Eligibility & Assessment

Nationally Consistent Assessment - Research and Development

Information about the work to develop nationally consistent assessment processes and the revised Australian Community Care Needs Assessment (ACCNA-R) and the Carers Eligibility and Needs Assessment (CENA-R)

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Background

In 2002, the Department of Health and Ageing (DoHA) initiated a review of its community care programs. Research associated with the review identified that from the consumer and carer point of view, the existing community care system was confusing, difficult to enter and required that clients be assessed multiple times in a variety of ways.

Currently multiple assessment processes and tools are used for Home and Community Care (HACC) services, such as the SCTT (VIC), ONI (QLD and SA) and HNI (WA). There are different assessment tools used for packages of community care to meet more complex care needs (i.e. comprehensive assessment) and for carer services. Additionally, specific service providers use their own processes to define details for service delivery to an individual.

The review resulted in the development of A New Strategy for Community Care – The Way Forward. One component of The Way Forward is to develop a nationally consistent way to assess consumers for HACC and other community care services which the Council of Australian Governments (COAG) endorsed in 2006.

Top of pageThe Way Forward proposed three tiers of community care services with levels of assessment as noted in the diagram below.

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Research: Comprehensive Assessment

DoHA engaged the Australian Institute for Primary Care (AIPC) at La Trobe University to undertake some initial research on the components that would be needed to develop a National Comprehensive Assessment Framework for community care.

AIPC examined client 'pathways' into and through the three tiers of community care: information services, basic care services and packaged care services. They reviewed eligibility requirements for packaged care services, and the relationships between initial intake screening/assessment and comprehensive assessment.

The consultants undertook a range of research activities to develop an options paper in October 2006 that included:

• a comprehensive literature review
• interviews with State and Territory Governments
• a consultation paper
• surveys of HACC providers and Aged Care Assessment Teams (ACATs)
• national consultation forums.

The report is available under Resources on this website.

Comprehensive Assessment in a National Framework

The AIPC findings were summarised and documented for review by the Eligibility and Assessment Working Group (EAWG).

EAWG considered elements of a national framework including:

• the purpose of comprehensive assessment
• the definition of comprehensive assessment (and required data elements to form the assessment questionnaire)
• options for a common approach for comprehensive assessment (including consideration of approaches to the assessment of younger people with a disability)
• access to comprehensive assessment
• agents for comprehensive assessment
• qualifications and background for comprehensive assessors
• efficient use of information on comprehensive assessment.

An understanding of these interdependencies was vital to inform work on other elements of community care reform, including the approach taken to 'packaged care', Access Points for entry by clients and their carers into community care, and initial intake screening/assessment processes to be used at the points of entry.

The Council of Australian Governments (COAG) agreed in February 2006 that a review of the Aged Care Assessment Program (ACAP) should occur. Information on work related to comprehensive assessment can be found at http://www.health.gov.au/acats.
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Research: Nationally Consistent Intake Assessment

To support the COAG decision for a nationally consistent approach to assessment, The Way Forward program included a project to develop a consistent process for initial intake screening/assessment for the basic tier community care services.

DoHA engaged the Centre for Health Service Development (CHSD), University of Wollongong, to develop an Australian Community Care Needs Assessment (ACCNA) questionnaire. The objective was to provide a nationally consistent approach to eligibility testing and assessment for client needs for basic care services across all community care programs and to trigger a more specialised or comprehensive assessment if required.

CHSD were also asked to develop in parallel a Carers Eligibility and Needs Assessment (CENA) tool to provide consistent eligibility testing and needs assessment for carers across the National Respite for Carers Program (NRCP). There was also potential that the CENA could be used by other services such as the HACC Program.

CHSD reviewed national and international literature on assessment for various community services. They also reviewed and analysed assessment processes used across Australia, by a variety of organisations. Taking the best from each, CHSD developed a set of questions for each assessment process – the ACCNA and CENA.

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ACCNA and CENA Field Trials

During 2006, CHSD undertook technical field trials of the ACCNA and CENA they had developed. The aim of these trials was to collect feedback from service providers on the usefulness and applicability of the assessment questionnaires.

Level 1 – Technical Field Test

A test was carried out involving 16 selected service providers. These service providers used the ACCNA and CENA in electronic form to assess clients' needs. In some situations, a paper form was used when an electronic form could not be utilised (eg during an in-home assessment). Additionally the CENA was trialled with the National Carer Counselling Program through Carers Victoria.

CHSD received approximately 1000 detailed assessments using the ACCNA and 650 assessments using the CENA. Nearly all of the assessments were conducted over the phone (ACCNA 94% - CENA 73%).

The two circumstances most likely to trigger an ACCNA assessment were hospital discharge and concerns over increasing frailty. The most reported referral outcome from the ACCNA was for domestic assistance followed closely by self-care services and vision related services.

Over half of the services reported that some questions in the CENA were better asked at a second point of contact (i.e. after the initial service has been arranged and a relationship built). The top two circumstances that triggered a CENA assessment were carer emotional stress and strain and expressed concerns about the care recipient's increasing needs.
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Level 2 – CD Review for Useability

ACCNA and CENA were offerred to service providers on a CD to test its useability and compatibility with their current systems. Fifty-nine organisations nominated to receive CDs.

Level 3 – Website Feedback

The ACCNA and CENA were available on the CHSD web site for participants to provide feedback on the acceptability of the tools. The ACCNA and CENA were accessed and viewed on line by 350 users, of whom 230 users registered to provide feedback.

Level 4 – Focus Groups

Focus Groups were conducted with service providers representing clients with special needs in the following areas:

Victoria - Working with Culturally and Linguistically Diverse groups

Tasmania - Working with groups that had not previously used a 'Common Assessment Tool'

Northern Territory - Working with Aboriginal & Torres Strait Islander as well as Rural and Remote groups

Queensland - Working with Torres Strait Islander service providers in Townsville and Thursday Island

New South Wales - Working with Aboriginal and Torres Strait Islander service providers (CENA), carers (CENA), and care recipients (ACCNA).
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Findings

Although each level of the field test had a different aim, targeted a different audience and was conducted separately, generally all service providers involved in the testing seemed satisfied and gave a positive response. All levels confirmed the acceptability and useability of both the ACCNA and CENA.

Early findings indicated, as anticipated, that the ACCNA and CENA would need further revision and refinement. While field testing found no major redesign requirements, minor modifications (eg addition of emergency contacts, GP details and further refinement of the priority rating) would be useful.

Feedback from the focus groups was generally positive on the design, domains, expanded functional profile, and action plan. In particular, Culturally and Linguistically Diverse groups wanted more items to cover greater depth on ethnicity and religion.

The main concerns noted were length of time to use, and potential intrusiveness of questions related to psychosocial and financial items for some clients. Some service providers felt the tool was too long and took too much time to complete, although others reported carers appreciated the time taken to assess their particular needs and felt validated in their caring role.

In later development work, the ACCNA questions were separated into modules for more flexible use in different contexts. In some situations, this reduced time required because an assessor could skip modules at his or her discretion.

Testing also found the amount of time taken for each assessment decreased with familiarity. On completion of the trial period, the average time taken to complete the CENA was 43 minutes and the ACCNA was 45 minutes. Assessors took less time to complete assessments as they became familiar with the tool, suggesting the average time would reduce further if assessors continued to use the tools.

More experienced assessors found the electronic version assisted decision making by making it easier to access, summarise and analyse information.

Service providers indicated a preference for the ACCNA and CENA to be interlinked electronically to their specific agencies, with flow through of information to automatically populate the relevant sections of their systems.

Service providers who participated in the field test felt several formats of the ACCNA and CENA should be developed for the implementation stage:

• data specifications that are compatible, where appropriate, with existing state and territory assessment systems
• stand-alone electronic version
• paper version with potential for self-rated modules
• compatible hand-held electronic version to support in-home assessments.

Findings also suggested that organisations would benefit from assistance with the electronic environment and that training was a high priority for successful implementation.

Recommendations

CHSD delivered a final CENA Report in January 2007 and ACCNA Report in June 2007.

Recommendations from the CHSD work were:

• merge key elements of the ACCNA and CENA to create a single and integrated 'broad and shallow' assessment instrument (the ACCNA- Revised) that would identify the immediate needs of both the client and carer (where present) in an integrated manner
• reconfigure the CENA to form a more in-depth assessment of the carer's needs (the CENA-R), building on the information in the ACCNA-R to minimise the need to repeatedly ask for the same information
• restructure the flow of questions in both processes to more closely resemble the conversational structure of assessment interviews
• review and redevelop the priority and trigger mechanisms leading to referrals
• reconsider the host software platform.

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The ACCNA-R and CENA-R

In mid-2007 DoHA engaged Applied Aged Care Solutions (AACS) to develop the ACCNA-Revised and the CENA-Revised assessment tools in line with the CHSD recommendations. AACS works under the guidance of the Eligibility and Assessment Working Group (EAWG).

In August 2007, AACS redeveloped the ACCNA-R and CENA-R to include additional input AACS received from the range of stakeholders. In particular, they significantly revised the business rules, priority setting processes and 'triggers' to comprehensive or specialist assessment.

AACS also developed the Community Care Access Support System (CCASS) which provides a web-based host software platform. This platform:

• allows users to complete the ACCNA-R and CENA-R online without having to install software locally
• contains the business rules and processes that automatically identify priorities and triggers referrals
• contains a database of service providers
• provides the capability to electronically forward information (consistent with privacy and consent provisions) to service providers and comprehensive assessors.

In January 2008 the ACCNA-R commenced User Acceptance Testing with three selected service agencies in Victoria. Further development of the ACCNA-R was undertaken based on feedback from these trials.

Some Access Point Demonstration Projects are now using the ACCNA-R. Further development of the ACCNA-R continues to be undertaken based on feedback from Access Points Demonstration Project staff, service providers, clients and carers. It is anticipated that in 2009 a final validated version will be available.

The CENA-R will commence UAT early in 2009.

For further information on ACCNA-R and CENA-R development, please refer to Nationally Consistent Assessment, Overview.
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