Defence Magazine

In October 2004, Defence began redeveloping its rehabilitation system to enhance the management of members being rehabilitated, as well as meet the new legislative requirements of the Military Rehabilitation and Compensation Act 2004. A One-Star Steering Committee, with representatives from Defence and the Department of Veterans' Affairs, was formed to oversee the redevelopment of the rehabilitation system. The new program, known as the Australian Defence Force Rehabilitation Program (ADFRP), aims to reduce the impact of occupational injury, illness and disease, thereby maximising Defence's capability.

The new ADF Rehabilitation Program

Broadly speaking, the ADFRP involves early identification, treatment and management of injury or illness, through a coordinated response involving all relevant parties.

The Australian Defence Force (ADF) has a responsibility to provide health care to its members in order to maintain the required level of operational readiness. Rehabilitation is a key component for facilitating the return of members to a state of readiness as soon as is practicable after injury or illness.

Rehabilitation has two purposes: the restoration of physical and mental functioning, and the restoration of productive work functioning.

Through effective rehabilitation, the ADF maximises the personnel dimension of capability with the intent to return an injured or ill member to maximum effectiveness within the ADF environment, or if this is not possible, the civilian environment.

The ADFRP has been developed to ensure Defence meets its duty of care to members and its responsibilities under legislation.

'The rehabilitation program and the injury prevention program—both of these are great initiatives,' said ACM Angus Houston, speaking about the current programs in Defence to the SLG in February. '[I]njury prevention must be a very high priority right across the board. If someone is injured, it's not a question of discharging them because they now don't meet the professional or the medical standards; it's a question of rehabilitating them and getting them back into the training system so that we make the most of these people who've committed themselves to serving Australia with the Australian Defence Force.'

Best practice to date

Clinical rehabilitation is currently provided as part of medical treatment through ADF health facilities for illnesses and injury. Specific ADF units provide rehabilitation programs based on unit requirements. The primary drivers of rehabilitation to date have been Army units, due to their inherently higher physical demands and injury rates.

2 Health Support Battalion (2HSB), Duntroon Health Centre and 1HSB have well-established rehabilitation programs. The services at Darwin and Townsville are newer, and growing with the local demand.

At present, approximately 3000 personnel are undergoing rehabilitation across the ADF.

The CDF spoke about his impressions of the current practice at the SLG Summit in February.

'One of the most impressive things I've seen since I became CDF was to go down to Holsworthy to 1HSB and the training command rehabilitation unit to see world's best practice in terms of rehabilitation taking place before my very eyes. And I asked 'What is the turnaround here? How many of these people are you getting back into the training system?' The answer was 82 per cent. We've got to have that right across the board and we've got to work very hard to look after our people—not just in terms of physical rehabilitation, but also mental rehabilitation. So that's an area of high priority and I expect all of you to give it your best shot in that particular area.'

What will change with the program?

Early intervention will involve immediate referral to rehabilitation assessment and coordinated management to deal with injury and illness quickly before they escalate into serious medical or psychological problems affecting a member's fitness.

Each member requiring rehabilitation will have a rehabilitation plan aimed at achieving a goal.

Case managers provide continuity of care throughout a member's rehabilitation through the timely provision of rehabilitation services and liaison with the member's chain of command.

Rehabilitation—personal stories

While on a posting with the peace monitoring team on Bougainville Island in 2000, Lieutenant Commander (LCDR) Belinda Mitchell, a night duty nurse, fell and sustained an ankle injury, which she thought little of at the time. She later realised it was more serious, and she had in fact ruptured ligaments. Having finished her time in Bougainville, LCDR Mitchell had sprained the ankle again due to its prior weakness.

As a nurse, being on her feet all the time was part of the job, so without being able to walk properly, LCDR Mitchell would not be able to do her job. She came to 2HSB, where she received support for complete rehabilitation to facilitate her successful return to Navy service.

In a very different case, Angela Walden, former Royal Australian Air Force Corporal/Clerk, was diagnosed with bipolar disorder. This diagnosis means that there is a genetic predisposition to bipolar behaviour, generally triggered by an environmental or external event. Having experienced an unpleasant situation at work, a manic episode was triggered. Angela had to leave work and rely on medication to remain calm. A psychiatric illness, bipolar disorder affects one in 50 Australians.

Angela was then posted to Brisbane, where her illness continued to affect her and she was unable to work. Despite this difficulty, she became an Enrolled Nurse. When her condition continued to deteriorate, she was put in contact with Enoggera Health Unit. Faced with the prospect of discharge, Angela gained a sense of purpose through rehabilitation, which allowed her to define some career goals. As a result of her rehabilitation, Angela is now managing her illness.

In a third example of ADF rehabilitation, Private (PTE) Riki Karena, a former Gunner in the Army, went to Malaysia early on in his career. During an exercise, he went to ground and found it difficult to get back up. Encouraged by those around him, he pushed through the pain and continued on working. One day, he was unable to get back up. He was taken to Penang hospital and put in traction for a week.

PTE Karena was then told by the doctors that he had done some very serious damage to his back and needed a major operation; the result was that he would never be able to run again. At first, it seemed as though this was the end of his Army career, and PTE Karena describes his pain, anger and desperate feeling of loss at this point. He regretted having pushed himself too far without seeking help, and felt a huge sense of emptiness.

After his operation, having decided he didn't want to end his career on such a low note, PTE Karena sought rehabilitation and went to the gym and trained within his limits. After a number of rejections he finally succeeded in gaining a place back in the Army and received a core transfer to a position in an office. He would rather be out in the field, but he feels he can still achieve his goals in the office and plans to stay in the Army, despite it all.

Ultimately, the goal is to rehabilitate people completely so that they can return to their original job. This is not always possible, so transferring to another area or to pursue a slightly different career path can be the result of a successful rehabilitation.

The goals of the ADFRP have been reached in each of these three cases.

The rehabilitation process

Under the new program, a member of the ADF would be deemed to require an assessment if:

Rehabilitation must occur as soon as possible in order to optimise the outcomes. Wherever possible, rehabilitation assessment will be conducted in the workplace, which is the most realistic environment in which to assess fitness for work.

The rehabilitation assessment is structured to identify the relevant goal of a rehabilitation program.

An important element of the program is an individual's rehabilitation plan. It is aimed at returning injured or ill members to suitable ADF employment, or if appropriate, providing a seamless transition to the civilian environment. All rehabilitation plans commence with a thorough assessment of a member's suitability and capacity to undertake rehabilitation.

Outcome

Service delivery model

The delivery of rehabilitation services will be provided by Defence Health Services (DHS) through the Joint Health Support Agency (JHSA), using a three-tier management system. The first tier of management will be provided by a newly established rehabilitation cell, located centrally within Defence and with responsibilities including policy, quality assurance, training and reporting.

Working to the rehabilitation cell through the senior health officers and providing the second tier of management will be 17 newly recruited rehabilitation coordinators, responsible for the contracting and coordination of rehabilitation case management services. These services will be provided by contracted civilian case managers who will provide the third tier of management by offering local support to those members requiring rehabilitation.

Measuring success

It is intended that the following outcomes will demonstrate the success of the program:

Current status

Work on the new program is being progressed by eight project teams, which are staffed by integrated teams of Defence Health Services; Navy; Army; Air Force; Joint Health Support Agency; Corporate Services and Infrastructure Group; Occupational Health, Safety and Compensation Branch; and the Department of Veterans' Affairs.

Jim Porteous is the Director of ADF Rehabilitation Services, Defence Health Services Division.

The DCOH launched on 4 April 2006 by the Minister Assisting the Minister for Defence, the Hon. Bruce Billson, MP

Photo by Phillip Vavasour

Help at hand for health

A new Defence Centre for Occupational Health (DCOH) has been established as a major initiative to address a key priority of the Defence Occupational Health and Safety Strategic Plan.

The DCOH, launched on 4 April 2006 by the Minister Assisting the Minister for Defence, the Hon. Bruce Billson, MP (pictured), will provide a range of services to assist with the promotion of health and safety at work. The centre will provide advice and information, policy guidance, training, and practical tools to support managers and supervisors in their responsibility to work areas. The DCOH will assist and support the whole of Defence, including civilian and service personnel.

In line with internationally recognised definitions of 'occupational health', the primary role of the DCOH is to assist Defence to promote health and improve prevention of occupational illness and disease through identification and effective control of hazards.

The initial work of the DCOH will centre around the priorities identified by the Defence Occupational Health and Safety Committee (DOHSC). These involve identifying high-risk issues concerning asbestos, beryllium, heat, lead, noise and aviation fuels.

'Health and safety for our military and civilian personnel is a top priority and this dedicated new centre aims to prevent health problems and tackle both short- and long-term health challenges,' Mr Billson said during his speech at the launch of the centre.

'The establishment of the DCOH is a significant initiative that provides Defence with a specialist team of experts to work closely with existing safety teams around Australia to eliminate occupational hazards.

'The Australian Government is committed to the safety and wellbeing of its people and to establishing Defence as an employer of choice that makes an outstanding contribution to the protection of Australia's national interests,' Mr Billson said.

Implementing the strategy

The ability of Defence to manage occupational health and safety (OHS) directly impacts our overall capability to defend Australia and its national interests. Protecting our people is the focus of the OHS Strategic Plan. Our objective is to prevent occupational illness, disease and injury by effectively identifying hazards, employing clear risk management principles and through engaging our people—all those involved in or affected by our activities.

Defence is committed to maintaining the health and safety of our people and recognises that there is room for improvement in our OHS performance. This is demonstrated by the establishment of the Defence Occupational Health and Safety Committee (DOHSC). This committee is charged with the responsibility for guiding OHS developments throughout Defence, to implement the Defence OHS Strategic Plan, and to promote the recognition and acceptance of the benefits that good OHS culture and behaviours bring.

To provide a catalyst to achieve this desired organisational change the Occupational Health, Safety and Compensation Branch was established within the Defence Personnel Executive. The branch's function is to support implementation of the OHS Strategic Plan throughout Defence by initiating or assisting projects whose purpose is to address one or more aspects of the eight priorities contained in the plan.

In considering implementation of these priorities, and the plan as whole, the DOHSC agreed that a structured, coordinated and appropriately resourced approach was necessary, and endorsed the adoption of a program approach to managing (as projects) our improvement efforts. The DOHSC also 'agreed in principle' to a funding limit of $103 million over the period 2004–14. The Corporate Implementation Program (CIP) is a collective of individual corporate-level projects, which require collaboration and together make up the program of work to achieve improvement at a whole-of-Defence level.

A number of project strategies have already been approved by the DOHSC to tackle areas where improvements in Defence's OHS Management Systems are needed. Key areas being addressed are:

In addition to these strategies in the workplace there are others that are targeted more immediately at improving OHS performance in the workplace. These projects include the development of hazard identification, maintenance and management skills (the hazardous substance safety officer (HSSO) course); guiding incorporation of safety considerations within equipment and procedures from the initial concept specification (SafeDesign); and importantly for the members of the ADF, safety in operations.

The projects make up the portfolio of the CIP, and while coordinated by the OHSC Branch, they are being undertaken collaboratively with areas of Defence that have particular expertise or responsibilities in aspects of these issues. It is important to understand that, although to date the OHSC Branch has led with the development of initiatives, funding can be sought from the DOHSC for Corporate OHS initiatives from within the groups and services. Further information about the CIP can be found at http://ohsc.defence.gov.au/StrategicOHSGovernance/CIP/default.htm.

Defence

Feature

Enhancing rehabilitation services in the ADF