4.5.32 Outreach services
WorkSafe Victoria can pay the reasonable costs of an Outreach Service when required as a result of a work related injury or illness in accordance with Victorian workers’ compensation legislation.
Psychosocial support provided through outreach services are non-clinical, person centred supports that assist workers experiencing barriers to their recovery due to their work related primary or secondary mental injury. Outreach Services include the development of a recovery plan with an injured worker which identifies the individual worker’s needs and goals.
This can include support with daily living activities, assistance to engage with services, development of self-management skills, support to connect with community and build natural supports, peer support, assistance to exercise choice and control, goal setting and capacity building according to individual need, and risk The probability of the worker not returning to work is known as the risk or risk factor. For example: if a worker is likely to return to work, the claim is categorised as low risk. and safety planning.
WorkSafe can pay for the reasonable costs of a medical and like expense where a worker is entitled to provisional payments on a claimed mental injury.
See: 6.5 Provisional payments for a mental injury
Policy
The policy provides guidelines for Outreach Services to workers.
See: Policy for Outreach Services
The policy provides guidelines about:
- expectations for service delivery
- what costs will be paid for
- what costs will not be paid for
- reporting requirements.
Fee schedule
WorkSafe publishes a fee schedule for the maximum amounts that it will pay for Outreach Services.
See: Fee Schedule for Outreach Services
Criteria for outreach services
The following should be used as a guide. A worker may benefit from Outreach services where:
- the worker has sustained a mental injury (primary or secondary)
- the worker has been identified as being at risk of developing a secondary mental injury, e.g. as indicated by the worker:
- not engaging with treatment
- having minimal social supports and/or is feeling isolated
- having psychological and mental health support needs
- requiring crisis support.
Expectations for service delivery from outreach provider
Providers must measure and demonstrate effectiveness, empower the worker to manage their injury, and use evidence-based methods to optimise the orker’s function and recovery.
Providers must maintain one-on-one contact with the worker and actively collaborate with their treatment team. Support must be linked with goals, as outlined in reporting templates.
This support aligns to the principles of the Clinical Framework for the Delivery of Health Services.
Referral and reporting requirements
The Agent will decide whether to approve an Initial Assessment and Support Package after receiving the treating medical practitioner request. An initial package can be pre-approved for up to 30 hours and subsequent hours can be pre-approved in one or more blocks of up to 30 hours.
WorkSafe does not allow outreach providers to initiate referrals to other health services. To initiate referrals, providers must link with the treating medical practitioner to action in writing (OUT5).
Providers must submit an Initial Assessment and Support Plan to the Agent, prior to the fifth session with the worker. Further updates and plans will be reviewed by the Agent, and must be submitted after the initial 30 hour package and then at the completion of any further hours requested. A final update must also be submitted at the completion of engagement.
This provider’s request must include the following information:
- outcomes and progress to date
- a summary of the hours of direct support provided to date
- the reasoning for ongoing service delivery
- expected outcomes/ SMART (specific, measurable, achievable, realistic and timely) goals for ongoing service delivery
- likely duration that service is still required
- level of consultation with the referring medical practitioner and treating team.
WorkSafe have developed a recommended template that providers should use when completing an Initial Assessment and Support Plan and Plan Update.
Outreach services are considered to be a time limited intervention. From the date of Agents approval of service, the initial support package is valid for 12 months.
Process
Follow these steps to assess an outreach services request.
| Step | Agent action |
|---|---|
| Receive request | Once a request for services is received, the Agent determines liability for services. |
| Review suitability for referral |
The Agent should review all available information on the claim file for information about the worker’s capacity and entitlement for Outreach Services giving consideration to circumstances outlined above. The Agent should also review information on file including but not limited to medical reports, independent medical exam reports and ADL assessments to assist in determining liability. A suitably qualified person (injury management) may provide guidance. Consider the Criteria for Outreach Services (above) as a guide in determining eligibility for this service. |
| If request is approved |
Approve liability/suitability for referral Agent sends a Request for Outreach Services letter and includes a completed Outreach Service Referral form (OSRF1) and a copy of the Initial Assessment and Plan template (OUT6) to the Outreach Service provider, thereby approving initial assessment and support plan. Prior to sending an approval letter to the worker, the Agent should discuss with the worker that an approval for liability by the Agent does not guarantee that the Outreach Service Provider will accept the referral. Agent then sends approval letter (OUT1) to the worker and medical practitioner notifying of approval of services, service provider details and expectations for initial engagement. Payment for services for the initial support package of 30 hours can commence once the approval letter is received. The Outreach Service provider completes the Outreach Service Referral form and will engage with the worker within five days of acceptance of the referral. Where the Outreach Service provider does not accept the referral, the Agent should receive a telephone call from the provider to discuss the reason why. |
| If request is denied | Agent to send denial letter (OUT2) to the worker and medical practitioner notifying of the rejection of Outreach Services within 10 days of receiving a request. |
| Review outcomes for further actions | The Outreach Service Provider submits an Initial Assessment and Support Plan to the Agent prior to the fifth session with the worker. |
| Subsequent requests |
Does worker require subsequent support hours? The provider will indicate on the Outreach Services Plan Update if the worker requires subsequent support hours beyond the approved initial support package of 30 hours. Subsequent hours can be pre-approved in one or more blocks of up to 30 hours. The Outreach Service provider may not utilise additional hours prior to receiving written approval from the Agent. The Agent will notify the Outreach Service Provider of the outcome of the request for subsequent hours within 10 days. Agent determines liability for subsequent support hours The Agent should consider:
|