Psychology management plan The Psychology management plan should be completed where more than six treatment sessions will be delivered within a practice, or as requested by the case manager. ReturnToWorkSA expects psychologists to integrate the principles of the Clinical Framework for the Delivery of Health Services (2012) in their daily practices and reflect these principles within this management plan. Claims agent lodgement and contact details: Post Email Fax Phone Employers Mutual GPO Box 2575, ADELAIDE SA 5001 faxes@employersmutualsa.com.au (08) 8127 1200 (08) 8127 1100 EnABLE Unit Gallagher Bassett GPO Box 1772, ADELAIDE SA 5001 FaxReception@gb.rtwsa.com (08) 8177 8451 (08) 8177 8450 GPO Box 2668, ADELAIDE SA 5001 EnABLE@rtwsa.com 13 18 55 (08) 8233 2051 Worker and employment details Name: Claim number: Date of injury: Case manager (if known): Pre-injury employer: Occupation/title: Current hours/week: Pre-injury hours/week: Current employment status: Same employer New employer No employer Current duties status: Pre-injury duties Alternative/modified duties Unfit for work Other If other, please give details: Clinical assessment Psychological diagnosis: Is your diagnosis different to the worker’s medical certificate? Yes No To what extent is the psychological diagnosis affecting the worker’s ability to participate in work? No effect Mild effect Moderate effect Severe effect Potential barriers to recovery and return to work Have you identified any non-clinical barriers or issues that may impede the worker’s recovery and return to work? (e.g. worker’s beliefs about injury/pathology, worker’s expectations about return to work, workplace matters)? Yes No EVALUATION If yes, please outline: Do other parties need to be notified/involved in addressing these barriers? Case manager Treating doctor Yes No Return to work consultant Other, please outline If action is recommended, please outline: Do you recommend a graduated return to work schedule for the worker? Yes Have you communicated your recommendations or the graduated return to work to the treating doctor(s)? No Yes No Management to date (If treatment has NOT been provided prior to this plan, go to Proposed management section below). Date of your initial psychology consult: Has the worker made the progress you expected? If no, please outline relevant factors: Proposed management Total consults to date: Yes No Treatment goals Intervention strategies Measures of progress Number of sessions required 1. 2. 3. 4. If this is an initial management plan please complete: Proposed number of consults to be delivered under this plan duration) consults over weeks (12 weeks maximum plan If this is a subsequent management plan please complete: Proposed number of consults to be delivered under this plan Plan commencement date: consults (up to maximum of 6 consults) over weeks Expected discharge date (if known): Treating psychologist details Print name: Practice name: Address: Phone number: Email: Fax Number: How would you prefer the case manager to notify you of the receipt of the plan? Email Fax The worker has been involved in the development of this management plan Yes A copy of this plan has been provided to the case manager, treating doctor and worker: Yes Treating psychologist’s signature: Date: Claims agent use only Psychologist notified of receipt of plan: Yes Date notified: Case manager name: Phone number: Phone Post Psychology management plan – explanatory guide The Psychology management plan should be initiated and completed by the treating psychologist when more than six treatments and every 12 weeks thereafter are required to manage a worker with an injury. The completed plan should be submitted to the relevant case manager, and copies provided to the treating doctor and worker. The plan should be invoiced using item number PSMP Please note: Management plans are practice-specific for individual workers. Worker and employment details • • Clinical assessment • • Modified duties refer to any changes or restrictions that are applied to a worker’s pre-injury duties to facilitate work participation where the injury prevents full participation. Alternative duties refer to the worker performing different duties to those in their pre-injury role. The psychologist should outline their psychological diagnosis and the level of impact this has on the worker’s ability to participate in work. If your diagnosis differs from that of the certifying doctor, it may be appropriate to have a verbal conversation in which this diagnosis or appropriative management can be clarified for consistency. Potential barriers to recovery and return to work (Principle 2 of Clinical Framework) • The psychologist should list in order of priority any non-clinical barriers or issues identified that may impede the worker’s recovery or return to work. If the psychologist believes these barriers require further assessment by another party please tick the appropriate boxes and outline the suggested action that is recommended e.g. case manager to arrange case conference, treating doctor to review need for further psychological management. Management to date • If treatment has been provided prior to the development of the management plan, the psychologist should confirm the initial consultation date and the number of consultations provided to date. The psychologist should indicate whether their treatment to date has achieved the expected outcomes or progress in the timeframe they estimated since commencing treatment. Where the outcomes or progress have not met their expectations, the psychologist should outline any relevant factors (clinical and non-clinical) that may have contributed to this situation. Psychology management that has failed to make measured progress towards goals may be inappropriate for a number of reasons. In these circumstances, it is expected that the psychologist will reassess the treatment approach, consider other strategies which may include ceasing treatment. • • Proposed management (Principles 1, 3, 4, & 5 of the Clinical Framework) • • • • • Evidence-based psychological treatment guidelines recommend setting treatment goals collaboratively with the worker to encourage their active participation in their recovery and self-efficacy. The establishment of agreed and specific goals ensures that the worker and psychologist are focused on similar objectives to achieve full recovery and return to work. Goal setting also ensures that appropriate measures are utilised to monitor recovery. Goal setting should be undertaken using the SMART (specific, measurable, appropriate, relevant, timed) method. Examples of SMART goals include: - Successful management of stressful work situations with supervisor during the next week by practising healthy assertion and diarising the outcomes - Increase pre-injury duties by 2 hours per fortnight when returning to duties that previously caused stress - Reduction in measure of distress in 4 weeks. The psychologist should briefly outline the proposed treatment strategies to address these goals including the relevant functional or psychometric outcome measures used to measure the worker’s progress. This may include standardised measures that are relevant for the client group (such as Depression Anxiety and Stress Scales (DASS) or subjective measures that measure progress at an individual and subjective level (such as Subjective Units of Distress (SUDS). It is assumed that as a part of normal psychological practice, baseline measures are taken and re-administered regularly as clinically appropriate. Initial management plan: When completing the initial plan, regard for the normal clinical course of the worker’s diagnosis will be made when proposing the number of consults/treatments required. The psychologist should outline the anticipated duration of the treatment (or component of treatment) and the expected discharge date (if known) or review date. The plan has a maximum duration of 12 weeks. Treating psychologist’s details • Subsequent plan: When completing a subsequent plan, the psychologist should document the number of consults/treatments expected to be delivered (up to a maximum of six consults/treatments), the anticipated duration of the treatment (or component of treatment) and the expected discharge date (if known) or review date. The plan has a maximum duration of 12 weeks. • Following review of the management plan the case manager will notify the treating psychologist to acknowledge receipt of the plan and support of the proposed management. The psychologist should indicate their preferred method of communication for this process. It is important that the worker is actively involved in the development of the management plan and that a copy of the plan is made available to them. A copy of the plan is required to be sent to the case manager and the treating doctor or referrer. • • The following free information support services are available: If you are deaf or have a hearing or speech impairment you can call ReturnToWorkSA through the National Relay Service (NRS): TTY users can phone 13 36 77 and ask for 13 18 55. Speak & Listen (speech-to-speech) users can phone 1300 555 727 and ask for 13 18 55. Internet Relay users connect to NRS on www.relayservice.com and ask for 13 18 55. For languages other than English call the Interpreting and Translating Centre on 1800 280 203 and ask for an interpreter to call ReturnToWorkSA on 13 18 55. For Braille, audio or e-text call 13 18 55. ReturnToWorkSA Enquiries: 13 18 55 400 King William Street, Adelaide SA 5000 info@rtwsa.com www.rtwsa.com © ReturnToWorkSA 2015 Amended: March 2015