Spinal community integration services policy

What WorkSafe will pay for

The WorkSafe Agent (the Agent) can pay the reasonable costs of the spinal community integration service provided by Austin Health when required as a result of a work-related spinal cord injury (SCI) under Victorian workers compensation legislation.

Background

Workers who sustain a SCI have particular needs with their transition from hospital to the community.

The Victorian Spinal Cord Service (Austin Health) offers a spinal community integration service (SCIS) designed to meet the transition and community integration needs of individuals with a SCI. The primary functions of the SCIS are to:

• facilitate a worker's transition from hospital and reintegration into the community
• provide a coordinated approach for workers to receive trans-disciplinary support and education

This program commences while a worker is an inpatient at either the Royal Talbot Rehabilitation Centre or Caulfield Hospital and continues for 12 months post discharge into the community.

This service does not substitute existing inpatient rehabilitation or community rehabilitation services. It is a specialised service that aims to increase independence, self management and integration in the community after a SCI.

The service works with hospital and community providers to provide specialist expertise related to the holistic management of a worker after a spinal cord injury.

Workers will still access existing community rehabilitation and disability providers through local community services.

The SCIS also focuses on enhancing the capacity of existing community rehabilitation and disability providers to better manage SCI specific issues faced by workers.

The SCIS does this by providing a tailored approach to community transition and integration through the identification of individual goals, facilitating family support and social networks and providing specialised SCI consultation and support to existing community providers.

Definitions

In this policy:

• Spinal Cord Injury (SCI) is damage or trauma to the spinal cord that results in loss or impaired function of mobility or sensation. It can also affect the functioning of internal organs and bodily systems.
• The Victorian Spinal Cord Service (VSCS) is a specialist spinal cord service that provides acute management and rehabilitation for people who have sustained spinal cord injuries. It provides inpatient and outpatient services at the Austin Hospital and Royal Talbot Rehabilitation Centre in addition to a range of clinics and community based services.
• An inpatient is an individual worker who receives treatment and other hospital services while admitted to a hospital for overnight care.
• A community outpatient setting is the setting for which the primary purpose is not medical care, e.g. schools, worksites, shopping centres, homes.
• A trans-disciplinary approach is a framework allowing a healthcare team to collaborate, pool and integrate expertise of team members to contribute to the assessment, planning and intervention with an individual. This approach usually results in fewer professionals working directly with individual workers.
• The Community Integration Program(CIP) is an initiative that provides specialist care for eligible catastrophically injured workers in partnership with the Transport Accident Commission (TAC). Eligible workers are defined as those who have an accepted claim for compensation for a SCI resulting in quadriplegia/paraplegia or an acquired brain injury rated as severe or moderately severe.
• The Agent refers to the CIP team at the TAC.

Guidelines

What can the Agent pay for in relation to the Spinal Community Integration Service?

The Agent can pay the reasonable costs of the SCIS for a worker:

• who is participating in the Community Integration Program
• when the services are:
  • required as a result of a work-related SCI
  • reasonable, necessary and appropriate in the circumstances
  • clinically justified, safe and effective
  • in accordance with WorkSafe's guidelines

Prior approval is not required for a worker to access the SCIS.

Who can provide the Spinal Community Integration Service?

The SCIS is a specialised service which can only be provided to workers with a SCI by the Austin Health VSCS.

In relation to the Spinal Community Integration Service what won't the Agent pay for?

The Agent will not pay for:

• treatment or services for a person other than the worker
• SCIS services not provided by the Austin Health VSCS
• fees associated with cancellation or non-attendance