The Immediate Needs Assessment (INA) is a vital part of the rehabilitation and case management process, and is carried out by Unite Professionals’ case managers when they begin work with a client. Here, we explore the INA, explaining its aims, why it is useful and how it helps achieve better rehabilitation outcomes.
The INA is pivotal in identifying how injuries sustained, impact on a person’s ability to engage in all aspects of daily life, physically and emotionally, and propose the optimum pathway of rehabilitation to support the recovery of that individual to the position they were in just prior to the incident that caused those injuries.
The INA is a report written by a case manager following a referral from both interested parties (Defendant insurer and claimant solicitor) known as a joint referral, or the case manager receives a referral from just the claimant solicitor (known as a single referral). The INA is expected (according to the revised Rehab code which guides the preparation, remit and expectation of report and timescales) to address 10 key markers.
It is expected to acknowledge any pre-existing conditions which may impact on the delivery and benefits of rehabilitation delivery and provide an objective, evidence-based overview of the client’s situation. This should be informed by corroborated medical documents in order to ensure that the document is current and well informed.
There needs to be consent provided from the client to the report being undertaken and to recommendations made. Recommendations provided to meet rehabilitation should be informed by the client’s motivators and agreed goals.
The coordination of appropriate interventions is the expectation of case management. To consider the evidence obtained during assessment, utilise experience, skills in understanding the sequence and timing of robust recovery and rehabilitation in representing the need for specifically qualified professionals, statutory or private to work together with the client to progress a sustained and measurable outcome.
The document is not disclosable as court evidence and should represent the ultimate rehabilitation proposal, giving due consideration to factors which may have been established within the litigation process such as split liability or contributary negligence, these issues will impact on how rehabilitation may be funded.
The INA reports on the client’s injuries, treatment received following admission to hospital and also following discharge. The case manager will be looking to see what the client needs to mitigate the effects of their injuries – whether that is support, equipment, adaptations, rehabilitation or an opinion on whether further surgery is required.
The INA covers all aspects of the client’s life, looking at how they were before the accident and identifying the impact their injuries have had and are going to have, both physically and psychologically, as well as in the way they live their lives.
The case manager seeks to put the person back as much as possible to where they were prior to the accident and will consider work, leisure, interests, relationships and the impact on all of these as well as the physical and psychological impact.
Goals for rehabilitation
The Case manager will support the client to identify their goals for their rehabilitation; essentially what they want to achieve. This helps to identify and prioritise clients’ needs and the rehabilitation recommended on areas that are of most importance to the client.
Obtaining client engagement in the process is key and Unite Professionals uses client-centred goals supported by case manager actions. The goals are set with the client during the INA and are long-term goals that they wish to work towards.
The third-party clinicians recommended by the case manager are engaged to facilitate the client to achieve their goals, and also to write more specific SMART goals which the case manager will monitor, evaluate and review as rehabilitation progresses. The SMART goals will be in the assessments and ongoing reports that clinicians produce and are shared with all parties.
Capturing the impact of injuries
Ensuring that the impact of the symptoms and injuries on individuals is captured and measured is very important. It not only reflects on the efficacy of the rehabilitation recommendations proposed by the case manager, but also enables the case manager to challenge the SMART goal progression of the professionals engaged. It is also critical in analysing the cost benefit of the investment in specific rehabilitation professionals.
The AIFE (Areas of Impact on Function and Employment) is an assessment tool designed by the clinical team at Unite Professionals and regularly reviewed by the case managers to gain a quantitative measure of selected domains. The tool captures improvement over time, in domains including mobility, activities of daily living, psychology, pain, sleep and cognition.
The tool has not been tested for validity or reliability but is scored consistently by the same case manager and is a broad guide on the efficacy of the recommended treatment pathway being advocated.
The tool is designed to measure improvement resulting from the delivery of the proposed rehabilitation and therefore the reader should be aware that an improvement in scores does not necessarily equate to an improvement in symptoms, but may be related to the introduction of equipment or therapy, for example, to allow the client to perform a given task more effectively.
What barriers exist?
The INA will identify what barriers currently exist that will prevent the client from achieving their goals and will make recommendations for how these can be overcome.
Services – what’s being used and what else is available?
A well-prepared INA will identify professionals and services, with the professional qualification to delivery evidenced-based, specialist intervention that is underpinned with competent report writing, sound awareness of the need to remain objective and accountable for progress of the goals identified and the spend incurred.
Unite Professionals has developed a highly-specialist database, informed by feedback from our case managers and clients of individual and company providers of rehabilitation, which can be accessed by case managers when assessing clients nationally.
Providing a tailor-made rehabilitation journey for each client we assess is our strap line: your rehab our priority and one which is pivotal to the success of the coordinated rehab we deliver.
The INA is one of the earliest stages of a long relationship between a case manager and their client. Unite Professionals has a long track record of delivering industry-leading case management within the personal injury industry for solicitors, insurers, private industry and private paying clients. For more information you can contact us here.