ONTARIO ASSOCIATION OF SOCIAL WORKERS (OASW) ROLE STATEMENT AND PROCEDURES FOR SOCIAL WORKERS TO GUIDE ASSESSMENTS AND TREATMENT

Transcription

1 ONTARIO ASSOCIATION OF SOCIAL WORKERS (OASW) ROLE STATEMENT AND PROCEDURES FOR SOCIAL WORKERS TO GUIDE ASSESSMENTS AND TREATMENT IN AUTOMOBILE INSURANCE SECTOR Final February 2012

2 OASW ROLE STATEMENT AND PROCEDURES FOR SOCIAL WORKERS TO GUIDE ASSESSMENTS AND TREATMENT IN THE AUTOMOBILE INSURANCE SECTOR PURPOSE The purpose of this document is two-fold: to outline the various roles that social workers play in working with individuals and families who have ongoing psychosocial issues related to disability following a motor vehicle accident (MVA) and to articulate the required skills and knowledge necessary to fulfill these roles. The role statement and procedures have been developed by the Ontario Association of Social Workers (OASW) in consultation with social workers who provide services in the field of rehabilitation under the Insurance Act. This document draws upon social work research, clinical practice and the Ontario College of Social Workers and Social Service Workers (OCSWSSW) Code of Ethics and Standards of Practice Handbook, Second Edition, The appendices include the following documents: How to Use This Document (Appendix A) Proposed Content of Social Work Assessment Report (Appendix B) Proposed Content of Social Work Treatment Report (Appendix C) Voluntary Assessment Guidelines for Social Workers Conducting Insurer Examinations (IEs) (Appendix D) Competency Profile for Social Workers Conducting Insurer Examinations (IEs) and Roster, (effective January 1, 2012). SERVICES PROVIDED BY SOCIAL WORKERS Social workers in the automobile insurance sector focus on assessment and treatment of individuals and families who experience disability as the result of injuries sustained in a motor vehicle accident. These include but are not limited to: Brain Injuries Spinal Cord Injuries Pain Disorders including whiplash, chronic pain Psychological Trauma Complex Orthopedic Injuries. Social workers provide services to MVA claimants and their families in acute care and rehabilitation hospitals; community-based agencies; family service agencies; rehabilitation OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 2

3 clinics; specialized treatment programs; and private practices using evidence-informed practice principles. Members of the profession perform many roles in this sector and may specialize in: the provision of direct assessment and treatment services (e.g., psychotherapy, psycho-educational service, couple counselling, family and group therapy, community work, vocational rehabilitation and case management services). Social workers may also work directly for the insurer performing specific assessments or insurer examinations. In addition, social workers may be contracted by lawyers to provide specialized assessments or other services. An increasing number of accident claimants and their families, health care professionals, insurers and lawyers are requesting social work involvement. This can be for long-term involvement with clients and families who will require multiple levels of interventions over many years. QUALIFICATIONS The qualifications recommended for social workers who are involved in the assessment and treatment of these impairments and the resulting bio-psycho-social issues include the following: Master s Degree or equivalent in Social Work and Registration with the Ontario College of Social Workers and Social Service Workers (OCSWSSW) Minimum of 5 years of supervised practice in the auto insurance sector post-graduation Continuing education in compliance with the Continuing Competence Program of OCSWSSW to stay abreast of current knowledge and skills for practice in this sector. ADDITIONAL KNOWLEDGE AND SKILLS Social workers in this sector require knowledge and skills in relation to specific social work services provided. Along with a strong clinical background based on evidence-informed practice principles, social workers require an understanding of the litigation process as it relates to their client. Moreover, they must be aware of the duties of an expert and be able to prepare objective and unbiased notes and reports. Furthermore, social workers must be attuned to an array of ethical issues associated with working with extremely vulnerable clients where stakes are high, related to the intertwining of funding, recovery and litigation. The provision of services to this client group is highly complex and requires specialized knowledge and skill sets, beyond those normally acquired through academic education and training provided through schools of social work. Social workers working in this sector also require extensive knowledge of: BSWs working in the MVA sector prior to December 31, 2011, who meet the other minimum requirements, will qualify as insurer examiners and/or service providers under a grand-parenting provision. OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 3

4 The Statutory Accident Benefits Schedule (SABS) under the Insurance Act; Policies and procedures set by the Financial Services Commission of Ontario (FSCO), including familiarity with content provided through the Superintendent Bulletins and Guidelines governing various aspects of procedures; The Health Claims for Auto Insurance (HCAI) system, an electronic platform for claim forms submission; and Issues specific to social work and the automobile insurance sector. ROLE OF SOCIAL WORK Social workers provide valuable and varied services to persons injured in automobile accidents. The scope of social work practice can be described as: the assessment, diagnosis, treatment and evaluation of individual, interpersonal and societal problems through the use of social work knowledge, skills, interventions and strategies, to assist individuals, dyads, families, groups organizations and communities to achieve optimum psychosocial and social functioning. (Ontario College of Social Workers and Social Services Workers Code of Ethics and Standards of Practice, Second Edition, 2008, p. 1) The scope of practice allows social workers to provide a number of services for auto insurance claimants that may include, but are not limited to: Case management Individual and family assessment and intervention Psychotherapy Insurer examination Crisis management and intervention Future care needs and cost assessments Vocational rehabilitation Community linkage Resource counselling Capacity assessments Facilitation of discharge referrals from hospitals to community and between community service providers. Treatment is highly individualized based upon social work assessment. Treatment should be goal and outcome oriented, using evidence-informed practice. It may include: Direct intervention designed to improve psychosocial status of the client. Direct intervention designed to improve psychosocial status of the client s family or significant others. Intervention to create a circle of care (home, school, or work) Assessment to determine the viability of a given strategy or approach Education or consultation with family and other professionals and community support persons OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 4

5 Referral to other professionals for assessment and treatment. TREATMENT EFFICACY The issue of treatment efficacy has gained importance in all areas of health care, inclusive of social work. Accordingly, use of an evidenced-informed practice process in the provision of social work services, is strongly encouraged. This process involves the conscientious, explicit and judicious use of best evidence in making decisions, together with clients, about their care. It integrates the social worker s use of clinical experience and professional judgment together with social work knowledge, research, ethics, an understanding of the client and their social context, and ongoing evaluation of the efficacy of the social work intervention(s) applied. Treatment is appropriate for as long as there is: A clear and achievable rehabilitation goal Demonstrated improvement in the client s functioning or a demonstrated need for continued intervention to prevent regression or deterioration of the client s condition or social isolation Consent to treatment from the client or his/her substitute decision-maker. PROTECTING AGAINST POTENTIAL FRAUD A. To eliminate potential professional identity fraud, OASW recommends that social workers: Do not use electronic signatures Exercise care to protect his/her OCSWSSW registration number by: a. not giving an electronic signature to a facility that you are working with b. ensuring that your name and registration number are removed from the facility s roster with HCAI upon termination of employment or working relationship with the organization/clinic. B. To eliminate potential billing fraud, OASW recommends the following: Ensure that billing for services rendered by your facility accurately reflect hours worked and services provided. Adapted from Haynes, R.B., Muir Gray, J.A., Richardson, W.S., Rosenberg, W.M., & Sackett, D.L. (1996). Evidence based medicine: what it is and what it isn t. British Medical Journal, 31, Retrieved from OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 5

6 APPENDIX A HOW TO USE THIS DOCUMENT The Ontario Association of Social Workers (OASW) role statement and procedures are intended to be used to: Establish consistent practice for the profession working in the MVA sector Guide continuing education endeavors for this area of practice Identify the basic knowledge and skills required to practice competently in this sector and assist in defining issues related to the profession s scope of practice and standards of practice, thereby enhancing the quality of service provided to the public, and Educate hospital administrators, government officials, the insurance industry, consumer groups, and other professionals regarding the role of social workers in assisting MVA survivors, thereby decreasing the further marginalization of these vulnerable clients, who are at heightened risk because of their physical and bio-psycho-social impairments stemming from the accident. Four appendices support the role statement: Appendix B and C articulate the process and activities required by social workers to complete an OCF-18 Social Work Assessment Report and Social Work Treatment Report, and Appendix D and E address the review of OCF-18 Forms completed by social workers as part of an Insurer Examination (IEs). Appendix D articulates voluntary guidelines for procedures for social workers conducting Insurer Examinations (IEs). Appendix E, on the other hand, outlines the minimum academic, skill and knowledge competency requirements for social workers conducting IEs. OASW members who meet this competency profile are then eligible to apply to have their name included in a Roster of social workers listed on the FindaSocialWorker.ca website. OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 6

7 APPENDIX B PROPOSED CONTENT OF A SOCIAL WORK ASSESSMENT REPORT PROCESS Assessment Report Content Summary and Recommendations ACTIVITIES Data to include, but not be limited to: Diagnosis: state medical diagnosis or presenting bio-psycho-social problems provided by other health professionals Demographic information: client name; date of birth, referral and loss Insurance company: name of company and adjuster; policy-holder; claim number; policy number and date of approved OCF-18 Legal representative: name of lawyer and their law firm Additional funding: note any additional third-party funding Treatment team and their affiliation: name, discipline and name of their employer (if not self-employed) Summary of activities related to assessment: reports reviewed and/or interviews conducted Reason for referral: as stated by the referral source and claimant Details of accident and treatment history: summarized from referral documents and/or corroborated by claimant Pre-and post-accident bio-psycho-social history: a) Physical health: diagnosis, current medications, treatment and what claimant reports as concerns b) Family relationships: family dynamics; others living in the home and quality of these relationships c) Significant others: other important people identified by claimant and/or family d) Mental health: adjustment issues, behavioural symptoms e) Environmental issues: housing and standard of living, daily life and activities; ability to get around home and community, etc. f) Employment: brief review of career including implications for planned return to work in same or different position, challenges, etc. g) Education: level of education completed and any plans of return to school h) Recreation and leisure activities i) Financial situation: income, debt j) Community involvement, access to services and/or resources: explore and document concerns; spiritual and cultural influences Main issues as presented by claimant State if they from original reason for referral Summary of findings Long-term treatment goals Short-term treatment goals OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 7

8 Development of OCF-18 for Treatment Treatment Plan Signing State type of intervention Prepare treatment plan with special attention to the following: Ensure Part 6 of OCF-18 reflects appropriate injury and sequelae codes for a social worker to treat (refer to OASW website-codes for Social Work) Choose goals (Part 9: OCF-18) according to client s and clinician s prioritization of greatest disabilities appropriate for social work intervention, etc. Identify anticipated outcomes and how progress will be measured Estimate costs for proposed treatment period in Part 12 Ensure Part 12 of OCF-18 reflects appropriate goods and services codes for a social worker to provide (refer to OASW website-codes for Social Work) Propose treatment length and frequency for period of 3-6 months followed by re-evaluation and updated treatment plan Include time needed for sessions, travel, consultation, preparation, reports and claim form Include brief summary of progress during last treatment plan, if applicable, what goals were achieved and what are continuing and barriers/ challenges that presented during the last treatment plan that delayed goal achievement with note to refer to social work report, if applicable Check to determine whether client has funding through other sources (e.g., employee group benefits plan). Contact selected/assigned health practitioner to review and sign Part 4 of OCF-18 after consent is obtained Review plan with claimant, answer any questions and obtain client signature Obtain claimant consent to use to send OCF118 Sign and submit treatment plan Keep original signed copy on file OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 8

9 APPENDIX C PROPOSED CONTENT OF A SOCIAL WORK TREATMENT REPORT SOCIAL WORK TREATMENT PRINCIPLES TO GUIDE INTERVENTION AND REPORT PROCESS Treatment Principles Treatment Report Content Summary and Recommendations Development of subsequent OCF-18 for Treatment ACTIVITIES Role of social work is multifaceted encompassing: individual and family counselling, group work, vocational rehabilitation, case management, future care costs and needs assessment, and rehabilitation planning. Specific interventions ought to be determined based on the individual social worker s expertise, the client s background and progress. Treatment ought to be based upon evidence-based practice. Social workers need to be aware of funding limits. Data to include, but not be limited to: Social Work Diagnosis: state presenting bio-psycho-social problems as well as diagnosis from other professions, when possible. Demographic information: client name; date of birth, etc. Insurance company: name of company and adjuster; policy-holder; claim number; policy # and date of approved OCF-18 Legal representative: name of lawyer and their law firm Additional funding: note any additional third-party funding Activities during the reporting period Long-term goals as stated in the approved treatment plan Short term goals as stated in the approved treatment plan Progress Barriers to progress Method to help client overcome barriers Main issues addressed Future plans Prepare treatment plan with special attention to the following: Ensure Part 6 of OCF-18 reflects appropriate injury and sequelae codes for a social worker to treat (refer to OASW website-codes for Social Work) Choose goals (Part 9: OCF-18) according to client s and clinician s prioritization of greatest disabilities appropriate for social work intervention, etc. Identify progress, barriers to progress if any, anticipated outcomes and how progress will be measured. Estimate costs for proposed treatment period in Part 12 Ensure Part 12 of OCF-18 reflects appropriate goods and services codes for a social worker to provide (refer to OASW site- Codes for Social Work) OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 9

10 Propose treatment length and frequency for period of 3-6 months followed by re-evaluation and updated treatment plan Include time needed for sessions, travel, consultation, preparation, reports, claim form, etc. Check to determine whether client has funding through other sources (e.g., employee group benefits plan). Treatment Plan Signing Contact selected/assigned health practitioner to review and sign Part 4 of OCF-18 after consent is obtained Review plan with claimant, answer any questions and obtain client signature Obtain claimant consent to use to send OCF-18 Sign and submit treatment plan Keep original signed copy on file. OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 10

11 Appendix D Voluntary Assessment Guidelines For Social Workers Conducting Insurer Examinations (IEs) (effective January 1, 2012) The Ontario Association of Social Workers (OASW) recommends the following Voluntary Assessment Guidelines for Social Workers Conducting Insurer Examinations of OCF-18 Forms prepared by social workers. These guidelines are predicated on the understanding that Social Work Insurance Examiners meet the qualifications articulated in OASW s Competency Profile for Conducting Insurer Examinations (2011). Depending upon the nature of the Insurer Examination (IE) request, either a paper review or an in-person social work assessment of treatment needs will be required. Paper Review (IEs) A paper review can be used to provide an opinion on whether an OCF-18 Form, submitted for a social work assessment or treatment, is reasonable and necessary. In fact, it is the preferred method to make this determination. The following guideline is recommended to assist an Insurer Examiner complete a paper review (IE): Documentation review Telephone interview with the treating provider(s) who submitted the OCF 18 Assessment and Treatment Form.* Telephone interview with the client, if deemed appropriate. Report summarizing information from the relevant documentation provided, summary of telephone interview(s), discussion of apparent psychosocial, vocational and/or case management issues, followed by either: a. Answers to insurer questions, or b. Indication that documentation review and phone interview(s) are inconclusive and in-person, formal social work assessment and treatment are required. In-Person Social Work Assessment (IEs) In-person or direct assessments should always occur if the OCF-18 Form relates to ongoing treatment. If this is the case, the following activities need to be undertaken: Documentation review. Telephone interview with the treatment provider(s) who submitted the OCF-18 Form requesting funding for treatment. In-person social work assessment with the client. Report summarizing results of in-person client and provider telephone interview; review of family relationships and environmental factors which will impact on OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 11

12 recovery, which may include, but are not limited to the following (housing, finances, education, physical and mental health, cognitive changes and availability of supports and resources); provision of any additional background information contained in the IE Paper Review; provision of an overall analysis and synthesis of psychosocial, vocational and/or case management issues, and answering insurer questions. Answer questions that precipitated the IE. * Note: Consent must be obtained for these phone consultations, so until FSCO changes the existing rules for this, the insurer, lawyer or treating provider must obtain this consent. OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 12

13 APPENDIX E Competency Profile for Social Workers Conducting Insurer Examinations (IEs) In keeping with recognized best practices, social work assessment and treatment plans must be reviewed by other social workers, rather than by other health professionals, due to the unique combination of knowledge and skills possessed by members of this regulated profession. It is also in keeping with best practices that social workers providing such second opinions must have a high degree of knowledge and expertise. It is strongly recommended that insurers, IE companies and law firms request that potential social work assessors provide evidence of qualifications in the following areas: Minimum Requirements: Master s Degree in Social Work with 5 years experience, or Bachelor s Degree in Social Work with 5 years experience prior to December. 31, 2011* Member of the Ontario Association of Social Workers Registered with the Ontario College of Social Workers and Social Service Workers Working knowledge of the Ontario College of Social Workers and Social Service Workers Standards of Practice and Code of Ethics Minimum of 5 years experience treating victims of motor vehicle accidents Current practice treating victims of motor vehicle accidents (at least 25% of clinical practice devoted to MVA cases) Working knowledge of the OASW Assessment and Treatment Guidelines for Social Work Practice in the MVA Sector (to be developed by January 2012) Working knowledge of the Statutory Accident Benefits Schedule (SABS) Evidence of ongoing professional development of clinical knowledge and skills relevant to the practice area Evidence of ongoing professional development related to the SABS and the Insurance Act Malpractice/Liability Insurance To assist insurers, IE companies, law firms and the general public, the Ontario Association of Social Workers (OASW) maintains a database of assessors who have submitted evidence of their qualifications and experience. Please note that this is a roster of IE assessors only. There are many treatment providers who also have these qualifications, but who do not complete IEs. BSWs working in the MVA sector prior to December 2011, who meet the other minimum requirements, will qualify as insurer examiners under a grand-parenting provision. OASW Role Statement and Procedures for Social Workers to Guide Assessments and Treatment in Automobile Insurance Sector 13