Allied Health Progress Report

The Lifetime Support Authority (LSA) is committed to working collaboratively with service providers to achieve Person Centred outcomes for
Lifetime Support Scheme Participants.

To maximise health outcomes for LSS Participants, the LSA expects providers to deliver evidence based, outcome focused services, that empower participants by facilitating their independence and community participation.

The purpose of this document is to provide a progress update to the LSA for each service period. It is a tool supporting you to provide sufficient information, goals, and outcome measures to demonstrate your proposed treatment plan is necessary and reasonable to meet the participant’s goals. Once complete, please email this form to the Participant’s service planner.

This may be used for all Allied Health therapy intervention and can be completed following an initial assessment or after an approved block of treatment.

Participant Information

Participant Name
LSA Service Planner and Team
Date of Injury
Injury Type and Functional Impact
Pre-injury Related Conditions or Limitations, and their Functional Impact Relevant to this Request
What is the current frequency of therapy?
How long has your discipline provided therapy services with the participant?
Issues/risks identified that are impacting on recovery. List any barriers that you have recognised and the steps you have taken or will be taking to address them.

Participant Goals

PARTICIPANT LONG TERM FUNCTIONAL GOALS / ASPIRATIONS

*While these may not be realistic in the short term, they will influence what the participant identifies as goals for the service period. Example Goal: The long-term goal is to be able to walk from my house to the local coffee shop on my own and order a coffee.

Goal 1
Goal 2
Goal 3

PREVIOUS SERVICE PERIOD GOALS

Goal 1 (SMART)
Achieved:	☐ Yes	Partially Achieved (some functional change observed)	☐ No	Deferred
If not achieved, detail why:

Goal 2 (SMART)
Achieved:	☐ Yes	Partially Achieved (some functional change observed)	☐ No	Deferred
If not achieved, detail why:
Goal 3 (SMART)
Achieved:	☐ Yes	Partially Achieved (some functional change observed)	☐ No	Deferred
If not achieved, detail why:

NEW SERVICE PERIOD GOAL

*Goal should focus on optimising function & participation, be achievable per service period, and may be a step towards participant long- term functional goal.

Example Goal: To independently hold a coffee cup in my preferred hand and drink three sips within four months.

Goal 1
Goal 2
Goal 3

Outcome Measures

*Please use validated outcome measures that will assist in understanding how the proposed intervention has / will assist the participant reach their functional goals.

Outcome Measure	Related ‘Previous Service Period Goal’ Number	Initial	Subsequent Reporting Period	Previous Reporting Period	Long-term Outcome Measure Score Aim	Expected Achievement Date
Date	Score/ Detail	Date	Score/ Detail	Date	Score/ Detail

Participant Empowerment to Manage Condition

Comment on the participant’s self-management strategies derived from treatment sessions, including therapy or functional support items/consumables. Where appropriate, attach any written materials or tools developed. Example: communication strategies for communication partners, home exercise programs, fatigue management strategies.
Describe what community or mainstream participation opportunities have been considered. Example: gym program.
Describe how you have engaged participant’s natural supports to meet their goals. Example: Support worker trained, and care plan provided to support participation and structure coffee outings.
Is the participant ready for group sessions? Please detail.	☐ Yes ☐ No
Outline the plan for future treatment frequency. Detail any discharge, maintenance or transition to self-management plans, including expected date for this to occur. Example: Support worker or AHA to support home exercise program

Proposed Treatment Plan to Achieve New Service Period Goals

Proposed sessions to be delivered: _____ sessions/hours over _____ weeks	Total hrs:
Rationale for the recommended frequency:
Proposed travel required: _____ sessions/hours over _____ weeks	Total hrs:
Rationale for travel requirements:
Report writing time required: ☐ Long report (initial report 60min) ☐ Short report (subsequent reports 30min)
Other (i.e., indirect hours): Rationale:
Proposed start date:	Proposed finish date:
This treatment plan has been discussed with the participant/guardian and they are aware that recommendations need to be deemed necessary and reasonable by LSA.	☐ Yes ☐ No
If not, please detail why:

Treating Clinicians’ Details

I understand I can only invoice the LSA for treatment that is specified in the agreed service schedule and is directly related to the Participant’s Motor Vehicle Injuries.	☐ Yes, I agree ☐ No
Name
Discipline
Organisation
Date
Signature