achieves work readiness. If a client achieves employment while receiving the work readiness service, an incentive payment to the supplier may be applicable if conditions of the service schedule are met. Suggested additional reading on the topic of work readiness: Bootes, K., & Chapparo, C. J. (2002). Cognitive and behavioural assessment of people with traumatic brain injury in the work place: Occupational therapists' perspectives. Work, 19, Franche, R.-L., Corbiere, M., Lee, H., Breslin, F. C., & Hepburn, C. G. (2007). The Readiness for Return to Work (RRTW) scale: Development and Validation of a Self-reported Staging Scale in Lost-time Claimants with Musculoskeletal Disorders. Journal of Occupational Rehabilitation, 17, 22. Innes, E., & Straker, L. (2002). Strategies used when conducting work-related assessments. Work, 19,

18 McPherson, K., et. Al (2009). Supports Needed for Return to Work: Testing a New Measure of Work-ability. AUT University, Auckland. Unpublished Report, Rosenberg, H., & Tesolowski, D. G. (1982). Assessment of Critical Vocational Behaviors. Career Development for Exceptional Individuals, 5(1), Serra, C., Rodriguez, M. C., Delclos, G. L., Plana, M., Gómez López, L. I., & Benavides, F. G. (2007). Criteria and methods used for the assessment of fitness for work: a systematic review. Occupational and Environmental Medicine, 64(5), Stergiou-Kita, M., Rappolt, S., Kirsh, B., & Shaw, L. (2009). Evaluating work readiness following acquired brain injury: Building a shared understanding. Canadian Journal of Occupational Therapy, 76(4), Strong, S., et al. (2004). Functional assessment of injured workers: A profile of assessor practices. The Canadian Journal of Occupational Therapy, 71(1), Work Readiness Level 1 and Level 2 Work Readiness level 1 and 2 services are for those client who have been identified as requiring rehabilitation to become work ready when it has been established, following appropriate recovery time and rehabilitation, that they are not able to return to their pre-injury job or cannot maintain their current job, but it is expected that they will achieve this work ready outcome in 8 weeks from the date of referral. Work Readiness service clients will have undertaken an Initial Occupational Assessment (IOA) and Initial Medical Assessment (IMA) that has identified sustainable work types that are appropriate and suitable for the client, including where some upskilling may be required. Note: Work Readiness Level 2 clients are expected to require a more extensive combination of function and/or vocational rehabilitation delivered by a multidisciplinary team. The supplier is expected to prepare a work readiness service plan that lists activities to be undertaken and timeframes to achieve the outcome specified in the referral, within 2 working days of receipt of the referral. The plan needs to be consistent with referral information including the Individual Rehabilitation Plan, IOA and IMA. It will include goals, activities and incremental steps to support the outcome within the expected timeframe where the supplier will be expected to: Obtain agreement of the medical practitioner not covered by the current medical certificate to any proposed functional rehabilitation programme before undertaking it. Attend case conferences where required by the claims manager Ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome. Report progress to the claims manager at the mid-point and end of the programme or more frequently if there are exceptions using the Work Ready Level 1 / 2 report. Reports should clearly document how the client is progressing with work trials, motivation, compliance, any barriers or issues identified that are likely to impact on the vocational independence process etc. The claims manager will: Acknowledge receipt of the work readiness plan within two working days of receipt of the plan and contact the supplier to discuss and negotiate changes to the plan where appropriate Purchase any additional support, e.g. equipment, that is agreed as necessary to support the work readiness programme Review progress reports and provide any necessary feedback to the supplier Arrange any case conferences considered necessary. 18

19 5.6.3 Work Readiness Level 3 Tailored with or without Lead Supplier services Work Readiness Level 3 services are for those clients who have been identified as requiring rehabilitation to become work ready when it has been established, following appropriate recovery time and rehabilitation, that they are not able to return to their pre-injury job or cannot maintain their current job, but it is not expected that they will achieve this work ready outcome in 8 weeks from the date of referral and may require more unique client-centred services to achieve their outcome. These clients may also require other services, not normally provided within those lower level services, which are tailored to achieve the client s individual outcome and to meet any unique identified needs. The length of service is dependent on the needs and services and timeframes for achieving the client s specific vocational rehabilitation outcome. Tailored services are planned and managed through a collaborative process between the claims manager, the certifying medical practitioner, the supplier and other suppliers. The claims manager will work with the client and their certifying medical practitioner to develop and agree the client s Individual Rehabilitation Plan. The claims manager will then determine which services are required to meet the client s needs and outline these in the referral. Options for a referral for a Stay at Work Level 4 (tailored) service are: A Work Readiness Level 3 service without any additional fee for service components that is used for a client requiring an extended period of vocational rehabilitation past 12 weeks from the date of referral acceptance by the supplier (i.e. a slower programme of rehabilitation but not more services). A Work Readiness Level 3 service with additional services required that will be paid on a fee for service basis including where there may be additional hours to ensure liaison and monitoring of the progress of any activities the client may be undertaking or may be engaging in within the work readiness service plan that extends the duration of services e.g. attending community funded computer courses. A Work Readiness Level 3 service with or without additional services paid under a fee for service and a referral for the supplier to act as a Lead Supplier (Refer section 5.5 Lead Supplier Co-ordination) Other services for Work Readiness clients A client may require other services, not normally contained within a Work Readiness programme, to facilitate the successful completion of the programme. These additional services are tailored to achieve the client s individual outcome and to meet their unique identified needs and may include, for example: dietary support and/or advice cultural support specific client job training or skill development e.g. operating Eftpos; customer service skills social support additional services not usually available through vocational rehabilitation but are claims manager directed and negotiated and considered necessary to assist achieve the vocational outcome (e.g. programme delivered by a sports physiologist or extensive gym based programme). Other types of services may also include those for clients who have been assessed as unlikely to achieve vocational independence or have been assessed as having not achieved vocational independence, but who may be referred with an outcome objective of maximum employment participation, and could include the following: Voluntary work programmes (where this is a step towards employment participation, rather than a final outcome) 19

20 Job Clubs (selected clients participate in facilitated group work to learn return to work strategies) Work Readiness Tailored Plan The Work Readiness Level 3 Services Tailored Plan is completed using an ACC template and details: a summary of the client s injury, work situation, objectives and any service components any issues, goals and actions proposed Work Readiness RTW Plan other Services that are reasonable and necessary if a work trial is planned and how this relates to the job options identified in the IOA/IMA if any work trial details have been sent to GP to obtain clearance to undertake work trial any additional job options identified that were not in the IOA/IMA relevant rationale, goals and activities related to those other services appropriate monitoring, milestones/ progress dates dates outcomes are to be achieved and measures of achievement any client specific activities linked to goal achievement any other service supports or activities that may be required e.g. case conferences any Lead Supplier Co-ordination to be undertaken, including the services to be coordinated, methods of co-ordination and frequency of progress reports/updates a Tailored Plan costs sheet that outlines any hours and costs (that are additional to those that are inclusive within a Work Readiness service) for the other services and/or Lead Supplier co-ordination. The supplier will: submit the Tailored Plan to the claims manager for approval within 4 working days from date of referral ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome report progress to the claims manager as agreed in the Tailored Plan for other services and/or as a Lead Supplier Work Readiness Level 3 Progress Reporting The supplier will submit Progress Reports for Stay at Work Level 4 services to the claims manager in the agreed timeframes and should outline: an overview of progress goals and outcomes achieved including any partial or full return to work any activities completed any new issues or barriers that have emerged If the supplier is a Lead Supplier the progress report should also include any comments about the co-ordination of other services to date Work Readiness Level 3 Outcome Report The supplier will submit Service Outcome Report to the claims manager 2 working days after the service completion. The Service Outcome report will outline: services provided goals and outcomes achieved any activities completed by the provider and/or client 20

21 if the client has achieve a partial or full RTW if the client has demonstrated an ability to be work ready and jobs identified if the client has not achieved the outcome of work readiness, reasons why and any recommendations general comments and whether there is any follow-up action required by ACC comments about service coordination (where applicable) The claims manager will: review and acknowledge receipt of the Tailored plan within two working days of receipt of the plan and contact the supplier to discuss and negotiate changes to the plan where appropriate arrange any additional support, e.g. transport, that is agreed as necessary to support RTW attend any case conferences considered necessary review progress reports maintain contact with the client and the supplier as appropriate Work Readiness Work Trial clearance for GP and Certifying Practitioners Suppliers need to provide a brief outline of any Work Trial to be undertaken and obtain medical clearance for the client to undertake a Work Trial. This Plan should be sent to the GP or certifying practitioner on the ACC124 Confirmation of Work Trial vendor and should contain - a brief outline of the proposed work trial and job activities - availability of work hours - any other activity recommendations Suppliers will consider cognitive factors when sourcing, monitoring and reporting on a work trial. This could include the clients ability to cope with stress; multi-tasking; ability to divide attention across tasks; controlling emotions; working autonomously; and handling the demands of the work. Clients with head injuries or long term pain and/or mood disorders will require additional support. The key work trial factors ACC requires information on are: Confirmation of the hours the client worked Detail of the tasks undertaken Any barriers such as pain that arose and how these were addressed Details of any non-compliance Details of the clients motivation and inclusion of employer comments It is helpful to ACC if the Supplier reports the full range of activities the client has undertaken each day presented on a weekly timetable for the period of the work trial, including their activities such as work, participating in other rehabilitation such as an exercise programme, vocational training and so on. This provides a full picture to ACC of the clients overall level of participation. The GP or certifying practitioner should complete the ACC 5657 Confirmation of Work Trial and return it to the supplier. The supplier will confirm the clearance with the claims manager. 5.7 Job Placement service The Job Placement service is available as either a Job Brokerage service or a Job Search service. These two different services are described below Job Brokerage services This is a service designed to provide an alternative to a Work Ready service where the client has been assessed through an Initial Occupational Assessment (IOA) and Initial Medical Assessment 21

22 (IMA) as having immediate transferable skills for one or more identified job types and does not require any further rehabilitation. The suppliers need to have excellent linkages with employers, and promote employment opportunities generally. It is designed to assist the client find work in identified job types. Only clients who have agreed to seek employment in suitable occupations are referred, as agreed as part of finalising the IRP This service is also appropriate for clients who: do not have any identified functional or vocational rehabilitation needs, who are motivated to find a job and only require assistance to access job markets are not expected to be able to return to full time work in any work type, and thus the vocational outcome identified is maximum employment participation Service requirements include: Development of a Job Search strategy plan that matches client s skills and work types identified as suitable in a client s IOA/IMA and proactively facilitates suitable job opportunities by: o o o connecting the client with employers and/or actively working with employers to identify suitable employment, acting as an intermediary with these employers on behalf of the referred clients. facilitating a positive and durable employment outcome for the client supporting a client s job search activities, e.g. curriculum vitae updating, job search strategies, teaching interview preparation and techniques, assisting with completion of applications, motivational coaching and follow up to ensure the job placement is durable Notification to ACC of any requirements for workplace modifications Progress and outcome reporting Job Search Services This service is for clients who have undergone the Vocational Independence Occupational Assessment (VIOA) and Vocational Independence Medical Assessment (VIMA) and it has been determined that they have capacity to work 30hrs per week in identified work types. The service was designed to provide additional support to assist those clients seek and secure employment three months before their entitlement to weekly compensation ends. The supplier will be provided with a copy of the client s VI06 Claimant notification of compensation cessation which outlines the identified work types that are suitable for the client. Service Requirements include: Development of a Job Search Plan that matches client s skills and work types identified as suitable and assisting in job search activities by: o Development or modification of curriculum vitae o Teaching job search strategies and interview techniques o Providing job seeking advice. Note: Clients who have been assessed as vocationally independent should also be advised that they can request additional support from their claims manager such as: Regular case management contact Budgeting and counselling assistance Enrolment with Work and Income 22

23 5.7.3 Reporting For both Services the supplier is required to ensure that services are delivered in a co-ordinated way within the optimum timeframe to achieve the outcome. Progress reports are only required for exceptions to the service e.g. non-compliance, issues impeding the service. The supplier is required to report the outcome of the service using the Job Placement template. The claims manager will: Acknowledge receipt of the job placement plan within two working days of receipt of the plan and contact the supplier to discuss and negotiate changes to the plan where appropriate Maintain contact with the clients as appropriate for the service 5.8 Sustained Employment Outcome payment This is an incentive payment where sustainable full-time (30 hours or more per week) employment results as a direct result of either the Work Readiness service or Job Placement Service; and has been continuously employed for 14 weeks following commencement of the employment The supplier will submit a Sustainable Employment report via the e-provider portal to the claims manager to confirm the continuous employment. Note that there is no outcome payment available for suppliers where an employment outcome is achieved for clients who cannot sustain full time employment. 5.9 Quality requirements Skills and competencies requirement for vocational rehabilitation services There is a separate document referred to in the service schedule that covers ACC s requirements for skills and competencies of vocational rehabilitation providers (including employees, contractors and sub-contractors). Note: Services must be delivered by suitably skilled and qualified providers as outlined in these requirements. The supplier should match the provider to the client s needs, for example, achieving a good cultural match; ensuring services are delivered by the most highly skilled and qualified provider for more complex clients. Support personnel (e.g. personal trainers) cannot be responsible for delivering a service and should work under supervision of a provider that meets ACC s requirements as outlined in the Skills and Competence Requirements document Organisational standards The organisation that contracts with ACC needs to hold the ISO9001:2008 Quality Management Systems or the Allied Health Services Sector Standard NZ8171:2005 (or any replacement or later version of this Standard). Subcontracting organisations need to be held accountable for performing against the standard, but are not expected to be certificated. 23

24 5.10 Concurrent services VR services may be supplied concurrently with other treatment or rehabilitation services. Where this is the case the claims manager will ensure that the VR services are appropriately co-ordinated (unless a tailored service with Lead Supplier is in place). Note that claims managers may also purchase other services concurrently as agreed in the client s individual rehabilitation plan which is developed by ACC. 6 Performance measurement, reporting and monitoring 6.1 Key performance indicators and service monitoring Key performance indicators are specified in the service schedule. Suppliers can expect to receive quarterly reports that track performance. In addition to the supplier KPIs, the overall effectiveness of the vocational rehabilitation services will be monitored as outlined in the service schedule. Suppliers are required to undertake an annual satisfaction survey of ACC clients that have used their services. Minimum requirements for the content of satisfaction surveys are outlined on the ACC website vocational rehabilitation page. Please note that it is important that questions are asked as stated on the webpage to enable comparison between suppliers. A variety of methods will be used to collect the data required for both key performance indicators and monitoring measures including data from the current system and processes, as well as information from employers, claims managers and suppliers via new systems or processes. 6.2 Supplier reporting to ACC ACC will receive reports from the supplier electronically, in a required format or template if available. Suppliers may also be required to complete outcome tools to measure specific outcomes. Organisational reporting will also be submitted to ACC on a regular basis. More detail on this will be available in the finalised operational guideline. 7 Payment and Invoicing 7.1 Electronic invoicing ACC will set up one account per supplier for payment of invoices. This means there is one supplier identification, one address for all correspondence (i.e. purchase orders and remittance advices) and one bank account number per supplier. The supplier must provide only one set of banking details for the provision of VR services under this contract. This requirement is to enable transparency of transactions for monitoring purposes by ACC. Where a supplier delivers services across multiple regions or sites, and has a requirement to identify the activities at these regions or sites, Facility Identification numbers can be provided by ACC to assist. Please contact the ebusiness support team on option 1 to discuss. 7.2 Purchase orders There may be occasions where a supplier is initially provided with a purchase order number that is cancelled because after negotiation the service level requirements for a client change and a new purchase order needs to be raised. The claims manager will provide the supplier with a new 24

25 purchase order number should the service level change. The supplier should use the new purchase order number for invoicing purposes. Note that any services provided under the former purchase order that was cancelled are effectively transferred to the new purchase order as it is inclusive of all services. Any changes to purchase order numbers would usually occur soon after the outset of services. 7.3 Pricing schedule explanation The prices set out in the service schedule are inclusive of all inputs associated with the delivery of the service. This includes direct and indirect staff time, overheads such as administration, information systems, travel costs and return on investment. Where the pricing unit is a package price this is a single fee that may be invoiced following completion of the service for a client. There is no provision for any other payment (e.g. do not attend fees or travel.) Part payments will not be made. Where the pricing unit is a fee for service this is an hourly rate that has been approved within either a Level 4 Stay at Work Service (Tailored) Plan or Level 3 Work Readiness Service (Tailored) Plan. Note where fee for service payments are applicable: The maximum number of hours are detailed in the plan and approved by the claims manager There is no provision for payments where clients do not attend services which are contracted on a fee for service basis. Travel is inclusive within the fee The supplier can bill at the end of each month for fee for service hours utilised 7.4 Timing of invoicing and payments Invoicing requirements are set out in the service schedule. Invoices will be paid on the 20 th of the month following the invoice. It is important for suppliers to include the start and end date of the service as these dates will be utilised to measure various durations as part of monitoring. Note that a supplier must bill for all services in a timely manner. This should always be within one month of the completion of services for each client. Late billing will interfere with service monitoring and disadvantage suppliers. ACC also reserves the right not to pay invoices which are dated more than 12 months after the completion of services. 8 Use of ACC logo Suppliers are not permitted to remove the ACC logo from any ACC form, template or document. If sending information under a supplier s letterhead, the supplier is not permitted to copy and paste the ACC logo onto their letterhead. The supplier is able to put a statement on their letterhead stating they are an ACC contracted vocational rehabilitation supplier. 9 Glossary Refer to the service schedule for definitions and use of terms. 25

26 10 Appendix case vignettes 10.1 Case example, Stay at Work, Level 1 John is 40 years old with a soft tissue ankle injury and is concerned about his ability to return to work as he has a manual job which he thinks may aggravate his injury. Two days after his injury John s GP has provided a medical certificate for three weeks that has identified he is fit for selected duties. He has spoken with his employer who is reluctant for him to return to work before he is fully fit. The ACC claims manager has referred John to the simple Stay at Work service with an expected RTW on usual duties set on expiry of the medical certificate. The vocational rehabilitation provider met with John and his employer together at his workplace and identified a range of duties John could comfortably undertake immediately and those that he could resume in two weeks time. John together with his employer agreed that this plan was achievable and John returned to work the following day on this basis. The provider agreed to phone John the following week to check on his progress and invited him to call them if he needed to. A simple plan was ed to the claims manager who has no concerns about safety Case example, Stay at Work, Level 2 Amanda works as a bank teller, sitting for long periods and reaching over a counter. Amanda has a back sprain injury and is having difficulty returning to work due to being worried that she will reinjure her back so has been resting up at home. She has seen her GP yesterday who has signed her off fit for selected duties for 10 hours a week for a further 3 weeks. Her employer is keen for her to return to work as soon as she can. With the information on hand the claims manager refers Amanda for a Level 2 service with an early return to work date for full duties/hours in 3 weeks. The claims manager chooses Level 2 as there are a number of risk factors impacting on the return to work although the employer appears supportive and Amanda is unlikely to need a highly supervised work fitness service. The vocational rehabilitation provider undertakes a workplace visit where adjustments are made to the teller s work station. Whilst at the workplace, the provider meets with Amanda and the employer where a range of alternative duties which prevents Amanda sitting for extended periods of time are identified. It is proposed that Amanda will initially work a few hours each day and extend the number of hours and range of activities she undertakes as part of a three week plan. The provider liaises with the GP to gain sign off on the proposed plan, which the GP supports.. Given Amanda s pain levels and inactivity to date the provider also works with Amanda to encourage her to be more active in the hours she is not working, provides advice on coping strategies and pain management tips to support Amanda s return to work plan. The provider agrees to visit Amanda on a weekly basis to make sure she is progressing as expected and update the programme as needed. 26

27 10.3 Case example, Stay at Work, Level 3 Dave works as a courier driver for a Courier Company. He has sustained an ankle sprain injury two weeks ago and has a medical certificate for a further three weeks, fit for selected duties. Dave says he is keen to return to work but cannot yet as he needs to be on his feet all the time carrying items or be driving both make his pain much worse. He has sent the medical certificate to his employer but has not spoken to them. The employer says they need Dave to be fully fit as there is no other work available and it is a busy time of year for him to be off. Dave has been attending physiotherapy sessions although he says he hasn t been that good at doing his exercises as they make his pain worse and has been spending a lot of time just resting his ankle. The claims manager refers Dave for a Level 3 stay at work service as there are multiple risk factors requiring intensive provider input. These include Dave s job being at risk, Dave s lack of engagement with his work and rehabilitation to date. The claims manager with the information to hand meets with Dave and sets an early return to work on usual duties/hours for four weeks. The vocational rehabilitation provider identifies that Dave is capable of working within the main warehouse where he could undertake some dispatching jobs and that he can safely drive a vehicle despite experiencing some pain. As Dave is experienced he can also help train a new courier driver and not need him to drive or carry items. The provider organises a meeting with Dave and the Courier Company where a plan is developed that steadily increases the amount of driving. The provider reviews Dave s physiotherapy programme ensuring it is tailored to increase work fitness and advises Dave on how to progress the exercises along with a daily activity programme to ensure Dave is kept busy. Dave is advised on coping strategies and pain management as his beliefs have been impacting on his progress. The provider liaises with his GP to ensure the GP approves the plan. Dave s motivation has been low so initial supervision is high and reduces over the next weeks. The provider reports back to ACC to advise that Dave s progress is on track to achieve the early return to work. 27

28 10.4 Case example, Stay at Work, Level 4 Service Bruce was in a major car accident where he sustained a moderate traumatic brain injury. As a result of this injury he is experiencing severe and frequent headaches, reduced concentration, irritability and fatigue. Bruce has also found he s now more sensitive to noise & light. Before his injury he had been working as a teacher. His employer is very supportive and keen that he returns to work, even if undertaking a different role as he has been a valued employee. Bruce s wife is supportive although she is finds Bruce s irritability and memory issues hard to manage. She has noticed that Bruce has a tendency to rush in to trying new activities and as a result has more headaches and fatigue for the next few days. Bruce has been receiving ACC support in increasing his independence with activities for daily living. Bruce is keen to return to work but cannot see how he will actually achieve this goal as he is worried he may over do it and let his employer down. Bruce has just seen his Specialist who is now supportive of a graduated RTW. The claims manager meets Bruce and his wife to discuss how to now support the goal of returning to his current employment. The CM recognises there are persisting physical, cognitive and emotional symptoms and that Bruce will need a tailored service to support a return to work that is durable and sustainable. The CM works with providers and the employer to develop coordinate an appropriate plan of services to address all of Bruce needs to help him achieve maximum independence and a sustainable return to work. The providers ensure they work together towards Bruce s agreed goals with an integrated approach. Bruce s plan is to start a progressive return to work that goal orientated, supports self management and can be provided with responsive support if any challenges arise. 28

29 10.5 Case example, Work Readiness Level 1 Roger had lumbar sprain injury 2 months ago. Roger was working in a very heavy manual work type and his employer has been unable to keep the job open. The treatment approach has been conservative with physiotherapy and the final report advises that Roger s progress has reached a plateau and he has a home programme, he has a good level of cardiovascular fitness and is unlikely to make any further significant gains. The physiotherapy report also advises that Roger had some difficulty with managing his pain however in the last weeks this has improved. Roger has had previous back claims and the medical information and other advice received indicates that it is unlikely he will be able to return to the same heavy work type. The IOA & IMA agree with this opinion and also identifies a number of other suitable work types that could be medically sustainable. These identified work types would require Roger to use Eftpos and some computer systems he is unfamiliar with. Roger appears to be struggling to accept that he needs to look at alternative work options as he has been in manual labour all his working life to date but is willing to accept help to find other work. The claims manager refers Roger to the work readiness service as Roger is intending to seek jobs identified in the IOA/IMA and as he has been in the same job for 6 years, he will require assistance with updating his CV and job search techniques. Roger would also benefit from a work trial to learn and practice Eftpos skills. Considering that Roger s level of fitness is satisfactory, his pain management reasonable and the nature of the up-skilling required, the claims manager refers Roger to Level 1. The claims manager proposes that the work readiness goal will be achieved in six weeks. The vocational rehabilitation provider meets with Roger and develops a plan agreeing that work readiness will be achieved within 6 weeks. Roger is provided with a CV, job search techniques including some coaching in interview preparation and technique. The provider sources a work trial in an identified work type where Roger has the opportunity to use Eftpos and refresh his customer service skills. The provider modifies the work place environment by trialling a perching stool and matting. The provider encourages Roger to continue with his physiotherapy home programme with it being tweaked to include a couple of exercises specific to the work trial. The provider works alongside Roger to help him effectively utilise his pain management and coping strategies whilst on the work trial. The provider s reports to ACC clearly capture all aspects of the services Roger has undertaken and how they relate to the relevant work types. They also show that Roger has now undertaken the rehabilitation required to demonstrate his work readiness ability. 29

30 10.6 Case example, Work Readiness, Level 3 Levi injured his back whilst lifting 2 ½ years ago. He is an experienced car mechanic who has worked in this role for many years. Levi has tried to return to work a couple of times but each time his pain has become excruciating and he s been housebound for the next few weeks. Levi is reluctant to participate in rehabilitation and leads a quiet life he avoids doing anything different as it makes his pain worse. With time Levi is now of the opinion that he does not think anyone will want to employ him as he is 55 years old and he d rather be under a car than having a job where you need to talk to people. The claims manager determines that a tailored programme of services will be needed to achieve a successful outcome. Recent IOA and IMA assessments have identified that he has unaddressed rehabilitation needs including pain management and physical deactivation and job types that would require a higher level of literacy and basic level of customer services skills. To address the pain issues the CM purchase a Comprehensive Pain Assessment. On review of the assessment and in meeting with Levi the claims manager proposes a plan for Levi to achieve work readiness in 20 weeks. The claims manager refers Levi to pain management providers to implement the recommendations of the CPA - pain medication therapies and pain management psychology and also to a vocational rehabilitation provider to address the other rehabilitation needs to assist Levi achieve his vocational objective.. The vocational supplier develops an integrated plan that incorporates the rehabilitation components needed to achieve the proposed outcome; they agree that the proposed goal is achievable which include functional restoration and management, literacy and communication skills development, a work trial and simulated work activities, and supporting Levi to regain his work ethic. A case conference is held before the programme starts with the claims manager ensuring Levi understands what is expected and that all providers are aligned in their approach. Further case conferences may be arranged for all stakeholders to quickly address any challenges that may arise. Regular progress reports back to ACC advise that Levi s progress is on track to achieve the proposed goal. 30

31 10.7 Case example, Job Brokerage Jane, aged 32, injured her shoulder 4 months ago. It has been diagnosed as a rotator cuff injury and the Specialist is not looking to operate. Jane has been regularly attending physiotherapy however progress has been slow. Jane has recently lost her job as a hairdresser and the Specialist is currently unsure that she will be able to medically sustain fulltime work in this role in the future. The IOA and IMA identify other suitable work types that are medically sustainable for 30 hours per week or more without any further rehabilitation, including salesperson and receptionist. Jane s previous job was in a small salon where she would also cover reception and make sales. Jane lives in the city where there are a number of large hair salons with dedicated reception/salesperson roles. Jane wants to get back to work and keen to explore this option. With Jane s high level of motivation, transferable skills and potential local job opportunities the CM refers Jane for the job brokerage service. The job broker meets with Jane and develops a plan. Jane has not been to an interview for more than ten years and is nervous about the process and questions she may be asked. The Job Broker develops a CV and coaches Jane on the interview process, including running through questions and answers. The Job Broker through established networks directly approaches salons to search out opportunities. One salon has a vacancy opening up in a couple of weeks, which they have not yet advertised. The Job Broker provides Jane s CV and she is offered an interview; with the Job Broker ensuring Jane is feeling confident before the interview. Jane is offered the role. The Job Broker makes sure Jane is confident in starting in the role; no modifications are required and follows up with Jane/employer once she has stated to ensure all is going well. 31