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