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Canberra Hospital and Health ServicesOperational Procedure Community Rehabilitation Team (CRT) Eligibility and PrioritisationContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Service Profile.........................................................................................................2

Section 2 – Eligibility for CTR services.......................................................................................3

ACT Residency.......................................................................................................................4

Private Clients....................................................................................................................... 5

Related Policies, Procedures, Guidelines and Legislation.........................................................5

Definition of Terms...................................................................................................................6

Search Terms............................................................................................................................ 6

Attachments..............................................................................................................................6

Appendix 1 – Community Rehabilitation Team Prioritisation of Clients...............................7

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Purpose

This procedure procedure describes the CRT service, which clients are eligible for the CRT service, and how these clients are prioritised by the disciplines of the CRT according to clinical need. This PROCEDURE is intended to ensure equitable access to appropriate services in terms of clinical skill and knowledge.

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Scope

This procedure pertains to staff working within RACC CRT and clinicians/individuals referring clients to RACC CRT. This procedure uses ‘clients’ as an inclusive term to include all adults who are eligible to access RACC CRT services.

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Section 1 – Service Profile

CRT is a specialised multidisciplinary allied health team. It provides goal-orientated, time limited rehabilitation services to clients residing in the ACT community and assists clients in achieving and retaining optimal functional independence while facilitating their reintegration into the community. Clients consist of adults with neurological conditions or amputations. CRT aims to: improve clients’ functional capacity; improve clients’ understanding of their condition; retrain lost or impaired skills; support psychosocial functioning and enhance psychological well being, particularly as it

pertains to rehabilitation; prevent deterioration of function.

CRT employs a multidisciplinary approach to these aims. Clients are individually assessed and goal-directed treatment plans are implemented in partnership with the client, and their carers if relevant. Due to the functional benefits of ongoing maintenance programs for clients with long-term disability, these clients are referred to general community-based services where possible.

This eligibility procedure applies to the following disciplinary teams with CRT: physiotherapy; occupational therapy; speech pathology; social work; rehabilitation coordination; disability counselling; clinical psychology;

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neuropsychology; allied health assistants, and Vocational Assessment and Rehabilitation Service (VARS).

CRT works closely with other RACC services such as Driver Assessment and Rehabilitation Service (DARS), Exercise Rehabilitation Service (ERS), Prosthetic and Orthotic Service (P&O), Falls & Falls Injury Prevention, the Rehabilitation Nurse Practitioner and Rehabilitation Medicine. This procedure does not apply to these services.

CRT members and associated assessment clinics are located at a variety of sites including Phillip Health Centres, Village Creek and The Canberra Hospital. Services are provided predominantly from health care settings, however treatment in the home is provided for those clients who are not able to attend a health centre and/or where an assessment and/or intervention in the home environment is an appropriate component of therapy. Services may also occur in other community settings such as community gyms or workplaces.

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Section 2 – Eligibility for CTR services

Clients are considered suitable for referral to CRT if they are 18 years of age or older, are resident of the ACT (see below) and present with clinical needs related to the following diagnoses: Recent stroke (<2 years); spinal cord injury – for 18 months post discharge from an inpatient rehabilitation facility

(unless referred via a rehabilitation specialist for spasticity management); recent traumatic or non-traumatic brain injury (< 2 years); upper limb or lower limb amputation (refers to major amputations affecting function

not fingers or toes); chronic (progressive) neurological condition e.g. Multiple Sclerosis, Motor Neurone

Disease, Parkinson’s Disease/Syndrome where the primary aim of referral is for a multidisciplinary package of treatment for a functional change i.e. NOT when there is a single defined issue such as equipment review, housing modification, or pressure injury;

clients with chronic stroke or traumatic brain injury (i.e. > 2years) will require a review with rehabilitation medicine prior to being accepted by CRT to ensure appropriate investigation of any recent functional difficulties that have led to a referral to CRT.

In addition to the clients described above, VARS will also accept referrals for: Clients with chronic pain . Clients aged 13 – 17 years with one or more of the above conditions. Clients who reside outside of the ACT where no equivalent service is available.

All VARS clients must have an interest in engaging with vocational rehabilitation. Further detail is contained within the VARS Standard Operating Procedures.

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The following clients are not eligible for CRT and are able to have their needs better met by other ACT Health services or by external agencies.

Clients who: are 17 years age or younger; require ongoing allied health input for a program to maintain (rather than improve)

their level of function, or are a resident in high level care facilities or in respite; have musculoskeletal pathologies (e.g. arthritis, connective tissue disorders, Complex

Regional Pain Syndrome); have severe behavioural disturbances; have acute unstable medical conditions; have mental health conditions that are unstable and need specialised/intensive mental

health services; have a permanent disability as a consequence of traumatic brain injury or disease

process sustained from birth to age 18 years; have a primary presenting issue unrelated to their coexisting neurological condition,

amputation or complex traumatic musculoskeletal pathology.

Clients who are receiving an Extended Aged Care at Home (EACH) package are not eligible for ‘maintenance’ health services (i.e. those designed to minimise deterioration in function). However, they are eligible for services following injury, surgery or trauma.

Clients who present with a concurrent clinical need while receiving a CRT service for their primary presenting issue will not necessarily be referred to an additional service provider if the CRT service can meet their need e.g. client receiving CRT physiotherapy after a stroke who also has a strained knee joint may be managed by the same CRT physiotherapist. However, if the client requires specialist services that are better provided outside CRT, the client will be referred appropriately. Clients whose needs may be better met by other ACT Health Directorate services will be referred via Community Health Intake.

Clients who are receiving ongoing neurological rehabilitation from a service provider other than RACC CRT (when referred) will not be eligible to enter the multidisciplinary CRT service for rehabilitation. This is to ensure the continuity and co-ordination of a client’s rehabilitation is provided for the greatest benefit to their recovery and progression. ACT ResidencyClients referred to CRT must be an ACT resident. This includes those who reside in the following accommodation: private or public housing; hostels; group homes (not including those funded for DHCS), or residential homes, including nursing homes.

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Temporary ACT residency is acceptable and must be registered in the ACT Patient Administration System (ACTPAS). CRT does not see clients who are residents of NSW, except in exceptional circumstances, in collaboration and discussion with the discipline managers and CRT Team Leader.

Private ClientsClients with the ability to access appropriate private allied health rehabilitation services (under Department of Veterans’ Affairs (DVA), private ancillary health insurance, Third Party Liability or Worker’s Compensation) are encouraged to consider other options for service at the point of intake and may be directed to the DVA Network or the Yellow Pages. However, clients may choose not to access private services, and are not refused access to CRT in these circumstances.

Clients with the intent to claim for Third Party Liability or Worker’s Compensation (or for whom liability is not yet accepted by the insurer) are eligible for the service and are advised that their insurer will be invoiced in the event that their claim becomes accepted.

CRT does not see clients who do not meet the above eligibility criteria, except in exceptional circumstances, in collaboration and discussion with the discipline managers and CRT Team Leader.

Outcome Measures All clients accessing CRT meet the eligibility criteria.

Method The RACC ‘Intake Team’ will undertake a yearly audit of clients referred to and accepted

by CRT to ascertain if 100% of clients have met the CRT eligibility criteria.

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Related Policies, Procedures, Guidelines and Legislation

Legislation Health Professionals Act 2004 Workplace Privacy Act 2011 Health Records Act 2001

Policies Interprofessional Learning, Education and Practice RACC Intake Referral Management Procedure Vocational Assessment and Rehabilitation (VARS) PROCEDURE(NB: all documents to be found on the ACT Health, Policy and Plans Register)

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Definition of Terms

Prioritisation – ACTPAS Category codes 2a, 2 and 3 (ACTHEIM Metadata draft Priority Categories Version 21/06/2007)RACC – Rehabilitation, Aged and Community CareVARS – Vocational Assessment and Rehabilitation ServicesCRT – Community Rehabilitation Services

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Search Terms

Community Rehabilitation Team Eligibility and PrioritisationBack to Table of Contents

Attachments

Appendix 1 – Community Rehabilitation Team Prioritisation of Clients

Disclaimer: This document has been developed by Health Directorate, Rehabilitation Aged and Community Care, Community Rehabilitation Team specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

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Appendix 1 – Community Rehabilitation Team Prioritisation of Clients

In general, CRT prioritises clients who are at risk of an adverse health outcome if a service is not provided in a timely manner. This may include, but is not limited to, clients who are at risk of: Falls, Pressure injuries, Avoidable admission to hospital or other care facilities, Aspiration, Significant psychosocial distress (including job loss), and/or Their carers being at risk of injury or psychosocial distress.

The priority categories are defined as follows: Category 2a: Contact within 48 hours. Allocated when the persons safety is at risk or

there is likelihood that the person will be hospitalised or required to leave their current residence. This may be due to a crisis in the home involving either the client or carer or a sudden change in the client/carer’s medical, physical, cognitive or psychological status.

Category 2: Contact within 3 to 14 days. Allocated when information available indicates the client is not at immediate risk of harm but a progressive deterioration of the client’s physical, mental or functional status, or their level of care currently available does not meet the client’s needs or is not sustainable in the long term.

Category 3: Routine priority, where delayed treatment will not result in an adverse health outcome (>14 days).

(ref: ACAT Referral Priority PROCEDURE)

The referrer and RACC Intake may assist in identifying the level of client priority. However this decision ultimately lies with the lead health professional for the discipline. Clients whose needs require a quicker response time than that which is indicated by their priority are discussed with the discipline-specific senior staff member and CRT Team Leader.

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