Directorate of ADF Rehabilitation Services

The following is an extract from "Defence" magazine - April 2006. The full article can be found at: http://www.defence.gov.au/defencemagazine/editions/200604/features/feature01.htm

Enhancing Rehabilitation Services in the Australian Defence Organisation

Defence has been leading the way with best practice rehabilitation and return to work programs for some time. Initiatives in this area affecting ADF members and APS employees in Defence include the new ADF Rehabilitation Program (ADFRP) and the Defence Civilian Injury / Illness Prevention and Management System (DCIPMS).

Defence began two major initiatives in 2004 to redevelop its rehabilitation system to enhance the management of injured or ill Defence people, as well as meet the relevant legislative requirements.

The following article provides an overview of the work Defence is doing to develop new approaches to rehabilitation and improve on current practice.

The new ADF Rehabilitation Program

At the recent Senior Leadership Group (SLG) Summit, the Chief of the Defence Force (CDF), Air Chief Marshall Angus Houston, expressed his pleasure at having seen best practice in terms of rehabilitation demonstrated by the 1 Health Support Battalion (1HSB).

In October 2004, a One-Star Steering Committee, with representatives from Defence and the Department of Veterans' Affairs (DVA), was formed to oversee the redevelopment of the rehabilitation system under the new Military Rehabilitation and Compensation Act 2004 (MRCA). The ADF Rehabilitation Program (ADFRP) aims to reduce the impact of occupational injury, illness and disease, thereby maximising Defence's capability.

The Australian Defence Force (ADF) has a responsibility to provide Health Care to ADF 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 fitness; and the restoration of productive work capability.

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.

The ADFRP has been developed to ensure Defence meets its duty of care to members as well as ensuring that Defence meets its responsibilities under legislation.

"The rehabilitation program, the injury prevention program-both of these are great initiatives," said the CDF, speaking about the current programs in Defence to the SLG in February. "[Injury 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 Australian Defence Force (ADF) health facilities. 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.

Approximately 3000 personnel are presently undergoing rehabilitation across the ADF.

ACM Angus Houston, 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 1 Health Support Battalion (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 turn-around here? How many of these people are you getting back into the training system?' The answer was 82 percent. 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 as well. 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's changing?

The new ADF Rehabilitation Program is aimed at ensuring that all injured or ill ADF members receive high quality, timely and coordinated rehabilitation. The key aspects of the changes being introduced are:

1. Early Intervention

• immediate referral to rehabilitation assessment
• coordinated management to deal with injury and illness quickly before they escalate into serious medical or psychological problems impacting a member's fitness

2. Goals

• each member requiring rehabilitation will have a Rehabilitation Plan aimed at achieving a Goal

3. Dedicated coordination and management

• a case manager provides continuity of care throughout a member's rehabilitation through the timely provision of rehabilitation services and liaison with the member's Chain-of-Command.

Process Overview

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

Triggers for Rehabilitation Assessment

• If a treating Medical Officer considers it necessary (including a routine appointment & MECR).
• If a member is to be on sick leave/restricted duties/convalescence > 28 days.
• If a member requests an assessment.
• If a member's CO requests an assessment.
• If recommended by the DVA needs assessment.

Assessment

Rehabilitation must occur at the earliest possible time in order to optimise the outcomes. Wherever possible, rehabilitation will be workplace-based as this provides the most realistic environment to assess fitness for work.

The Rehabilitation Assessment is structured to identify the relevant goal of a rehabilitation program. The Goals are:

• Goal 1 - Fit for duties and rehabilitate to pre injury status
• Goal 2 - Fit for duties with a change in duties /location /service
• Goal 3 - Stabilise, transition out of the ADF

Rehabilitation Plan

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.

Service Delivery Model

The Directorate of ADF Rehabilitation Services (DRS) is located in the Health Services Branch of the Joint Health Command, Vice Chief of Defence Force group.

Rehabilitation services are provided using a three-tiered service delivery model. Case Management services are delivered by contracted civilian case managers who provide the first tier of service delivery by giving local support to those members requiring rehabilitation.

Through Case Management we will deliver:

• Improved coordination of rehabilitation services in the ADF;
• Greater continuity of care between agencies;
• Improved support to members and their chain of command; and
• A coordinated transition management plan to support members requiring a medical discharge.

Working to the DRS through the Area Senior Health Officers, and providing the second tier of service delivery, are the ADF Rehabilitation Coordinators responsible for the contracting and coordination of rehabilitation case management services.

Measuring Success

• Increase ADF capability by having more members who are employable and deployable (MEC 1 & 2)
• Increase number of members retrained
• Increased value of return on Recruiting costs
• Defence will meet its legal obligations
• Reduce number of members who medically discharge
• Reduce impact/duration of absences and duty restrictions

23 September, 2008