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Complex
Case Integrated Intervention
This service provides intervention to patients from
point of post-acute/rehabilitation hospitalization (or
subsequent point) discharge planning through to ultimate
vocational rehabilitation. Utilizing the ROMS outcome
measurement protocol, rehabilitation barriers,
functional limitations and vocational status are
serially re-evaluated throughout the process, in order
to assure that short term rehabilitation goals are
moving towards long term maximal ADL and vocational
functioning. Ongoing rehabilitation profiling through
each serial re-evaluation (through ROMS based in-home
assessment, and functional ability evaluation), barriers
are re-considered and an intervention plan is
implemented, until the endpoint goal of vocational
rehabilitation is reached. A smooth transition between
interventions and rehabilitation phases is assured
through ongoing graphical outcome measurement, thus
assuring that functional gains are consolidated rather
than eroded. Functional plateaus and occupational
shortfalls are also rapidly identified in order to
ascertain whether further recovery is feasible, and/or
whether the individual should be shifted to a vocational
intervention emphasis. For further details, please visit
Clinical Services Listing.
Rehabilitation Profiling & Dormant File “kick starts”
Utilizing File Analysis and Rehabilitation Baseline
tools, previously rehabilitation-dormant files may be
brought back into the rehabilitation process through the
identification of the primary rehabilitation barriers,
primary patient coping issues, and functional
shortfalls. Ongoing rehabilitation profiling is then
accomplished through serial ROMS outcome measurements in
the same manner as described above in the Complex Case
Integrated Intervention paragraph.
Mini-Functional Assessment
The mini-functional assessment is a less costly, streamlined version of a traditional functional ability evaluation (FCE/FAE). It is comprised of a series of objective formal and informal measures tailored to the case requirements, i.e.
focused strictly upon those physical capabilities that need to be measured in order to progress rehabilitation, rather than covering the full gambit of functions measured by FCE/FAE. The service is typically
conducted in the client's home rather than in clinic, and is most often conducted in conjunction with an initial Intake Assessment. The Mini-functional results can be delivered at the same time that the initial rehab consultant’s visit report is submitted, thereby reducing delays in the progression of the file and hence can assist in reducing file duration. The assessment is also integrated with comprehensive
Rehabilitation Outcome Measures (ROMS) including rehabilitation barriers, symptom rating/coping measures, and activities of daily living measurement. This allows for an appropriate baseline to be established for subsequent graphically based progress monitoring.
Applications/Limitations include:
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The Mini-Functional provides only those objective
measures required to progress rehabilitation (i.e.
the objective information that would enable the
rehab consultant to seek medical support, further
employer discussions, or counsel the client toward
more active vocational planning, etc).
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The Mini-Functional assessment is carried out by an
OT who understands the specific claims/rehab
requirements of the file and can facilitate
progression of that file in the vocational/return to
work process.
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The Mini-functional does not replace the FAE/FCE in
cases where there are credibility issues; the FCE
would remain a better tool to address adversarial
and potentially litigious files. The Mini-Functional
would not have the same credibility in the courts
that existing FAE/FCE approach has.
Catastrophic Case Management
Traditional case management services but with ongoing
rehabilitation profiling through serial ROMS outcome
measurements in the same manner as described above in
the Complex Case Integrated Intervention paragraph.
Catastrophic Impairment Applications (OCF 19)
In conjunction with
Dr. J. Douglas Salmon, Jr. & Associates, this
service provides state of the art specialty medical,
neuro/psychological and/or OT functional assessment
towards addressing MVA Catastrophic Impairment
entitlement. The process commences with a careful review
of the CAT IE Report to identify clinical and/or
methodological errors in the report including but not
limited to the following issues:
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Improper or insufficient
assessors
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Impairments which were omitted
from the total rating
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Inappropriate rating
methodologies and protocols
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Inappropriate application of the
AMA Guides
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Incorrect diagnoses
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Lack of empirical basis for
conclusions (especially psychiatry whereby rarely
are psycho-diagnostic or cognitive measures utilized
to support opinion)
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Inconsistencies between IE
opinions within the IE multi-disciplinary report
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Failure of diagnostic assessors
to integrate functional findings of OTs
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Failure to utilize best
practices, state of the art methodology for OT
In-Home Assessment to provide evidence base for the
Mental/Behavioural ratings
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Failure to utilize a Situational
Work Assessment to provide evidence base for the
Adaptation domain rating
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Failure to provide a Desbiens
rating at all
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Failure to provide Desbiens
rating that is consistent with that directed in the
case law (e.g. the California method has not been
supported)
Upon identifying the weaknesses of
the CAT IE report, a cost-conscious staged approach is
utilized to provide a report which challenges the IE
assessment on the basis of evidence based assessment(s).
The CAT ratings always include consideration of the
Desbiens case law of combining psychological and
physical impairments and
utilize
Dr.
Salmon’s unique methodology to address
evolving case law. Moreover, highly rigorous objective
testing is employed to measure actual shortfalls in
independent functioning (including parental
responsibilities and daily financial independence)
relative to the requirements of the Glasgow Outcome
scale. Additionally, when indicated specialty medical
investigations (e.g. EMG, specialized radiological
investigations) may be utilized to assure maximal rating
considerations.
Catastrophic
Impairment IE Review & Challenge
In conjunction with
Dr. J. Douglas Salmon, Jr. & Associates, this service provides
state of the art medical, neuro/psychological and OT
functional assessment with rehabilitation profiling
towards addressing MVA Catastrophic Impairment
entitlement, and ROMS graphical depiction of key
impairments and functional limitations to clearly
substantiate serious and permanent impairment in
relation to the AMA Disability Guides and SABS criteria.
A well founded rating is considered relative to the
Desbiens case law of combining psychological and
physical impairments, and in addition highly rigorous
objective testing is employed to measure actual
shortfalls in independent functioning (including
parental responsibilities and financial independence)
relative to the requirements of the Glasgow Outcome
scale. Additionally, when indicated specialty medical
investigations (e.g. EMG, specialized radiological
investigations) may be utilized to assure maximal rating
considerations. This interdisciplinary team is led by
Dr. J. Douglas Salmon, Jr., who chaired the original
FSCO AMA Guides Mental/Behavioral Catastrophic DAC
Committee, was an active member of the FSCO Catastrophic
DAC Glasgow Outcome Scale Committee, and provides
extensive Catastrophic Impairment training to the
clinical and legal professional communities.
Pre and Post 104 Week Income Replacement Assessments/ IE
Review & Challenge
In conjunction with
Dr. J. Douglas Salmon, Jr. & Associates, this service consists of
a multi-day situational work assessment to provide an
evidence based disability assessment to evaluate the
client’s capacity to sustain attention/concentration,
work activity pace, persistence, productivity and
stamina at a competitive level in
consideration of presenting cognitive, emotional,
social-interactional and/or physical impairments in the
context of work demands across these same domains.
Standardized work samples and simulated work activities
form the basis of the evaluations. The following two
disability criteria may be distinctly evaluated using
this methodology:
(a) the “own occupation” (pre-2 year) disability status
is evaluated by considering the client’s capacity to
perform pre-condition essential job tasks at a
competitive employment level. The evaluation may be used
as an initial assessment or as a rebuttal to an insurer
examination.
(b) the “any occupation” (Post 104 week/2 year)
disability status is evaluated by considering the
client’s capacity to perform occupations previously
selected as being suited by reason of “education,
training or experience” at a competitive employment
level. The evaluation may be used as an initial
assessment or as a rebuttal to an insurer examination.
If used as a rebuttal to an insurer examination (IE),
the assessment considers whether the IE selected
appropriate occupations for the individual, and whether
the IE considered the case law requirements of
“commensurate remuneration” and “commensurate
socioeconomic status” in rejecting the client’s Post 104
week eligibility. It also provides a multi-day
situational work assessment to ascertain the
individual’s actual competitive employability on
a full time basis as required of the Post 104
case law, but typically ignored in Post-104 Week
Disability IE assessments. Future
Cost of Care Assessments
Traditional Future Cost of Care assessments to identify
and cost out patient’s life long needs, but with
occupational therapy provided In-Home Assessment with
ROMS outcome measurement based rehabilitation profiling
to graphically depict residual physical, cognitive and
emotional impairments and objective ADL functional
shortfalls.
Vocational Rehabilitation Services
These services are comprised of an array of integrated
and coordinated vocational interventions including but
not limited to:
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