Community Neurobehavioural Service policy

The TAC can pay the reasonable costs of the community neurobehavioural service required as a result of a transport accident injury under section 60 of the Transport Accident Act 1986 (the Act).

The TAC will periodically review a client’s entitlement to the community neurobehavioural service to ensure that it remains reasonable for the transport accident injury and is payable under the Act.

DEFINITIONS

In this policy:

  • Community Neurobehavioural (CNB) Service: This is a time-limited residential program for clients with an Acquired Brain Injury (ABI) and significant behaviours of concern. The service will assist a client to transition to more independent, long-term accommodation and support options. The service is delivered by a multidisciplinary team of highly trained allied health and support staff who use an evidence-based neurobehavioural rehabilitation model. Residents receive an intensive individualised program of support which provides opportunities to develop positive behaviours and independent living skills. The goal of the CNB service is to reduce behaviours of concern and increase independence. The client will transition into a more independent living situation such as their family home, a community rental, purchased home or into standard shared supported accommodation (SSA) as they achieve the goals of the CNB program.
  • Functional Independence Review (FIR): The report the TAC requires for requests for attendant care and similar supports.
  • Independence Plan: The Independence Plan contains a clear set of short and long-term goals regarding the TAC client's home and living arrangements, health, vocational rehabilitation and quality of life. It includes the dates when each goal will be achieved and who is responsible for them.
  • Protective factors are the aspects of a client and their environment or personal experience that make it less likely they will experience risks and vulnerabilities associated with their behaviours of concern and/or co-morbidity.


GUIDELINES

What can the TAC pay for in relation to the community neurobehavioural service?

The TAC can pay the reasonable costs of the CNB service for eligible clients:

  • Where required as a direct result of the transport accident injury.
  • Where reasonable, necessary or appropriate in the circumstances.
  • Where clinically justified, safe and effective.
  • Initially for a maximum of 6 months and for no more than 12 months.
  • When requested by an occupational therapist, neuropsychologist or medical practitioner.

All CNB services must be approved in writing by the TAC before they are provided.

Who is eligible for community neurobehavioural services?

A client must meet all of the following criteria to be eligible for a CNB service:

  • An acquired brain injury as a result of a transport accident which has caused severe to extremely severe cognitive-behavioural impairments and include behaviours of concern that limit the client’s ability to achieve the independence goals in their Independence Plan.
  • Suffers cognitive, memory and executive function disorders with reduced insight and awareness.
  • In receipt of attendant care or is receiving or requires active service support to manage their behaviour.
  • Able to walk independently indoors.
  • Have independence goals and a realistic prospect of being able to return home or to a less dependent accommodation and support option than CNB services.
  • Medically stable (not requiring daily medical/nursing care).
  • Require 24-hour shared support.
  • Have identified “behaviour” as an Independence Plan goal and agree to participate in an inpatient rehabilitation program.

Other potential co- morbidities may need to be discussed with the provider on a case by case basis including:

  • pre-injury mental health issues
  • psychological problems, e.g. depression and anxiety
  • neuropsychiatric disturbances, e.g. pseudoseizures

A TAC client is not suitable for the service if any of the following applies:

  • Medically diagnosed substance abuse which the client is not willing to address.
  • A history of violent behaviour or the client requires physical restraint as the primary prescribed method of intervention.
  • The client requires regular active overnight attendant care (10.30pm to 7am).

The TAC will pay a daily bed fee for the following services delivered by the CNB provider:

  • 24-hour shared support.
  • An individually structured program including a specified number of hours of allied health therapy support, occupational therapy and neuropsychology.
  • Equipment owned by the provider to be shared among clients.
  • Training of attendant care agency staff and /or family in the neurobehavioural rehabilitation model for transition into the community (i.e. shadow-shifts at the facility or in the client’s home).
  • Local transportation (less than 5km) to and from recreational activities, appointments and home visits directly linked to the client's CNB program and goals.

The TAC can continue to pay for the transport accident-related treatment and services reasonably required by the client while participating in the CNB program. This includes:

  • Medical treatment provided by a registered medical practitioner.
  • Transport accident related:
    • pharmacy items;
    • standard consumables, such as dressing and continence supplies;
    • specialised dietary requirements such as PEG feeds;
    • client-specific equipment which is taken with the client after discharge from the CNB service;
    • additional allied health services that are not included as part of the standard community neurobehavioural service;
  • daily living expense contribution including rental costs, food and utilities; and
  • travel expenses for the client to receive medical, rehabilitation and disability services that are not included in the CNB service.

The client will pay for the following:

  • Expenses related to personal travel which is not directly related to the client’s transport accident injuries.

Requests for any treatment, services or travel will be considered under the respective policy.

Who can provide the CNB service?

CNB services can only be provided by an organisation which:

  • uses suitably qualified allied health and therapy support staff who are trained and experienced in an evidence-based model of neurobehavioural support; and
  • is authorised to provide CNB services under section 23 of the Transport Accident Act 1986

What information does the TAC require to consider paying for a CNB service?

The TAC requires a written referral to the CNB service from the client’s treating occupational therapist, neuropsychologist or medical practitioner containing the following information:

  • How the CNB will assist the client to achieve their Independence Plan goals including the expected outcomes by the conclusion of the service.
  • Degree and frequency of behaviours of concern and their impact on the client and their family.
  • Diagnosis of any co-morbidities.
  • Historical/current use of drugs and/or alcohol dependence.
  • Whether the client poses a risk of harm to themself and/or others.
  • Any difficulty experienced in engaging with support services.
  • Details of the client’s accommodation history.
  • Current level of functioning in everyday activities and level of community participation.
  • Details of the health and/or community service providers engaged with the client and the services being provided.
  • The client’s ability to walk indoors and his/her need for medical or nursing care and overnight support
  • Details of health services and support previously provided to the client. 
  • Barriers to treating the client’s behaviour of concern such as social, emotional or environmental factors.

CNB service suitability assessment (pre-admission screen)

If the treating health practitioner referral to a CNB service is approved:

  • The TAC will provide relevant information to the proposed CNB service provider including the client’s Independence Plan.
  • The CNB service provider will assess whether the client is suitable for the program. 
  • The CNB service provider will submit a “Mental Health Neurobehavioural Treatment Plan” (MHNTP) including the anticipated length of the service to the TAC.

Admission and Planning

The client will be admitted to the CNB service if the MHNTP is approved by the TAC. Upon admission, the CNB service provider will then be required to:

  • Outline  the independence goals being addressed from the client’s Independence Plan including details of the functional outcomes which it is anticipated the client will achieve.
  • Schedule three-monthly  meetings with the CNB service, the client and the TAC  to report outcome measures and monitor the goals in the client’s Independence Plan. An outcome report must be provided to the TAC after each meeting, refer Outcome reports section below.

Outcome reports

After each three-monthly meeting, the CNB provider must provide an outcome report which  covers:

  • A description with supporting evidence of the client’s progress towards the independence goals (in the Independence Plan), in the previous  three months including the outcomes:
    • achieved;
    • yet to be achieved and,
    • any barriers to reaching them.
  • Analysis and assessment of data about the frequency of behaviours of concern and the cause of the behaviours.
  • The frequency and analysis of critical incidents.
  • Critical observations and learnings.
  • The focus of the CNB service provider’s support for the client in the next three months.
  • Details of any discharge and transition planning (if applicable).

Transition planning includes the client trialling and transitioning to their discharge accommodation option. This phase may last a maximum of 8 weeks and includes a reduce bed fee (75%) for the nights the client is not at the CNB facility.

Discharge planning and exit report

A BASSA OT will work with the client and the CNB team to conduct a FIR of the community supports the client will require during transition and discharge from the CNB service. This will occur within three months of the planned discharge. The BASSA OT will work closely with the CNB service to support the client’s smooth transition to more independent accommodation.

The CNB provider will submit an exit report at the conclusion of the service covering:

  • The client’s strengths and protective factors.
  • Ongoing client behaviour management plan and strategies.
  • The most appropriate services for the client’s ongoing support including any accessibility issues.
  • Any change in frequency and/or severity of behaviours of concern over the duration of the program.
  • Documented causes of behaviours of concern
  • Other risks and ongoing concerns.
  • Recommendations for future support/management related to suitable accommodation and support options.

When will the TAC respond to a request?

The TAC will respond to written treatment and service requests as set out in the TAC Service Charter.

What are the TAC’s invoice requirements?

Refer to the TAC Invoicing Standards.

What fees are payable for the community neurobehavioural service?

The TAC can pay the reasonable costs of the CNB service.

In relation to the community neurobehavioral service, what won’t the TAC pay for?

The TAC will not pay for:

  • treatment or services for a person other than the client
  • treatment or services not authorised by the TAC under the Transport Accident Act 1986
  • treatment or services subcontracted to, or provided by a non-registered provider
  • concurrent treatment, i.e. additional neuropsychology or occupational therapy
  • fees associated with cancellation or non-attendance
  • incidental items that occur as part of a client's residential stay, e.g. telephone calls, television hire and general toiletries, e.g. toothpaste or soap
  • treatment or services provided outside the Commonwealth of Australia
  • treatment or services provided by telephone or other non-face-to-face mediums
  • telephone calls and telephone consultations between providers and clients/workers, and between other providers, including hospitals
  • treatment or services provided more than two years prior to the request for funding except where the request for payment is made within three years of the transport accident.  Refer to the Time Limit to Apply for the Payment of Medical and Like Expenses policy.

View Independence Plan - Information for providers

Independence Plan - Information for providers

Summary:

Our attendant care providers support clients to achieve their independence goals in daily living activities, therapy support, personal and domestic skills retraining and community access skills.