Guidelines for Assessment and Treatment
Running Head: OPA GUIDELINES FOR AUTO INSURANCE CLAIMS
Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance
Claims
January 11, 2005
OPA Auto Task Force
1
Guidelines for Assessment and Treatment
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ONTARIO PSYCHOLOGICAL ASSOCIATION GUIDELINES FOR ASSESSMENT AND
TREATMENT IN AUTO INSURANCE CLAIMS
3
Introduction
3
General Principles
4
Current Standards and Ethical Practices .......................................................................... 4
The Practice Context of Assessment and Treatment in Auto Insurance Claims
5
Psychological Pre-Assessment Guidelines
6
Intake Screening for Proposing Psychological Assessments ......................................... 6
Indicators to Complete an Intake Screening to Propose a Psychological Assessment
................................................................................................................................................. 6
OCF-22 Application for Approval of Assessment Steps ................................................ 6
Guidelines for Completion of the OCF-22 Application for Approval of Assessment 8
Psychological Assessment Guidelines
8
Indicators for General Clinical/ Health/ Rehabilitation Psychological Assessments
................................................................................................................................................. 8
Indicators for Specific Specialized Psychological Assessments .................................... 8
Assessment Interventions ................................................................................................... 9
Assessment Guidelines ..................................................................................................... 10
Table #1 Guideline for General Clinical/Health/ Rehabilitation Psychological
Assessment .......................................................................................................................... 12
Table #2 Guideline for Neuropsychological Assessment ............................................ 13
Table #3 Guideline for Psychovocational Assessment ................................................. 14
Table #4 Guideline for Psychoeducational Assessment ............................................... 15
Guidelines and Procedures for Psychological Treatment Plan Proposals
16
Indicators to Propose Psychological Treatment ............................................................ 16
OCF-18 Treatment Plan Application ............................................................................... 16
Treatment Guidelines ........................................................................................................ 19
Outcomes............................................................................................................................. 19
Table #5 TREATMENT GUIDELINES: Initial General Clinical/ Health/
Rehabilitation Psychological Treatment Plans .............................................................. 20
Complicating Factors ......................................................................................................... 20
Exceptions ........................................................................................................................... 21
Table 6: Complicating Factors .......................................................................................... 22
Conclusion: Application of Guidelines to Individual Patients ................................... 23
Guidelines for Assessment and Treatment
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ONTARIO PSYCHOLOGICAL ASSOCIATION
GUIDELINES FOR ASSESSMENT AND TREATMENT IN AUTO INSURANCE CLAIMS,
Introduction
Consistent with the purposes of the 1990 Ontario Psychological Association (OPA) Guide to Fees
and Billing Practices, and the 2001 Psychology Assessment and Treatment Guidelines, published by
the Financial Services Commission of Ontario (FSCO), these Ontario Psychological Association
Guidelines for Assessment and Treatment in Auto Insurance Claims are intended to provide
assistance and guidance to practitioners and those using their services. They are not intended to
“manualize” assessment or treatment. Instead, they are to function as guidelines for reasonable
practices based on currently accepted community and professional standards. As such, the documents
describe normative assessment and treatment practices based on both the psychological scientific and
research literature and professional consensus regarding clinical practice. These practices reflect
current understanding of legislation, regulations, and psychological science and practice in Ontario.
Readers are reminded that changes to each of these occur on a regular (and sometimes frequent) basis
which necessitates continual self-education regarding potential changes to areas covered by this
document.
These Guidelines represent the current standard expected of psychological services for auto injuries
in Ontario. They define when an assessment is reasonably required, provide a description of the
assessment process, and detail reasonable associated costs. They also present a model describing
indicators for reasonable and necessary initial treatment plans which can be applied to the vast
majority of adult patients. Although assessments and treatments for geriatric adults, children and
adolescents may sometimes be provided within the time ranges outlined in the Guidelines, services
for these age groups often require time beyond that given in the Guidelines. The Guidelines offer
reasonable frameworks for clinical assessment and treatment rather than directions for how to
complete an assessment, review a peer’s proposed treatment, determine disability status, determine
catastrophic impairment status, or perform an independent examination (whether insurer or
plaintiff/claimant funded in legal cases) to answer specific questions. However, the OPA expects that
the Guidelines will provide a standard by which to review proposed psychological assessment or
treatment plans, and well-documented criteria regarding the reasonableness of proposed services.
The current documents are intended to update the Psychology Assessment and Treatment Guidelines
published by the FSCO in March 2001 following discussions between the Ontario Psychological
Association and the Insurance Bureau of Canada. The final product is actually two separate
documents: (1) the Guideline document itself, which describes what are considered to be reasonably
required assessments, as well as reasonable and necessary plans for treatment/ rehabilitation; and (2)
a Companion document, which reviews the pertinent scientific literature, legislation, and practice
information that form the rationale for the Guidelines. The Companion document therefore supports
and explains the content of the Guidelines. It is recommended that the two documents be read
concurrently in order to grasp fully each practice recommendation in the Guidelines and the
reasoning supporting it.
The Guidelines and accompanying Companion document approximate the usual sequence of events
that occur in providing an initial plan for clinical psychological services under auto insurance in
Ontario. Receipt of a referral prompts an intake screening and completion of the OCF-22 application
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(for approval of an assessment). This is followed by psychological assessments (including general
and specific specialized assessments), preparation of a treatment plan and completion of the OCF-18,
and decisions regarding disposition after treatment. Note that this applies to an initial treatment plan
only. Decisions regarding disposition after completion of the initial treatment plan may indicate that
treatment is ended, referral to another provider is made, or subsequent treatment plans may be
submitted.
Each section contains tables that outline reasonable services required, under typical circumstances, to
conduct an assessment or complete a treatment plan with a MVA-injured individual. These tables
include recommended components for assessment and treatment interventions and the usual ranges
of time for each component. Potential complicating factors that reasonably necessitate the upper end
of the service ranges are noted, as well as factors that may create exceptions to the ranges presented
(e.g. services presented in a second language when no possible options for services in the patient’s
native language exist in the region). In such “exceptional” cases, the general guidelines will apply but
the usual limits on the time ranges for each intervention component do not. It is reasonable that such
circumstances will necessitate more time than presented. Readers of these guidelines should note in
particular the usual ranges of time for each intervention component, as well as potential exceptions
noted in the body of the document and in each table.
The vast majority of MVA survivors in Ontario, especially those in minor accidents (i.e. where no
medical attention was sought for injuries sustained in the accident) are rarely seen by psychologists.
Current FSCO statistics indicate that only 2-4% of all MVA claimants in Ontario receive
psychologists’ services. MVA survivors who suffer significant psychological impairments are
complex, vulnerable, and at high risk for developing chronic disabilities that create substantial costs
to the system. Psychological treatments prevent and reduce disability, return patients to work, reduce
suffering, improve quality of life, and provide substantial cost savings to payors. A comprehensive
psychological assessment can identify those at risk for developing such impairments and ensure early
and appropriate psychological treatment. Psychological assessments also convey valuable
information to other health care providers to facilitate and direct appropriate interventions, and can
serve as an indispensable communication tool in explaining a given patient’s lack of expected
progress in their physical rehabilitation.
The adjudicative nature of assessments under auto insurance requires that they be consistently
comprehensive, high quality, and robust. They must be able to withstand intense scrutiny by a
number of readers and reviewers including patients, psychologists, other health professionals,
adjusters, lawyers, mediators, arbitrators and judges. All psychologists providing services under auto
insurance in Ontario should be familiar with the content of these Guidelines and the Companion
document.
General Principles
Current Standards and Ethical Practices
All psychological assessment and treatment is subject to current professional standards and ethical
principles, as identified by the Canadian and Ontario Psychological Associations, as well as the
College of Psychologists of Ontario. Specific standards for ethical practice with regard to
assessments and treatments under auto insurance have also been published by the College of
Psychologists of Ontario, and disability assessment standards have been published by the Canadian
Academy of Psychologists in Disability Assessment. Psychologists in all their practices adhere to the
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professional standards established by the national and provincial associations and the College.
Psychologists practicing under auto insurance follow the specific relevant standards published by the
OPA and the College. Psychologists practicing in this field should be familiar with relevant
publications.
The Practice Context of Assessment and Treatment in Auto Insurance Claims
Patients with psychological impairments arising from automobile accident injuries typically have
more complicated treatment needs than patients in general mental health settings because of the
potentially interacting effects of physical injuries resulting in pain, brain injuries resulting in
cognitive impairments, psychological injuries resulting in adjustment difficulties (including grief,
depression, and traumatic stress symptoms), and the combined functional limitations created by all of
these. Motor vehicle crashes often produce multiple injuries/impairments, and may involve injuries
to several family members in the same accident, resulting in greater psychological disturbance. Auto
insurance legislation also creates additional professional practice responsibilities that must be taken
into consideration. Therefore, psychologists working in this area must be familiar with specific
legislation, regulations, and patient presentation requirements before undertaking assessments and
treatments of auto crash survivors.
The principle of insurance is that the benefits are designed to return the injured individual to his/her
pre-accident level of function in the family, work place, school, and community. The courts require
that the insurer “take the insureds as they find them”. This means that insureds who are more likely
to be injured or suffer prolonged disability in an accident have the same rights to be able to return to
their pre-accident status as those who are resilient to injury and recover quickly and effectively.
However, this typically is constrained by a wide variety of limits, exceptions, and exclusions in the
insured’s insurance policy. For accidents since November 1, 1996 the basic policy provides for up to
$100,000 for medical and rehabilitation goods and services over ten years (longer for children under
age 21). The catastrophic policy limits are $1,000,000 medical and rehabilitation goods and services
for life. Under Bill 198 (post October 1, 2003) the basic and catastrophic limits remain the same and
there is a new ability to sue a responsible party in court for excess medical care for patients with
“serious and permanent impairments”.
Insurance legislation requires that the impairment for which the insured is seeking benefits must be a
“direct result of an accident”. The courts describe this as the accident having “a material impact on
the insured person”. The accident need not be the only factor influencing the impairment. It is critical
that psychologists are cognizant of both health professional and legal definitions of causality, as the
insured’s rights to benefits and the insurer’s obligations depend on satisfying the applicable legal test.
In particular, psychologists should review literature, which deals with issues such as pre-existing
conditions, co-existing conditions, and the legal definitions of “thin skull” and “crumbling skull”
vulnerabilities. In this way, all psychological assessments performed under auto insurance legislation
are considered “adjudicative”; that is, the claimant’s qualification for benefits and the insurer’s
obligations are dependent on the attribution of causality to the MVA.
For access to medical and rehabilitation benefits, such as psychological treatment, the claim for
goods and services must meet certain tests: assessments must be reasonable and reasonably required,
and treatment must be “reasonable and necessary”. This means that assessments must be reasonable
and treatments proposed by health providers must be considered both reasonable and necessary in
order to be approved for funding. For psychology it is critical to understand that the reduction of
impairments and functional restoration are fundamental to treatment/ rehabilitation efforts.
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Given that these assessments have implications for patient entitlements and insurer obligations to pay
for services, the reports must provide sufficient information to meet the needs of all parties.
Psychological Pre-Assessment Guidelines
Intake Screening for Proposing Psychological Assessments
Psychologists must now apply (with rare exceptions) for prior approval to proceed with assessments
in order for the insurer to be obligated to pay for an assessment. This entails completing an OCF-22
Application for Approval of Assessment form describing the insured’s present symptoms, and the
rationale for, and details of, the proposed assessment. The information required to complete the OCF22 is obtained through an intake screening. Exceptions to the requirement for prior approval are
included on the OCF-22 and are described in the Statutory Accident Benefits Schedule (SABS).
Once the OCF-22 is submitted, the insurer must respond within specified timelines or the assessment
is “deemed approved”.
Indicators to Complete an Intake Screening to Propose a Psychological Assessment
Reports of symptoms or functional impairments that reasonably suggest that an impairment exists
that may be the result of an MVA injury are indicators to complete an intake screening.
OCF-22 Application for Approval of Assessment Steps
1) Information Required for Completion of the OCF-22:
In order to complete the OCF-22, the psychologist must obtain sufficient information regarding the
patient’s situation to show that a psychological assessment is reasonably required. Although it is not
intended that the psychologist complete an assessment in order to propose an assessment, the OCF22 does require considerable information. Information is required to address the following questions:
 What is the status of the claim and insurance information?
 What extended Health Benefits are available?
 Is there any conflict of interest?
 Does the patient consent to communicate with treating health professionals and the insurer?
 What is the nature of the accident and injuries (in brief)?
 What is the purpose of the assessment under the regulations?
 What are the patient’s present complaints (in brief)?
 Is there an initial indication of a psychological/ cognitive impairment and/ or functional limitations
requiring treatment, and/or psychological factors relevant to treatment/ recovery from physical
impairments?
 Is there an initial indication that the impairment or condition may be the result of an MVA?
 Has the applicant already been provided treatment under your care? If so, what are the clinical
indicators to substantiate the reasonableness of the proposed assessment?
 Is it reasonable to proceed with psychological assessment at this time, including the following:
necessary file information is available; assessment and treatment of physical impairments do not
preclude psychological assessment; if a previous psychological assessment has been completed,
further assessment is reasonable at this time?
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 Does it appear that this assessor is appropriate to conduct the assessment in keeping with current
accepted community and professional standards (including consideration of language, areas of
professional competence, and other factors)?
 What are the specific details of the assessment (assessment interventions required, duration and
estimated cost) and the rationale for this patient? For multidisciplinary assessments, what are the
details and rationale for each component of the assessment?
 Does the patient consent to the proposed assessment, and further review if the insurer does not
approve the assessment?
 Does the patient present with complicating factors necessitating proposing the upper end of the
range for assessment time?
2) Interventions used to Obtain Information for the OCF-22:
The following steps may be utilized to complete the OCF-22:
 Receipt of the referral from the patient, health professional, insurer, other;
 Preliminary review of referral;
 Determination of the appropriateness of the referral;
 Patient contact to obtain patient consent for communication with insurer and treating health
professionals (obtain signature on OCF-5 or other document to confirm consent to communicate
with insurer and health professionals);
 Contact with collateral sources to obtain additional information and clarification, which may
include: referral source; other health professional(s); adjuster; others;
 Brief review of medical file documentation (more extensive medical file of greater than 25 pages
would generally take place within the assessment itself);
 Review of available previous psychological assessments and data (previous psychological
assessments not available at the time of the application and raw test data would generally be
reviewed as part of the assessment itself);
 Patient completion of a brief screening questionnaire, scoring, and interpretation by the
psychologist;
 Patient contact to confirm/clarify information regarding present complaints (may be completed
by telephone or the psychologist may choose to complete in initial meeting);
 Preparation of the OCF-22 application;
 Review with the patient of the content of the proposed assessment to obtain consent for
submission of the application to the insurer and participation in a review process if the
application is disputed by the insurer;
 Patient signature on the OCF-22 is optional for submission to the insurer; if the insurer disputes
the application, the psychologist may facilitate a review by obtaining the patient signature.
3) Submission of the OCF-22 to the Insurer for Approval:
The Psychologist submits the OCF-22 to the insurer for approval by FAX. The insurer must respond
within the specified time lines or the plan is deemed approved. The insurer is allowed to provide
complete approval, partial approval, or denial of the proposed assessment.
4) Possible Review:
If the insurer contemplates disputing the proposed assessment, they must refer the proposal to the
specified health professional examination for an opinion.
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Guidelines for Completion of the OCF-22 Application for Approval of Assessment
 Up to 2 hours of professional time for completion of psychological screening interventions is
considered reasonable. This time is described and included on the OCF-22.
 This maximum does not include costs of disbursements or completion of OCF-22 forms as
prescribed by the Professional Services Guideline published by the Superintendent of Insurance.
Payment for interpreters or patient transportation is to be billed directly to the insurer.
 For patients with “exceptional” characteristics, additional time beyond this maximum may
reasonably be required.
 The OPA recommended hourly fee for 2005 is $195 per hour. However, the auto insurer is not
required to pay more than the hourly rate in the Professional Services Guideline published by the
Superintendent of Insurance.
 Note: The insurer is not obligated to pay for the preparation of an application for assessment
unless that application is approved.
Psychological Assessment Guidelines
Indicators for General Clinical/ Health/ Rehabilitation Psychological Assessments
Consistent with accepted community and professional standards a General/Clinical/Rehabilitation
Psychological Assessment is reasonably required in the following circumstances:
 A claim has been made for the MVA to which the impairments are attributed; and
 The patient will consent to the proposed assessment and the necessary communication with
treating health professionals and the insurer; and
 The following are suspected/ reported to be associated with an MVA:
o Possible psychological impairment; or
o Reported symptoms of psychological distress or role impairment; or
o Psychological factors affecting the patient’s response to other treatments for MVArelated impairments, or
o Possible presence of “Yellow Flags” as defined by the New Zealand Guide to Red
and Yellow Flags; or
o Possible interference in the patient/claimant/client’s usual home, school, or work life,
due to psychological impairments.
Indicators for Specific Specialized Psychological Assessments
In addition to the general health/clinical/rehabilitation psychological assessment, specific
neuropsychological, psychoeducational, and psychovocational assessments may be reasonably
required. These specific specialized psychological assessments are diagnostic, descriptive, and
prescriptive. They are reasonably required in some situations to address relevant questions and
provide necessary information for treatment/rehabilitation planning or application for other benefits.
In cases where multiple specialized assessments in addition to a general health/ clinical/
rehabilitation psychological assessment are reasonably required (e.g. a traumatic brain injured adult
with pain and PTSD who likely cannot return to work and may require re-education or retraining), it
may be advantageous to propose combining assessments in order to provide more cost-effective and
streamlined services. In such cases, the resulting neuropsychovocational/ neuropsychoeducational
assessments will include assessment intervention components and specialized tests from multiple
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specialized assessments in addition to the basic general health/ clinical/ rehabilitation assessment
interventions required for all psychological assessments. Such comprehensive, highly specific and
specialized assessments may reasonably require proposals that fall outside the usual costs and total
number of hours required for any one of the assessment types noted in these Guidelines. However,
they should require cumulatively less time (and therefore cost) than conducting full separate
assessments.
The specific specialized assessments described in these Guidelines are indicated and reasonably
required in the following situations:
 Psychovocational assessments provide objective documentation of vocational interests and
abilities and are useful for planning treatment and rehabilitation in addition to vocational reintegration. Vocational issues including apparent difficulty returning to, or maintaining, level of
performance in former employment are identified.
 Psychoeducational assessments provide objective documentation of cognitive abilities and
academic achievement; they are useful for planning treatment and rehabilitation in addition to
educational re-integration where indicated. Educational issues including possible effects of
MVA-related impairments on educational performance are noted.
 Neuropsychological assessments provide objective documentation of cognitive and motor
complaints and are useful for planning treatment and rehabilitation, as well as educational and
vocational integration. Neuropsychological concerns indicating that assessment may be
warranted include: reports of cognitive and information processing impairments/ deficits; post
concussion type symptoms; or any history suggestive of concussion/ brain injury sequelae or
neurobehavioural disorders. Neuropsychological assessments are not limited in relevance to
patients with evidence of structural brain damage, but are also necessary to document
impairments in patients with possible/ probable diagnosis of general clinical psychological
disorders, neuropsychological and neurobehavioural disorders, and are the tool of choice
whenever documentation of cognitive difficulties and symptom validity testing are indicated.
Assessment Interventions
The most reliable and valid data for assessment are a combination of information from various
sources, including for example, the patient’s self-report, collateral reports from teachers, family
members, or other treating health professionals, clinical observation, psychometric data. In
completing OCF insurance forms, all interventions utilized to obtain assessment information must be
coded and labeled according to the Canadian Classification of Interventions (CCI) system.
Specific assessment interventions are chosen according to patient needs, questions to be addressed,
and the professional judgment of the psychologist. For example, different tools are needed to address
questions of impairment due to post-traumatic anxiety than are needed to address questions of
potential future employability. In the first case, clinical psychological interview and psychometric
assessment may be reasonably required; where in the second, psycho-vocational interview and
specific testing regarding abilities, aptitudes, and interests would be more appropriate. The choice of
what to do and which particular tests to use is determined by the individual psychologist, according
to the standards in that area of inquiry (e.g. clinical psychology regarding anxiety disorders and the
effects of traumatic stressors in the first case, vocational psychology regarding the effects of
disability on retraining and employability in the second). In order to ensure adequate assessment,
psychologists include time for consultation with allied health providers currently treating the patient,
team meetings with other providers as necessary, and full review of the patient’s clinical file,
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including review of previous test data obtained during any assessment process.
It should be noted that under the SABS, psychologists are required to assess and identify
impairments; there is no requirement for the constellation of impairments identified to meet
diagnostic criteria for a clinical syndrome. Further, all psychologists doing assessments under auto
insurance must be aware that ICD-10-CA classification terminology and codes are required, not
DSM-IV diagnoses. While many of the clinical conditions indicated in the ICD-10 have a parallel
DSM diagnosis, there are also a number of problem areas and impairments that are described within
the ICD-10 nomenclature as appropriate for treatment that are not contained within the DSM. The
ICD has a much broader orientation than the DSM and actually lists disorders, symptoms, factors
influencing health status, and problems. Assessment interventions should be tailored to meet this
requirement, including noting subscales (rather than only total scores) on some psychometric
instruments, and assessing for specific impairments and limitations in functioning, rather than
assessing only for symptom presence and determining whether the total number of symptoms noted
meets diagnostic criteria for a clinical disorder.
Note also that standardized psychometric measures may not be appropriate for some patients (e.g.
those with English as a second language, or those whose cultural or educational background is
inconsistent with the norms of particular tests).
Assessment Guidelines
Typical assessment interventions and hours reasonably required for general clinical/ health/
rehabilitation psychological assessments and the specific specialized assessments (psychovocational,
psychoeducational, neuropsychological) are described and summarized in Tables 1-4.
Guidelines for Psychological Assessments and Treatment Plan proposals are outlined on pp. 12-23
including: indicators for proposing psychological treatment; information required to complete an
OCF-18 form; considerations for ongoing evaluation and modification of treatment; treatment plan
components and reasonably required hours; a description of potential Complicating Factors (see
Table 6) that would reasonably necessitate assessments and treatment plans in the upper end of the
ranges presented; and a description of “exceptional” patient characteristics that make it reasonable to
expect that the assessment or treatment will require time and costs beyond those described in the
Guidelines.
Psychological assessments reasonably include the following cost components: Clinical Interview(s)
with the patient and collateral sources, Psychological Testing, Disbursements, Review of External
File Materials, Consultation with Health Professionals and Others, Documentation and Report
Preparation, and Feedback/Treatment Planning Interview.
It is the responsibility of the psychologist who is completing the assessment to determine which
assessment components are necessary and the amount of time for each that is reasonable and
necessary given the circumstances.
Cost of completion of the OCF-18 is additional. Fees for travel time required by the psychologist to
assess the patient in the home or workplace are additional, and require pre-approval via the OCF-22.
Interpreter services are normally invoiced by the interpretation service directly to the insurer,
following prior notice to the insurer of the need for interpretation service and insurer agreement to
fund the service.
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The Guideline in Table 1 describes the usual hour ranges for the component activities of General
Clinical/ Health/Rehabilitation Psychological Assessments.
The Guideline in Table 2 describes the usual hour ranges for the various assessment components for
neuropsychological assessments.
The Guideline Table 3 describes the usual hour ranges for various assessment components for
psychovocational assessments.
The Guideline in Table 4 describes the usual hour ranges for the various assessment components for
psychoeducational assessments.
It would be unusual for any individual to require the upper end of the range for all components of an
assessment. Where the psychologist anticipates that the assessment will require the upper end of the
range of the assessment components or more, the psychologist should describe the reasons on the
OCF-22, referring to the presence of particular Complicating Factors and/or Exceptional
Characteristics affecting patient presentation. Note in particular, that when working with geriatric
adults, children, and adolescents, multiple clinical interviews, consultations with other health
providers, and feedback interviews are more often required (e.g. school, residential facility, rehab
staff, family members/ caregivers); additionally, recommendations for academic planning or
residential management are additional aspects of planning rehabilitation and treatment that can add
substantially to report writing time. As a result, more time may be required for these particular
components of an assessment with these age groups than is indicated in the range as applied to
adults, thereby creating potential “exceptions” to many of the Guidelines (note that the
psychoeducational guidelines have been developed to apply to children and adolescents).
Psychologists should note these factors when requiring more time for their services than is indicated
by the time ranges described here.
These Guidelines were developed based on review of the professional scientific literature and
surveys of practitioners. They are considered to apply to all initial assessments for treatment planning
for adults injured in MVAs in Ontario.
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Table #1 Guideline for General Clinical/Health/ Rehabilitation Psychological Assessment
Indicators for Assessment: A General Clinical/Health/Rehabilitation Psychological Assessment is reasonably required when the
intake screen suggests that:
 A claim has been made for the MVA to which the impairments are attributed; and
 The patient consents to the proposed assessment and necessary communications with their treating health professionals and their
insurer; and
 The following are suspected/ reported associated with an MVA:
o Psychological impairment or
o Symptoms of psychological distress or role impairment; or
o Psychological factors affecting the patient’s response to other treatments for MVA-related impairments, or
o Presence of “Yellow Flags” as defined by the New Zealand Guide to Red and Yellow Flags; or
o Interference with usual home, school, or work life due to psychological impairments.
Assessment Activities
Assessment Intervention and CCI Code
Hours
2.5 - 6
Clinical Interview(s) with Patient and Collateral Sources (2.AZ.02)
Time required within the range is dependent on length of time needed for patient interviews and/or additional
interview(s), e.g., due to intellectual limitations, language impairments/ disabilities, need to clarify a complex history,
issues of causation, unusual clinical presentation, or multiple impairments.
General Clinical/ Health/ Rehabilitation Testing (2.AZ.08)
1-5
Includes test administration, scoring and interpretation. Assessment may include testing the following domains:
emotional/health status, coping strategies, personality, psychopathology, mood, anxiety, pain, traumatic stressors,
family/social relationship functioning, general intellectual/cognitive functioning, rehabilitation status and validity
measures. Time required within range is dependent upon need for more depth/ breadth of testing.
Billed on
Disbursements (G.XX.99)
Appropriate disbursements may include cost of obtaining relevant records and previous raw test data, consumable test
a cost
materials, and use of external scoring services. Such items are invoiced on a cost recovery basis.
recovery
basis
1-4
Review of External File Material (7.SJ.13)
Includes review of medical chart, IMEs, DAC reports, school and work records. Time required within the range is
dependent upon the complexity and length of the file.
.5 - 2
Consultation with Health Professionals, the Insurer, or Others as Required (7.SF.12)
Time required within the range is dependent upon the need for additional consultations and/or information gathering
from other parties to clarify assessment issues.
4-6
Documentation (7.SJ.30)
Includes analysis of all data, formulation of a diagnosis, plan for treatment, and preparation of an assessment report.
Increase time as required within the range for complex situations that require more extensive data analysis and
documentation.
1-2
Feedback Interview (2.AZ.02)
Includes review of assessment findings, treatment planning, and obtaining consent for treatment and communication.
Time required within the range increases with need for longer or additional interview(s), e.g., patients with intellectual
limitations, language impairments/disabilities, or with serious or multiple psychological impairments.
10 - 25*
Total Assessment Hours
* Note: these times do not include the fees for completion of required OCF forms or for disbursements such as obtaining records and test data, or consumable test
materials and scoring services. Patients with exceptional characteristics may reasonably require additional time and costs beyond the ranges shown. Such exceptions
include: geriatric adults, children, adolescents and any patients or other interviewees (e.g. parents/ caregivers) who have severe psychological disorders, moderate to
severe cognitive impairments, significant communication disorders, or language limitations requiring use of an interpreter (when reasonably available, services should
be provided in the person’s native language.)
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Table #2 Guideline for Neuropsychological Assessment
Indicators for Neuropsychological Assessment:
When neuropsychological concerns including reports of cognitive impairments/ deficits, post-concussion type
symptoms, and history suggestive of concussion/ brain injury are noted, neuropsychological assessment is
reasonably required. Neuropsychological assessments are diagnostic, descriptive, and prescriptive and are not
limited in relevance to patients with evidence of structural brain damage, but are also necessary to document
impairments in patients with possible/probable general clinical psychological disorders, and neuropsychological and
neurobehavioural disorders. Neuropsychological assessment provides objective documentation of cognitive and
motor complaints and is useful for planning treatment and rehabilitation, educational and vocational integration.
Assessment Activities
Assessment Intervention and CCI Code
Hours
2.5 - 6
Clinical Interview(s) with Patient and Collateral Sources (2.AZ.02)
Time required within range is dependent on length of time needed for patient interviews and/or
additional interview(s), e.g. due to intellectual limitations, language impairments/ disabilities, need to
clarify complex history, causation, unusual clinical presentation, or multiple impairments.
8 - 12
Neuropsychological Testing (2.AZ.08)
Includes test administration, scoring and interpretation. Assessment may include testing the following
domains: emotional/health status, coping strategies, personality, psychopathology, mood, anxiety, pain,
traumatic stressors, family/social relationship functioning, general cognitive functioning, adaptive
abilities, rehabilitation status and administration of validity measures. In addition, Neuropsychological
Assessments may include sensory abilities; motor skills; psychomotor speed; attention/concentration;
language; visuo-spatial/ constructional abilities; intellectual abilities; memory and learning; executive
functioning; judgment; self awareness; initiation; and self-control. Time required within range is
dependent upon need for more depth/ breadth of testing
Billed
Disbursements (G.XX.99)
Appropriate disbursements may include cost of obtaining relevant records and previous raw test data,
on a cost
consumable test materials, and use of external scoring services. Such items are invoiced on a cost
recovery
recovery basis.
basis
3-8
Review of External File Material (7.SJ.13)
Includes review of medical chart, IMEs, DAC reports, school and work records. Time required within
range is dependent upon the complexity and length of the file.
.5 - 2
Consultation with Health Professionals, the Insurer, and Others Required (7.SF.12)
Time required within range is dependent upon need for additional consultations and/or information
gathering.
5-8
Documentation (7.SJ.30)
Includes analysis of all data, formulation of a diagnosis, plan for treatment, and preparation of an
assessment report. Increase time as required within range for complex situations that require more
extensive data analysis and documentation.
1-3
Feedback Interview (2.AZ.02)
Includes review of assessment findings, treatment planning, and obtaining consent for treatment and
communication. Time required within range increases with need for longer or additional interview(s),
e.g., patients with intellectual limitations, language impairments/ disabilities or with serious and multiple
psychological impairments.
20 - 39*
Total Assessment Hours
* Note that these times do not include the fees for completion of required OCF forms or for disbursements such as obtaining records and test data,
or consumable test materials and scoring services. Patients with exceptional characteristics may reasonably require additional time and costs
beyond the ranges shown. Such exceptions include: geriatric adults, children, adolescents, and any patients who have severe psychological
disorders, significant communication disorders, or language limitations requiring use of an interpreter (when reasonably available, services
should be provided in the person’s native language.)
Guidelines for Assessment and Treatment
14
Table #3 Guideline for Psychovocational Assessment
Indicators for Psychovocational Assessment:
When vocational issues are anticipated, for example, difficulty returning to or maintaining level of performance in
former employment, need to identify suitable alternative employment type or vocational retraining needs, then
psychovocational assessment is reasonably required.
Assessment Activities
Assessment Intervention and CCI Code
Hours
2.5 - 6
Clinical Interview(s) with Patient and Collateral Sources (e.g., employer) (2.AZ.02)
Time required within range is dependent on length of time needed for patient interviews and/or
additional interview(s), e.g. due to intellectual limitations, language impairments/disabilities need to
clarify complex history, causation, unusual clinical presentation or multiple impairments.
8 - 12
Psychovocational Testing (2.AZ.08)
Includes test administration, scoring and interpretation. Assessment may include testing the following
domains: emotional/ health status, coping strategies, personality, psychopathology, mood, anxiety, pain,
traumatic stressors, family/ social relationship functioning, general cognitive functioning, adaptive
abilities, rehabilitation status and administration of validity measures. In addition, Psychovocational
Assessments may include testing of intellectual abilities; academic aptitude (reading, writing,
numerical); communication/language abilities (expressive, receptive); organizational and planning skills;
abstract reasoning; distractibility; vocational aptitude; vocational interests; task skills analysis;
transferable skills; endurance; persistence; adaptation and flexibility; motivation; achievement need; and
learning ability. Labor market assessment may be required. Time required within range is dependent
upon need for more depth/ breadth of testing
Billed
Disbursements (G.XX.99)
Appropriate disbursements may include cost of obtaining relevant records and previous raw test data,
on a cost
consumable test materials, and use of external scoring services. Such items are invoiced on a cost
recovery
recovery basis.
basis
3-8
Review of External File Material (7.SJ.13)
Includes review of medical chart, IMEs, DAC reports, school and work records and Labour Market
documentation. Time required within range is dependent upon the complexity and length of the file.
.5 - 2
Consultation with Health Professionals, the Insurer, and Others Required (7.SF.12)
Time required within range is dependent upon need for additional consultations.
5-8
Documentation (7.SJ.30)
Includes analysis of all data, formulation of a diagnosis, plan for treatment, and preparation of an
assessment report. Increase time as required within range for complex situations that require more
extensive data analysis and documentation.
1-3
Feedback Interview (2.AZ.02)
Includes review of assessment findings, treatment planning, and obtaining consent for treatment and
communication. Time required within range increases with need for longer or additional interview(s),
e.g., patients with intellectual limitations, language impairments/disabilities, or with serious and multiple
psychological impairments.
20 - 39*
Total Assessment Hours
* Note that these times do not include the fees for completion of required OCF forms or for disbursements such as obtaining records and test data,
or consumable test materials and scoring services. Patients with exceptional characteristics may reasonably require additional time and costs
beyond the ranges shown. Such exceptions include: patients or other interviewees (e.g. parents/ caregivers) who have severe psychological
disorders, moderate to severe cognitive impairments, significant communication disorders, or language limitations requiring use of an interpreter
(when reasonably available, services should be provided in the person’s native language).
Guidelines for Assessment and Treatment
15
Table #4 Guideline for Psychoeducational Assessment
Indicators for Psychoeducational Assessment:
When educational concerns are anticipated, for example, difficulty returning to or maintaining level of performance
and progress in former educational program, or need to identify suitable alternative modifications or supports, then
psychoeducational assessment is reasonably required.
Assessment Activities
Assessment Intervention and CCI Code
Hours
2.5 - 6
Clinical Interview(s) with Patient and Collateral Sources (e.g., parent, teacher) (2.AZ.02)
Time required within range is dependent on length of time needed for patient interviews and/or
additional interview(s), e.g. due to intellectual limitations, language impairments/disabilities, need to
clarify complex history, causation, unusual clinical presentation or multiple impairments.
8 - 12
Psychoeducational Testing (2.AZ.08)
Includes test administration, scoring and interpretation. Assessment may include testing the following
domains: emotional/ health status, coping strategies, personality, psychopathology, mood, anxiety, pain,
traumatic stressors, family/ social relationship functioning, general cognitive functioning, adaptive
abilities, rehabilitation status and administration of validity measures. In addition, psychoeducational
assessments may include testing of intellectual abilities; academic skills and underlying processes
(reading, writing, numerical); communication/language abilities (expressive, receptive); organizational
and planning skills; abstract reasoning; distractibility; vocational aptitude; vocational interests; task
skills analysis; transferable skills; endurance; persistence; adaptation and flexibility; motivation;
achievement need; and learning ability. Time required within range is dependent upon need for more
depth/ breadth of testing
Billed
Disbursements (G.XX.99)
Appropriate disbursements may include cost of obtaining relevant records and previous raw test data,
on a cost
consumable test materials, and use of external scoring services. Such items are invoiced on a cost
recovery
recovery basis.
basis
3–8
Review of External File Material (7.SJ.13)
Includes review of medical chart, IMEs, DAC reports, school records. Time required within range is
dependent upon the complexity and length of the file.
.5 - 2
Consultation with Health Professionals, the Insurer, and Others Required (7.SF.12)
Time required within range is dependent upon need for additional consultations.
5–8
Documentation (7.SJ.30.ZZ)
Includes analysis of all data, formulation of a diagnosis, plan for treatment, and preparation of an
assessment report. Increase time as required within range for complex situations that require more
extensive data analysis and documentation.
1–3
Feedback Interview (2.AZ.02)
Includes review of assessment findings, treatment planning, and obtaining consent for treatment and
communication. Time required within range increases with need for longer or additional interview(s),
e.g., patients with intellectual limitations, impairments/disabilities, or with serious or multiple
psychological impairments.
20 - 39*
Total Assessment Hours
* Note that these times do not include the fees for completion of required OCF forms or for disbursements such as obtaining records and test data,
or consumable test materials and scoring services. Patients with exceptional characteristics may reasonably require additional time and costs
beyond the ranges shown. Such exceptions include: any patients or other interviewees (e.g. parents/ caregivers) who have severe psychological
disorders, moderate to severe cognitive impairments, significant communication disorders, or language limitations requiring use of an interpreter
(when reasonably available, services should be provided in the person’s native language).
Guidelines for Assessment and Treatment
16
Guidelines and Procedures for Psychological Treatment Plan Proposals
Indicators to Propose Psychological Treatment
Accepted community and professional standards indicating that psychological treatment is
reasonable and necessary include that an appropriate assessment has identified the following:
 A psychological impairment/ condition/ disorder resulting from the accident and its sequelae, and/
or psychological factors that are having an effect on the treatment/ rehabilitation of physical
injuries;
 An effective or reasonable intervention exists;
 The patient is sufficiently motivated and can access treatment (barriers addressed);
 A sufficiently/ appropriately qualified practitioner is available.
OCF-18 Treatment Plan Application
After completing the appropriate assessment, the psychologist completes the OCF-18 and with
patient consent, submits it to the insurer.
1) Information Required for Completion of the OCF-18 Treatment Plan Application:
The psychologist must obtain the following information in the assessment in order to complete the
OCF-18 Treatment Plan Application Form:













Patient self-report of symptoms;
Details of the motor vehicle accident, including patient’s subjective reactions;
Description of injuries/impairments/disorders/conditions resulting from the MVA;
Description of treatments previously received for impairments resulting from the MVA and
response, including specific detail regarding treatments previously received for psychological/
neuropsychological impairments/conditions/disorders resulting from the MVA;
History of pre-existing conditions and treatment (including chronic pain conditions);
Family medical and psychiatric/mental health history;
Developmental, psychosocial, psychiatric/mental health diagnostic and treatment history
(including substance use, and previous exposure to traumatic events and subsequent PTSD) and
vocational history (including previous disability status);
Mental status;
Pre-accident functional status in both employment and activities of a normal life;
Any specific functional limitations resulting from the accident, including in employment and
activities of normal life (including travel); determination of availability of modified work if
required;
Co-existing/concurrent conditions and treatment, including presence of potential Red and Yellow
Flags;
Description or diagnosis of psychological/ neuropsychological impairments/disorders/conditions
resulting from the MVA, according to ICD-10-CA classification (not DSM-IV criteria), including
ICD-10-CA codes and differential diagnoses based on this assessment;
Causal Role of the MVA, including consideration of the potential role of pre-existing conditions/
vulnerabilities;
Guidelines for Assessment and Treatment
17
 Description of goals of the Treatment Plan to restore function and/or reduce impairments,
symptoms, or pathology;
 Appropriate evaluation methodology to determine treatment progress including re-administration
of psychometric measures as necessary;
 Factors that may affect treatment including determination and description of barriers to recovery,
and recommendations to address such barriers;
 Concurrent treatment for the accident-caused impairments;
 Applicable psychological treatment utilization guidelines;
 Description of proposed goods and services with CCI codes, including number, duration and cost;
 Documentation of patient consent to the proposed treatment.
2) Treatment Plan Application Approval, Review, and Initiation of Treatment
The insurer must respond within two weeks with either full or partial approval or refer the disputed
application for review. If the insurer does not respond within the time frames, treatment may begin
and the insurer is obligated to pay for any treatments provided until a response is given. If the insurer
disputes the proposed treatment plan and refers the matter to a reviewer, the reviewer is expected to
begin the assessment within specific time lines. The reviewer determines whether the proposed
treatment is reasonable and necessary. The insurer is only obligated to pay for treatment that has been
approved by the insurer or by a reviewer.
3) Treatment Interventions
Treatment is evidence-based where applicable evidence exists to support the use of a particular
intervention; otherwise psychologists use a reasonable approach. The report and OCF-18 must
indicate specific type(s) of therapy proposed, for example: psychotherapy (individual, couple, family
group, in-vivo sessions), psycho-education, and/ or cognitive rehabilitation. When more than one
type of psychological treatment is proposed, for example, individual and family therapy, the rationale
for each type of intervention must be provided in the report (all interventions utilized are described
within the language of the Canadian Classification of Interventions (CCI) and an associated
intervention code is provided).
Frequency and duration of sessions within the total number of hours in the Guideline are to be
determined by the individual treating psychologist according to the specific needs of the patient and
may vary over the course of the treatment plan.
4) Review of External File Information as Received
During the course of therapy, new documents and reports will often be completed on the patient that
are relevant to treatment (e.g. medical reports from treating physicians, physiotherapists,
chiropractors, occupational therapists, independent psychological examinations, treatment plan
review reports, disability assessment reports, Functional Abilities Evaluations (FAEs), in-vivo driver
re-training progress reports, etc.). In order to maintain adequate and informed treatment and
appropriate continuity within the circle of care among treatment providers, these documents should
be reviewed by the treating psychologist as they are received. The treatment plan therefore should
include time that is anticipated to be required for review of external file information received during
the course of treatment.
Guidelines for Assessment and Treatment
18
5) Consultation, Collaboration, and Communication
Ongoing consultation, collaboration, and communication with treatment providers and others (e.g.
phone calls, team meetings, contact with other treatment providers, insurers, teachers, employers) are
an essential component of the treatment and rehabilitation process. This ongoing communication is
necessary to provide integrated treatment and avoid duplication. The communication allows multiple
independent treatment providers to function as a “virtual clinic” to meet the needs of the patient in
the most effective and efficient manner. In those instances where in-person team meetings are
required, the specific rationale should be described and the additional time indicated. The treatment
plan includes the time that is anticipated to be required for consultation, collaboration, and
communication.
6) Ongoing Evaluation, Formal re-Assessment, and Modification of Treatment
Because the trajectory and ultimate results of treatment can vary so greatly, regular re-assessment of
functioning and progress in therapy is essential to providing effective, efficient, high quality care. All
psychologists, regardless of their orientation, education, or training, should engage in regular
outcome evaluation of their patients in order to determine and document progress in therapy. Such
outcome evaluations to document progress and modify treatment as necessary are a critical part of
the treatment process, and are to be included in the OCF-18 treatment plan, rather than requiring a
separate OCF-22.
It is expected that ongoing evaluation to monitor treatment progress and modify treatment when
warranted must occur as an integral component of psychological treatment and rehabilitation.
Ongoing evaluation and formal re-assessments are employed in order to track and document
outcomes during the therapeutic process. Firstly, in order to determine whether treatment is effective
in attaining the goals set at the outset of therapy and to make any required modifications to the
treatment process, ongoing evaluation of progress must occur. Such evaluation and modification of
treatment is a critical part of care. Secondly, formal re-assessment during and at the conclusion of the
treatment plan is required in order to document changes, modify treatment as indicated and is
mandated on the OCF-18 treatment plan. Such formal evaluation, including diagnostic queries and
repeat psychological testing should occur at specific intervals during treatment (minimally including
mid-way through the treatment plan and upon completion of the treatment plan).
In order to meet these expectations for ongoing evaluation and formal reassessment, time for the
ongoing evaluation and formal reassessment during and at the completion of the treatment plan
should be included on the treatment plan proposal. Ongoing evaluation could include for example,
clinical observation, patient self report, reports from significant others and completion of satisfaction
questionnaires. Formal re-assessment will require re-administration of psychological tests. (If the
need for additional specialized assessments, for example, psychovocational assessment, is identified,
a separate OCF-22 should be submitted.)
Note that standardized psychometric measures may not be appropriate for some patients and most
evaluations should be augmented by other measures to evaluate functional goals. In those instances
when it would be inappropriate to administer formal psychometric tests, the rationale should be
stated and the alternative method of evaluation should be indicated. Psychologists should use their
professional judgment, including review of the current scientific literature and should follow
contemporary standards of practice when determining the best strategies for evaluating outcomes and
progress in treatment.
Guidelines for Assessment and Treatment
19
7) Preparation of Progress Reports, Discharge Reports, and/or Subsequent Treatment Plans
Results of formal assessments should be communicated to the patient, other treating health
professionals, and the insurer, as available, with patient consent. Communication of results of formal
evaluation throughout the therapy process with interested parties (including the referral source,
family physician, other treatment providers, and adjuster with patient consent is essential to effective,
integrated care of the patient. Time for preparation of progress reports, discharge reports and/or
subsequent treatment plans should be included in the treatment plan.
8) Consumable Goods used in Therapy
These consumable goods are distinct from the “cost of doing business” which is absorbed by the
health professional. Consumable goods and disbursements are billed on a cost-recovery basis.
Examples of consumable materials and goods used in therapy include for example, workbooks and
tapes for patient practice between sessions, test booklets, consumable test scoring software, and use
of scoring services. It is anticipated that the consumable goods and disbursements required for a
treatment plan will be billed to the insurer on a cost recovery basis. The anticipated cost of these
goods and disbursements should be included in the treatment plan.
Treatment Guidelines
For those patients with uncomplicated, mild impairments and no or few complicating factors (see
Table 6 for a description), briefer initial treatment plans of between 12-38 hours spanning 8-16
weeks may be reasonable. Due to the complexity of patient presentation after auto injuries, the initial
treatment plan may typically range from 25-60 hours over 17-26 weeks. Total treatment plan hours
as presented includes time spent in activities on behalf of the treatment of the patient in addition to
the therapy sessions themselves (see table 5). Individual treatment sessions may vary in length of
time required. Therapy with patients injured in motor vehicle accidents often requires longer sessions
than those for general mental health patients due to their frequent presentation with multiple different
problems requiring attention in therapy sessions. All treatments proceed in phases with ongoing
evaluation, monitoring and modification of treatment and re-administration of psychological tests.
Consultation with other treating professionals and reporting to provide integrated care are required
components of sound treatment/rehabilitation.
Note: Patients presenting with more serious conditions and/or more Complicating Factors (see Table
6) will reasonably require the upper end of the range for components of a treatment plan. Patients
with “exceptional” characteristics may reasonably require additional time and costs beyond the
ranges described in these Guidelines. These exceptions include patients who have severe
psychological disorders, moderate to severe cognitive impairments (some of these patients may
require a period of inpatient treatment); significant communication disorders, or whose first language
limits their ability to participate fully in an assessment and treatment (when reasonably available,
services are appropriately provided in the person’s native language).
Outcomes
Evaluation of the patient’s progress in therapy at the final formal evaluation point will yield
information regarding whether the patient requires further psychological treatment, and how to
proceed to either discharge or submitting a plan for extension of treatment.
Guidelines for Assessment and Treatment
20
Table #5 TREATMENT GUIDELINES: Initial General Clinical/ Health/ Rehabilitation Psychological Treatment
Plans
Applicable Patient Groups
Intervention
Treatment: psychotherapy (individual, couple, family group, in-vivo
sessions), psycho-education, cognitive rehabilitation (6.AA.30)
Review of external file material as received (7.SJ.13)
Consultation, collaboration, and communication with treatment
providers and others (e.g. phone, email and team meetings with other
treating health professionals, contact with insurers, teachers,
employers) (7.SF.15)
Ongoing progress evaluation and formal reassessment: includes
continuous evaluation of progress and formal re-administration,
scoring, and interpretation of psychometric tests ( 2.AZ.08)
Preparation of progress reports, discharge reports, and/or subsequent
treatment plans (7.SJ.30)
Disbursements and consumable goods used in therapy: Appropriate
goods may include: books, manuals, workbooks, and tapes or CDs to
support therapy; consumable test materials; use of external scoring
services; and the cost of obtaining relevant records. Such items are
invoiced on a cost recovery basis (GXX11)
Total Treatment Plan Hours
Patients with: Mild
and/or Uncomplicated
conditions
(Treatment Plan: 8 - 16
weeks*)
Hours
8 - 24
Patients with: Moderate/ Serious
or Complicated conditions (See
Table 1: Complicating Features);
(Treatment Plan: 17 - 26 weeks*)
0-2
0-4
0–3
1-6
2-4
3–6
2-4
4–6
Billed on a cost
recovery basis
Billed on a cost recovery basis
12- 38**
25 - 60**
Hours
17 - 39
** Note that these times do not include the cost of goods used in therapy, disbursements, or the cost of OCF forms. Patients with “exceptional” characteristics may
reasonably require additional time and costs beyond the ranges described in these Guidelines. These exceptions include patients or other interviewees (e.g. parents/
caregivers) who have severe psychological disorders, moderate to severe cognitive impairments (some of these patients may require a period of inpatient treatment);
significant communication disorders, or whose first language limits their ability to participate fully in an assessment and treatment (when reasonably available, services
are appropriately provided in the person’s native language).
Outcomes: Discharge or submit new treatment plan according to patient status:
Impairment resolved, function restored, no further treatment required; OR
Impairment continues, functional limitations continue, but no further psychological treatment is indicated; OR
Impairment continues, functional limitations continue, further psychological treatment is indicated; AND/ OR
Other assessment and/or treatment is indicated.
* It may be appropriate to utilize a few sessions at less frequent intervals in a “follow-up” phase for consolidation and relapse
prevention as well as support for work/school reintegration. Such “follow-up” should be anticipated in the treatment plan; although
delivery of such sessions may extend beyond 26 weeks of treatment, they should be included in the total number of hours
recommended for treatment. In this way, the “follow-up” phase will not add additional hours or cost to the treatment described in this
Guideline.
Complicating Factors
Factors that contribute to the variability of the nature and extent of assessment and therapeutic
interventions may be either complicating or facilitating of assessment and treatment. Various factors
combine to determine the intensity, frequency, and duration of assessment processes and treatment
plans. These include degree of impairment (mild vs. moderate-serious) and number and degree of
complicating factors (none-mild vs. multiple-severe). Note in particular, that when working with
geriatric adults, children, and adolescents, multiple clinical interviews, consultations with other
health providers, and feedback interviews are generally required (e.g. school, residential facility,
Guidelines for Assessment and Treatment
21
rehabilitation staff, family members/ caregivers): additionally, recommendations for academic
planning or residential management are additional aspects of planning rehabilitation and treatment
that can add substantially to report writing time. As a result, more time may be required for these
particular components of an assessment with these age groups than is indicated in the ranges as
applied to adults. Patients with more serious impairments/conditions and more complicating factors
generally require more intense treatment of longer duration. Thus, based on the clinical research
literature, patients with more of the indicated complicating factors (see Table 6 below) could be
expected to require longer treatment duration and more time for indirect services, such as
consultation with other treating health professionals, while those with fewer of these factors could be
expected to require shorter and simpler assessments and treatments. Note that the lists below are not
meant to be comprehensive; other factors may also exist that will either complicate or facilitate
assessment and treatment of individual MVA survivors. Individual psychologists should indicate
when these are relevant in order to flag the presence of complicating factors and explain the need for
services in the upper end of the range of time within the Guideline required.
Exceptions
Patients with “exceptional” characteristics may reasonably require additional time and costs beyond
the ranges described in these Guidelines. Psychologists submitting OCF-22 Applications for
Approval of Assessment and OCF-18 Treatment Plan Applications should demonstrate consistency
with the current guidelines by including applicable components for assessment and treatment in their
plans; however, exceptional characteristics that explain time required outside the usual ranges for
must be noted. These exceptions include patients who have severe psychological disorders,
moderate to severe cognitive impairments and/ or significant communication disorders, and whose
first language limits their ability to participate fully in treatment (when reasonably available,
services are appropriately provided in the person’s native language). Patients with “severe”
psychological disorders are considered “exceptional” as they would frequently require more
intensive assessment and multidisciplinary treatment (including the possibility of inpatient
treatment) than is contemplated by these guidelines. Such disorders include for example, patients
presenting with severe depression and active suicidality or during an acute psychotic episode. Also,
while efforts have been made to include recommendations for assessments and treatment of geriatric
adults, children, and adolescents, we wish to emphasize that working with these age groups will
often require time beyond that included in the Guidelines. Thus, anyone working with these age
groups should note consistency of content with the present Guidelines, but exception from the usual
time ranges as required. Applicable exceptions are noted in each Guideline table.
Guidelines for Assessment and Treatment
22
Table 6: Complicating Factors
Age

Assessment of children, adolescents, or geriatric adults often requires greater time for clinical interviews,
consultation with other health providers, and feedback interviews.
Presence of pre-existing and co-existing psychological and physical vulnerabilities, such as:
 Previous exposure to traumatic events, especially recurrent childhood traumatic exposure
 Depression, anxiety disorders, pain disorder
 Physical injuries, acute and chronic debilitating medical conditions
 Impaired cognition
 Disability status, including learning disabilities
 Significant problems with attentional or behavioural control and regulation
 Developmental delay, ADHD, behavioural or conduct disorder
Absent or poor social supports or environmental resources, such as:
 Poor parenting skills or dysfunction within the family
 Difficulties with school re-entry, or limited resources within the school and community
 Poor marital relationship
 Limited social support network
 Problematic work environment, currently off work and no modified work available if needed, or no return
to work program available when needed
 Limited education and/or transferable vocational skills
 Limited social skills
 Insufficient income replacement and/or funding for housekeeping, childcare
 Lack of access to timely and appropriate medical care and other needed treatment
 Presence of multiple external stressors/stressful life events
 Lack of availability of therapist with capacity to provide treatment in native language
Psychological treatment issues affecting patient presentation, such as:
 Limited psychological-mindedness
 Influenced by mental health stigma
 Lack of openness toward therapy
 Limited beliefs in benefits of therapy
 Difficulty establishing therapeutic relationship
 More challenging coping and personality styles, for example: catastrophizing, ruminative, avoidant,
dependent, intense emotionality (Borderline Personality Disorder), high anxiety sensitivity/ somatic focus
 Language/cultural barriers to optimal communication;
More complex/serious injury/impairment/presentation as a result of the MVA, such as:
 Significant injuries to other family members in the MVA
 The MVA resulted in death to another person
 Slower than expected/incomplete recovery from physical injuries
 More complex/serious/persistent psychological symptoms/ impairments
 Multiple diagnoses (physical and/ or psychological), impairments, and limitations in functioning
 Presence of post-traumatic numbing
 Cognitive impairments
 More time elapsed since MVA (e.g., greater than two years)
 High distress associated with claim, anger/hostility or guilt regarding the index MVA, sense of loss of
control over life, “litigation stress” (high levels of general distress about a pending case)
Significant functional impairments in the home, school or workplace as a result of the accident injuries
Guidelines for Assessment and Treatment
23
Conclusion: Application of Guidelines to Individual Patients
Survivors of auto crashes present with a wide variety of problems. It is the responsibility of the
individual psychologist to determine how to approach these problems. These Guidelines are not
meant to dictate a particular approach or to prescribe a particular theoretical orientation or set of
techniques or interventions for treating survivors of MVAs. Rather, they are presented as assessment
and treatment principles, independent of particular models or theories; each psychologist is
responsible to draw on the state of the science in the area of concern (e.g. traumatic brain injury,
PTSD, bereavement), and to supplement this with his/ her own clinical training and experience in
order to ensure that appropriate service is rendered to the individual adult, adolescent, or child MVA
survivor.
While it is expected that all psychologists are knowledgeable about a range of evidence–based
assessments and treatments, it is also expected that the responsible treating psychologist will apply
the techniques and procedures that are appropriate to the individual MVA survivor and his/her
specific situation. For instance, it is expected that valid, reliable assessments and re-evaluation will
be employed before, during, and after therapy in order to document progress and determine
outcomes. Treatment approaches must be similarly evidence-based where applicable, but flexible,
and employed within the context of an empathetic therapeutic relationship. However, it must be
noted that assessment instruments and treatment approaches may vary widely. The severity of the
impairment/condition and presence of Complicating Factors contribute to variability within the
Guideline ranges. For these reasons, these Guidelines describe usual ranges for professional time and
costs for assessments and treatment plans for most patients, rather than prescribe specific hours and
procedures for particular patient presentations. As a result, these Guidelines are not intended to
prescribe a set assessment or treatment plan duration for all MVA victims. Nor do these Guidelines
dictate the use of particular approaches; rather, they are intended to encourage the utilization of
sensitive, flexible, evidence-based assessment and treatment approaches.