Case Management

Service Description

Case Management is a time-limited service which assists clients with disability to navigate their supports to achieve their transport accident-related injury goals.

Case Management services support clients to:

plan and coordinate their transport accident injury supports, treatments and services
navigate government and non-government systems
prepare for events or crises which may impact service access and/or achievement of goals relating to transport accident-related injury.

Case Management can support clients to achieve a range of goals relating to their transport accident injuries, including:

transitioning from a clinical or forensic environment into the community
sourcing housing that is appropriate for the client’s injuries
exploring opportunities for access and inclusion in the community
engaging with guardianship and VCAT administration applications
navigating non-TAC related legal matters that impact the client’s accident injury goals.

The Case Manager role includes:

developing a service implementation plan aligned to the goals in the client’s TAC MyPlan
supporting the client to navigate the service system or achieve outlined goals
liaising with members of the client’s treatment and support teams to ensure alignment of treatment and supports
identifying and managing client risk, including completion of needs and risk assessments
completing and submitting progress and exit reports to the TAC
developing and implementing plans for client transition out of or between Support Navigation services.

Eligibility

The TAC can pay for the reasonable cost of approved Case Management services for clients who, due to their transport accident-related disability, require additional support to coordinate their treatment and services or navigate systems. Prior written approval for Case Management services must be provided by the TAC before payment for services can be made.

What the TAC will pay for

The TAC will pay the reasonable cost of:

face-to-face Case Management support
Case Management support delivered via phone or videoconferencing (Telehealth) where appropriate
Case Manager travel to engage with the client or their service providers
completion of client progress, evaluation and exit reports requested by the TAC.

What the TAC won't pay for

Case Management activities performed by persons who do not meet the Provider Guideline requirements or comply with the TAC Support Navigation policy
Case Management support that is not evidence based, reasonable, clinically justified and outcome focused
Case Management services that do not relate to the client’s transport accident injury supports or achievement of goals that have been approved by the TAC
Case Management support that exceeds a reasonable duration
costs associated with referring a TAC client to a service provider not approved by the TAC
multiple Support Navigation services at the same time, except when a specialised service (Specialised Housing Case Management or Community Access Planning) is used in conjunction with a generalist Case Management service. When providing concurrent services, Support Navigation providers are expected to work in close communication and aligned goals
Case Managers acting in the capacity of guardian, administrator or legal power of attorney

Case Management referrals

The TAC will gather information from the client, their treating team, support providers and networks when developing a referral.

The referral will outline primary and secondary reasons for referral and any known client goals.

The TAC matches clients with providers based on expertise, experience and location.

In general, the TAC approves services for three months at a time and requires 3-montly progress reports. Extensions depend on client progress and need.

Provider guidelines

Service Standards:

It is expected that Case Management services:

Incorporate person-centred, strength-based approaches
Recognising the client as an expert in their own circumstances, client engagement should be maximised to ensure support is tailored to individual goals, strengths and interests.
Promote client independence
Case Managment services aim to build the client’s capacity to plan, coordinate and navigate systems to achieve future goals independently. Providers should avoid client dependence by performing activities on the client’s behalf only when necessary.

For clients who require significant assistance to manage their supports, the Case Manager may work towards empowering the client to lead the Case Management process in incremental stages. For example:

First Phase – Do for
The Case Manager contacts a support provider to discuss the client’s requirements.
Second Phase – Do with
Alongside the client, the Case Manager contacts the support provider to organise an appointment
Third Phase – Do for themselves
The client schedules their own appointment with support. Once the client has developed capacity to complete tasks independently, the Case Manager oversees transition of remaining support requirements to attendant care or the client’s natural supports.
Are goal-oriented and time-limited
Case Management services should be used as a point-in-time intervention to assist in the achievement of a specific goal(s) approved by the TAC. It is expected that providers plan for clients to be transitioned off Case Management supports as approved goals are achieved. While service duration will vary, the TAC expects that most clients will transition out of Case Management within 12 months.

Some clients may require multiple periods of Case Management support across their lifetime due to the complexity of their injuries. It is expected that support hours are tailored to reflect periods of stability and instability. The TAC does not consider ongoing, continuous Case Management with consistent support hours to be reasonable in most circumstances.

Engage the client’s support system
Where appropriate, providers should work with the client’s formal supports (such as attendant carers) and natural supports (such as family and friends) to develop sustainable strategies for supporting the client. This should include building the skills of the client’s support network to maintain structures established by the Case Manager upon client transition and exit.
Develop and implement transition plans
Providers are expected to develop robust plans to support client transition out of Case Management services. It is expected that the transition plan is shared with the TAC and relevant members of the client’s support network to ensure ongoing stability.
Be delivered in an appropriate format by providers with necessary skills and specialised knowledge

The TAC recognises that providers who specialise in a specific area are more likely to achieve positive client outcomes. Providers are expected to:

be equipped with specialised skills and knowledge directly related to client goals, including knowledge of the service systems in the client’s local area where required
only take on client referrals that align with their recognised area of expertise
deliver services face-to-face, using Telehealth only where necessary.

Registration

All case management providers must meet and maintain the TAC’s disability service provider registration requirements in order to deliver services to a client with a disability.

The requirements outlined in the policy and provider guidelines must be adhered to as part of TAC’s provider registration requirements.

When assessing the suitability of providers for the delivery of Case Management, the TAC considers several criteria including whether the organisation:

delivers safe and high-quality services
employs staff with relevant qualifications, skills and experience.

Qualifications

Case Managers must be qualified and experienced in delivering Case Management. Minimum qualifications are required to be at a diploma level and can include social work, community service work, disability work, allied health or nursing.

Safeguarding

TAC Safer Services Support provides TAC clients and the community a pathway to raise concerns or complaints about the quality and safety of TAC funded services.

Reporting

Progress reports:
Providers are required to complete 3-monthly progress reports updating the TAC on the client’s progress. Reports will identify and record progress toward TAC approved client goals which are specific, measurable, achievable, realistic and timely (SMART).

When making decisions about funding for further support, the TAC considers whether the progress report demonstrates evidence that the support is reasonable, clinically justified and outcome focused.

Exit Reports:

The Case Manager must submit an Exit Report to the TAC upon conclusion of the service.

The Exit Report must include a summary of supports provided, the outcomes of the service, key areas of support moving forward, risk management information and how support roles have been handed over to key stakeholders (natural supports, attendant care providers, community access providers or other services).

How the TAC makes a decision

The TAC uses the following principles to aid socially and economically responsible decision-making in line with the Transport Accident Act 1986:

1. Entitled:

The TAC client is entitled to Case Management if:

the TAC has accepted liability for transport accident-related disability associated with the Case Management support
the client is not able to coordinate their services or navigate systems to achieve transport accident-related injury goals.

2. Reasonable:

When determining whether Case Management is a reasonable cost in the circumstances, the TAC considers:

if the Case Management service is necessary because:
- the client is unable to achieve their transport accident-related injury goals independently
- the client’s natural support system (family, friends) is unable or does not have the skills to support the client to achieve their goals
- the supports cannot be provided by an attendant carer.
If the cost of the service is reasonable in relation to the service (see the Case Management Fee Schedule).

3. Clinical Justification:

When deciding if Case Management is clinically justified, the TAC considers whether:

the support is recommended by the client’s treating team (e.g. General Practitioner, occupational therapist or psychologist) or is necessary to connect the client with services.
the requested hours of support and duration of support are appropriate for the client’s condition and transport accident-related injury goals. While support duration may vary depending on client need, the TAC expects that most clients will not require Case Management for longer than 12 months.

When considering requests for additional support hours, the TAC considers whether reports provided to the TAC contain evidence that the:

effectiveness of the support has been measured
support provider has adopted a biopsychosocial approach
provider has taken steps to build client independence and self-management
support aligns with client goals
support is based on best available research and evidence, including through compliance with the Case Management Service Standards.

4. Outcome Focused:

When deciding if Case Management is outcome focused, the TAC considers whether:

the service is progressing or achieving the referral goals
the service promotes self-management and independence
the support approach is adapted to the client’s progress, including tapering of services as the client’s situation stabilises.


Case Management Service Description Case Management is a time-limited service which assists clients with disability to navigate their supports to achieve their transport accident-related injury goals. Case Management services support clients to: plan and coordinate their transport accident injury supports, treatments and services navigate government and non-government systems prepare for events or crises which may impact service access and/or achievement of goals relating to transport accident-related injury. Case Management can support clients to achieve a range of goals relating to their transport accident injuries, including: transitioning from a clinical or forensic environment into the community sourcing housing that is appropriate for the client’s injuries exploring opportunities for access and inclusion in the community engaging with guardianship and VCAT administration applications navigating non-TAC related legal matters that impact the client’s accident injury goals. The Case Manager role includes: developing a service implementation plan aligned to the goals in the client’s TAC MyPlan supporting the client to navigate the service system or achieve outlined goals liaising with members of the client’s treatment and support teams to ensure alignment of treatment and supports identifying and managing client risk, including completion of needs and risk assessments completing and submitting progress and exit reports to the TAC developing and implementing plans for client transition out of or between Support Navigation services. Eligibility The TAC can pay for the reasonable cost of approved Case Management services for clients who, due to their transport accident-related disability, require additional support to coordinate their treatment and services or navigate systems. Prior written approval for Case Management services must be provided by the TAC before payment for services can be made. What the TAC will pay for The TAC will pay the reasonable cost of: face-to-face Case Management support Case Management support delivered via phone or videoconferencing (Telehealth) where appropriate Case Manager travel to engage with the client or their service providers completion of client progress, evaluation and exit reports requested by the TAC. What the TAC won't pay for Case Management activities performed by persons who do not meet the Provider Guideline requirements or comply with the TAC Support Navigation policy Case Management support that is not evidence based, reasonable, clinically justified and outcome focused Case Management services that do not relate to the client’s transport accident injury supports or achievement of goals that have been approved by the TAC Case Management support that exceeds a reasonable duration costs associated with referring a TAC client to a service provider not approved by the TAC multiple Support Navigation services at the same time, except when a specialised service (Specialised Housing Case Management or Community Access Planning) is used in conjunction with a generalist Case Management service. When providing concurrent services, Support Navigation providers are expected to work in close communication and aligned goals Case Managers acting in the capacity of guardian, administrator or legal power of attorney Case Management referrals The TAC will gather information from the client, their treating team, support providers and networks when developing a referral. The referral will outline primary and secondary reasons for referral and any known client goals. The TAC matches clients with providers based on expertise, experience and location. In general, the TAC approves services for three months at a time and requires 3-montly progress reports. Extensions depend on client progress and need. Provider guidelines Service Standards: It is expected that Case Management services: Incorporate person-centred, strength-based approaches Recognising the client as an expert in their own circumstances, client engagement should be maximised to ensure support is tailored to individual goals, strengths and interests. Promote client independence Case Managment services aim to build the client’s capacity to plan, coordinate and navigate systems to achieve future goals independently. Providers should avoid client dependence by performing activities on the client’s behalf only when necessary. For clients who require significant assistance to manage their supports, the Case Manager may work towards empowering the client to lead the Case Management process in incremental stages. For example: First Phase – Do for The Case Manager contacts a support provider to discuss the client’s requirements. Second Phase – Do with Alongside the client, the Case Manager contacts the support provider to organise an appointment Third Phase – Do for themselves The client schedules their own appointment with support. Once the client has developed capacity to complete tasks independently, the Case Manager oversees transition of remaining support requirements to attendant care or the client’s natural supports. Are goal-oriented and time-limited Case Management services should be used as a point-in-time intervention to assist in the achievement of a specific goal(s) approved by the TAC. It is expected that providers plan for clients to be transitioned off Case Management supports as approved goals are achieved. While service duration will vary, the TAC expects that most clients will transition out of Case Management within 12 months. Some clients may require multiple periods of Case Management support across their lifetime due to the complexity of their injuries. It is expected that support hours are tailored to reflect periods of stability and instability. The TAC does not consider ongoing, continuous Case Management with consistent support hours to be reasonable in most circumstances. Engage the client’s support system Where appropriate, providers should work with the client’s formal supports (such as attendant carers) and natural supports (such as family and friends) to develop sustainable strategies for supporting the client. This should include building the skills of the client’s support network to maintain structures established by the Case Manager upon client transition and exit. Develop and implement transition plans Providers are expected to develop robust plans to support client transition out of Case Management services. It is expected that the transition plan is shared with the TAC and relevant members of the client’s support network to ensure ongoing stability. Be delivered in an appropriate format by providers with necessary skills and specialised knowledge The TAC recognises that providers who specialise in a specific area are more likely to achieve positive client outcomes. Providers are expected to: be equipped with specialised skills and knowledge directly related to client goals, including knowledge of the service systems in the client’s local area where required only take on client referrals that align with their recognised area of expertise deliver services face-to-face, using Telehealth only where necessary. Registration All case management providers must meet and maintain the TAC’s disability service provider registration requirements in order to deliver services to a client with a disability. The requirements outlined in the policy and provider guidelines must be adhered to as part of TAC’s provider registration requirements. When assessing the suitability of providers for the delivery of Case Management, the TAC considers several criteria including whether the organisation: delivers safe and high-quality services employs staff with relevant qualifications, skills and experience. Qualifications Case Managers must be qualified and experienced in delivering Case Management. Minimum qualifications are required to be at a diploma level and can include social work, community service work, disability work, allied health or nursing. Safeguarding TAC Safer Services Support provides TAC clients and the community a pathway to raise concerns or complaints about the quality and safety of TAC funded services. Reporting Progress reports: Providers are required to complete 3-monthly progress reports updating the TAC on the client’s progress. Reports will identify and record progress toward TAC approved client goals which are specific, measurable, achievable, realistic and timely (SMART). When making decisions about funding for further support, the TAC considers whether the progress report demonstrates evidence that the support is reasonable, clinically justified and outcome focused. Exit Reports: The Case Manager must submit an Exit Report to the TAC upon conclusion of the service. The Exit Report must include a summary of supports provided, the outcomes of the service, key areas of support moving forward, risk management information and how support roles have been handed over to key stakeholders (natural supports, attendant care providers, community access providers or other services). How the TAC makes a decision The TAC uses the following principles to aid socially and economically responsible decision-making in line with the Transport Accident Act 1986: 1. Entitled: The TAC client is entitled to Case Management if: the TAC has accepted liability for transport accident-related disability associated with the Case Management support the client is not able to coordinate their services or navigate systems to achieve transport accident-related injury goals. 2. Reasonable: When determining whether Case Management is a reasonable cost in the circumstances, the TAC considers: if the Case Management service is necessary because: the client is unable to achieve their transport accident-related injury goals independently the client’s natural support system (family, friends) is unable or does not have the skills to support the client to achieve their goals the supports cannot be provided by an attendant carer. If the cost of the service is reasonable in relation to the service (see the Case Management Fee Schedule). 3. Clinical Justification: When deciding if Case Management is clinically justified, the TAC considers whether: the support is recommended by the client’s treating team (e.g. General Practitioner, occupational therapist or psychologist) or is necessary to connect the client with services. the requested hours of support and duration of support are appropriate for the client’s condition and transport accident-related injury goals. While support duration may vary depending on client need, the TAC expects that most clients will not require Case Management for longer than 12 months. When considering requests for additional support hours, the TAC considers whether reports provided to the TAC contain evidence that the: effectiveness of the support has been measured support provider has adopted a biopsychosocial approach provider has taken steps to build client independence and self-management support aligns with client goals support is based on best available research and evidence, including through compliance with the Case Management Service Standards. 4. Outcome Focused: When deciding if Case Management is outcome focused, the TAC considers whether: the service is progressing or achieving the referral goals the service promotes self-management and independence the support approach is adapted to the client’s progress, including tapering of services as the client’s situation stabilises.