rehabilitation psychology and counselling services · web viewrehabilitation counselling involves...

CHHS18/038

Canberra Hospital and Health ServicesOperational ProcedureRehabilitation Psychology & Counselling ServicesContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Service Description.................................................................................................2

Section 2 – Methods of Referral...............................................................................................3

Section 3 – Eligibility and Prioritisation for Psychology & Counselling......................................4

Section 4 – Receiving Referrals and Wait List Procedures.........................................................8

Implementation........................................................................................................................ 9

Related Policies, Procedures, Guidelines and Legislation.........................................................9

Search Terms............................................................................................................................ 9

Attachments..............................................................................................................................9

Attachment 1 – Areas Covered by RACC Psychology & Counselling....................................11

Attachment 2 – Other options for services:........................................................................12

Doc Number Version Issued Review Date Area Responsible PageCHHS18/038 1 13/02/2018 01/12/2022 RACC Psychology

& Counselling1 of 12

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Purpose

To provide staff of the Rehabilitation Aged and Community Care (RACC) Division with clear guidance on eligibility criteria, prioritisation of services, communication and administrative processes following the receipt of referrals and when necessary, placement on a waiting list for the delivery of Psychology & Counselling Services across RACC.

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Scope

This operational procedure is applicable to all RACC Psychology & Counselling staff and Health Directorate staff (Medical, Nursing, and Allied Health) who refer clients to this team.


Section 1 – Service Description

RACC Psychology & Counselling provides clinical psychological, rehabilitation counselling and neuropsychological assessment and therapeutic intervention.

Clinical Psychologists (CP) specialise in the assessment, diagnosis and treatment of psychological and mental health problems (e.g. depression, anxiety), delivering a range of techniques and therapies with demonstrated effectiveness in treating such problems. Clinical Psychologists apply psychological theory and scientific research to work with the client to solve complex clinical problems with individually tailored therapeutic programs.

Rehabilitation Counsellors (RC) work with individuals (or family members) who have experienced an injury, disease and/or chronic illness in order to achieve independence in their rehabilitation goals, to provide counselling support and facilitate psychological wellbeing. Rehabilitation Counselling involves working with the client in a client focused way to maximise adjustment to disability whilst considering the client’s psychological and social needs. Counselling staff will work with the client’s strengths to work towards positive adjustment to their disability.

Neuropsychologists (NP) specialise in the assessment, diagnosis and intervention for cognitive sequelae associated with conditions affecting the brain (e.g. traumatic brain injury, stroke, dementia). Neuropsychologists’ skills are underpinned by knowledge of brain structure, function and dysfunction, and the effects of multiple factors on cognition, behaviour and emotional functioning. Neuropsychological assessment provides a detailed profile of a client’s cognitive strengths and weaknesses and is recognised as a sensitive tool for the identification of the presence and nature of cognitive impairment. Neuropsychologists aim to assist with diagnosis, treatment planning, and therapeutic management strategies.



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Please see Attachment 1 for areas serviced by Psychology & Counselling.


Section 2 – Methods of Referral

Referrals may be made by the any Medical, Nursing, and Allied Health staff.

Note:Methods of referral to Psychology & Counselling team vary, depending on the source of the referral (e.g. inpatients or outpatients).

2.1 Inpatients1. For the Canberra Hospital (CH) based inpatients referrals can be received by:

o treating teams via case conference, o contacting a Psychologist/Counsellor within the service, or o via the Psychology & Counselling Manager, if the former is unavailable.

2. For Calvary inpatients, the staff member requesting the referral contacts a Psychologist via telephone (6244-2772) as referrals are received.

3. A referral is made to RACC Psychology & Counselling Services specifying whether Clinical Psychology, Rehabilitation Counselling or Neuropsychology assessment/intervention is required.

4. Referrals received will be deemed as appropriate against eligibility criteria (see sections 3, 4, and 5 of this document) by a Psychologist/Counsellor or in consultation with the RACC Psychology & Counselling team).

5. Referrals are responded to within 2 working days. o If the referral is appropriate - responding to the referral could include reading the

medical record, speaking with the treating team and/or meeting with a client. Sessions are scheduled by the Psychologist/Counsellor with the client as appropriate.

o If the referral is not appropriate - feedback is provided to the treating team for any inappropriate referrals, including the rationale on why the referral is inappropriate. Recommendations to refer to other services/disciplines are provided as appropriate.

6. The referral, the response and all contact with the client is documented in the client’s medical record and on ACTPAS.

2.2 Outpatients1. Following receipt of referrals by RACC Intake Line (62079977), all referral information is

forwarded directly to the RACC Psychology Outlook inbox. This includes relevant attachments (e.g. letters from the referring Doctor).

2. The RACC Psychology & Counselling Manager (or delegate) checks for referrals daily (processes are described in detail in Section 4).

3. The RACC Psychology & Counselling Manager (or delegate) reviews the referral information, and informs RACC Intake Line if the referral is appropriate or inappropriate for the service. The referral is not processed until feedback is provided to RACC Intake Line.



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4. If the referral is appropriate , the RACC Psychology & Counselling Manager (or delegate) informs RACC Intake of the following:a. Information to include in the ACTPAS referral:

i. Staff team (RACC Allied Health (AH) Community Rehabilitation Team (CRT), RACC AH Inpatient (IP), RACC AH Geriatric Outpatient (Geri OP) or RACC Memory Assessment Service (MAS)) and

ii. Speciality (Counselling, Clinical Psychology or Neuropsychology).b. Information sheet to send to clients (i.e. Clinical Psychology, Neuropsychology or

Rehabilitation Counselling).c. Waiting list letter (i.e. Clinical Psychology, Neuropsychology or Rehabilitation

Counselling) to send to clients and the current waiting time.5. RACC Intake Line will make the ACTPAS referral and will contact clients in writing to

inform them of the referral, the duration of the wait and send out an information sheet for the relevant discipline.

6. If the referral is not appropriate , the RACC Psychology & Counselling Manager (or delegate) informs RACC Intake Line of this and advises RACC Intake Line of appropriate services that the referrer could refer the client to. The RACC Psychology & Counselling Manager (or delegate) informs RACC Intake Line that the referrer is welcome to contact the RACC Psychology & Counselling Manager (or delegate) to discuss further if required.

7. The RACC Psychology & Counselling Manager (or delegate) places new referrals on the RACC Psychology & Counselling Service waiting list located on Q:\RACC\Psychology\Corporate\Waitlists.

8. The waiting list is reviewed at RACC Psychology & Counselling team meetings, and is managed by the Manager (or delegate).

9. All contact with the client is documented in the client’s clinical record. 10. Clients who are concurrently receiving services from other RACC Services are discussed

as appropriate within team meetings or case conferences upon receipt of the referral from RACC Intake Line.


Section 3 – Eligibility and Prioritisation for Psychology & Counselling

Any member of the treating team can refer clients to RACC Clinical Psychology, Rehabilitation Counselling or Neuropsychology. Prior to the referral being made, the referrer must discuss the reason for referral with

the client, and confirm the client’s interest in seeing a Psychologist or Rehabilitation Counsellor.

The referrer must state in their referral a clear reason for referral and confirm the client’s consent has been obtained.

Clients referred for outpatient psychology or rehabilitation counselling services must also meet other relevant aged care or rehabilitation service eligibility requirements (refer to Community Rehabilitation Team Eligibility and Prioritisation procedure).

In general, Psychology & Counselling prioritises referrals for clients who are at risk if a service is not provided in a timely manner.



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3.1 Eligibility for Clinical Psychology referral Individuals who are appropriate for Clinical Psychology services are those:

a. with suspected or confirmed emotional, psychological or behavioural problems (e.g. anxiety, depression)

b. whose difficulties are of a severity thought to be impacting significantly on the client’s treatment or rehabilitation process and/or the client’s quality of life

c. who are believed to have the potential to participate in and benefit from an assessment and psychological therapies and where therapeutic goals can be reached through short-term psychological therapies.

Individuals who are not appropriate for Clinical Psychology services are those:a. who do not consent to the serviceb. who are in an acute confusional state or post-traumatic amnesia c. suffering from severe cognitive and/or communication difficulties that preclude

engagement and learning in psychological therapy d. would benefit more effectively from pharmacological treatment (at least initially) e. when referral reason is for normal (non-pathological) bereavement or adjustment

and coping issues (these clients may be seen by the Rehabilitation Counsellor or other allied health professionals such as the Social Worker)

f. when referral reason is for difficult or eccentric (but non-pathological) personality traits

g. clients requiring treatment/management of long term psychiatric conditions or therapy not available in RACC (e.g., Bipolar Disorder, Narcissistic Personality Disorder). However, this does not exclude short-term intervention (i.e. up to 8 weeks of assessment/therapy) associated with their current episode of care (e.g. fear of falling; supportive counselling)

h. clients who have an established therapeutic relationship with other clinicians.

Prioritisation of Clients: If prioritisation of requests/referrals is necessary, where possible, clinical priority will be given to: Clients whose active participation in treatment or rehabilitation is limited by the nature

of their current psychological functioning. Clients whose well-being is severely compromised by their current psychological

functioning.

3.2 Eligibility for Rehabilitation Counsellor referral Individuals who are appropriate for Rehabilitation Counselling Services are:

a. rehabilitation clients who experience a disability b. family members or carers of rehabilitation clients who experience a disability.

The Rehabilitation Counsellor can assist the client and their family at any stage in the rehabilitation journey when:a. they have difficulties coming to terms with the disability or impairment



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b. participation in rehabilitation/discharge planning is limited by adjustment to the disability

c. well-being is compromised by adjustment to the disability.

Individuals who are not appropriate for Rehabilitation Counselling services are those:a. who do not consent to the service b. in an acute confusional statec. suffering from severe cognitive and/or communication difficulties that preclude

engagement in counselling d. when referral reason is for difficult or eccentric (but non-pathological) personality

traitse. clients requiring treatment/management of long term psychiatric conditions or

therapy not available in RACC (e.g., Bipolar Disorder, Narcissistic Personality Disorder). However, this does not exclude short-term intervention (i.e. up to 8 weeks of assessment/therapy) associated with their current episode of care (e.g. fear of falling; supportive counselling)

f. clients who have an established therapeutic relationship with other clinicians.

Prioritisation of Clients: If prioritisation of requests/referrals is necessary, where possible, clinical priority will be given to: Clients whose active participation in rehabilitation is limited by the nature of their

current adjustment to disability or impairment Clients whose well-being is severely compromised by their adjustment to disability or

impairment Assisting clients to achieve their rehabilitation goals within agreed timeframes as per

goal setting (e.g. return to work, decision making around discharge options).

3.3 Eligibility for Neuropsychology referral Individuals who are appropriate for Neuropsychology services are those with suspected

or confirmed cognitive difficulties, where neuropsychological assessment can add significantly to diagnosis, ongoing care, rehabilitation, treatment planning and/or discharge planning of the client.

Individuals who are not appropriate for Neuropsychology services are those who:a. do not consent to the serviceb. are acutely medically unstable or have reversible causes of cognitive impairment (e.g.

UTI, acute delirium).

Individuals may not be appropriate for Neuropsychology services are those who: (referrers who are unsure of client’s eligibility should contact the neuropsychology team)a. are suffering from very severe communication deficits, severe sensory deficits,

severe psychiatric conditions or combinations of these, or present with particular co-



CHHS18/038

morbidities where neuropsychological assessment is unlikely to be reliable and assist in diagnosis, rehabilitation or management

b. have had a recent neuropsychological assessment (within the last 6 months) or are likely to require another assessment in the near future (e.g. for return to work), as practice effects are likely to impact on validity of test results.

Neuropsychologists do not determine the following (however, neuropsychological assessments can be performed to assist the multi-disciplinary team(MDT) in making these decisions): a. determinations of specific domains of decision-making capacity b. determinations of whether the client has the ability to live alone in the communityc. determinations of a client’s suitability to return to driving a motor vehicle, or to work

or study.

Prioritisation of Clients: Upon receipt of referrals, clients will be prioritised according to the following categories:

Prioritisation categories Category 1 - Urgent Clients who have cognitive difficulties that are currently impacting on their ability to

participate and progress in rehabilitation Clients with cognitive difficulties that are jeopardising their current work or study

arrangements Clients for whom an Occupational Therapy assessment has identified significant safety

concerns related to their cognition.

Category 2 - Semi-Urgent Seen according to the planned date of the client’s return to activities or specialist review Clients who have cognitive difficulties that may impact on their planned return to work,

study, driving, or leisure activities Clients for whom diagnostic clarification is required (e.g. differential dementia

diagnoses) Clients who require neuropsychological assessment for an upcoming National Disability

Insurance Scheme (NDIS) planning meeting.

Category 3 - Non-urgent Clients who would benefit from general education and recommendations to address

cognitive difficulties (not significantly interfering with their functioning) Baseline assessments for clients with neurodegenerative conditions.


Section 4 – Receiving Referrals and Wait List Procedures



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1. RACC Psychology & Counselling Manager (or delegate) to check pigeon holes on level 1 and RACC Psychology email Inbox daily for referrals.

2. Team members to check pigeon holes on level 2, RACC Psychology email Inbox and ACTPAS (referrals to their discipline).

3. If a new referral is received via the RACC Psychology inbox, the staff member is to send an email to all members of the Psychology & Counselling team, alerting them to the referral with the subject: New Referral (relevant discipline).

4. If the referral is appropriate the team member sends an email to RACC Intake Line and CC’s the rest of the team with the following information:a. Referral is appropriate for CP, RC or NP.b. Make an ACTPAS referral to the specific staff team (RACC AH CRT, RACC AH Inpatient,

RACC AH Geri OP or RACC MAS) and Speciality (RACC Clinical Psychology, RACC Rehabilitation Counselling or RACC Neuropsychology).

c. RACC Intake Line to send out waiting list letters (see Attachment 2) and appropriate approved Information sheet to the client.

5. Any accompanying clinical documentation or communication is to be scanned (if in hard copy) and saved in: Q:\RACC\Psychology\Corporate\Waiting Lists\Referral documents - clinical information accompanying referrals with the following format: Surname, First name (document # if multiple documents) services referred toe.g. Smith, John (1) CP DC.

Smith, John (2) CP DC.6. Steps 3 to 5 to be instigated within 1 working day of referral being received.7. If there is a current waiting list (e.g., for Neuropsychology), referral is to be saved in

correct discipline tab (i.e., RC, CP or NP) within excel spreadsheet: CURRENT Referral List Waiting Lists.xls, found on: Q:\RACC\Psychology\Corporate\Waiting ListsThe following information is required (as information becomes available): Client Name URN Date of birth Referred by Date received Clinician (once allocated) Date of first contact or reasons why the client is not currently appropriate for the

service (e.g. has a review with medical specialist on xx/xx for review of antidepressants.)

8. If client requires follow up or review (e.g., Review Neuropsychological Assessment), the review or follow up is to be placed on a Waiting List indicating clearly when review may be required with any comments (e.g. client seen in October 2017; review recommended in 12/12, therefore October 2018).

9. Current ACTPAS referral needs to be closed. If client is to be reviewed, a new referral needs to be made to Speciality (e.g. RACC Neuropsychology), with notes made that client has been previously seen and is due for review in n months.



CHHS18/038

10. Staff to take on clients (if they meet eligibility criteria & are appropriate for the service) as current case load allows, in collaboration with the Psychology & Counselling team.

11. The Psychology & Counselling Manager updates RACC Intake Line with current waiting list times as they change for each discipline.


Implementation

The operational procedure will be provided during orientation to new staff members. The procedure will be communicated to staff via an all staff email and via team meetings.


Related Policies, Procedures, Guidelines and Legislation

Procedure Community Rehabilitation Team Eligibility and Prioritisation Procedure


Search Terms

Clinical Psychology, Counselling, Rehabilitation Counsellor, Eligibility, Psychology, Neuropsychology, Waiting list, Wait list.


Attachments

Attachment 1 – Areas Covered by RACC Psychology & CounsellingAttachment 2 – Other options for services



CHHS18/038

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 14/12/2017 Complete Review ED RACC CHHS Policy Committee

This document supersedes the following: Document Number Document NameN/A Psychology and Counselling Eligibility Wait List



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Attachment 1 – Areas Covered by RACC Psychology & CounsellingNEUROPSYCHOLOGY CLINICAL

PSYCHOLOGYREHABILITATION

COUNSELLING11A 12B RILU CRT Falls Clinic TTCP Memory Assessment Service

RACC Geriatricians outpatient clinics

CALVARYACRU (KEANEY BUILDING)

(if clients are under the care of a RACC Geriatrician

or Rehabilitation Consultant)

RACC Geriatricians outpatient clinics

- Service provided by RACC Psychology & Counselling - Service not provided by RACC Psychology & Counselling



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Attachment 2 – Other options for services:Please see below if you are seeking compensation or would like to see a Psychologist in the private sector who may be able to offer you an appointment sooner: Contact the Australian Psychological Society Psychologist Referral Service on 1800 333

497 and ask for a Clinical Psychologist Look under ‘Psychologists’ in the Yellow Pages. Some assessment, counselling and therapeutic services are also available through the:

o Australian National University Psychology Clinic (Ph: 6125 8498),o the Psychology Clinic of The University of Canberra (Ph: 6201 5843) and o Relationships Australia (Ph: 1300 364 277).

Please note, that as of 1 November 2006, the Australian Government introduced new Medicare items for psychological treatment by registered psychologists. This assists people in the community gain better access to registered psychologists working in the private sector (i.e., via G.P referral). For more information please discuss with your G.P or see www.psychology.org.au.

Please see below if you are seeking compensation or would like to see a neuropsychologist in the private sector who may be able to offer you an appointment sooner:

Where can I find a Psychologist: Look on the Australian Psychological Society’s website under the “Find a Psychologist”

tab - http://www.psychology.org.au/FindaPsychologist/Default.aspx?ID=1204 or phone: 1800 333 497.o Under “what are the issues” scroll down to find the reason for referral (e.g. under

assessment select “neuropsychological assessment”).o Under location enter “Canberra”o Set the radius to “within 200km”

Look in the Yellow pages under Psychologists



http://www.psychology.org.au/FindaPsychologist/Default.aspx?ID=1204

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