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ACC Waikato

VIEWS: 16 PAGES: 32

									Concussion
  Service




           Service Schedule

   Operational Guidelines

                        July 2010




This is a living document and will be updated as required
                              Concussion Service – Operational Guidelines

Contents

Introduction to Concussion Services ................................................................. 1
    Contract changes and transitional instructions..................................................... 1
    Purpose and philosophy of the Concussion Service ............................................... 2
    Useful contact numbers .................................................................................... 2


Expectations ...................................................................................................... 3
    Provider responsibilities .................................................................................... 3
    Referrer responsibilities .................................................................................... 4
    Client responsibilities ....................................................................................... 4
    ACC responsibilities ......................................................................................... 4
    Communication protocols ................................................................................. 5


About the Service .............................................................................................. 6
    Service flow diagram ....................................................................................... 6
    Referring a client ............................................................................................. 7
    Maximum funding limit ..................................................................................... 9
    Maximum duration .......................................................................................... 10
    Timeframes ................................................................................................... 10
    Service location .............................................................................................. 10
    Provider approval process ................................................................................ 10
    Stage 1 – education, risk assessment, and planning ........................................... 11
    Stage 2 – clinical assessment and treatment ...................................................... 13
    Client non-attendance ..................................................................................... 15
    Client exit ...................................................................................................... 16
    Post-service client support ............................................................................... 17
    Not included in the service ............................................................................... 17


The ACC884 Statement of Outcome Form ......................................................... 17


Monitoring Service Performance and Developing Best Practice ........................ 18
    Annual targets and best practice ...................................................................... 18
    Quarterly service monitoring ............................................................................ 18
    Reporting template ......................................................................................... 21


Invoicing for Travel and Services ..................................................................... 22
    Invoicing for travel ......................................................................................... 22
    Invoicing for services ...................................................................................... 24


APPENDICES ..................................................................................................... 25
    Appendix 1: Biopsychosocial model ................................................................... 25
    Appendix 2: Continuum of care model ............................................................... 27
    Appendix 3: Risk assessment matrix ................................................................. 28



                                                   January 2010
                           Concussion Service – Operational Guidelines

Introduction to Concussion Services

Contract changes and transitional instructions

The Concussion Service (CS) contract has replaced the Mild Traumatic Brain Injury (MTBI)
contract, which operated in the community as the Concussion Clinic until June 2010. Most of the
service provision is the same but the clinical cover has been extended to include moderate
traumatic brain injury (TBI).


The Concussion Service involves two stages:
   Stage 1: Education, risk assessment, and rehabilitation planning
   Stage 2: Assessing for treatment and providing treatment.


Note:
Stage 1 assessment may show that Stage 2 treatments are not needed.


Transitional instructions from MTBI to CS for 1 July 2010
From 1 July 2010 all clients currently in the Mild Traumatic Brain Injury Service (MTBI) are to be
transferred to the Concussion Service. Any services will be paid for under the new contract.


All current contract holders of the MTBI Service (Concussion Clinics) will review and identify any
clients who require further services.


  If…                                    then…

  the MTBI vendor now holds a new        the vendor should contact the case manager to arrange
  Concussion Service contract            for a new purchase order to be created.


                                         The new purchase order should have the number of
                                         services approved under MTBI. The new service item
                                         codes will reflect the intended types of service approved
                                         under MTBI.
  the vendor does not have a             the vendor can use the existing purchase order with
  Concussion Service contract and        MTBI codes and complete the service.
  the remaining services can be
  completed during July 2010
  the vendor does not have a             the vendor should contact the case manager to arrange
  Concussion Service contract and        for the client to be transferred to a contracted provider.
  the remaining services cannot be
  completed during July 2010




July 2010                                                                               Page 1 of 30
                           Concussion Service – Operational Guidelines


Purpose and philosophy of the Concussion Service

Purpose
The purpose of the service is to:
      provide early intervention rehabilitation to support clients‟ recovery and prompt return to
       everyday life, including work or school
      identify clients who are likely to develop long-term consequences, such as post-concussion
       syndrome (PCS), and provide them with effective interventions and education.


Philosophy
The Concussion Service has three core philosophies.


      Individual needs
       Each person who receives a brain injury responds differently due to a number of factors.
       These differing rehabilitation needs mean that ACC and providers will adapt services to get
       the best rehabilitation outcomes.


      Interdisciplinary team
       The Concussion Service is provided by an interdisciplinary team specialising in treating
       mild to moderate traumatic brain injuries. It includes assessments and treatments that
       enable providers to help clients achieve a long-term recovery where they no longer need
       support from ACC.


      Relationships
       ACC and providers work together to foster client rehabilitation. This is achieved by
       maintaining close working ties through good communication, respecting each other‟s areas
       of expertise, and fully engaging clients in their own recovery process to ensure they get
       the services they need.


Useful contact numbers


  Provider helpline                  Health Procurement                    Inquiry Service
  Ph: 0800 222 070                   Ph: 0800 400 503                      Centre (ISC)

  providerhelp@acc.co.nz             health.procurement@acc.co.nz          Ph 0800 101 996

  The provider helpline staff can    Health Procurement can advise         For general enquiries,
  answer queries relating to         on appropriate documentation in       ISC will answer your call
  provider numbers, ARTP             relation to applying for contracts.   and refer you for further
  updates and general enquiries.                                           assistance if required.




July 2010                                                                               Page 2 of 30
                           Concussion Service – Operational Guidelines



Expectations

Provider responsibilities

The provider is responsible:


  to…          for…

  clients         providing services in a prompt and timely fashion, for example:
                   -   making the first appointment within 2 days of the referral being received
                   -   holding the first appointment within 5 days of the referral being received
                  promoting the client‟s self-management and active participation in the
                   rehabilitation process
                  providing high quality assessments and treatment services
                  conducting services only when clinically necessary
                  ensuring the client‟s family and whanau are included, where appropriate.

  ACC             nominating a provider to have primary contact with ACC
                  acting in a timely way to maximise the client‟s rehabilitation outcome and
                   minimise weekly compensation costs
                  maintaining all timeliness requirements as outlined in the service specification
                  maintaining agreed contact with the case manager (weekly, fortnightly or
                   monthly) to discuss changes or developments, eg the client‟s reduction or
                   increase in symptoms, work readiness, social, family, or financial issues etc,
                   to help ACC support the client
                  giving ACC a copy of any clinical information provided to the GP
                  maintaining high quality clinical notes to:
                   -   support and verify any risk assessment or Statement of Outcome form
                   -   provide clinical information to aid decision-making for ACC and other
                       providers as appropriate
                  operating the service within the terms and principles of the Concussion
                   Service contract and these Operational Guidelines.

  referrers       providing timely relevant clinical information to support the overall care of
  (GPs)            the client such as:
                   -   assessment and treatment programmes including medication
                   -   rehabilitation plans for return to work
                  recommending return to work time frames.

  other           maintaining good working relationships based on respect for each other‟s
  service          area of focus
  providers       providing and receiving information appropriate to the situation and need.




July 2010                                                                               Page 3 of 30
                             Concussion Service – Operational Guidelines
Referrer responsibilities

The referrer has a responsibility to only refer clients who need and will benefit from the
Concussion Service. The client should have signs and symptoms of mild to moderate traumatic
brain injury (TBI) or post-concussion syndrome (PCS). The referrer is expected to complete and
submit an ACC883 Concussion Service Referral form for approval. However, other formats for the
request are acceptable if the information requested on the ACC883 is given.


Client responsibilities

The client is responsible for:
      attending scheduled appointments or reorganising them when unable to attend
      participating in the rehabilitation process
      discussing any problems that may hinder their recovery with their case manager and
       provider.


ACC responsibilities

ACC is responsible:


   to…                for…

   clients               ensuring they get the appropriate services and support to help them
                          rehabilitate and return to everyday life, including work or school
                         making decisions in a timely, prompt, efficient, and effective way

   service               making prompt decisions based on the available information or, if the
   providers              information is unavailable, investigating as appropriate
                         operating in partnership with the provider to rehabilitate the client
                         keeping the provider informed of any delays or issues that may impact
                          on service provision
                         following up with the provider if they have not been in touch
                         seeking clarification from the provider if progress and outcomes are not
                          being achieved

   referrers (GPs)       confirming the acceptance or decline of the referral
                         keeping the GP informed of the client‟s progress

   employers             keeping them up to date with the client‟s rehabilitation process and
                          encouraging them to keep the client‟s job open

   other service         keeping them informed of any relevant information for coordinating the
   providers, eg          rehabilitation process.
   Stay at Work
   or other
   vocational
   programmes




July 2010                                                                                 Page 4 of 30
                            Concussion Service – Operational Guidelines


Communication protocols

Relationship expectations
The rehabilitation partnership between the provider and the case manager is one of the most
important tools for ensuring the recovery of the client. The client‟s rehabilitation will be enhanced
by the provider and case 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:
      providers and ACC staff will work together to rehabilitate the client
      both parties will respect each other‟s area of expertise
      providers are experts in the rehabilitation of brain-injured clients and are responsible for
       achieving the service outcome for the client within the context of the Concussion Service
       (as defined in the services specification)
      ACC staff are expert at managing the complex mix of rehabilitation, entitlements, and
       compliance relating to claims
      ACC is ultimately responsible for funding rehabilitation services.


The vendor 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 vendor in service performance discussions
      inform ACC promptly when any contact details change.


Communicating instead of reporting
Formal written clinical reports are not purchased in this service. The assessments determine the
client‟s requirements for the Concussion Service and are not intended to determine cover or
entitlement, although they may confirm diagnosis. Instead, providers are asked to convey to ACC
information that supports appropriate fact-based decision-making.


The reporting structure in the Concussion Service highlights the importance of effective
communication between ACC and the provider.


Phone calls and emails should cover the following topics:
      the client‟s current status
      the potential recovery timeframe/ plan
      the impact on other issues for the client
      any recommendations or needs the provider may have.




July 2010                                                                               Page 5 of 30
                                        Concussion Service – Operational Guidelines

About the Service

Service flow diagram

The following flow diagram explains the workflow process.



                                                            Referral from                      ACC Self
                                                             ED or GP                          Referral


                                                                         Must be at least
                                                                        10 days after injury




                                    Criteria Based Acceptance                   Branch             Criteria Based Declined

                       Education,
                                                                                              Recovered                      End
                   Risk Assessment &
                  Rehabilitation Planning
                     (Up to 3 hours)

                                                                       Statement of Outcome
                                                                             Recommendation                    Recovered


                                                                            Not Recovered


                                                                                Branch


         Recommend to:                                                                                    Recommend to:
         - Stay in Concussion Service                                                                     - Exit Concussion Service
         - Provider led within funding maximum.                                                           - ACC manages Client services
         - Risk assessment by Provider                                                                    (More targeted ongoing service provision)
         - Select a variety of services within Rehab Plan
         - ACC prior approval
         (Limited services to achieve outcome goal)




            Recommend and Deliver from a selection
                                                                                                                 Other ACC Treatment and
                  of Concussion Services
                                                                                                                   Rehabilitation Services
                                                                                                           - Neuropsychological Assessment
            Assessment Services                                             Not Recovered
                                                                                                           Service
            - Neuropsychological Assessment
                                                                                                           - Clinical Services contract
            - Medical Assessment
                                                                                                           - Psychological Counselling Service
            - Allied Health Assessment                                 Statement of Outcome                - Physiotherapy contract
            - Other Speciality Assessment                                    Recommendation
                                                                                                           - Training for Independence
                                                                                                           - etc
            Treatment Services
            - Psychological Counselling                                       Recovered
            - Medical Consultation
            - Allied Health Services
            - Did Not Attendance Fee not included                            Concussion
                                                                            Services Cease




July 2010                                                                                                                                   Page 6 of 30
                            Concussion Service – Operational Guidelines


Referring a client

The referral form
Use the ACC883 Concussion Service Referral form to refer a client for the Concussion Service. The
ACC883a Completion guide which shows how to fill out the referral form, and all other Concussion
Service forms are located at For Providers > Publications > Concussion Service.


Who can refer?
Registered medical practitioners refer clients to the Concussion Service by sending the ACC883
form to the local ACC branch for consideration.


Clients can also be referred to the Concussion Service by their case manager if they consider that
the client may have sustained a TBI. In this case the case manager also completes the ACC883
form to ensure the provider receives consistent information. If there has been no diagnosis of the
TBI by a medical professional, the provider is expected to request a medical assessment to
confirm the diagnosis in Stage Two.


If the referral is accepted ACC will notify the client directly. The ACC883 form is faxed to the
provider to start the Stage One service. If the claim is declined, ACC will notify the referrer and
the client.


Who cannot refer?
Other clinical professionals such as a physiotherapist cannot refer a client to the Concussion
Service. They may, however, refer a client to a registered medical practitioner for a medical
assessment, after which the client may be referred to the Concussion Service.


Client eligibility
The client can access the Concussion Service by either being referred by a medical practitioner or
an ACC case manager. The client must be referred at least 10 days after the injury so there is
some healing, and the client cannot be referred if the injury was more than 12 months before the
referral and any subsequent treatment. To be referred by a medical practitioner the client:
      must have an accepted ACC claim, and
      must be diagnosed with mild TBI, moderate TBI or post-concussion syndrome, and have
       ongoing signs and symptoms such as:
       -    mood changes
       -    memory problems
       -    fatigue
       -    difficulty concentrating
       -    loss of balance
       -    headaches
       -    visual disturbances
       -    nausea
       -    muscular aches.




July 2010                                                                               Page 7 of 30
                               Concussion Service – Operational Guidelines


To be referred by the case manager the client must be considered to have been likely to have
received a traumatic brain injury and would benefit from this service.


The criteria for „likely‟ are:
      The mechanism of injury indicates that the head and brain has been moving and then
       stopping rapidly, eg in
       -      a motor vehicle crash
       -      sports injury.
      The client has not recovered as expected because:
       -      of a prior head injury
       -      they are elderly and have had falls
       -      they are a child and have had a fall.


„Would benefit‟ means:
      The early education component would help the client cope with the immediate impacts of a
       brain injury
      The assessment process would clarify the existence of a brain injury either:
       -      supporting the client‟s ongoing need for services, or
       -      identifying that the symptoms reported by the client are not brain injury-related.


Clinical diagnosis - severity of injury
Clients diagnosed with a mild or moderate Traumatic Brain Injury (TBI) are suitable for the
Concussion Service. The table below is used to categorise TBI acutely.


                                                                 Duration of post-traumatic
    Severity of injury         Glasgow coma scale (GCS)
                                                                       amnesia (PTA)

             Mild                         13-15                              <24 hours

           Moderate                       9-12                               1-6 days

            Severe                         3-8                          7 days or more

(Source: Evidence best practice guideline – traumatic brain injury: diagnosis, acute management
and rehabilitation 2006 (TBI Guidelines)


Note:
Where the GCS and PTA do not correlate then the client will be assigned to the greater of the two
severity categories. Example: A client has a GCS score of 14 and also experiences PTA of 2 days.
Based on the more severe indicator (PTA of two days) the client is considered to have a moderate
TBI.


The diagram below compares the severity table from the TBI Guidelines and ACC‟s National
Serious Injury Service (NSIS) management and Concussion Service coverage.




July 2010                                                                                Page 8 of 30
                                Concussion Service – Operational Guidelines


          NZ TBI Guidelines                         Severe                                  Moderate                        Mild

         Glasgow Coma Scale          3       4       5       6      7        8          9    10      11       12       13       14      15
       Post Traumatic Amnesia                    7 days or More                             1 – 6 days             Less than 24 hours


                                                                                 Concussion Service Coverage
                                                                                 Any overlap of clients will be referred where needed

                                                    Severe                                                         Old MTBI Service
         ACC Serious Injury      GCS 8 and under, assess post resuscitation or
                                       on admission to an A & M Dept.                                                  Coverage

                                                                           Mod.

        Glasgow Coma Scale          3       4        5       6     7        8       9       10      11       12       13       14       15
       Post Traumatic Amnesia                    PTA 8 days or More                                                Less than 24 hours

                                                                         PTA Up to
                                                                        and including
                                                                           7 days




Injuries that show a severe TBI will be managed by the NSIS group. Injuries that have a GCS
greater than 9 and a PTA of fewer than 7 days will be managed by a case manager in a branch.
However, the NSIS may refer moderate clients to the Concussion Service if their injuries have a
GCS score of 8 or 9, and a PTA up to and including 7 days.


If notification of a TBI has been delayed but is less than 12 months after the injury, branch staff
will check both the GCS and PTA, where provided, and any other information such as clinical
notes, to review the concussion symptoms and decide if it is appropriate for the client to receive
the Concussion Service.


Maximum funding limit

The Concussion Service has a maximum funding limit of $2,800 plus a single Did-Not-Attend
(DNA) fee. ACC will approve services up to that limit based on the risk assessment completed by
the provider. The risk assessment is provided after the first three hours of consultation in Stage 1
(TBI21) and identifies factors that may affect the client‟s ability to recover.


For further treatment within the Concussion Service to be approved:
        services must be requested on the ACC884 Concussion Service - Statement of Outcome
         form
        services must be provided within the maximum funding limit of $2,800
        the risk assessment must show an increase in the client‟s risk factors that warrants further
         treatment.


The vendor is responsible for ensuring that the maximum funding limit is not exceeded. The
vendor and ACC determine the best service provision together. If the vendor and ACC do not
agree, ACCis responsible for the final decision and for the client‟s rehabilitation outcome. The
maximum service limit does not include travel costs or the single payment for non-attendance by
the client.


July 2010                                                                                                               Page 9 of 30
                            Concussion Service – Operational Guidelines


Maximum duration

The maximum duration for services is 12 months from the date of the referral to the last
treatment date. There is an expectation that providers will work to ensure the client achieves the
service objective described in Section 2 of the contract as quickly as possible.


ACC will monitor client duration and it will be discussed regularly as part of the dialogue between
provider and case manager.


Timeframes

ACC has 2 working days to review the referral and claim information, determine whether the client
is entitled to the Concussion Service and then forward the form to the provider. If ACC declines
the referral the referrer and the client will be notified within 5 working days.


The provider has 1 working day to confirm the acceptance or decline of the Concussion Service
referral. This allows ACC update the client‟s record and, where the referral was declined, make
other arrangements for services.


Service location

ACC prefers vendors to provide services in a location that best meets the rehabilitation needs of
the client within the current best practice guidelines. This may be the:
      client‟s home, workplace, or other appropriate community location
      vendor‟s facility.


Provider approval process

ACC reserves the right to verify that service providers meet the qualifications and experience
outlined in the Concussion Service contract. To that end the vendor is required to submit a copy of
the provider‟s current annual practicing certificate, full curriculum vitae and, if required, evidence
of educational qualifications to Health Procurement.


ACC will review the documentation and notify the vendor via letter (and email) of the decision
within 7 days.




July 2010                                                                              Page 10 of 30
                            Concussion Service – Operational Guidelines


Stage 1 – education, risk assessment, and planning

The service item code for Stage 1 is TBI21. Once the provider holds that purchase order number
they will meet with the client face-to-face for up to 3 hours to assess them. The provider can
determine the best way to allocate this time, eg 3 x 1 hourly sessions, 6 x 30 minute sessions, 2 x
1 hr 30 minute sessions, or 1 x 3 hr session.


Note:
Travel time and distance must be kept to a minimum so the provider will need to show a clear
clinical need for 6 x 30 minute sessions rather than 3 x 1 hour sessions.


TBI21 is provided by highly experienced allied health providers such as:
      occupational therapists
      physiotherapists
      speech therapists
      registered nurses with a rehabilitation specialty.


In the assessment the provider will:
      educate the client (and family/whanau) about concussion
      identify any barriers (or risks) to the rehabilitation process by doing a risk assessment (see
       Appendix 3: Risk assessment matrix on pg 27)
      identify the client‟s needs and develop a rehabilitation plan
      notify ACC of the outcome of stage 1 and, if required recommend any further services on
       the ACC884 Statement of Outcome form and send it to ACC.


The client should receive TBI21 as soon as possible after referral to get the benefit of the injury
and rehabilitation education. Research indicates that early education reduces the incidences of
post-concussion syndrome and improves the client‟s recovery.


Education
The education given to the client and their family should be clear and easily understood. It must
cover, but not be limited to, the following items:


  Symptoms                                  Rehabilitation process

      describe the symptoms                   rehabilitation response
      describe the recovery journey           how it‟s different for everyone
      describe the treatments that will       self-management
       target the individual symptoms          help from family and friends
      cover lifestyle responses and           provider support via an interdisciplinary team
       dealing with stress
                                               getting back to normal functioning – having
                                                realistic expectations
                                               returning to work if appropriate




July 2010                                                                              Page 11 of 30
                            Concussion Service – Operational Guidelines



  Brain injury                              Other support (where appropriate)

     structure of the brain                   Other ACC services available
     mechanism of injury                      working with the case manager
     acute response                           working with the employer


The provider should explain the partnership between the provider and the ACC case manager in
the client‟s rehabilitation.


Risk assessment
The risk assessment is a key tool in the communication between the provider and ACC. It seeks to
categorise the client within the four main groups - physical, psychological, work, and social. The
1-5 rating system identifies where there is little to no impact on the client‟s rehabilitation (1) to
where there is a significant impact in the client‟s rehabilitation (5). The risk assessment matrix is
described in detail in Appendix 3: Risk assessment matrix on pg 27.


The provider interviews the client to identify and document the client‟s physical, psychological,
work, and social history. This helps identify any barriers to a rapid recovery.


If the provider believes that the accuracy of the risk assessment is compromised by a lack of
disclosure on the client‟s part they may, with the client‟s approval, contact the client‟s family,
friends, and employer and ask relevant questions. The provider must take care to maintain client
confidentiality.


The risk assessment is based on all available information. If risks cannot be identified due to non-
disclosure then the assessment will be at the less complex (1-2). The request for services will
reflect this assessment. The provider should explain to the client that the amount of service
available is based on the information they give.


Note:
While a vendor may choose to have this service provided at a more qualified level, the service will
only be paid at the contract TBI21 allied health rate.


Rehabilitation planning
The provider is encouraged to discuss the client‟s assessment and treatment rehabilitation needs
with other members of the interdisciplinary team where there is an apparent need for further
services. This time is considered to be the responsibility of the vendor. The provider should
complete the ACC884 Statement of Outcome form after planning the rehabilitation.


Additional providers
Services are intended to be provided on the basis of one provider to one client (family included).
Should a vendor decide that two fully qualified and experienced providers will consult and treat
the client at the same time, ACC would expect to be consulted. This is to confirm the clinical
efficacy of that treatment programme and to ensure that a sufficient number of hours has been
allocated. If ACC does not approve, the vendor may still choose to have two providers per contact
hour but ACC will only pay for one provider.



July 2010                                                                             Page 12 of 30
                            Concussion Service – Operational Guidelines


Stage 2 – clinical assessment and treatment

The service item codes used in Stage 2 are TBI22 to TBI28 consecutively.


In Stage 2 the vendor has the opportunity to provide the tailored services identified in Stage 1.
They will:
      assess the client‟s needs in detail
      develop a treatment plan
      provide treatment to help the client fully recover.


Details of individual services are available in the Concussion Service specification.


Purchase orders
The vendor must hold a purchase order that approves the specific service items. The vendor may
provide some or all of the approved services in the order determined by the interdisciplinary team
and based on the identified clinical need.


Available services
Both assessment and treatment services are available. The assessments are done to better inform
the provider of the treatment therapies required.


The provider is not able to trade one service item for another. If the client‟s service needs have
changed, the provider should contact ACC with an amended ACC884 Statement of Outcome form
and negotiate to amend the purchase order.


Clinical reporting
Detailed clinical reporting is not specified in the contract. The provider is responsible for achieving
the rehabilitation outcome and ensuring the client‟s healthcare providers have enough information
to coordinate the client‟s care. ACC requires summary information to show good decision-making
and good communication between the provider and the case manager.


If a client does not achieve the expected rehabilitation outcome the provider must provide a copy
of the clinical notes (including the results of tests) so that other clinical professionals can
understand the treatment regimes and their results.


If a clinical diagnosis of mild to moderate TBI or post-concussion syndrome has not be made prior
to Stage 2, the provider must allow appropriate clinical examinations to be done to make a clear
diagnosis.


Use of time
In the ACC884 Statement of Outcome form the provider will outline a treatment plan based on
current best practice, and recommend the types of services and the amount of hours required.
The provider can determine how that time is to be used.




July 2010                                                                               Page 13 of 30
                           Concussion Service – Operational Guidelines


Interdisciplinary team
The vendor must have an interdisciplinary team of providers with a minimum of two years
experience in acquired or traumatic brain injury (TBI).


The vendor‟s team of providers must include:
      medical specialists with qualifications in neurology or internal medicine with a particular
       focus in brain injury
      clinical neuro-psychologists
      occupational therapists.


The vendor‟s team of providers may also include:
      physiotherapists
      registered nurses, preferably with a rehabilitation speciality
      general practitioners
      speech language therapists.


The vendor may (within the Concussion Service) refer the client to another clinical specialist to
obtain further advice on the client‟s specific rehabilitation needs.


In addition to the vendor‟s interdisciplinary team, they must have access to:
      optometrists
      speech language therapists
      alcohol and drug addiction counsellors
      vocational counsellors
      anger management services
      driving assessment services
      cultural advisors, or services for Maori and Pacific Islanders and other ethnic groups if
       appropriate, which may include interpreting services
      consumer advocacy and support services.


Trainee health professionals
Vendors may use trainees for limited duties with written approval from ACC and with agreement
from the client. The trainee must be directly supervised by a fully qualified provider who is:
      present when the treatment is delivered and takes full responsibility for it
      competent to train and supervise others.


The vendor and the supervising provider remain responsible for ensuring client safety and for
providing quality services.


Note:
Many of our providers are training health professionals by giving them guided experience with
injured clients.




July 2010                                                                              Page 14 of 30
                           Concussion Service – Operational Guidelines


Completing or furthering the service
The ACC884 Statement of Outcome form must be submitted within:
      2 working days when further treatment service needs are requested or
      5 workings days when all services are complete, no further services are required and the
       client is exiting the Concussion Service.


The 2-day requirement recognises that both the provider and ACC want to respond promptly so
the client‟s access to rehabilitation is not restricted. If this response time is not required the
provider can indicate a more appropriate timeframe on the form or in discussion with the case
manager.


The 5-day requirement recognises that the client is no long in need of services and, therefore,
while a timely response is required there is no urgency.


If further services are requested ACC will review the case, make a determination and, if approved,
forward the purchase order within 2 working days. If the continuance is not approved, they will
send decline letters to the client and the provider.


Further concussion services
The provider can request further services at any time after starting Stage 2 by submitting an
updated ACC884 to the ACC case manager. The case manager will use the same assessment
parameters as at the end of Stage 1 services.


The provider will:
      continually evaluate the client‟s need for treatment services throughout the programme
      adapt to the needs of the client
      only provide services for which there is a clinical need.


Other ACC services
The provider may recommend that the client is given access to other ACC services when they
believe it will improve the client‟s recovery. The case manager is responsible for reviewing the
recommendations and deciding if the client is entitled to the services recommended. The provider
will be notified accordingly.


ACC may request clinical notes
Vendors will provide any clinical notes within 5 working days when requested by ACC. This
recognises that there will be some situations where the summary information provided in the
Statement of Outcome form will be insufficient. Vendors are expected to have their client‟s clinical
notes maintained to a high standard and detailing the client‟s status, rehabilitation needs, and all
treatments provided to date.


Client non-attendance

Clients who keep their appointments generally take less time to recover and achieve better
recovery outcomes than those who do not.


July 2010                                                                             Page 15 of 30
                            Concussion Service – Operational Guidelines


Non-attendance paid by ACC
The service item code for non-attendance is TBIDNA and may be used in Stage 1 or Stage 2.


ACC will pay only one non-attendance (DNA) fee per client, no matter how many times they failed
to attend an appointment.


The Concussion Service purchase order is updated for a single DNA fee by the case manager when
the provider:
      sends the case manager an ACC885 Concussion Service - Did-Not-Attend form within
       1 working day of the missed appointment and explains why the client did not attend, and
      has made all reasonable efforts to remind the client of the appointment, such as an
       appointment card, a reminder letter, a phone call the day before and finally a text message
       on the day to the client‟s and a contact person‟s mobile phone.


If the above criteria are met ACC will confirm funding within 2 working days of receiving the form.


The ACC885 Concussion Service - Did-Not-Attend form and ACC885a Completion guide which
shows how to fill out the Did-Not-Attend form, and all other Concussion Service forms, are located
at For Providers > Publications > Concussion Service.


Billing the client for non-attendance
The service relationship is between the client and the provider and ACC plays no part in making
the appointments. Therefore after the first incidence of DNA where ACC has already paid a non-
attendance fee, the vendor may choose to bill the client directly if the client continues to fail to
attend appointments.


The vendor should to alert the client and their supporting family or whanau both verbally and in
writing at the start of the service about the possibility of being charged for non-attendance.


Service exit due to non-attendance
The provider must notify ACC on each occasion of non-attendance. If the DNA fee is not being
paid, notification can be by phone or email. If clients repeatedly do not attend appointments they
can be exited from the service. This may result in all services and entitlements ceasing, including
their weekly compensation.


Client exit

A client exits the service when they have achieved the identified outcomes that enable them to
return to work or school, and/or normal daily living.


Note:
If the client has not achieved these outcomes within the specified timeframe the provider must
make a full comment on the ACC884 form and record whether this is for non-compliance or a non-
injury related factor, eg schizophrenia.




July 2010                                                                              Page 16 of 30
                           Concussion Service – Operational Guidelines


Post-service client support

Ongoing support will be provided to the client throughout the treatment programme and the
vendor will act as a point of contact for a reasonable period afterward. The vendor will contact
ACC and refer the client to their ACC case manager if the client reports new symptoms.


Not included in the service

The following services are not included under Concussion Services:
      Transporting the client to and from the clinic
      Transport from the provider‟s place of residence to the base of operation
      Transport from the base of operation to another base of operation
      Inpatient services for traumatic brain injury
      Elective surgical treatment arising out of any initial assessment
      Social rehabilitation assessments
      Vocational rehabilitation services where there is an identified need for long-term support
      Radiological and other clinical investigations, for example:
       -    computerised tomography (CT)
       -    magnetic resonance imaging (MRI)
       -    electro-encephalogram (EEG)
      Sleep studies.


The ACC884 Statement of Outcome Form

The need for formal reports has been greatly minimised in this service. The ACC884 Concussion
Service - Statement of Outcome form is structured so that providers report on the outcome
attainment. The ACC884a Completion guide which shows how to fill out the Statement of Outcome
form, and all other Concussion Service forms are located at For Providers > Publications >
Concussion Service.


The form summarises the information collected by the provider during the 3 hours spent with the
client. It does not need to give a complete clinical picture of the client as ACC won‟t use the
information to determine the client‟s cover and entitlement to services. It is a communication tool
so that the provider can bring the case manager up to date on the client. In particular, the risk
assessment rating is intended to give the case manager an indication of the client‟s complexity
and risk factors.


A Statement of Outcome form should be submitted when:
      Stage 1 of the Concussion Service is complete
      the client has achieved the agreed outcomes
      further issues to rehabilitation have become apparent
      requesting more services within the Concussion Service
      requesting services from outside the Concussion Service.


July 2010                                                                            Page 17 of 30
                           Concussion Service – Operational Guidelines


Monitoring Service Performance and Developing Best Practice

The Concussion Service is an outcome-based contract. Not only does the vendor have to ensure
that individual clients recover, the overall service has to have a high level of success.


Annual targets and best practice

Annual targets will be based on results for the previous year. In the first year of operation the
service will have nominated targets. The targets help understand best practice service provision.


Annual targets are set with an expectation that the majority of the clients will recover and the
provider will achieve the required outcome. They also recognise that not every client will recover
but this does not automatically mean that the vendor has failed. Overall, ACC and vendors will
identify and improve best practice by monitoring performance through the submission and
analysis of client data.


ACC will issue a report at least annually providing national averages that will show a comparison
of vendor performance. Vendors with the best outcomes at the lowest cost will be studied to
identify their clinical best practice. This information will be shared so other vendors can improve
their practice.


Quarterly service monitoring

Measuring the overall success of the service is done quarterly via a reporting template. Each
provider is required to submit data on all Concussion Service clients who were discharged from
the service in the previous three months. This will form the basis of ACC‟s monitoring and
reporting for this service as the outcome measures. Once the information has been compiled, data
will be extracted from ACC‟s systems, in conjunction with the vendor‟s data, analysed and
reported on. When sufficient data has been collected ACC will produce reports that will be
available to both internal (named) and external (anonymous) parties.


Note:
A client‟s return to work is not necessarily an indicator of recovery because the client may need
continuing support to ensure that they don‟t develop post-concussion syndrome or become overly
stressed.


    Period start        Period finish        Submitted by         Summarised by

    1 July              30 September         31 October
                                                                  ACC will produce
    1 October           31 December          31 January           summarised reports when
    1 January           31 March             30 April             the data is sufficient for
                                                                  robust analysis
    1 April             30 June              31 July




July 2010                                                                             Page 18 of 30
                          Concussion Service – Operational Guidelines


Completing the reporting template
The reporting template is completed from a combination of clinical notes and the ACC884 form.
The templates are mostly completed with pre-selected drop down fields. This ensures that the
information is categorised to allow better analysis. The vendor provides information that is not
easily available to ACC such as risk assessment, pre-injury employment and the client‟s
employment and recovery status at exit. Once the all the spreadsheets have been collated data is
extracted from ACC‟s systems.


  Field name            Data type/content         Description
  Date of discharge     DD/MM/YYYY                Exit date
  Claim number          10 digit – 1000567891     A unique identifier for an accepted claim
  Surname               Alphabetic                The client‟s last name. This is used to
                                                  search should the claim number be
                                                  incorrect.
  Given name            Alphabetic                The client‟s first and second names. This
                                                  is also used to search should the claim
                                                  number be incorrect
  Date of birth         DD/MM/YYYY                The client‟s date of birth. This is also used
                                                  to search should the claim number be
                                                  incorrect
  Work status prior     Drop down selection       The information is available on the
  to injury                                       ACC884 Statement of Outcome form
  Return to work        Drop down selection       provided to the case manager at exit
  status
  Outcome status        Drop down selection
  Physical risk         Drop down selection
  assessment
  Psychological risk    Drop down selection
  assessment
  Work (vocational      Drop down selection
  or school) risk
  assessment
  Life-social risk      Drop down selection
  assessment
  Client satisfaction   Drop down selection
  Comment               Alpha numeric             During the transitional period the vendor
                                                  should identify clients that began service
                                                  in the previous MTBI contract.




July 2010                                                                            Page 19 of 30
                             Concussion Service – Operational Guidelines


Client satisfaction survey
The vendor will survey the client at the end of the programme. The customer satisfaction survey
should cover:
      any topics about service or quality that interest the vendor
      ACC‟s requirement that the client should have the opportunity to indicate their overall
       satisfaction with the vendor using the following question:


       Thinking of the service provided by <Vendor Name> are you…?
       1. Completely satisfied
       2. Mostly satisfied
       3. Neither satisfied nor dissatisfied
       4. Mostly dissatisfied
       5. Completely dissatisfied.




July 2010                                                                            Page 20 of 30
                                                                                          Concussion Service – Operational Guidelines


Reporting template

Concussion Service Quarterly Discharge Report
               Provider Name                                       Period Start
                               A N Example                                                   01-07-2010
             Contract Number                                      Period Finish
                               CSS12                                                         30-09-2010
                                                                                                                                                                              Client Risk Assessment

  Date of
               ACC Claim                           Client First   Date of Birth Work Status Prior to
 Discharge                      Client Surname                                                                  Return to Work Status          Outcome Status      Physical    Psychological    Work     Life-Social    Client Satisfaction Comments
                Number                                Name         dd-mm-yy           Injury
 dd-mm-yy

 20-07-10      1000012457      Smith             Jane               01-08-46      Non working adult                                           Achieved in Full   Low/Medium Medium             Medium Medium/High Completely Satisfied Transitional

 25-07-10      1000012547      Brown             William            15-09-82      Adult working full time Full Time - Samejob/same employer   Achieved in Full   Medium       Low/Medium       Low     Low             Completely Satisfied New




Work Status Prior to Injury                      Return to Work Status                                            Outcome Status                 Risk Assesment Client Satisfaction Survey

Child not attending school                       Full Time - Samejob/same employer                                Achieved in Full               Low                          Completely Satisfied

Child attending school                           Full Time - Same job/diff. employer                              Partially Achieved Low/Medium                               Mostly Satisfied

Adult attending school                           Full Time - Diff. job/same employer                              Not Achieved                   Medium                       Neither Satisfied nor dissatisfied (Don't know)

Non working adult                                Full Time - Diff. job/diff. employer                                                            Medium/High                  Most Dissatisfied

Adult working part time                          Part Time - Samejob/same employer                                                               High                         Completely Dissatisfied

Adult working full time                          Part Time - Same job/diff. employer

                                                 Part Time - Diff. job/same employer

                                                 Part Time - Diff. job/diff. employer




July 2010                                                                                                                                                                                                                                Page 21 of 30
                            Concussion Service – Operational Guidelines



Invoicing for Travel and Services

Invoicing for travel

The service item codes for travel are TBITT5, TBITT1, and TBITD10 depending on the type of fee.
The codes are used in both Stage 1 and Stage 2.


If the services are provided in a place other than the vendor‟s facility and the provider needs to
travel to the client, travel should be managed to maximise coverage and service time, and
minimise the distance travelled.

Maximise coverage
All attempts should be made to ensure that the provider is fully occupied throughout the day of
travel, therefore, multiple appointments should be made and the maximum number of clients
scheduled.

Service time
The scheduled service time will be appropriate to clinical need and best practice and will only be
as long as required. If the time with the client is less than required the provider should fill in the
time up to the scheduled time with client-related activities such as updating client notes, phone
calls etc.

Distance travelled
Appointments will be arranged to ensure the shortest distance between clients, thereby
minimising the time and distance travelled. The vendor cannot claim travel time or distance when
a provider travels from one base of operation to another, or from their private residence to the
base of operation.



       Home
      or Base       ûTravel Not Covered           Base        üTravel Covered            Client
                                                                                        Location


                                                No Travel


                                                  Clinic
                                                 Based
                                                 Service




July 2010                                                                                Page 22 of 30
                                   Concussion Service – Operational Guidelines


Travel distance TBID10
ACC expects that vendors and their providers work to minimise travel costs. Travel from a base of
operation should be for services to a number of clients.

      As represented in this loop            ü                               rather than this star          û
                   2
                                                                                            2
                                    25 kms

          18 kms                                                                                 26 kms
                                                                                  26 kms
                                                                                                                       3
                                                  3                                                    25 kms


     1                                                                      1     20 kms

                                                      15 kms
 20 kms                                                                                                           18 kms
                       Base                                             20 kms                  Base

                                                                                                                       4
                                                      4                                                 18 kms
                                28 kms




In the case of the loop the vendor would recognise a single incidence of 20km, whereas the star
would recognise four incidences of 20km.


In many instances clients may not all be ACC clients. Allocation of travel costs between the clients
should be done in a fair and reasonable way that is reflective of the true costs.


This example assumes one of the clients is not being funded by ACC.



           ü                  Total Travel
                                 Costs
                                                 Return
                                                 Travel
                                                               Tot. Incl Return
                                                                    Travel
                                                                                   ACC
                                                                                  Clients
                                                                                                 Less 20 km
                                                                                                  deduction
                                                                                                                   Invoiced

    Client 1 – Other               20                 7               27
    Client 2 – ACC                 18                 7               25            25                  7             18
    Client 3 – ACC                 25                 7               32            32                  7             25
    Client 4 – ACC                 15                 7               22            22                  6             16
     Return Travel                 28                                  -
         Total                    106             28                 106            79                 20             59



            û                 Total Travel       Return
                                                 Travel
                                                                   Total
                                                                   Travel
                                                                                   ACC
                                                                                  Clients
                                                                                                 Less 20 km
                                                                                                  deduction
                                                                                                                   Invoiced

    Client 1 – Other              20              20                  40
    Client 2 – ACC                26              26                  52             52                20            32
    Client 3 – ACC                25              25                  50             50                20            30
    Client 4 – ACC                18              18                  36             36                20            16
         Total                    89              89                 178            138                60            78


Travel time TBITT5
If it takes 15 minutes to travel the first 20km and the overall time spent travelling for the day is
140 minutes, then the vendor can invoice for 125 minutes of travel time if all the travel time
relates to ACC clients.



July 2010                                                                                                       Page 23 of 30
                            Concussion Service – Operational Guidelines


Invoicing for services

The vendor completes an invoice schedule, attaches a GST invoice for the total amount and sends
it to the relevant processing centre. Payment by ACC is usually made 12 days after receiving a
manual invoice and six days after receiving an electronic invoice.


Invoicing an hourly rate
The invoice should present the time in hours and minutes. Each separate service should be listed
by date.


  Information                 Example                       Minutes     %
                                                               5        8.3
  Client name                 John Smith
                                                              10       16.7
  Client number               123456789                       15       25.0
                                                              20       33.3
  Purchase order number       1234567                         25       41.7
  Service date                DD/MM/YY                        30       50.0
                                                              35       58.3
  Service code                TBI21                           40       66.7
                                                              45       75.0
  Time/ Quantity              1 hour 15 mins
                                                              50       83.3
  Amount claimed              $126.79 (GST Exc)               55       91.7
                                                              60      100.0
  Service date                DD/MM/YY

  Service code                TBI22                         Divide the hourly rate with the
  Time/ Quantity              30 mins                       appropriate percentage to calculate
                                                            the portion of the hourly rate.
  Amount claimed              $50.71 (GST Exc)              1 hour                      $101.43
  Total amount of invoice     $177.50                       15 mins = 25%               $ 25.36
                                                            Total                       $126.79
  GST                         $22.19

  Total                       $199.69




July 2010                                                                          Page 24 of 30
                           Concussion Service – Operational Guidelines

APPENDICES

                        Appendix 1: Biopsychosocial model

This model was sourced from The Brain Injury magazine January 2005; 19(1): 39-53 and based
on the article called Continuum of care model for managing mild traumatic brain injury in a
workers’ compensation context: a description of the model and its development by Jeremy M.
Rose of Millard Health, Edmonton, Alberta Canada. Its source reference was the World Health
Organisation.


The following extract from that paper describes the biopsychosocial model:


“The model is not exhaustive but represents some of the common variables thought to influence
outcomes following mild Traumatic Brain Injury (TBI). The model is broken down into pre-, peri-
and post-injury variables. Four key points are:
      recovery following mild TBI can be influenced by a complex interaction of a variety of
       variables
      some people appear to be at risk for developing more chronic post-concussion symptoms
       after mild TBI
      post-concussion-type symptoms can potentially develop in the absence of any permanent
       structural damage to the brain following mild TBI
      differential diagnoses must be assessed in order to provide appropriate treatment.


“In relation to interventions following a mild TBI, the biopsychosocial model highlighted the need
to:
      assess risk factors for a protracted recovery
      educate the injured worker and his/her support system (eg family) in order to counter any
       tendency to catastrophize about symptoms or misattribute normally occurring symptoms
       (such as memory slips) to the head injury
      assess for differential diagnoses
      address co-morbid physical injuries
      develop and implement a treatment and case management plan before the symptoms
       become chronic.”


The paper presented the WCB Continuum of Care model developed by Millard Health. ACC‟s
model, which is based on the WCB model, is presented Appendix 2.


ACC recognises the biopsychosocial impacts and requires providers within this contract to identify
and assess the degree of risk to recovery through use of the risk assessment matrix described in
Appendix 3.




July 2010                                                                            Page 25 of 30
            Concussion Service – Operational Guidelines




July 2010                                                 Page 26 of 30
                                            Concussion Service – Operational Guidelines



                                  Appendix 2: Continuum of care model

This continuum of care model for concussion rehabilitation management is based on the model
developed by the Workers Compensation Board of Alberta, Canada. The model recognises that all
clients‟ rehabilitation needs will vary significantly, even for similar accidents, therefore:
        set protocols cannot address the needs of every client consistently, and
        services must be able to adapt to the needs of the individual.


The Concussion Service was designed to enable the provider to, as soon as possible:
        identify the client‟s needs, and
        develop a rehabilitation programme that will deliver as rapid and full a recovery as
         possible.


The diagram below is a representative example of the Concussion Service in action and the
approximate timeline indicates that treatments do not need to be sequential. Instead providers
can choose to give treatment therapies when it best meets the needs of the client.


  Injury Onset

 Weeks    2         4       6           8    12                              26                                                      38     52




                                                                                                                                                 Time & Cost Limited Services
              EARP

                                   CPC       CPC     Neuropsych                   CPC         CPC
                                                       Screen

                             Medical
                                              MSC         MSC
                           Assessment


                        Allied Health
                                             AHT    AHT     AHT        AHT           AHT      AHT        AHT             AHT
                        Assessment


                                                                OSA



       Maintain / Obtain Employement

                 Education, Assessment and
         EARP                                        CPC Clinical Psychologist Consultation    MSC Medical Specialist Consultation
                 Rehabilitation Planning

         AHT Allied Health Treatments                                                          OSA Other Specialist Assessment




The rehabilitation time for each client will vary and only a small percentage of clients are likely to
need all the service items shown. Many will require just the EARP, whereas others may need a
combination of services.




July 2010                                                                                                                        Page 27 of 30
                                      Concussion Service – Operational Guidelines

                                    Appendix 3: Risk assessment matrix

  The purpose of the risk assessment is to measure the biopsychosocial factors that may impact on
  the client‟s rehabilitation outcome and help to determine the amount and type of services needed
  for rehabilitation. The risk assessment is not a clinical report and can only be used as an indicator
  of risk to the rehabilitation outcome. It is not be used to determine cover or entitlement to
  services.


  There are four areas of client rehabilitation risk:
            Physical
            Psychological
            Work (employment)
            Life and social.


  The highest rating from each of the four risk assessments will be recorded in the ACC884
  Statement of Outcome report for the case manager‟s consideration.


                                                          Low –                            Medium –
                                            Low                           Medium                                 High
                                                         Medium                              High
                        Physical                1             2               3                4                   5

                    Psychological               1             2               3                4                   5

                           Work                 1             2               3                4                   5

                   Life and Social              1             2               3                4                   5




4. RISK ASSESSMENT

Level of risk that may impact the
                                      1 – Low       2 - Low / Medium       3 - Medium       4 – Medium / High          5 – High
client’s recovery

        RISK              LEVEL                                        BRIEF DESCRIPTION

PHYSICAL

PSYCHOLOGICAL

EMPLOYMENT

LIFE - SOCIAL




  July 2010                                                                                                     Page 28 of 30
                                                                                                         Concussion Service – Operational Guidelines




                                                                                     Note: These pages are sized A3 and may not be printable



Areas / Flags                               1 - Low Risk                           2 - Low / Medium Risk                               3 - Medium Risk                            4 - Medium / High Risk                                    5 - High Risk
Meaning or                      The client does not appear to have            The client appears to have some                 The client appears to have some                 The client appears to have identifiable           The client appears to have significant
                                obvious or identifiable risk to their         identifiable risk factors that are not so       identifiable risk factors but they are          risk factors that are likely to impact on         risk factors that will impact on their
interpretation of               recovery                                      severe as to cause significant risk to          either:                                         their recovery that may or may not be             recovery.
risk levels                                                                   their recovery                                                                                  manageable within the services
                                                                                                                                 not so severe as to cause                                                                     The option is to access a more
                                                                                                                                  significant risk to their recovery, or      requested                                         complete range of services in this
                                                                                                                                 they can be managed within the                                                                service in order to gain full recovery.
                                                                                                                                  services requested
                                The client has (and/or)                       The client has (and/or)                         The client has (and/or)                         The client has (and/or)                           The client has (and/or)
Physical
                                -   never had a previous head injury          -   had a mild TBI over 5 years previously      -   had a mild TBI 2–5 years ago                -   had several TBI’s within the last 2           -   had a moderate TBI within last 12
-   Frequency of TBI
                                -   no reported loss of consciousness or      -   had a minor knock to the head, ie fall      -   had a knock to the head, ie fallen onto         years                                             months or had severe TBI within last
    injuries
                                    PTA                                           forward with an injury to face or side of       hard surface                                -   had repeated knocks to the head                   10 years
-   Severity of TBI injury
                                -   had a minor knock to head, ie hit by          head                                        -   sustained other injuries that required          during contact sports / in last 12            -   received a high speed impact such as
-   Presence and severity
                                    cupboard door etc                         -   a minor physical injury that did not            treatment but not hospitalisation and/or        months or received a high speed                   a fall from moving horse, bike, cycle or
    of other physical
                                -   no other physical injuries                    require any significant medical                 a minor physical injury that require            impact such as a fall from moving                 MVA
    injuries
                                -   no physical disability or any other           intervention                                    some medical intervention                       horse, bike, cycle or MVA                     -   received multiple physical injuries that
-   Physical disabilities
                                    health issues                             -   a minor physical disability or health       -   moderate physical disability/health         -   received moderate physical injuries               required a long stay in hospital
                                                                                  issues                                          issues                                          that required hospitalisation                 -   a severe physical disability with high
                                                                                                                                                                              -   a severe physical disability and has              support and/or equipment needs
                                                                                                                                                                                  good support/equipment.

                                The client has (and/or)                       The client has                                  The client has (and/or)                         The client has (and/or)                           The client has (and/or)
Psychological                   -   no pre-injury mental health condition     -   diagnosed mild mental health issue(s)       -   a diagnosed mental health needs that        -   significant mental health issue(s) that       -   severe mental health issue(s) with high
-   Pre-injury mental           -   said that they do not drink or take           or has had diagnosed mental health              may affect their rehabilitation                 are under control with good support               support/medication needs
    health diagnosis                drugs                                         needs that are now fully resolved           -   a moderate use of recreational drugs            and medication                                -   full dependency on hardcore drugs or
-   Post-injury alteration in   -   reported no alteration in mood post-      -   a mild use of recreational drugs or             or alcohol                                  -   a high use of recreational drugs or               alcohol
    mood                            injury                                        alcohol                                     -   mild alteration in mood post-injury             alcohol                                       -   a severe alteration in mood post-injury
-   Reaction of family          -   supportive family and friends who         -   a mild alteration in mood post-injury           (anxiety, tearfulness, irritability,        -   a moderate alteration in mood post-               (suicidal, anger, anxiety, depression)
-   Personality and coping          display a positive attitude, have             (anxiety, tearfulness, irritability,            frustration)                                    injury (anxiety, tearfulness, irritability,   -   self/family/friends are placing very
    skills                          realistic expectations, and a good            frustration)                                -   family and friends whose expectations           frustration)                                      unrealistic expectations to function at
-   Beliefs about the injury        understanding of the impact of the        -   family and friends whose expectations           are somewhat unreasonable and have          -   Self/family/friends are placing                   the pre-injury level and are not
-   Life stressors                  injury and the recovery pathway               are reasonably good but have some               some minor anxiety regarding the                unrealistic expectations to function at           receptive to information to change
                                -   said that the accident was not                minor anxiety regarding the effects of          effects of TBI and the recovery                 the pre-injury level but have been            -   experienced several aspects of the
                                    traumatic in any way                          TBI and the recovery pathway                    pathway                                         receptive to information to change                accident or subsequent treatment as
                                -   a positive personality with good coping   -   limited support from family and/or          -   little or no identified support to assist   -   experienced several aspects of the                traumatic in nature and is highly
                                    skills                                        friends due to their commitments, eg            them in their rehabilitation                    accident or subsequent treatment as               anxious, such as MVA with fatality,
                                -   no stressors that will impact on their        they work full time                         -   experienced several aspects of the              traumatic in nature and is anxious                unprovoked assault, assault by a
                                    recovery                                  -   good coping skills but there are some           accident or subsequent treatment as         -   few or inadequate coping skills and               family member
                                                                                  minor stressors that may impact on              traumatic in nature                             does not appear to cope with the injury       -   a highly dependant personality with no
                                                                                  their rehabilitation.                       -   moderate coping skills and there are            or requirements for rehabilitation, and           real coping skills, a very poor ability to
                                                                                                                                  some stressors that may impact on               will need support                                 action plan for the resolution of
                                                                                                                                  their rehabilitation                        -   has moderate to high life stressors that          problems or barriers
                                                                                                                                                                                  are impacting on their rehabilitation         -   significant family and social stress that
                                                                                                                                                                                                                                    is likely to impact on their recovery




    July 2010                                                                                                                                                                                                                                        Page 29 of 30
                                                                                                      Concussion Service – Operational Guidelines




Areas / Flags                        1 - Low Risk                             2 - Low / Medium Risk                                3 - Medium Risk                            4 - Medium / High Risk                                   5 - High Risk
Meaning or              The client does not appear to have               The client appears to have some                 The client appears to have some                 The client appears to have identifiable          The client appears to have significant
                        obvious or identifiable risk to their            identifiable risk factors that are not so       identifiable risk factors but they are          risk factors that are likely to impact on        risk factors that will impact on their
interpretation          recovery                                         severe as to cause significant risk to          either:                                         their recovery that may or may not be            recovery.
of risk levels                                                           their recovery                                                                                  manageable within the services
                                                                                                                            not so severe as to cause                                                                    The option is to either access a more
                                                                                                                             significant risk to their recovery, or      requested                                        complete range of services in this
                                                                                                                            they can be managed within the                                                               service to gain full recovery, or to refer
                                                                                                                             services requested                                                                           the client to other ACC services.
                        The client (and/or)                              The client (and/or)                             The client (and/or)                             The client (and/or)                              The client (and/or)
Work                    -   is maintaining pre-injury work status        -   is managing pre-injury work hours but       -   is managing reduced hours at work with      -   is unable to work due to the severity of     -   is unable to work due to the injury
-   Work demands            with low level of stress                         is struggling due to symptoms and/or a          support of employers                            their injury but is keen to return to work   -   believes work achievement
-   Workplace           -   enjoys their workplace and is either             stressful work situation.                   -   is anxious about their workplace and is         due to the positive work environment,            requirements in the workplace are
    perception              back at work or is keen to return as         -   OK with their workplace and is either           either back at work or is somewhat              good job satisfaction                            excessive/unrealistic/unfair
-   Social support at       soon as they can and believes the                back at work or is unexcited to return to       resistant to return to work. They believe   -   is very anxious about their workplace        -   has severe anxiety about returning to
    work                    workplace achievement requirements               work. They believe the workplace                the workplace achievement                       and is resistant to return to work. They         work due to a lack of workplace
-   Nature of work          are good/fair                                    achievement requirements are realistic          requirements are realistic normally but         believe the workplace requirements will          support. They believe the workplace
-   Job satisfaction    -   has a strong network of supportive               normally but may now be challenging             will now be challenging                         now be too challenging and unfair                requirements are unfair
-   Work organisation       colleagues in the workplace                  -   has a network of colleagues in the          -   has one or two work colleagues the          -   has one or no work colleagues in the         -   tried to return to work but failed and
                        -   is employed in a job in which they can           workplace                                       workplace. There are a number of                workplace. There are a lot of people             now has severe anxiety around
                            manage their own workload demands,           -   is employed in a job where they have            people there who are unsatisfactory to          there who are unsatisfactory to work             returning to work
                            or which lapses in concentration and             some ability to manage their own                work with                                       with                                         -   has no friends in the workplace and
                            memory will not be risky or dangerous            workload demands, or where lapses in        -   is employed in a job where they have        -   is employed in a job where they are              people there are unsatisfactory to work
                        -   has excellent job satisfaction                   concentration and memory will not be            little ability to manage their own              responsive to the needs of others and            with
                        -   has a supportive work organisation that          risky or dangerous, ie office worker            workload demands, but where lapses in           they have no ability to manage their         -   is employed in a job where they are
                            is keen to participate in the immediate      -   enjoys the work tasks they do most of           concentration and memory will not be            own workload demands, or where                   responsive to the needs of others and
                            or gradual return to work                        the time and has good job satisfaction          risky or dangerous, ie teacher,                 lapses in concentration and memory               they have no ability to manage their
                                                                         -   has a fairly supportive work                    receptionist, student etc                       will put self and others at risk, ie             own workload demands, or where
                                                                             organisation that will provide              -   sometimes enjoys the work tasks they            machine operator, commercial driver              lapses in concentration and memory
                                                                             opportunity to participate in the               do and has fair job satisfaction                etc                                              will put self and others at risk, ie
                                                                             immediate or gradual return to work         -   has a work organisation that will           -   seldom enjoys the work tasks they do             surgeon, pilot etc
                                                                                                                             provide some opportunity to participate         and does not often achieve job               -   dislikes the work tasks they do and
                                                                                                                             in the immediate or gradual return to           satisfaction                                     never achieves job satisfaction
                                                                                                                             work, although they don’t seem overly       -   has a work organisation that requires        -   has a work organisation that is not
                                                                                                                             keen                                            considerable education about TBI if the          interested in participating in the client’s
                                                                                                                                                                             client is to make a successful                   return to work. They believe the client
                                                                                                                                                                             graduated return to work                         will not be able to return
                        The client (and/or)                              The client (and/or)                             The client (and/or)                             The client (and/or)                              The client (and/or)
Life-Social             -   has no financial stress and is financially   -   has moderate financial stress with          -   has moderate financial stress with no       -   has severe financial stress but has          -   has severe financial stress with no
-   Life stressors          stable                                           available options or support for                available options or support for                readily available options or support for         readily available options or support
-   Financial           -   lives in a stable quiet environment and          improving their situation                       improving their situation                       improving their situation                    -   has responsibility for earning money
-   Social                  is managing minimal social roles             -   lives in a busy but structured household    -   lives in a busy but structured household    -   lives in a busy unstructured household           within a business, which is now failing
                            satisfactorily                                   and has minimal social responsibilities         and has responsibility for extended             and has minimal social responsibilities          due to the injury
                                                                                                                             family/whanau as well as several social                                                      -   lives in a busy unstructured household
                                                                                                                             responsibilities                                                                                 and has responsibility for extended
                                                                                                                                                                                                                              family/whanau as well as several social
                                                                                                                                                                                                                              responsibilities




    July 2010                                                                                                                                                                                                                                   Page 30 of 30

								
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