Virtual Integrated Assessment Tool (IAT) – Train-the-trainer session 1

Presenters: 

• Kathryn Foley
• James Robertson
• Carla Scalia

[The visuals during this webinar are of each speaker seated together at a table in a room speaking to camera, with reference to the content of a PowerPoint presentation being played on screen] 

Kathryn Foley:

Thank you very much for joining us for this virtual IAT Train the Trainer Session today. We’ve been running these sessions face to face around the countryside and now this is the opportunity to deliver it to everybody that wasn’t able to join us in person.

To start off with I’d just like to acknowledge the Ngunnawal people as traditional custodians of the land that we’re meeting on today which is in Canberra and recognise any other peoples or families connected to the lands of the ACT and region. I’d also like to acknowledge and welcome all other Aboriginal or Torres Strait Islander people who may be attending today’s event and acknowledge the traditional custodians of the lands on which you are joining us today.

So thank you very much. So today we are the team from the My Aged Care Capability Group here at the Department of Health and Aged Care. My name’s Kathryn Foley. I’m going to be doing the introduction today. My usual job is training policy, training governance, and you may know me from your new learners because I do a lot of work with the new learners in appraisal activities. To my left we’ve got James Robertson who’s our learning partner and we’ve also got Carla Scalia who’s our learning design lead. Both of these people have developed all of the training that you’ll see here today plus our wonderful online learning modules hopefully that you can now access online. We launched them on Friday afternoon. So we’ll be taking you through the training session today. So we might just kick off the slide deck so we can step you through where everything’s going. All right.

[Visual of slide with text saying ‘Welcome’, ‘Train the trainer session’, ‘Integrated Assessment Tool (IAT) Implementation’]

There we go. All right. So that as I’ve said is our team. Also on the line is Justin Benn who’s our Director of our team at the moment. So he’s been leading us very successfully through this training process. Okay. I’m really struggling with this clicker.

[Visual of slide with text saying ‘Part 1) Introduction’]

Because I’m pressing the wrong button.

[Visual of slide with text saying ‘Structure of session’]

All right. So first of all we’ll step you through the structure of the session today. So the purpose of this session is to prepare workplace trainers from assessment organisations to deliver training on the Integrated Assessment Tool and its implementation. So all the IAT training is based on assumed working knowledge of the National Screening and Assessment Form, the My Aged Care Assessor Portal and the My Assessor app. And at the end of this session participants should understand how the IAT implementation arrangements and system changes work, be aware of IAT training requirements and delivery, be aware of IAT training resources and guidance documents and be aware when they can raise IAT training related queries.

Okay. So today the session materials are available on MAClearning and as it says there that’s our training system that was launched in 2023 and replaces the previous MACLE system. And you should be able to access all the information and resources by logging into MAClearning and then looking at the IAT tile. And I can see that a lot of people are having a few system problems there. So be assured that we are just going through the warm up sessions now so hopefully you can get your sound checks right. And we are also recording this session so you will be able to play it back afterwards if you are having trouble with sound or vision. Another helpful thing is to just jump out and jump back in again and Webex seems to right itself the second time around. So that’s another good option.

Okay. So the structure for today’s session. So we are doing this training session over two days. So today’s session will go we estimate for three hours and 30 minutes. It might go a bit quicker. So we’re going to go through this welcome, an overview of IAT implementation and then training arrangements. Then we will go into IAT triage and assessment overview and we’ll walk through all the detail of IAT triage and IAT assessment.

Then we’ll take a break there and we’ll pause until tomorrow’s session when we’ll go through the training exercise that we’ll give you. We’ll go through some Q&A and then we’ll walk you through trainer preparation section which is a refresher on the key points and walking you through all the training materials. So yeah pretty long session today. Hopefully a shorter session tomorrow.

All right. Now because we’ve got a very high number of attendees on the session today, a lot more than we were expecting which is fantastic – and I can see now that we’ve reached 130 people online – we have turned off everybody’s sound. So we are going to be monitoring the chat and we’d really encourage you to put any of your comments and questions in the chat for us and we’ll be taking breaks throughout the session to try and address those comments and questions that are put in the chat and follow up on them. For those that may have attended our face to face sessions we have adapted to reflect some of the comments that we’ve received from the face to face training. So hopefully we can address some of the more common questions but we do appreciate that people have brought up some really good questions during our sessions across the country so we do appreciate all the questions that we get. 

So yeah if you can please pop those in the chat section. We are actively monitoring the chat and we’ll pause at regular intervals to try and go through those questions. We won’t get through all your questions today. We will have to take some on notice because some of them will be quite detailed as we’ve experienced. So if we can’t answer them we will take them on notice and we will collate up the questions and probably answer them in groups. So we mightn’t call out your individual question but we will try and address the theme or the topic where we can. So yeah bear with us. We do appreciate your questions so send them in through the chat and hopefully we can address them if we haven’t already done it through the slides that we’re going to go through today.

Okay.

[Visual of slide with text saying ‘IAT implementation’]

All right. So starting the main presentation now. So IAT implementation. So the IAT is being implemented on 1 July 2024. IAT implementation is the first stage of single assessment reform announced in the 23-24 Budget. And that’s really important to acknowledge that this is the first stage in a longer journey that we’re going on. IAT will replace the existing National Screening and Assessment Form. So the NSAF will finish and the IAT will take over from the NSAF through a staged approach. And the IAT will include a new triage process which is typically completed when an assessment referral is received.

The IAT design is similar to the prototype used for the IAT trial that was done last year but there have been changes made to the layout, questions and response options. So very importantly this IAT is different to the one in the trial so all assessors will need to do the training and pass the training to be qualified to use the IAT. And please note that there have been some tender processes that have been on foot, so one for single assessment workforce and then one for RAS services in Victoria. They relate to the later stages of the reform and not the scope of the IAT implementation. So what we’re talking through here will be independent of the outcomes of those tender processes. And there’s further information about the stages of single assessment later on.

All right.

So overview of the IAT. So it’s a new assessment tool for older Australians who are seeking to access Government subsidised aged care services. The IAT will replace the NSAF on 1 July 2024. And the overall purpose of the IAT is to support the introduction of functions for a single assessment workforce that will be introduced iteratively from 1 July 2024. So this slide shows the different stages of those functions that will be implemented over time starting from the triage delegate role, which will look at eligibility, pathway priority and appropriate assessor, moving onto soft screening, then to the implementation of a single assessment workforce in merging RAS and ACAT assessment workforces together. That will then lead to the need for clinical oversight when we operate as one IAT so assessors can complete the clinical aspects of assessment with clinical oversight where required. And finally the implementation of an IAT algorithm.

Okay. And then this slide shows the stages that will occur. So you can see on the left hand side that we are with IAT implementation with the new assessment tool and then later on we will move into the next stages of the implementation of single assessment and then finally the reforms that will come with the new Aged Care Act implementation. So we’re at the start of this very long and complicated journey and that’s an important time then to reflect that it is – our term that we use is lumpy. So it is going to be a bit of a lumpy implementation. We’ve been developing the training as the process has been developed in itself so it’s been a bit of an iterative process and that’s why we’ve needed to make a number of revisions along the way and we’ll continue to make revisions. So what we’re telling you now is the best advice that we can give you at this time, noting that there will be future revisions that will be provided through. So just bear that in mind. We’re wanting to work with you to make sure that you have all the information that you need but that information may come in a few versions along the way.

Okay. So these two slides walk us through the changes that will be included in IAT implementation. So first of all one of the big changes is the introduction of a triage stage which is a new on-system triage process for assessment. So we realise that some organisations already do a triage stage when they do intake and they first contact the people that are being referred to them. This triage stage is about putting that individual process on system so that it’s standardised and it’s a national process for each assessment organisation. 

So the bottom section there shows the different steps including triage consent will be required. There will be limitations on assessment referrals while triage is in process. So you can’t transfer and reject a triage once it’s underway. You can do it before and after but you can’t do it while it’s in transit. There will be lots of pre-population available for triage from the client screening information and that’s going to be a big thing that we’ll mention many times during this presentation. Pre-population is the key to ensuring that the IAT can be implemented successfully and that the consumer will have a better experience by not needing to repeat their story many times.

So that’s the summary of the changes at triage. Then moving onto assessment. So the IAT will replace the NSAF for the needs assessment undertaken with clients. So this will be stepping you through a new set of questions that are quite similar to the NSAF but different structure and different scope. So there will be new assessment questions and there will be new validated tools that will be embedded within those questions. Again there will be option to pre-populate fields in the IAT from a client’s previous assessment including NSAF and triage. So again lots of opportunities to use the information that’s already been recorded in the system to pre-populate and then to continue on with your assessment.

All right. Then we move onto support plan. So support plan will have the same look and feel and structure as it is now. We’re retaining the ISBAR format that you’re all so familiar with. Support plan will pre-populate as well but it will have a different structure to the pre-population and we have developed some guides to assist you with learning how that pre-population works. And there will also be new functionality to transfer support plan reviews and that’s hopefully going to be something that you will all appreciate. We’ve had some positive reviews from that out in the field.

And finally then transition. There will be arrangements to support the transition from NSAF to IAT. Assessors will still need to complete an NSAF for clients with in-flight assessments on 1 July 2024. So if your assessment is already underway on 1 July 2024 you can finish in the NSAF. But assessors will need to complete an IAT for clients assigned but not yet commenced assessments on 1 July 2024. And we’ll go into further detail about that in the slides later in the presentation.

[Visual of slide with text saying ‘New Aged Care Assessor App’]

Okay. New Aged Care Assessor App.

All right. So as part of the IAT implementation the MyAssessor App is being replaced with a new Aged Care Assessor App. The new app will have the same structure as the old app but with a refreshed look and feel. The new app can be used for all assessments using the IAT and assessment using the NSAF cannot be reviewed or completed on the new app. From 1 July assessors will need to download the new app to their devices to undertake mobile assessments and a warning message will be displayed on the MyAssessor App when users should instead be using the new Aged Care Assessor App.

So there will be a new app and we’ll go into more detail about how that functionality works.

All right. This screen just shows a bit of a demonstration about the new assessment dashboard and how it will look. The IT guys had a bit of fun here and they’ve used references from the Big Bang TV show there. So we’ve got Sheldon Cooper’s screen there and a few nicely named outlets there. So just a bit of fun so you can see what it looks like.

[Visual of slide with text saying ‘Transition arrangements’]

All right. Transition arrangements.

So any in progress assessment on 1 July 2024 can be completed using the NSAF. An assessment that has not yet commenced on 1 July 2024 will need to be completed using the IAT. Depending on the assessment referral status different transition arrangements for triage will apply. And that’s described down the bottom in the table so you can see the different stages. So when it’s a referral issued but not yet accepted the team leader will need to conduct triage after accepting the referral. Referral accepted but assessment not yet assigned, the team leader will need to conduct triage before the assessment can be assigned. An assessment assigned but not yet commenced, assessment will need to be reassigned to a team leader to complete triage before the assessment can commence.

So while you’re thinking all that through this is probably an appropriate time to talk about the importance of the team leader role. We’ll go into it in more detail but you can see what we describe there, that the team leader an action at the triage, and that’s an important point to consider when you’re working through the arrangements in your organisation about how this is going to be implemented, that team leaders are a really pivotal part of undertaking triage.

So this just describes what’s happening in the app. So an in progress assessment that’s been downloaded to the MyAssessor App can be finalised on the legacy version of the MyAssessor App after 1 July 2024. Any assessment downloaded onto the app but not yet commenced will transfer to the new app if the device is online. So that’s where the device is loaded and running on the system. If the transfer has occurred a warning will display flagging the assessment needs to be completed on the new app. And did we confirm that people can run both apps at the same time?

James Robertson:

For the initial period. Yes. So assessments that are still in progress can be completed on the older version of the app at the same time as the new app’s live.

Kathryn Foley:

Excellent. And finally then the support model. Assessors should continue to contact the My Aged Care Contact Centre after 1 July 2024 for queries on the Assessor Portal or the My Aged Care Assessor App. And the same arrangements that are occurring now will continue to occur post 1 July.

[Visual of slide with text saying ‘New terminology’]

All right. So now we’re moving onto some of the new things that we’re going to be introducing with the IAT. So we’ll be walking through new terminology, and that includes new descriptions of assessor types, new descriptions of assessment types and descriptions of question types. So they’re the three new sets of terminology. So first of all we’re going to walk through the assessor types. So the IAT implementation will introduce new terminology on assessor types of being clinical assessor and non-clinical assessor. So this terminology relates to future changes post 1 July on the establishment of the single assessment workforce and the single assessment system implementation. 

So this language replaces RAS and ACAT. So clinical assessor will always be an ACAT assessor. Non-clinical assessor will always be a RAS assessor. This is regardless of any qualifications or experience being held by the assessor. And we genuinely appreciate that there are many RAS assessors out there that hold a range of qualifications and skills that are linked to clinical roles, but for the purposes of the IAT and aged care assessment we’re going to be using these two assessor types which is either clinical or non-clinical.

Okay. Then moving to assessment types. So the IAT implementation will also introduce a new terminology on assessment types which also relates to future changes post 1 July 2024. So these will be complex assessments and simple assessments. So complex assessments relate to comprehensive assessments or ACAT assessments that are currently undertaken by ACAT assessors. Simple assessments relate to home support assessments or RAS assessments that are currently undertaken by RAS assessors.

Now both these new terminologies, the assessor type and the assessment type, set us up for the next stage of implementation which is single assessment workforce, where in the future the organisation will then choose which type of assessor goes out to which type of assessment. So this is one of the lumpy parts at the moment where these functions are not yet being implemented but we need to implement the language and the terminology at this stage so it will set us up for the future.

Okay. Finally then we’re going to talk about question types. So this is a really critical change and an important part of how the IAT works. So there’s four different types of questions that are included in the IAT. So first of all we’ve got a base question which is available for all assessors. So it will be presented in all assessments either used by clinical or non-clinical assessors. Then we move onto nested questions for all assessors. So these are follow up prompts based on a previous response, for example providing additional detail on a response to a previous question. And again for all assessors.

Then we move onto threshold questions which are questions presented to clinical assessors to determine if the corresponding additional questions are necessary. Additional questions will be prompted if the response to a threshold is above a certain threshold. Now threshold questions will display for non-clinical assessors however the response will not prompt any additional questions regardless of the response. Now I’ll let that sink in for a moment.

What we’ve done in training is made the decision to provide training across all questions for all assessor types because we think it’s important for non-clinical assessors to understand when those questions will stop. So when they will hit a question where they will not get the follow up questions flowing on. There was previously a discussion about doing a popup alert in the system to alert non-clinical assessors to those questions. Unfortunately that wasn’t able to be implemented so what we’re doing instead is providing you with the instruction and guides on how to identify the threshold questions for non-clinical assessors so that they understand the structure of those questions.

Finally we’ve got additional questions for clinical assessors. So these are the ones that will pop up or be opened for clinical assessors once the threshold of the threshold question is triggered. So they will display for clinical assessors only. They will not display for non-clinical assessors.

[Visual of slide with text saying ‘Clarifications’]

All right. So we might pause there and just check in and see how we’re going with the questions in the chat and what issues have been raised.

So I think no, we haven’t seen any questions yet. So I’m just getting – here’s one. 

Q:         How will pre-population from the IAT to the assessment summary for medical conditions be fixed? 

And that’s just disappeared off our view so we’ll see – there it is again.

Q:        Currently when it pre-populates it includes the ACAP health code.

No. That is something – is that something that we address in user guide? No. Okay. We’ll have to take that one on notice then. That’s quite a detailed question that we’ll need to look into and check. 

Q:        Will this slide pack be available to us post training?

Yes indeed. It’s on MAClearning right now so it’s part of your resources for the IAT training module. So yep. Feel free to jump into MAClearning now and you should be able to see it.

Q:        Can we print the assessment dashboard?

Good question. We haven’t had that one before. No. Okay. We will have to take that one on notice in terms of that function.

James Robertson:

Just to add a point there, with most browser types you can print what’s displaying on your screen. So that might help answer that question. But I don’t think there’s any built in functionality with a print icon to print anything at the moment.

Kathryn Foley:

Okay. 

Q:        The duration of the IAT training for assessors in MAClearning?

So we’re currently estimating that – Carla do you want to take that one? 

Carla Scalia:

Five hours is what we’re estimating at the moment. Validated assessment tool was a contentious element because it has a lot of different things for lots of different assessors. You may find that some of your assessors are familiar with most of the tools. Others are not. We did send the element out to our lead educator network to get a gist of timings and the average was two hours. So we’ve allocated a two hour timeframe to validated assessment tools, one hour for the other three elements. That equals your five hours of online learning. We did have this question come up a lot in face to face training. It is important to note that we do work within the realm of adult education and so some learners may take quicker, some may take longer. So it’s always really hard nailing down a timeframe that’s accurate because everyone learns differently. But for the sake of I guess guesstimates we’ve gone five hours for those online learning elements.

Kathryn Foley:

Thanks Carla. Okay. 

Q:        Is there a spellcheck function in the new app?

I’m assuming it has the same functions as the current app. So we’ll have to take that one on notice Andrea.

Q:        Will the new app be useable offline?

Kathryn Foley:

Yep. Same function as now so yes it will be available offline.

Q:        The team leader role as identified in My Aged Care as opposed to in an organisation?

Yes William. That’s a very important role. So it is the team leader role as identified in the MAC Portal. We do recognise that you will have different team lead arrangements in your own organisations but it is holding that team leader role in the MAC Portal. And we do know that people can hold more than one role. So yep. Katrina.

Q:        Were older people consulted regarding the new terminology?

I think that was part of the trial in that there was a number of consultations on the terminology. So we’re working on the finalised product here but it’s definitely something we can look into.

Tony has come back saying:

Q:        Yes there is a spellcheck in the assessment summary.

Thanks Tony. 

Q:        But it needs to be activated manually.

Right. Okay. And Athlea I think – this looks - - -

Yes. Yes. So there is going to be some lumpiness as we describe it with the management of existing assessments and the waiting lists for triage. We will go into that in more detail but yes, it is going to be something that each organisation is going to have to look into closely and look at how they’re going to manage.

Q:        Interested in the feedback of simple assessment.

Right. Yep. Comment noted Michelle.

Q:        Where are the slides in MAClearning?

The slides are located in the resources which is attached to your MAClearning training element. That was assigned to every assessor on Friday I believe. We also assigned the resources to everybody who accepted this invite as well for virtual train the trainer. So hopefully you’ll be able to find those slides in MAClearning Nicole.

All right. I think we’ve probably reached the natural end of those questions there. Hang on.

Q:        When will the assessors have access to the IAT quiz training?

Thanks Amanda. IAT training is available now. It was assigned to every assessor late on Friday so it should be showing up on your dashboard now. So yeah if you do have a role type of assessor in MAClearning and you haven’t received your training talk to your manager who can work through how we can get that assigned to you. But it was assigned to everybody with a job role of assessor in MAClearning.

All right. So I think we’ve probably reached the end of the questions there. Thank you for all those. Keep them coming in. We’re taking a note of them all. And we will move onto training arrangements. So I think I’m passing the baton. It’s me. Sorry. I’m continuing on. Sorry.

[Visual of slide with text saying ‘Training arrangements’]

I should be used to this by now. I’ve still got five slides to go. All right. So this is the description of where we’re up to in the training journey. So as you can see in the first part we’ve gone through all of our face to face training and this will be our final session of virtual training delivered. And we’ll also be recording this session so that people will be able to access it after the fact. 

The second part of the training is when the virtual training environment goes live on the 17th of June. This will be the opportunity for everybody to login and experience the IAT in a digital format and be able to practice using the IAT. We’ve created a range of scenarios for you to use. They’re both ACAT and RAS scenarios, or clinical and non-clinical. So they’ll be available and they are available now in your learning on MAClearning. And we’ll be also walking you through those and going through an exercise that you’ll be able to do offline and prior to our session tomorrow.

All right. So this explains the four different stages of doing training on IAT. So there’s four parts to this. So that’s a workplace training session where learners will attend a training session delivered by their workplace trainers. This complements the online learning which we provided through MAClearning. Second stage is the online learning goal. So learners will need to complete a mandatory IAT transition learning goal. To complement that as well, as I said, they can complete training scenarios. They can complete them in hard copy using the offline form or after 17 June they can complete them online using the training environment and the scenarios that have been provided in the training.

And finally the last component is completion of an online quiz which is available through MAClearning. So completion of the quiz is the part that triggers your certification to prove that you’ve completed IAT training. So we’ve made it a requirement that everybody that’s an existing assessor does need to complete IAT training and get the certificate before they can use the IAT after 1 July. So pretty much after 1 July everybody needs to have completed the training and received the certificate otherwise they cannot use the IAT and will need to complete the training before they can use it.

So we’ve had a lot of discussion about the stages of this training, the sequencing. We don’t think there’s any one particular way that it should be done. You can do the online learning first and then do the training session. You can set up the training session for your staff and then do the online learning goal but we strongly encourage you to work through all four stages and of course the online quiz is the required part to get your certificate to ensure that you’re fully compliant with training.

Okay. And then this just recaps the points that I went through then. So strongly encourage all staff to complete all components of the IAT training. The completion of the learning goal is the mandatory part for assessors and staff with a team leader role. The training consists of four learning elements and a quiz. So the online training, the four elements are IAT, support plan, triage and validated assessment tools. So they’re the four different elements. Validated assessment tools is the one that’s most comprehensive and it’s the one that takes the most time. And then of course there’s the quiz at the end. As I said upon successful completion you’ll receive a certificate which will be recorded in MAClearning.

All right. And also at the bottom these training requirements apply to existing staff only and other arrangements are in place for new staff joining organisations after 1 July 2024. So we are updating our baseline training so that after 1 July there won’t be any need to do additional IAT training. It will be included in the baseline training. If you’ve got any assessors that are currently training at the moment there’s a fact sheet on MAClearning that gives you information about that but basically we very strongly encourage you to support them to get through goals one, two and three on MAClearning, especially goal three, which teaches them how to be an assessor and understand the NSAF. And then pass appraisal activity two. And then those new learners should be included in your workplace training for IAT so they can get their IAT certificate while they’re completing their base training.

All right.

So role of trainers to support the initial training. So we think that there’s four roles for trainers as part of this training. So ensure the staff are aware of IAT implementation and training arrangements, organise and deliver classroom style IAT training sessions in person and virtual, ensure staff have MAClearning access and complete the IAT transition learning goal, and ensure staff are aware of the available training materials and where they can be accessed on MAClearning. And if you have any staff that don’t currently have access to MAClearning please get your organisation manager to register them with us as soon as possible so we can get them on the system. We’re pretty confident that we’ve got the majority of people on the system now.

All right. And this just reiterates that we’ve got the availability to the virtual training environment, the Assessor Portal training environment where people can go in and practice using IAT in an online setting. We strongly encourage all organisations to support their staff to access the training environment during that two week window from 17 June to the end of June. It is a short time period but we are confident that we’ve got enough licences and accounts to be able to support everybody to get in there and do practice in the virtual environment. So we strongly encourage people to be using that environment.

All right. So this just gives us a bit of background on how we got to this point with the previous IAT trials. So it gives us some history on how we got here and where we’re going. We would like to acknowledge the assistance of all the organisations that participated in the trials. We know that that was a lot of work for all the assessors out there and so we appreciate the time that they took to give us feedback and help us to understand how the IAT would work in real life.

As we said before this IAT is different to the IAT that was provided during the trial. So for any assessor that was involved in the previous trial please only refer to the training materials on IAT implementation on 1 July as some arrangements from the previous trials will differ. And so where in doubt we ask you to go back to MAClearning to look at the latest versions of information there as opposed to any of the previous resources.

[Visual of slide with text saying ‘Clarifications’]

All right. So I can see we’ve got a few more questions on the chat here. 

Q:        Have admin people also got access to their MAClearning component?

Yes they do. So anybody who’s got the team leader role who’s not an assessor can do specific training on triage. They can go into MAClearning and search for ‘Triage IAT’ and they can find that training and sign up to it. It’s only one hour of training. It’s just the triage element, not the other three elements that we’ve got in the training for assessors. And it’s all online and there is no quiz. So admin or team leader staff are strongly encouraged to go in there and do that training as well.

Q:        Does the online training tool that goes live on the 17th also allow for the use of the new app within the training?

No. So I think it’s just the tool. 

James Robertson:

At this stage just the Assessor Portal but we’re waiting for further advice regarding the new app and if that will be available in a training environment as well. So when we know we’ll let you know as well.

Kathryn Foley:

Thank you. All right.

Q:        Will the trainers in this group need to complete the online training?

So anybody who’s got a job role as an assessor in the MAC Portal will need to complete the training. So we strongly encourage trainers who are assessors to complete the training and any training staff because it’s really important that everybody has the same baseline learning for the IAT.

Right.

Q:        How many attempts are there for the quiz?

Okay. Carla do you want to talk through this one?

Carla Scalia:

Yep. It’s unlimited. So what we’ve done is a rotating quiz or a randomised quiz. It’s a little bit different from the other quizzes that you’ve engaged in and that’s because usually with the end of goal quizzes that your new assessors have done within goals one to six it’s further backed up by appraisal pieces. But for this piece of work the only way we can rigorously assess your knowledge in this area is through an online quiz, so we have made it a little bit more robust. Basically it will be 12 questions long. You’ll need to get 100% pass mark to pass. Basically what we’ve done is we’ve built what’s called a question bank. So question banks are assigned to each of the four elements and what we’ve told the computer to do is to pull three questions from each of the four elements to make up your 12 question quiz. And so that does mean that you’ll go in, you’ll complete as multiple choices, true or false. It’s comprehension based only so there’s no application. It’s just basically read the content, make sure you’ve understood it, complete the quiz.

Like I said it is 100% so if you don’t get 100% you’ll need to retry the quiz again until you do, noting that some questions will be the same, some will randomise. So just to keep you on your toes a little bit. But as I’ve said in face to face sessions it’s not rocket science. As long as you’ve read your materials you’ll be able to pass that quiz.

Kathryn Foley:

Thank you. All right.

Q:        Does workplace training we complete for our team need to be recorded anywhere in MAClearning?

No. The only thing that needs to be recorded in MAClearning is completion of the quiz which will generate a certificate. So we know that each organisation will do it differently so it’s really just each assessor has to go in and complete the quiz to get their certification.

Q:        Is there any materials for the trainer to access to train the assessors?

So all the materials for trainers and learners are in the resource section on MAClearning. So you’ll see in there we’re working through the train the trainer slide deck now but there is also a training slide deck which covers the majority of what we’re providing here. There’s also a learner guide, a trainer guide, and many other resources. So we’ll run through all those resources that we’re providing.

James Robertson:

Just to jump in on that one it seems to be a question asked by a few people. They may be looking in the learning goal instead of the train the trainer area of MAClearning. So the learning goal was launched on Friday last week for learners but your information relating to this train the trainer session and all of the resources for trainers is separate to that. So please look in that separate area for train the trainer sessions. I think it’s called Virtual IAT Train the Trainer Session and that’s where the list of resources for trainers is included.

Kathryn Foley:

Excellent. 

Q:        Minor differences noted between the MAClearning online virtual training and this presentation.

So yes. We are continuing to update the content. We have updated this slide deck to reflect what we’ve learnt through the face to face training. And what we’re intending to do is update the resources to reflect all of these changes. We’re not wanting to bombard you with version after version after version so we’re wanting to do them in a job lot so that you know where the versions are up to. We’re hoping to do that late this week, early next week. Please note that each document on MAClearning has a version control on the bottom and the latest document will always be available on MAClearning. So when in doubt please look at MAClearning and that will show you the latest documents. But yes unfortunately we are continuing to need to update as we learn more things and as the system is finalised so bear with us.

Q:        What about assessors on long service leave or mat leave?

Yes. They will need to complete IAT training when they return. So if they’re on extended leave they will need to complete IAT training before they go out and do IAT assessments on return.

Q:        Can assessors complete the final quiz for certification prior to June 17?

Yes they can. And we’ve actually awarded our first certificate already. We’ve already had somebody that’s completed all the training and has got their certificate. This is one of our star trainers out there. So yes it is open.

And a comment from Sue. Thank you very much Sue. Good to have you on board. Sue was at our New South Wales training, our Sydney training. And I know we’ve got a few people doing this as a repeat as well so hopefully they’re picking up on all the things that we’re offering.

Q:        Can you clarify what admin staff need to do to complete to be able to do triage? 

So we strongly encourage administration staff to complete the triage IAT training. So that comes up when you search triage and IAT. It is a training goal that just has one element in it which is the triage only element. So that’s what we strongly encourage any admin staff that’s got the team leader role to be doing that training. One hour no quiz. Hopefully that gives them the information needed to be able to start doing triage.

Q:        Will an IAT summary be provided if there are any changes to the live document versions?

Okay. I think you’re asking for a change log. We are working on some change logs to make it clear on what we’re changing but as you said some of these documents are quite extensive. The IT user guide I think is over 280 pages. So we keep reiterating that when in doubt the most current version will be on MAClearning.

[Visual of slide with text saying ‘Part 2) Triage and IAT overview’]

Okay. I think we’re at the end of the questions there.

James Robertson:

Over to me. Hi all. James Robertson here. So I will talk through this introduction here. So the bulk of the train the trainer session today will be our triage and IT walkthrough. So if you recall the agenda from a little bit earlier on we’ve got triage that will go for about 45 minutes and our IAT assessment tool section will go for about up to two hours. We did do these sessions in the face to face sessions with lots of Q&A, so similar to what Kathryn’s covered before with those clarification slides we’ll pause at various points to cover some of the key questions that have come through. But that might mean that we get through the content a little bit quicker than the face to face session. And also noting that part two in the virtual session tomorrow we will come back with more considered responses to many of the questions raised today as well so that will be a bit more of a Q&A session.

So with our deep dives on triage and the IAT we are trying to provide as much information as possible. There was some feedback from those of you that participated in the IAT live trial last year and the training that accompanied that. Learners were keen for more content on how to respond to questions and to get into the nitty gritty on validated tools as well. So what that means – we’ve incorporated that feedback. What that means though is that there is a lot to get through here and it is not always conducive to ideal learning where there’s a bit of information overload. So please be assured that you don’t need to leave today’s session being an expert on everything to do with triage and the IAT overview. We’re hoping it gives you a really good flavour of what’s included and some useful information on where to go back to to fill in any gaps coming out of the sessions.

So in terms of how we’ve structured the triage and the IAT overviews we’ll start up the top with a high level summary, so just building a little bit further detail on what Kathryn’s flagged in the introduction. We’ll then go into process and system arrangements. With triage and the IAT, similar to current arrangements, there are sometimes alternative arrangements that are needed for particular circumstances so we’ll go into those as well. So an example is how in hospital assessments are managed and some of the other alternative arrangements. And then finally we’ll go into the questions that are included in triage and what’s new in the IAT and get into response guidance on responding to those questions.

[Visual of slide with text saying ‘Triage walkthrough’]

So let’s start with the triage walkthrough. As I said this will go for around 45 minutes. In terms of the material that we provided to you as trainers to deliver in your own training sessions this has been split into two. So for triage we’re covering everything together here for our train the trainer session but in the sessions that trainers are delivering to their staff we’ve got an overview of triage that’s been designed for all learners and then we’ve got separate content on the detail of the triage process. That content’s been designed for those who are undertaking triage post 1 July, so those with a team leader role in the My Aged Care Assessor Portal.

So Carla to my left here and I, we’re going to tictac through these items. I’ll cover the first couple. So I’ll do the overview and roles and responsibilities and system arrangements. Carla will get into all things consent, give a good summary of the process – we’ve got a good video there that we’ll also play – those other arrangements, pre-population and how to view previous triage information. We’ll then quickly flag the resources to assist, and then finally back to myself, I’ll get into the structure of triage and the breakdown of the triage questions and response guidance.

So the overall purpose of triage. First of all just to acknowledge triage is something that is a term or something similar that is conducted by assessment organisations currently but for the purpose of the IAT what triage means and its purpose is to validate outcomes produced at screening. So a client will go through screening. They will then have a series of outcomes from that screening. And triage conducted by assessment organisations is to validate those outcomes.

So first of all it’s looking at the client’s eligibility for aged care services to make sure they’re appropriate to receive an assessment. Then it’s looking at if the assessment pathway allocated during screening is appropriate as well. So based on the triage questions and the conversation with the client if a home support assessment or a comprehensive assessment is appropriate. Then it’s also looking at the priority of assessment and confirming if that’s appropriate and making any changes if not. And then finally it’s another opportunity to determine the need for urgent services, so if there’s any urgent service referrals required.

So that’s the overall purpose of triage. Moving into an overview of triage in a bit more detail. So as I mentioned before a number of different forms of triage are currently undertaken by assessment organisations. Those arrangements may still need to continue if those activities are not being picked up by this new process. So for example we know some assessment organisations use a form of triage to get a bit more information about what’s needed to start the assessment, so their contact details or any safety considerations, the what to do on the day. So those sorts of arrangements may still need to continue alongside this triage process or indeed separate to it as well.

So what is triage in the context of the IAT? We’ve got six key points here that summarise the arrangements. So first of all it’s a new process to complete when an assessment referral is received in the My Aged Care system. So the assessment referral is what triggers the new triage process. We’ve got arrangements there for self-referrals as well but typically for normal assessment referrals they’ll come through in the My Aged Care Assessor Portal and once they’ve been responded to within the current KPI arrangement the next step then is to complete the triage process.

So when we complete the triage process that involves the completion of triage questions with the client or their support person. We’ll get into arrangements for consent and who you can conduct the questions with shortly. As you’ve probably gathered so far this is all managed on system. So this is to ensure information is consistent, structured and transparent. So what one assessment organisation undertakes for triage will be able to be viewed by other assessment organisations as well. It is completed by staff with a team leader role in the My Aged Care Assessor Portal. So to be able to do the triage process you need to have that team leader role allocated to yourself and that’s where you get the system functionality to complete triage.

In terms of timeframes the KPIs to respond to assessment referrals remains unchanged. So you’ll still receive those assessment referrals and have a need to respond to those assessment referrals within three days. In regards to what happens after you respond to that assessment referral the expectation is that triage will be completed in a two week timeframe. I should note here that this is not a KPI but it’s to fit within the other KPIs that continue downstream as well. So the two week timeframe is the logical I guess duration to complete triage to keep within the KPIs that happen later on.

And then the last point to raise on this slide, and it is one that Kathryn mentioned earlier, the triage delegate role. Some may have seen this if you were involved with the tender process recently or have been engaged with the consultations on the new Aged Care Act. This is not a formal role that’s being introduced as part of this triage process on 1 July. It is something that’s being looked at in the future. But again just reiterating if you’ve got the team leader role in the My Aged Care Assessor Portal that’s the requirement needed to undertake triage and future changes will likely change that. But for that initial period the team leader role is sufficient.

I do see some questions coming through in the comments box. I’ve got a couple more slides to get through and then we’ve got a clarification slide shortly. So let’s spend a bit of time going through those questions in a sec.

Triage system arrangements. So triage in most circumstances will be completed on the Assessor Portal just like the assessment referrals. So when you go in you look at your assessment referral and accept. Rather than jumping straight to allocating the assessment to an assessor you’ll go through the triage process. So there’s all this new system functionality being introduced to enable that middle step between the assessment referral being accepted and the assessment being allocated to the assessor. And you can see a couple of screenshots on the slide at the moment just showing what some of that looks like.

There are arrangements where triage can be completed on the new Aged Care Assessor App. This is just in situations where a self-referral for assessment has been undertaken. Not all organisations can undertake self-referrals for assessment and nothing changes in this regard. So if you do have the functionality to do this this is where triage questions can be completed on the app. But there’s a few additional steps that Carla will go into shortly about self-referrals.

Okay. So I might pass across to Carla. Hopefully we’re not having too many audio issues. I did see a couple of comments come up that you’re losing the voice. But just keep adding comments if it’s still not working but hopefully it’s addressed. 

Carla Scalia:

Cool. Okay. Thanks James. We’re going to start my shift, starting with consent. So you will need to obtain a client’s consent to proceed with triage. The good news is that consent will be recorded on system in the portal and the app. So as you know with assessment there’s the consent form that you get filled out and you upload. There’s no form engaged with the triage consent requirements. It’s all on system. So what will basically happen is you’ll click that ‘Start triage’ button and you’ll be presented with a consent script which you’ll need to read out to the client or their support person, whoever’s present. And then you’ll be required to record who you captured that consent from by selecting an option from a list of values that are presented in a dropdown box. So you’ll have the option to gain consent through several avenues by recording it into the system. You can gain consent from the client themselves, from the client with the help of a support person or through the client’s legally appointed representative.

It is important to note that this consent stage does not I guess null and void assessment consent. We did get some feedback in face to face asking ‘Do I still need to ask for consent for assessment?’ Yes you do. This is an additional step for triage consent. It should be noted that if you don’t gain the client’s consent you’re unable to proceed to triage, and so you are going to have to click that consent not given option. You’ll get a text box where you’ll need to put in your reasons for why the consent was not given and then at that point you’ll get the option to cancel the triage, noting that when you cancel triage you will also reject the referral. So it’s really important to make note for the client that if consent is not obtained for any reason that’s okay, but you’ll be unable to proceed to assessment and that will result in the referral being rejected.

We do have a little video for you to give you an overview of what triage is and then we’re going to touch base on some key points within the video.

[START VIDEO PLAYBACK]

Speaker:

In this video we’ll provide a high level overview of triage so that you understand the end to end process, noting that triage can only be completed by an assessment organisation staff member who has been allocated the team leader role in the My Aged Care Assessor Portal. The first step in the triage process is receiving the incoming assessment referral. This will be no different to how referrals are managed now. Referrals will come in through the My Aged Care Assessor Portal and be visible on the dashboard. Assessment organisation staff will still be able to view the details of all referrals such as those related to KPIs, overdue actions as well as a breakdown of referrals by outlet.

Once received team leaders will be required to accept, reject or transfer the assessment referral within three days of it entering the portal. It is important to note that all assessment referrals will need to be accepted before they can undergo the triage process. Once the referral has been accepted it is ready for triage. Triage should be completed within two weeks of accepting the referral. It is recommended that prior to contacting the client information in the client record is viewed so that those conducting triage are aware of existing information that has already been collected during the screening process. This may include urgent services that have been issued to the older person as well as linking supports they have been offered. 

Team leaders will have the option to pre-populate the triage form with information collected at screening or a previous assessment. Pre-population is recommended so that clients are not required to repeat their story for a second time. The client or their support person can now be contacted preferably by phone to arrange and conduct the triage process. Before asking questions team leaders will need to obtain consent by reading the script provided and recording this in the system. With consent obtained use the triage questions to guide the conversation with the older person, remembering that they have already been through a screening process where similar questions were asked. Team leaders should use what has already been collected to verify the needs of the older person as well as obtain any new information that might be relevant to the assessment.

Team leaders are to use the triage process to confirm the older person’s eligibility for aged care services, confirm the assessment pathway they are to undertake, confirm the priority level of their assessment as allocated during screening, as well as identify the need for urgent services. If the priority of assessment needs to change team leaders can action this after triage. Likewise urgent services can be issued to the client if needed before or after the triage process has taken place. 

Once triage is done team leaders will be required to assign an assessor to the client’s assessment. Alternatively there may need to be a change to the client’s assessment pathway with a referral to RAS or ACAT enacted. If transferring the referral to another organisation triage will not need to be completed by the receiving organisation. Triage information collected will display in a read only state for the new organisation to use towards the client’s assessment process. If assessment is not required at the end of the triage process triage can be cancelled which will result in the client’s referral being rejected and the assessment process ending.

Historical information relating to triage will be viewable in the portal. This includes viewing information around who conducted triage when it was completed as well as the information collected during the process.

[END VIDEO PLAYBACK]

Carla Scalia:

There we go. That’s our slide just in case the video doesn’t work. We’ve always got a plan B. So just some key points to call out regarding triage. So when it comes to actioning assessment referrals there’s no changes to how assessment referrals are to be actioned. They’re still to be accepted, rejected or transferred within three days of them entering your portal. So as we said no changes to that now. That KPI still remains in place. The only difference you will find now is once you accept a referral instead of assigning it to an assessor for assessment you will assign it to a team leader for triage. The way that you do that is exactly the same way as how you assign an assessor for assessment. You pop the ‘Assigned’ button. A little popup will come up with the names and you’ll be able to assign it to a team leader or yourself obviously because you’ll be holding the team leader role because you’re managing those referrals for action.

It is important to note as well that those team leaders are able to move those referrals for triage around, so a team leader can unassign themselves and assign another team leader to that triage for it to be actioned as well. So there is some functionality in the system for that to happen. Making contact with the client or the support person. It is important to note that again as we talked about there is that two week timeframe for referrals once they’ve been accepted for it to be triaged. Noting that it is not a formal KPI. It is a recommended timeframe just to support consistent assessment practices across all of our organisations. 

Pre-population we talk about a lot in our face to face sessions. Pre-population is your friend. We’ll be talking a lot more about it as we go on. It’s a hot word for this session but it really is a great functionality to use and there is definitely the recommendation that before triaging your team leader should be reviewing the client’s record and pre-populate that information so that the client’s not having to tell their story for a second time. Again we talk about it. Clients have already been through a screening process. The screening questions are very similar to those within triage. Pre-populating that information over so that the client is not having to tell their story for a second time is really important. 

It is important to note we talk about the lumpiness of this process. The triage function as it operates now to what it will be within single assessment is very different. So at the moment there is this I guess semi-duplication between screening and triage that pre-population is going to help us out with. Moving forward obviously Contact Centre screening will change as we evolve into a single assessment workforce and that will obviously change the nature of that screening to triage. But for the moment pre-population is really good to use. Noting that you can edit any information that is pre-populated over but it can save you a lot of time and most importantly just provide a much more user friendly experience for the client.

And transferring/rejecting a referral after triage. Referrals can’t be transferred or rejected whilst triage is in progress. So this can only take place after the completion of triage in the system. If transferring a referral to another assessment organisation after triage has been completed the receiving organisation will not need to complete triage again and the information moves into a read only format. So you’ll still be able to transfer or reject a referral before triage has happened. You’ll also be able to do it after triage has happened. But once you click that ‘Start triage’ button it moves into a triaging progress status and triage needs to be completed before any further action can take place in the portal.

As far as triage and self-referred assessment goes, assessors will still continue to have the ability to self-refer clients for an assessment. Noting that obviously we know that ACATs can do this. There are limited RAS organisations that can do this. But if you can currently self-refer clients for assessment you will continue to be able to do so post 1st of July. Self-referred assessment can be completed in both the My Aged Care Assessor Portal and the new Aged Care Act. So it is important to flag that the only time triage can be completed in the new Assessor App will be in cases of self-referred assessment. So all other referral types will be required to be triaged in the Assessor Portal before they can then be assigned to an assessor. You can then go forth and proceed with assessment in the app but that triage process will need to happen in the portal unless it’s a self-referred assessment and then you’ll be able to go from woe to go. It’s for this reason that the Department recommends that assessors who are engaging in a lot of self-referred assessment be also given the team leader role within the portal because it means that they will be able to manage that process end to end. What that basically will look like is that they’ll be able to generate the referral, accept it, assign it to themselves and triage it because they’re wearing their team leader hat. Once that’s done they’ll be able to assign it to themselves as an assessor, pre-populate that information over and go forth and proceed with assessment with the IAT and the support plan. So it’s a much more smoother process.

It should also be noted though that assessors who are not team leaders will still be able to complete triage and assessment however it can only occur under supervision. So what will happen in that case is that a popup banner will appear where that assessor will need to nominate a team leader that will supervise them for the triage process. They’ll be able to complete triage and move through to assessment in the portal but they will need to make sure that they’ve basically got that team leader supervision authority gained before they can finalise the assessment. So they’ll still be able to proceed but they’ll need to nominate someone for supervision and have that ticked off in the system before they can finalise that assessment. And so it’s for that reason that again, just reiterating, it may be a much easier, more streamlined process for your assessors to be assigned the team leader role in the portal.

When it comes to triage and in-hospital assessments, in-hospital assessments will require to be triaged after 1st of July. It is recommended that triage is completed using clinical records and/or information that is available in liaison with the hospital discharge team. Noting that there is still the consent process that needs to happen before you can engage in using those records. We did have some questions come in around if hospital staff consent can be used towards consent for triage. We’ve taken them on notice and they’re on our list of questions for the policy area. But it’s usually a question that did come up when we showed this slide so I’m getting in before you guys throw in the question that has come through and we have flagged it for further clarification.

We do know that with in-hospital assessments they do get I guess generated through different ways. We know some assessment organisations create those through self-referred assessment and others, those in-hospital referrals will come through GP referrals or through the website. It is again just going back to that self-referral slide that we talked about, how triage is managed. If it’s self-referred again if that assessor is in the hospital setting and they have the team leader role they’ll be able to engage in the triage and assessment process end to end. If that referral is generated through the website or GP referral it will need to be triaged in the portal and then moved to an assessor to be able to be completed via the app in the hospital setting. So it is important to note that again we talk about it a lot in our face to face but if you do have assessors that are in hospital and you think that they will need to triage and assess at the same time, obviously giving them the team leader role to be able to do that in the portal will make life a lot easier for them.

Just remember in these cases again we talk about our favourite word pre-populate. When you’re working with self-referred assessment and even those coming through from portal to app, pre‑populating that information can save a lot of time and again just make sure that that client is not telling their story a second time.

When it comes to accepting assessment referrals in bulk you’ll still be able to complete that task. Noting that there are some default settings as outlined on the slide. If you are choosing to accept assessment referrals in bulk just make note of those default settings because you obviously don’t want to create any more work for yourself and be selective, noting that things will default back to a medium priority and for your hospitals they will go back to non-hospitals.

Pre-population. Again our favourite word of the day. So team leaders will have the option to pre‑populate triage responses with information from screening or from a previous assessment, being that of the IAT or NSAF. It is important to flag that pre-population does not occur automatically. You are going to get the choice with pre-population. You can choose to pre‑populate or you can choose to proceed to triage with a blank form. It is important to note that once you make your choice though you are all in. So if you decide to go forth with a blank triage form and choose not to pre-populate that’s fine but you’re not going to be able to go back and revert that choice. So it’s best to pre-populate, noting that you will be able to edit the information that pre-populates over.

As far as pre-population choices if it’s a new assessment you’re going to have the option to pre‑populate from screening. If the client has an assessment on file and they need to undergo a new assessment the option to pre-populate triage from their most recent assessment will be the option. And if you’re self-referring a new client pre-population won’t be offered because there’s nothing to pre-populate to. We did as part of our resources provide you with a diagram that outlines a pre-population. It’s the diagram that we always joke is about a kilometre long. It will give you an idea of what pre-populates from screening, triage, the IAT and the support plan and may be a handy resource for you to use. Noting that the IAT user guide also outlines what questions pre-populate to and from. So good resources to have.

You will be able to view previous triage information in the portal and the app. And you’ll be able to do this by clicking on the client summary tab under assessments. You’ll see a little magnifying glass icon which you’ll open up and you’ll be able to see the triage form which will have all the information that’s been collected during triage in a read only format. So if you decide to pre‑populate triage into the IAT what matches will move over. If you choose not to though you will still be able to view that triage information in the IAT. And we’ll go through a bit of a screenshot about that a bit later on.

There are some resources to assist with triage. Noting that again we’ve got our online elements in MAClearning available for you. We’ve got the IAT user guide which will be your source of truth moving forward, a very invaluable document to use and very helpful as we move through these early stages. We also have a triage fact sheet which is also available in MAClearning for you to be able to view as well.

[Visual of slide with text saying ‘Clarifications’] 

Kathryn Foley:

All right. Let’s get into some of these questions that we’ve got through. So first one.

Q:        Will people still be eligible for an assessment just to be registered for future planning as they come through quite often?

So I think my answer to that is it’s the same as what it usually is in NSAF. So it doesn’t change. That part of it doesn’t change. It’s just the different system. So same as the process that you’re currently undertaking. All right. Next question.

Q:        How does triage process work with support plan reviews?

Carla Scalia:

I was going to say we always get eager beavers. I love these questions. Yes. Support plan review is still the same but if a support plan review triggers the need for a new assessment, yes that new assessment becomes a new referral and will need to be triaged. Noting that you can pre-populate from the previous assessment into the triage. So again you’re moving information over to support that process. But yes a new assessment which has been recommended as a result of a support plan review will be required to undertake triage.

Kathryn Foley:

Okay. All right. Next one.

Q:        Will all referrals need to come via MAC including hospital referrals to triage?

Carla Scalia:

I believe in-hospital can come through self-referrals as well. So yes. If it’s a self-referral you’ll be able to complete it in the app. If it comes through your MAC website GP referral it will need to come through your portal.

James Robertson:

Yeah. And just to emphasise there any referral will be through the system and referrals all require triage.

Kathryn Foley:

Okay.

Q:        Can clients see triage on the system?

So this was one that we got asked a couple of times.

James Robertson:

This was raised in the face to face sessions. So I understand currently clients are able to view the NSAF for their assessment, so the completed answers in the online account that’s accessible and the screening information as well. So based on that it’s our understanding that triage will be the same in the future arrangements but it is one of the questions we took on notice in the face to face sessions to just have that 100% clarified, but we suspect that will be the same arrangements as what happens currently with the NSAF. So triage would be included there.

Kathryn Foley:

All right. Next question.

Q:        Does the assessment KPI start after the triage has completed or does it start as soon as the referral has been accepted?

So I think Carla did address that in one of the slides in that it does start as soon as the referral’s been accepted.

Carla Scalia:

I don’t believe anything changes around KPIs. It’s same as. Yep. So from the acceptance.

Kathryn Foley:

Okay. The next one’s a specific question about triage.

Q:        When can we use the outcome the reason care approval meets needs?

I’m guessing that’s one that we would address in the user guide.

James Robertson:

I’m not too clear on that question. So whoever sent that through if you could just ask it with a little bit of extra information that would be handy. I just don’t want to give the wrong answer.

Kathryn Foley:

Otherwise we’ll take that on notice and look into that a bit more. Next question.

Q:        Will inpatient assessments need to go through triage first?

Yes. They will. Hospital assessments will need to go through triage. There was discussions early on about whether hospital assessments would need to do triage but the decision has been made that yes they will need to be triaged. And I think that’s why we strongly encourage those assessors to also have the team lead role so that then they can assign it to themselves, do the triage, assign it back to themselves and do the assessment.

Q:        Does the triage need to be clinical or non-clinical?

James Robertson:

Just to add a bit of context to my answer. So triage is undertaken by someone who’s a team leader. They don’t need to be a clinical person. And the process of triage is to determine whether or not a clinical or non-clinical or a comprehensive or a home support assessment is required. So at this stage during the initial period the triage person undertaking triage, they don’t need to be clinical.

Kathryn Foley:

All right. Hopefully that covers off what you were asking there. Next question.

Q:        Bulk accepting referrals. It defaults to all referrals as a medium but can we override that manually?

Carla Scalia:

I believe you can. Yes. It’s just that manual default apparently occurs.

Kathryn Foley:

All right. Next question.

Q:        Does the support person need to be with the client at time of triage to get consent? Most service referrals have a separate contact person and number and not listed as the client rep.

Carla Scalia:

It’s a question taken on notice. We have sought clarification around just a little bit more guidance about how to manage triage with support people involved. Because it has been a question that has come up a lot face to face. So policy guidance would be required for that.

Kathryn Foley:

All right.

Q:        Triage for remote clients who can’t be contacted by phone.

Yes. We do welcome our colleagues from Northern Territory online today.

So I think that’s one we’re going to have to get more advice on. In theory triage does need to be completed. I think for these people though again it comes down to whether the person’s got the team leader role so then when they’re going out to see them they can do the triage and then move it back to the assessment phase. But we will get some policy advice on that one.

James Robertson:

Just to add a point there too. From our Perth session we were dealing with some trainers from remote locations. We were advised that these were often managed as self-referrals for assessment just because of the practicalities of getting in touch with the client and having that timing met. So that might be a helpful response to this question. If it is a self-referral for assessment don’t forget that point that Carla mentioned that you can complete triage and the assessment questions at the same time. So that might address the need to be able to contact a remote client over the phone first that’s not contactable.

Kathryn Foley:

The other thing that we are looking into as well is people that provide consent in their own language such as through their GP or through their support worker and that was included in the referral. We’re looking into that, whether that can also count as part of the triage consent process. Because we’re conscious especially in remote areas that then needing to get a translator to repeat the consent takes up a lot of time and it just may not be possible. So yeah we’re definitely looking into that one as well.

All right. Next one I guess is a bit more of a comment.

Q:        With increasing phone scams some people are unwilling to give personal information over the phone. What rights do people have if they want an assessment but don’t want to give personal information to a stranger with no identification over the phone?

That’s definitely one we’re going to have to get some policy advice on. At the moment if they explicitly decline triage I think then that they can’t go any further. But yeah we’ll definitely get some advice on that one.

Next one.

Q:        We receive a lot of referrals and cannot allocate an assessor for several weeks. Can the assignment of an assessor be delayed after triage? We have a huge waitlist.

So maybe this is the unassigned.

James Robertson:

Yeah. So the answer to this question is yes. The current arrangements to unassigned continue post 1 July.

Kathryn Foley:

All right. Next one.

Q:        Have concerns regarding incorrect information on pre-population. I’ve seen this many times, no allergies, no falls, where there have been major allergies and multiple falls.

And there was some agreement there from some people online. I guess yes we do realise there are some issues with pre-population from screening and from other documents but in the most part we think that that information is being recorded as accurately as possible. Our colleagues in the screening service do an excellent job in trying to get the information from people over the phone and put it into the screening. So we know there’s problems with it. It can be edited. I guess what we’re saying is that if you can use it as a starting place and then edit it as you go on with your discussion with the person you’re just going to improve that information that’s on the record. And to note we are doing training with the Call Centre and our ACSO colleagues as well as yourselves. So we are disseminating information across the board on IAT to try and improve the process for everybody.

All right. Next question.

Q:        Can we unassign the accepted referral after the triage has been completed?

Yes. So I think we covered that before. 

James Robertson:

Yeah. And if that relates to the triage person having the triage list displaying all together, just to flag that they are categorised so you will only see – well you can choose to view just the pending triage, then you can separately view the accepted referrals that you’re actioning and then also the referral history as well. So I think that with this question I think the point was that they were trying to understand if they can not view the ones that they’ve already completed. So that’s the case. Yep. 

Kathryn Foley:

Excellent. All right. Next one.

Q:        Can you confirm what information will be captured by MAC and to what extent they will be screening clients when clients register and before the assessment agency receives the referral?

So MAC will continue to do the screening and they will be using the - - -

Carla Scalia:

The screening form. There’s no changes to screening process. The questions will remain the same. The process will remain the same. The only difference is – it’s the same as what you do now. The only difference is that you’ll have the option to pre-populate the information that they capture into the triage form if you so wish.

Kathryn Foley:

Okay. Next question.

Q:        If you choose to pre-populate are you able to edit?

Yes indeed. You can definitely edit. Next question.

Q:        Can inpatient assessors self-refer in the app without having team leader status?

I think that’s a no.

James Robertson:

Our understanding is there’s no change to what assessors can do with the app. Just noting here if you were doing a self-referral you do get yourself into that situation that Carla flagged before about needing to complete triage questions then having a team leader approve it once the assessment’s completed as well. So ideally if it works for your organisation an inpatient assessor would have that team leader role so they can do the assessment nice and smoothly with the client.

Kathryn Foley:

All right. Next question.

Q:        If an assessor triggers a re-assessment, a support plan review will triage be required and by whom?

James Robertson:

Answer’s yes. And it will be required through a new assessment referral. So it needs to be completed by the person that’s completing that new assessment referral and the triage process happens afterwards.

Kathryn Foley:

Okay. Next question.

Q:        Can the triage process be completed and then another staff member assigned to an assessor who has the team leader role? 

And I think yes that’s the case. After triage it can be assigned to another team leader. It can be assigned to unassigned. So definitely allows you to move them around to different staff.

Next question.

Q:        What is the KPI on triage, ie percentage of clients triaged within two weeks?

So there is no change to the KPIs. KPIs are the same as what they are currently. So there is no specific KPI for triage.

Next question.

Q:        Can triage referrals be allocated to an assessor at a later date or do these have to be assigned at time of triage? 

James Robertson:

So I think that’s answered with the earlier comment about assigned to unassigned. That arrangement continues.

Kathryn Foley:

Okay. Next question.

Q:        How many team leaders can an organisation have?

I don’t think there’s any cap. I think they can have as many as they choose to have. So I don’t think there’s any limit on how many team leaders you can have.

Next question.

Q:        Will the MAC Contact Centre be seeking consent from a client prior to referral being issued?

Carla Scalia:

They do that now. Yep. The client will go through a consent process with the Contact Centre. In fact they can’t do anything without that consent first. So yes. That will still remain in place.

Kathryn Foley:

So just to clarify there will be consent at the MAC Contact Centre. There will be consent for triage. And then there’ll be consent for assessment.

Carla Scalia:

Correct.

Kathryn Foley:

Okay. So I think we’ve got two more questions left in this section and then we will continue on.

Q:        Self-referrals tend to have minimal information included. Will this change with more information from screening?

I think it will just continue on as the same.

Carla Scalia:

Well if it’s a self-referred assessment there’s nothing to pre-populate from screening because you’re creating the referral yourself. So the good news is that you’ll be able to fill that triage form with lots of information and pre-populate into the IAT.

Kathryn Foley:

Okay. The question about triage outcomes.

Q:        There is an option that states care approval meets needs. In what circumstances does this get used?

So that was an earlier question as well. I think we’re probably going to have to take that one on notice to give you some more detailed information, because we probably need to give you some detailed information on that one. 

James Robertson:

So on notice but what may assist with the answer to that question is don’t forget you can answer the assessment referral before or after the triage. So I think what that question relates to – and again we’ll take it on notice – is when you typically take an action when you receive the assessment referral. So that may still be appropriate but let us take that on notice. I think that’s what it’s saying. 

Kathryn Foley:

Okay. All right. And last question for this section.

Q:        Does the current team leader access automatically migrate with the new IAT?

Yes. If you’ve got team leader now you will continue to have team leader in IAT.

All right. We’ll pause on the questions now and get back to the presentation. 

James Robertson:

Okay. Back to me. So we’ve spent a fair bit of time covering the triage process but you’re all probably wondering what the triage questions are. So let’s go through those for the next part of today’s session. So in the system – you can see that I’ve got the triage questions structured on the slide. Don’t worry. We’ll go through each individually so if it is hard to read that’s okay. We’ll be able to look at it a bit closer later on. But in the system triage questions will be presented as one list rather than broken up into these categories. So we’ve broken them up into these categories to make sense of the structure of the triage questions for training purposes and also to help give you an indication about some of those pre-population arrangements and what question fits where etcetera.

So I won’t read out these questions word for word on this slide now but I’ll just flag the categories that the triage questions sit within. So first of all there’s a triage screen details. This is the upfront information about triage. Then there’s the reason for assessment, current access to services function. This covers some key function areas but not the whole list that’s included as part of the assessment and not to the same extent as they’re covered in the assessment. General health, general wellbeing and safety and then finally advice for assessment. So that last category is not part of the triage conversation that you have with the client or their support person. It’s the outcomes of that conversation and what the recommendations are.

I’m just keen to show everyone what the triage questions look like in the Assessor Portal. We just have an Assessor Portal screenshot here but it will have a similar structure in the app as well. It will essentially look like a section of the IAT, so a domain of the NSAF using current language. So all of the arrangements that are in place currently for completing questions on the Assessor Portal will remain. So for example some of the indicators that you can see on the screen. The green colouring when a question is completed, that will continue. The red asterisk to flag a question if it’s mandatory, that continues as well. The little ‘i’ box for help text. So when you hover over that little ‘i’ box you’ll be able to get some more information about what the question’s asking. That also continues. Same as the save functions and the ability to clear page information as well. So there’s a new set of questions but all the functionality on the Assessor Portal remains the same.

Just while we’re talking about the save function as well it is a long list of questions. Highly recommend – I know there’s autosave arrangements but just like a Word document if you keep bumping that save button you can take away that risk of losing any information if there’s any hiccups or system outages etcetera.

[Visual of slide with text saying ‘Response guidance for triage questions’]

So let’s go into the response guidance for each of the triage questions, so what team leaders should be considering. This is all available in the IAT user guide. So we’ve picked out the key guidance information from the user guide. We’ve also got page references throughout. I’m jumping ahead here but at that top right hand corner you’ll see a page reference there. That’s where to go if you need some more information, so some additional guidance.

So to keep to time we will go through these questions fairly quickly. I think there’s about 25 or so questions in total. So we’ll go through fairly quickly. We’ve got another clarification slide after the questions as well. So keep dropping in your questions about the questions in the chat box and we’ll cover those at the end. We’ve flagged some of the resources earlier. Carla mentioned the pre‑population one as well. Have a look at that. That will let you know what to expect to come through from screening if that’s been completed by the Contact Centre. Because some of those triage questions will be pre-populated where appropriate. 

In regards to the structure of the guidance slides that we have I’ll just quickly cover those now. So on the left hand side those categories that I mentioned before, that’s where they’re listed. The category in red is the focus on what the slide relates to. Then we’ve got the list of questions in that category in the second column on the right hand side. The red text is the question that’s been covered. And then on the right hand side of the slide response options. So if it’s multiple choice we’ll list all the options available. If it’s free text we’ll flag that there as well. And then key guidance. As I said this is just picking up some key information from the user guide. Fairly high level so please go have a look at that user guide for more information.

Before I get into the first question did also want to flag that the overall purpose of triage is to get through these questions fairly quick and at a high level understanding. So it’s not going into the same level of detail that you would in an assessment. It’s going through the questions fairly quickly. We have been advised that the estimate to complete triage questions is around 20 minutes. Obviously that’s going to vary client to client. And as team leaders or triage people are getting used to the new questions it might be a little bit slower to start with, but the intention is it will take about 20 minutes.

So let’s jump into the questions. We’ll start with triage details. Date of triage. This is a calendar response where you select the date from a calendar. This is the date that these questions were completed with the client or their support person.

Then we get into the next question which is registration screen information collected from. So who is the information being collected from for triage. This also includes if you’re getting any additional information to supplement the triage conversation so please indicate here, similar to what you do currently with the assessment.

Third question is if the client is an admitted inpatient, a hospital patient. So yes/no. We did get a question here about if it’s yes and the triage is being undertaken by a RAS organisation what do you do at this point? The answer is you still complete triage and then you consider if a comprehensive assessment is required as part of the advice for assessment at the end.

The last question in the triage details category is a notes box. So anything relevant from the previous questions.

Then we go into the reason for assessment category. The first question here is the key circumstance triggering contact. You’ve got a list of options to choose from. If the key circumstance doesn’t relate to any of those options you’ve got an ‘other’ box at the bottom where you can add free text. Just noting here this is the key circumstance. There may be multiple circumstances. So please pick the primary circumstance. And then the follow up question is a comments box. This is where you can add a bit more information or for question four comments about circumstance. So there’s a couple of free text boxes in this category where you can add some of that additional detail.

That second question comments about trigger, so any information that you can provide about the trigger for contact to My Aged Care and the reasons behind the assessment being undertaken.

Third question is how long has the client experienced this circumstance? So if it’s a recent acute illness or event, if it’s been a gradual increase in needs over time, if it relates to a long term disability, and again you’ve got your ‘other’ free text box as well.

And we covered this one at the start.

Current access to services. So this is the third category in triage. First question relates to if the client is currently receiving aged care services. So as mentioned before reassessments will have triage included. So there may be circumstances where clients are already receiving services and being reassessed for needs. Just to flag here please make sure you’re looking at the definition of an aged care service when answering this question. That’s a service aimed at older people. It’s not services aimed at the general population. So supermarket delivery services, it’s probably not a great example, but it’s an example that’s population wide and not targeted towards older people. So the options here are yes, no and not sure.

The follow up question is the type of aged care services currently being accessed by the client. So here is where you can provide some more information on the response to question one or anything else that’s relevant. So for example if they’ve recently received services and that’s stopped or something like that, you can flag that here as well.

I did skip ahead on a point I wanted to make on aged care services as well. Unpaid carer. That’s not an aged care service as well. So if they’ve got a family member providing support full time at home that lives with the client that’s not an example of an aged care service.

Now into the function category. So there are ten functional areas that are looked at as part of the triage questions. These are all covered in the assessment questions as well but they go into additional detail in the assessment questions and there are also additional functional areas that are covered in the assessment questions as well. All of the function questions ask for the client’s perception of what they’re able to do. So this is what we’re basing the responses off. Please also consider cognitive as well as physical reasons as well.

So I’ll go through the ten questions now fairly quickly. All of them have the same response options. Yes and no is fairly straightforward. We do have some examples of somewhat in the user guide. We suspect this might be pretty useful trying to understand when yes becomes a somewhat or when no becomes a somewhat. So have a look at those. They’re not exhaustive lists. So for example a client’s ability to undertake housework, we haven’t got an itemised list of everything that housework can be counted as and when that differs from light housework to heavy housework, so please use them as examples. But don’t be too fixed into what’s the difference between somewhat and yes if it fits outside those examples. Please just go with your instincts.

So we’ve got walking. So an example of somewhat here might be if the client uses a walking stick but it’s not meeting their needs or the client’s at risk of falling.

Taking a bath or a shower. So this might be if the client has any nerves or hesitations or just needs assistance from time to time to be taking a bath or a shower or if they’ve got aids or equipment to assist.

Transferring. So this relates to their ability to maintain or change body position, carry, move or manipulate objects or get in and out of chairs. In regards to a somewhat response for this question this might be if they’re able to do certain tasks but they require verbal or physical prompting, they need assistance or they use an aid to assist.

Dressing. So their ability to put on clothes. So the example for somewhat here is if they need assistance or prompting or they can only do so with some items or they use an aid or equipment to assist.

Next question is getting to places out of walking distance. So yes, no, somewhat. Again the same responses. So a somewhat response might be here if they require informal or formal assistance from a person, if they have a restricted driver’s licence and are unable to attend some appointments outside those restrictions. So just a couple of examples there.

Housework. Did just want to flag here that as part of the new IAT housework questions in the assessment questions are being split between light housework and moderate and heavy housework. So the triage question on housework relates to light housework tasks only. That’s because that will then pre-populate through to the light housework task function questions in the assessment. So please consider those light tasks when answering this question. Some examples are dusting, dishwashing, washing clothes, but it doesn’t include those big tasks like moving a fridge around or rearranging furniture etcetera.

Shopping. This relates to their ability to go shop for groceries or clothes, assuming that they’re able to get to the shops. In regards to the somewhat response here this would be if they need assistance in certain circumstances or they need assistance with certain tasks that relate to shopping or if they are able to understand what to shop for but they need to provide that list to someone else to then go out and get those items.

Driving or public transport. Now this question is very similar to three questions earlier, getting to places out of walking distance, so I suspect the response will be quite similar. So this is just confirming if they’re able to drive or take public transport. And the somewhat response here might be if they are only comfortable doing it at certain times of day or certain types of public transport.

Preparing meals. So this relates to their ability to prepare meals, help with meal preparation and manage nutrition. The somewhat response here would be they’re able to do certain things but are not able to cook full meals themselves or consistently. So for example if they can prepare sandwiches but not hot meals or if they’re able to heat pre-prepared meals but not prepare them from scratch.

Into the last functional area covered is toileting. So their ability to go to the toilet, wipe and redress. The yes, no, somewhat responses also apply for this one here. Somewhat would be if they need aids or are not consistent with their ability to toilet. So we do have some further examples of the somewhat in the IAT user guide as well.

So that’s a fair few functional areas to get through as part of the triage questions. Please don’t forget like the other categories you’ve got a notes section at the end. So any context or background or anything relevant that the assessor receiving the assessment referral might need to know please feel free to include that here as well.

Then we get into our general health questions. So three more categories to go. The first question here is has the client experienced any health issues affecting activities over the last four weeks? So in regards to the response options to this question they’re listed on the screen. I’ll just read out the definitions because the difference between slightly and moderately might trip a few people up. So slightly, the definition here is if it’s a change to one or two of the client’s normal activities over that timeframe but this is managed by doing things slightly differently, so they’re able to make do with those activities. Moderately is if there’s a change to some of the client’s normal activities. So we’re looking at an impact on an increased number of activities and that also includes an inability to complete some of those activities. So they’re just not able to do it at all. And then not at all and a great deal is fairly self-explanatory there.

The next question relates to recent falls or near miss falls in the last four weeks. So yes, no, unsure is your response options. Suggest here for any near miss falls or any nuance relating to this answer use the notes question at the end because a yes can mean very different things so any context that you can add is useful.

Same again for pain impacting day to day activities. It’s a yes, no, unsure question. So any context is probably useful to add to that general health notes at the end.

Then we have the weight loss or nutritional concerns question. A couple of things to note here. When we talk about weight loss throughout the IAT, so for triage but then also the assessment questions as well, this is weight loss without trying. So if they are losing weight intentionally the answer would be no because it is weight loss by trying. And then nutritional concerns, just in regards to what a definition means for nutritional concerns, this is poor appetite or poor dietary intake for a period of more than two weeks. So we’re looking at sustained poor dietary intake and poor appetite rather than an impact over a shorter timeframe.

And that general notes section at the end to add any comments as well. So I flagged a couple of those points earlier about things where you can add a bit of extra detail or context in this notes field.

Then we get into the last set of questions that will be covered as part of the triage questions before you get to the advice for assessment. The first one is if the client is feeling lonely, down or socially isolated. With this question please look at it from the client’s perspective. So it’s not an assessment of their social life. It’s about how they feel. In regards to the response options it’s not a simple yes/no question. So to read out those middle options outside of no and most of the time and not sure, occasionally is if they’re content with their social situation but only feel lonely or down occasionally. Sometimes is if they’re not content with their social situation and sometimes feel lonely or down. So it’s an increased frequency of feeling lonely or down and how they’re feeling about their social situation. No not at all, most of the time is fairly straightforward to answer. For the not sure this is similar to the other triage questions. This is if you’re not able to get the answer because you’re hearing conflicting information or the client is genuinely not sure.

The next question is if the client experiences memory loss or confusion. So again using those same definitions and the same response options for frequency. This could include short term or long term memory loss so please consider it from a number of different perspectives.

Third question in general wellbeing and safety is if the client thinks they have risks, hazards or safety concerns in their home. So this goes back to the yes, no, unsure response options. In regards to what’s being covered here in this question, so it’s the physical risks and hazards, so tripping hazards, clutter or hoarding, those sorts of physical examples, but also any personal safety issues as well, so family violence or abuse. That should be considered as part of this question. 

And then finally there’s the notes section. So any context or information you’d like to share on those previous three questions can be included here.

We have also had questions raised about if there’s a lot of information being included in the free text response, what to do in those circumstances. Please don’t forget the client record has got the ability to upload attachments. So if you have anything additional to flag that’s not covered in the free text response please also look at the client record and their attachments.

Now that’s the end of the questions that are covered with a client or their support person. To finish up the triage questions the triage person needs to answer these five questions. The first one relates to the type of assessor recommended for assessment. So this is using our new language that Kathryn covered earlier. So if we believe that a comprehensive assessment is required with an ACAT organisation clinical would be selected here. If you believe that a home support assessment with a RAS organisation is required then non-clinical is selected. The other option would be for example if you’ve determined from triage that they no longer wish to have an assessment conducted.

We did have a question in a lot of our face to face sessions about what to do here if you’re selecting the other assessor type. Please revert to your current practices if you are completing the assessment before undertaking an assessment referral for a comprehensive assessment for RAS organisations. We know that happens currently when there’s long waitlists for comprehensive assessments and the assessor takes the view that a home support assessment is better in the meantime than having no support or no assessment until they’re able to have that comprehensive assessment. So nothing changes there.

Priority of assessment. So this is based on the responses to the triage questions, if you believe the priority of assessment is high, medium or low. Please note this does nothing to the assessment referral and the assessment priority set beforehand. So you’re answering the question here but you will need to action elsewhere if you do need to change that assessment priority. Same again for the assessor recommended.

The third question is if the client requires an urgent assessment. There’s some definitions to go through here. And again this does nothing in the back end so you’ll need to action accordingly as well.

The fourth question covers any linking supports that may be suggested for the assessment. So here’s some notes that you would include for the assessor to consider as part of that assessment on linking supports. And then finally the other triage notes. So anything else not captured elsewhere that you want to flag, please include it here, or anything on those previous four questions as well.

Okay. So as I said that’s a lot to go through and it’s probably going in one ear out the other, but hopefully these slides are handy to go through in your own time as well to get a bit more of a feel for the triage questions. As I said at the start the advice we’ve received is it should take about 20 minutes to go through these questions. So now that we’ve gone through them it probably emphasises that point that I made that you do need to move through quite quickly to be able to cover it within that timeframe.

[Visual of slide with text saying ‘Clarifications’]

Okay. Over to Kathryn for clarifications. I can see a few pop up.

Kathryn Foley:

Let’s start working through these questions. Okay.

James Robertson:

And Paul I just saw a five minute break question. We’ve got a break after these clarifications so definitely well timed your comment.

Kathryn Foley:

Absolutely. Yep. So we’ve got a couple of comments up the front so we might work through those first. One person says:

Q:        Clients are expected to share information for screening SPR, triage and again at assessment.

I think that’s where we keep referring back to our wonderful pre-population, in that what we’re trying to do is build the information through the form rather than having to ask the client the same question over and over again. So that’s what we’re trying to do here. Hopefully the information collected at screening will then build and more information will be collected at triage and then it will populate through to the assessment so that the information will all be there and so that the questions won’t have to be asked again and again. But we do recognise your comments there that there’s a lot of – you’re raising some relevant concerns and we will pass those back to policy.

Next one is:

Q:        Has the role of Contact Centre staff changed?

No it hasn’t. No. Contact Centre still do the same role.

All right. Next one.

Q:        The triage process is very dependent on a client being able to converse and answer questions on the phone. Many clients have auditory or comprehensive attention difficulties and do not have a representative. How will the process of triage will be more accessible to clients who fall within those groups? The process relies on clients being able to hear and understand information.

That is all very good comments and someone else has also added in about the same concerns for clients with non-English speaking backgrounds. So definitely all reasonable and relevant concerns and we can certainly pass those back to policy.

All right. This is a new one.

Q:        Does triage look the same for younger people or will information be completed by MAC prior to referral being inputted and pre-populated? 

So we’ll certainly take that on notice but I would say if that younger person is actually accepted as needing an aged care assessment then they will go through all the assessment steps. But we’ll definitely take that one on notice and get more information on that one. Great question. Okay.

Q:        What happens if a client has referral codes but no services available and services cease but no end date in portal? Does this pre-populate into the triage tool?

James Robertson:

Nothing on the – I think this relates to the question about aged care services that they currently receive or have previously received. Unfortunately nothing pre-populates there. It might be an enhancement that is considered in the future. It makes a lot of sense. But none of the triage questions are pulling information from elsewhere in the client record about their services or that other information or is it pushing information to action referrals in a certain way.

Kathryn Foley:

Okay. All right. Next question.

Q:         Is there a specific reason why triage cannot be conducted at the same time as client screening process? Currently MAC determines what priority they send referrals to RAS and ACAT.

So this is one of the stages that is setting us up for the single assessment workforce. This is one of the instances that we described where it’s lumpy, where this is the step preparing us for when we have single assessment workforce and each organisation will do more of that assessment when they receive the referral and then determine who to send out. So we agree there is screening and then we move to triage but it’s setting us up for the future. So that’s where we need to learn this process now.

Next question.

Q:        In the event of cognitive impairment or issues impacting on the client’s ability to answer questions is an assessment able to proceed if mandatory triage questions are unable to be answered with consent provided of course?

Carla Scalia:

No. I would imagine the assessment wouldn’t even be able to proceed now if the client is unable to do that. So it would be the same with triage. The client consent is pivotal to being able to move forward so if that’s unable to be obtained you’d record that in the system and action things as you would now.

James Robertson:

I imagine a client in that situation would probably need an authorised representative to support them throughout the whole process. So please don’t forget that the triage questions can be completed with an authorised representative and they can provide consent to complete it, or a support person if the client’s provided consent with that support person. So that might be the way that that circumstance is managed.

Kathryn Foley:

All right. Next question.

Q:        So health issues are only those that affect activity within the past four weeks. No need for a more in-depth summary of health or medical issues anymore?

So this is where it comes back to where we were talking about this is a brief assessment at the start in setting you up to do your further detailed assessment. So this is just about trying to address the questions in a rapid process so you can get to the result and then move on to the comprehensive assessment.

Next one.

Q:        IAT user guide seems to be missing prompts for driver transport following question.

James Robertson:

Good pick up. So that has actually been incorporated as part of the update that’s been or being released.

Kathryn Foley:

Will be released. Yep.

James Robertson:

So that was an additional triage question that we discovered on Friday. So rest assured that will be there.

Kathryn Foley:

All right. And then I guess the next one is a similar comment to what we’ve had before.

Q:         Triage is going to take longer than current RAS processes which will affect workloads. Regardless of being able to triage within the two weeks triage is assessment focused and will add to our time of scheduling of clients. Surely this is part of screening that could be carried out by MAC Call Centre?

Yep. We take all those comments on board and we’ll pass them on. As I said it is about setting us up for the future of the single assessment workforce. So we do recognise that it is going to be lumpy at this time. Okay.

Q:         Please clarify for me. A client calls requesting a review. They need to be triaged, then a review, then the review will trigger a new assessment for them, they have another triage, then the booking team, then a new assessment?

James Robertson:

So that’s not quite the steps. So they wouldn’t need to be triaged based on the support plan review. So that’s one less step in the six that are specified there. But the rest of it is correct. So if the review triggers a new assessment then triage will need to occur. Don’t forget pre-population because that previous assessment might have all the triage questions answered and it might only need a couple of validations rather than the full conversation. And then the rest seems accurate as well. That would then proceed through to the assessment. 

Kathryn Foley:

Okay. Thank you. All right. Next one.

Q:         Is there any guidance on which type of assessment is recommended or is it just the triage team leader judgment based on the assessment?

James Robertson:

We can’t provide guidance on thresholds for questions and what triggers comprehensive or home support. A lot of it’s based on the conversations. So I agree. The triage team leader judgment is required. I suspect that will be very similar to what happens currently when managing an assessment referral and getting an idea if it’s been referred to the wrong assessment organisation. So perhaps that’s worth encouraging to learners in the training that do what you do currently with assessment referrals if it’s incorrect.

Kathryn Foley:

And I think we do have some guidance in the triage element that talks about who should be doing triage and the supports that they need as well. So I think that’s worth looking at the online training there as well. All right. Next one.

So next one’s I guess more of a comment I think.

Q:         Asking people about their health, falls and impact on activities raises strong feelings for people. It’s unrealistic to allow 20 minutes to race through the questions. Many people have complex situations and living in difficult circumstances.

Yes we agree. Yes it is challenging to be doing these assessments, but it is the first part in the step of the process. We keep coming back to it but it is about the pre-population, about trying to build on understanding the person’s circumstances so that when you do get to the assessment process you’ve already got a good understanding of where they’re up to and you can more efficiently assess them and get them the services that they need. So understand this is part of where we’re moving to as part of this reform to get to a more efficient and effective process. So yeah. Take that comment on board.

And then I think a similar one next.

Q:         Information collected at triage screening and then assessment can change especially if there’s months of wait time between an assessment.

Agree. Yes. We do know that there’s long waitlists and there can be changes in time. I guess that’s why we’re saying pre-populate but then also edit. We do expect you to have some of that conversation, pick up on the queues that you’re getting from the client. You all have exceptional skills in being able to distil the information from the clients and their families and be able to use that to support what you’re putting in the assessment. So yeah. We’ll take that comment on board. All right.

Q:         What happens if a client is triaged as non-clinical and when a non-clinical assessor attends the client and the client’s needs are high requiring clinical assessment? Quite often clients and their families exaggerate the needs to get an assessment.

Again this is part of the usual practice that we know that you’re seeing out there. So it will continue on the way that you are doing it at the moment. The IAT is the new tool to get the information but we do realise that this happens and you will have to refer on. I think as James said we know that sometimes you’re faced with a person with very genuine high needs but you know that the waiting lists are long so you refer them to a home support assessment in the interim for them to get some services while they wait. And we’re certainly passing these comments on to policy to talk further about how the system responds. So thank you for that.

All right.

A comment there.

Q:         I can see how the triage will be a positive process to the client being referred for assessment. Will also give the assessor a clear understanding of the assessment.

Thank you for that comment. Next one.

Q:         Are all triage questions compulsory? I’ve noticed that some MAC screening are more thorough than others. Can some triage questions be skipped if the client seems to be getting tired of the process?

James Robertson:

So as a general rule the multiple choice questions in triage are mandatory to complete and then the notes questions are optional. Please feel free to tailor or tweak the wording or answer it based on a conversation rather than going through each question word for word. That might assist. I suspect it would be very similar to what happens currently if you’re undertaking an assessment and the client gets tired and you’re not able to complete that process. It might need to be picked up again or you can use the information that you’ve gathered to answer the questions. So I suspect they’ll be quite similar to what happens currently with assessments.

Kathryn Foley:

Great. All right. I’m conscious of time. I think we’ve got about six questions currently on the list so we’ll try and push through those and then see if we can give everybody a break to stand up and move around a bit. Okay.

Q:         Can a client demand a comprehensive assessment regardless of their triage outcome?

Yes. That would be the same as what’s happening now. So yes. They can definitely request that.

Q:         Will Contact Centre advise family to complete authorised representative status so we are able to complete triage?

Carla Scalia:

That’s client dependent but they do set that up currently but it does come down to the client’s situation. It’s not something that the Contact Centre can dictate for a client. It needs to come through a consent process. 

Kathryn Foley:

And then a similar linked one.

Q:         Can representatives answer triage on a client’s behalf without consent from the client first?

Carla Scalia:

It has to be an authorised representative. Yep.

Kathryn Foley:

Okay. 

Q:         From 1st July will all current clients on our waitlist need to be re-triaged, incoming and accepted referrals?

So as we went through at the start when I was going through some of the transition arrangements if the assessment’s in train then it can be finished in NSAF. But if it hasn’t started yet through those different stages that I outlined I think around slide 18 or 20 then it does need to be completed in IAT. There’s some pretty – well we do advise that in the lead up to transition if you want to commence a number of your existing assessments in NSAF and park them then they do not need to be re-triaged, that you can complete them in NSAF. But we realise that for some people with enormous waiting lists that this is only going to be a stopgap so there will be a percentage of referrals that you have on your books that will need to be re-triaged after 1 July. And that’s unfortunate but that’s how the system is. But please refer back to those earlier slides that will give you some guidance on the transition processes. Okay.

Q:         A client wanting an ACAT clinical assessment may not warrant one enough for the RAS to refer onto ACAT?

Yes. So we answered that previously. So that sort of aligns with the person demanding a clinical assessment.

Q:         Often Call Centre will be issued an emergency service for clients. When calling the client for assessment they mention this service in place already and decline assessment. Can client decline assessment with services in place?

So I think that’s in line with your normal arrangements. That won’t change with the IAT. It’s what you would do with that client in your usual situation.

And then finally.

Q:         Is the client advised at triage of the decision of whether they’ll be receiving a complex or a simple assessment?

James Robertson:

It would be more the case that they’d be advised if they need to go to another assessment organisation to have a different assessment type. I think that’s where it would be more relevant, where the client’s advised about a change to their pathway and needing to go down a different route.

Kathryn Foley:

All right. I can see we’ve just got some final questions coming in there so we might just address those and then we will draw the line on this section.

Q:         What happens if a client dies while a triage is pending given their questions are mandatory and the client may not have a rep? Do all questions need to be answered before the referral is rejected?

James Robertson:

No. You can cancel the triage. That’s an example of why you would cancel a triage.

Kathryn Foley:

And then:

Q:         To confirm an authorised rep can assist with triage, not regular rep or support person?

Yes. Only an authorised rep. So I think we might call it - - -

Carla Scalia:

Sorry. Just to interject, they can support with assessment but they can’t provide consent on behalf of the client. So they can certainly assist in the process but there’s certainly some stopgaps when it comes to getting consent. Support people and regular reps can’t provide consent on behalf of a client.

Kathryn Foley:

And we can see that there’s lots of questions about consent so that’s certainly something that we’ll pass on to our policy colleagues to get some advice on. All right. The time is 3:17 here in the ACT. It’s slightly different in other states around the country. 

[Visual of slide with text saying ‘Quick break’]

Okay. Thanks very much everybody. Welcome back. We’ll continue on. Carla’s going to pick up the baton. Just to note though we are going to take a few more of the questions on notice and probably hold them over until tomorrow. We’re conscious of time so we want to make sure we get through all the content for you. So we’ll just try and keep the question sessions a little bit shorter than what I have been. All right. I’m just looking at the technology here and make sure we can get that working.

Carla Scalia:

[Visual of slide with text saying ‘IAT assessment walkthrough’]

There we go. Okay. All right. Sorry guys. Okay. So back from the break. I hope you’ve made yourself a cuppa and had a comfort stop. We’re going to go through the IAT now.

With this next session James and I are going to tic tac again through the content. We’re going to be giving you an overview of the IAT. We’re going to be showing you a video about the differences between the NSAF and the IAT. We’re going to go over some validated tools. We’re going to talk pre-population. We’re going to unpack threshold questions and additional questions, outline some resources to assist and go through some of those question topics of each section with the guidance on responding to those questions, focusing on new questions that are within the IAT, not those that are currently visible in the NSAF and that will be also visible once again in the IAT moving forward, support plan development, and then we’re going to talk about initial assessment versus reassessment.

So as you are all aware the IAT will be replacing the NSAF and will be the new assessment tool for older Australians who are seeking access to Government subsidised aged care services. There are a number of sections within the IAT. Fourteen listed here. So no more domains. They’re known as sections. So you’re going to have the assessment details, reasons for assessment, carer profile, function. DEMMI modified is a section that will be only visible to ACAT assessors obviously because residential respite care sits under the Act and so we can only be assessed and granted by ACAT assessors. So if you’re a RAS when you jump into the IAT you won’t see the DEMMI modified section. ACATs will. Medical and medications, physical and personal health and frailty, social, cognition, behaviour, psychological, home and personal safety, financial or legal, which is a new section, and support considerations. And then in addition to those sections in the IAT you still will have your support plan in place which outlines your assessment summary, goals and recommendations.

A bit of a screenshot of the IAT for you so that you can get a bit of a sneak peek at what it looks like. Very similar to as James pointed out the triage form. So what you’re looking at is the assessment details page within the IAT. When you enter the IAT for the first time you’re always going to land on this page. So it’s important to note that. As you’ll see you’ve got your navigation on the left hand side with all of your sections. You’ll be able to jump around those sections as you need. You can start your assessment anywhere you like, end your assessment anywhere you like based on the nature of the conversation you’re having with the older person. There is a tab which you will see above assessment details which is your triage tab. As mentioned before all of the information captured in triage will be moved over to that tab in a read only format. If you choose to pre-populate from triage into the IAT the relevant information will feed into the relevant sections of the IAT. So you can either see it all in read only, you’ll also be able to see it in sections if you’ve chosen the pre-population option.

You’ve got those help options as James talked about before, the little ‘i’ icon to give you information if you hover your mouse over. You’ve got red asterisk there for mandatory questions. You’ve got the colour indicators, green meaning that you’ve answered the question, red meaning that it’s outstanding. Radio buttons, textbox dropdown boxes. Same sort of functionalities you have within the NSAF. You also have your clear page information button up the top to clear any information on the page that you don’t need anymore and you wish to redevelop. And you’ve got your save assessment button as well which you can see above the navigation menu there.

Again we’ve developed a short video for you to outline some of the differences between IAT and the NSAF.

[START VIDEO PLAYBACK] 

Speaker:

In this video we will provide a summary of the key differences between the National Screening and Assessment Form and Integrated Assessment Tool, otherwise known as the IAT.

One IAT. The IAT consolidates into a single dynamic tool adjusting questions based on various factors such as a client’s First Nations background, previous given answers and whether the assessor is clinical or non-clinical. Unlike the National Screening and Assessment Form that has two different versions for use the IAT will be the same form used by all assessors to identify the needs of older Australians.

Nested questions. The IAT has nested questions that have been designed to tailor the assessment experience only diving deeper into areas where concerns are flagged ensuring a proportionate assessment process. Nested questions will not initially be visible to assessors when entering the IAT but will unfold and display if triggered by the answer given to a base question. Nested questions are used to capture additional information about the client’s need as indicated to questions asked during the assessment process.

Threshold questions. Threshold questions are questions that are presented to both clinical and non-clinical assessors but are the trigger for moving the IAT into comprehensive areas for clinical assessor only completion. Threshold questions allow for a more focused, in-depth exploration of flagged concerns contrasting with NSAF’s more uniform questioning.

New focus areas. The IAT includes topics not covered or not as extensively covered in the NSAF. New topics and areas of questioning relate to financial and legal matters, medical issues, social and behavioural factors, frailty and current supports and services accessed by the client.

Validated assessment tools. The IAT integrates 11 validated tools directly into the assessment process enhancing the depth and clinical relevance of the assessment compared to the NSAF where such tools were treated as supplementary.

[END VIDEO PLAYBACK]

Carla Scalia:

There we go. That is our back up slide in case the video doesn’t work again. But I know that we do get a lot of questions about the threshold questions. We are going to cover them in more detail. So hopefully by the end of this session you’ll have an idea of those questions and what they trigger for ACAT completion.

Moving though onto our validated tools. We’re going to give a high level overview of validated tools noting that we are going to unpack these a little bit more as we move through the session. But basically there will be 11 new validated tools embedded into the IAT. I shouldn’t say they’re all new because as you’ll see on that slide there are a few old faithfuls that still remain. You’ve got your revised urinary incontinence scale and your revised faecal incontinence scale which still sit in the NSAF at the moment. They will be continued to be used in the IAT. You’ll find those within your function section of the IAT. You’ve got the DEMMI modified which is going to be sitting in its own tab by itself as flagged before for ACAT assessor completion.

You do have a few new validated tools within the IAT. You’ve got the Duke Social Support Index which captures components of a client’s social support network. You also have the Good Spirit Good Life which is a quality assessment tool for First Nations clients, which both of those tools will sit within the social section of the IAT. It is important to note as we cover the Good Spirit Good Life – and we’ll unpack it a little bit more – within the validated assessment tools you’ve got four tools that are validated for use for First Nations clients. That’s your Good Spirit Good Life and your three KICA Cog tools. You’ve got your KICA Cog, your KICA Cog regional urban and your KICA carer. It is important to note that within the IAT these tools don’t display by default. They need to be switched on. And the way that you switch them on is through the client demographic area when you’re conducting triage and assessment. You’ll come to that client demographic question where you’re covering off on their details and there’s some radio buttons there that you need to identify if the client identifies or is an Aboriginal or Torres Strait Islander person. If you click that they are that triggers the IAT to display these validated tools for use. And we’ll go over that in a little bit more detail. But they’re not there by default. You do need to switch them on and the demographics will basically trigger these tools for display and for use.

You do have access to the GP Cog noting that the GP Cog has two steps in it. Step 1 is the tool that you complete with the client. Step 2 is the tool that you complete with their support person. You’ll find those within the cognition section of the IAT. You then have your KICA Cog as I mentioned previously which is in the NSAF at the moment, will continue to be used within the IAT. Your KICA Cog regional urban which is a new tool. It’s pretty much the same as the KICA Cog. You’re assessing the same attributes of the client. Just a little bit of a change in language. It’s contextualised for a more I guess formal urban use. You’ve got the KICA Carer. Again that’s a tool that’s used within the NSAF. You’ll continue to use it in the IAT. Those three KICA tools are found within your cognition section of the IAT.

You’ve then got your Patient Health Questionnaire 4 or your PHQ4. That’s a new tool that you’ll find within your psychological section of the IAT. It’s a tool that screens for depression and anxiety. It is important to note that the PHQ4 is a little bit different to the other validated tools. It’s not called out explicitly. The PHQ4 you’ve got four questions within that screening tool. Those four questions are the four questions that are in your psychological section. So when you go into your psychological section of the IAT the four questions you ask the client are those four questions within the PHQ4. The reason why we’ve called them out as a validated tool is because there’s a scoring mechanism behind those four questions. We’ll unpack them as we move through today’s webinar but basically the inputs to the answers will trigger further questions for ACAT assessors. So that’s why we’ve got that flagged as a validated tool.

And last but not least is your geriatric depression scale which is found within the psychological section of the IAT. It is important to note that not all of these tools will be visible to all assessors. Some of these tools are triggered by threshold questions and will only be validated for use for ACATs. Big difference to flag though is that your KICA Cog tools at the moment within the NSAF are available for use for ACATs. Moving forward into the IAT RAS assessors will be able to use those KICA Cog tools moving forward with the IAT. Quick question about carer stress. No. Unfortunately not. That carer tool is not included in the IAT. The tools that are on your screen which I believe were the same tools used in the trial are the ones that will remain moving forward into the version of the IAT going live on the 1st of July.

Moving over to James.

James Robertson:

Okay. Speaking of the trial the concept of threshold and additional questions is a big change. So during the trial you were presented the one IAT with all the questions that were displaying for all assessors regardless of if they’re from a RAS or an ACAT organisation. Those arrangements will change with the introduction of the threshold and additional questions that Kathryn covered at the start.

So as mentioned there are base questions that will be covered for everyone. Those base questions can also trigger nested questions where additional details are asked wherever appropriate. Again that applies for everyone as well. But when we get into the question types for clinical assessors the threshold questions will be what triggers those additional questions. So as Carla mentioned some of those validated tools are examples of additional questions. There’s also what’s called extended or advanced assessments. They’re other examples of additional questions where it’s asking for a bit more of a deep dive into topics where it’s been flagged as part of the threshold.

Now those additional questions, they aren’t strictly for clinical purposes only. So we do know some RAS assessors have clinical experience and what not and might be asking ‘Why aren’t I getting those questions displayed?’ They’re being triggered because they relate to comprehensive assessment considerations. So what we’ve flagged on the slide there is it’s clinical comprehensive considerations. It relates to the fact that it’s a comprehensive assessment and not based on the assessor’s skills and qualifications.

In regards to what RAS assessors will see, so the threshold questions will look the same to them as the base questions. So there will be no indicator to say that it’s a threshold question, no triggers prompting other questions if they’re above the threshold. So that’s why we think it’s very important as part of the training that you deliver to learners to flag what these threshold questions are because it may be helpful information to consider if a comprehensive assessment is needed as you’re going through that home support assessment and also it relates to some of the future changes that will be included in later stages of the single assessment reform where those questions will begin being opened up for non-clinical assessors when that concept of clinical oversight is introduced.

That’s everything I want to flag on this slide which expands on what Kathryn covered earlier. This slide here really just emphasises the point that the threshold questions look exactly the same as the other questions to both RAS and ACAT assessors. For the ACAT assessors you would answer in this example no to the urinary incontinence issues. You will then see new questions appear on the screen. And for RAS assessors even if you click no it will take you to the next topic rather than going into it further.

Now let’s go through the threshold questions. There’s ten in total from memory. What I’ll flag here is what’s being prompted once you hit the threshold and what that threshold is. We’ll also cover most of these questions in a bit more detail when we start going through the response guidance for questions in the IAT that weren’t previously in the NSAF.

So in the function section there’s two questions that are threshold questions. Urinary incontinence issues which is a nested question that relates to toileting, if there’s any bladder concerns. So it is a nested question that then prompts a threshold question to consider if further additional questions are needed. So if you were to flag that they’re incontinent or that there is issues involved in the response to the first question you will then be asked if the client’s managing that issue. If they’re managing it then no further questions necessary. If they are not then that’s what prompts the validated tool and the Revised Urinary Incontinence Scale. Those same arrangements apply for bowel incontinence issues and the validated tool on the Revised Faecal Incontinence Scale will be prompted instead.

Then we’ve got the medical and medications section. So you might recall this question from the triage questions. So this is one that’s answered in triage then it comes through to the assessment questions. If moderately and quite a bit is selected for the question on if there are impacts on health issues outside of normal activities during the past four weeks this is what prompts the advanced medical assessment for the ACAT assessors. The advanced assessments or extended assessments, they go into a number of different topics to try and understand that level of impact. So once we get through these threshold questions I’ll show you what the topics are for those advanced or extended assessment questions.

Into cognition. There’s two questions here that are threshold questions. The first one is the whole of the GP Cog Step 1 validated tool. So if incorrect is answered to any of the questions in the Step 1 GP Cog that will prompt what’s called the extended cognitive assessment and it will also prompt the GP Cog Step 2. So the GP Cog Step 2 won’t be available to all assessors. It will just be available to ACAT assessors and its purpose in the IAT post 1 July will be if extra information is needed from that Step 1 alongside the extended assessment.

The next threshold question, this one’s a bit of a strange arrangement due to the lumpy implementation upfront that is building towards the longer single assessment reforms. There will be a question included there to say is there an informant available to complete GP Cog Step 2? As I said the GP Cog Step 2 won’t be available to RAS assessors but they will still see this question. So regardless of what they respond it won’t prompt the GP Cog Step 2. So we did want to flag that in training because we don’t want to create a situation where queries are coming through to the Contact Centre to flag system issues. This is built as intended and it’s just a bit of a hiccup in the set of questions until the full question set’s opened up for everyone.

Behaviour. There’s two questions that are threshold questions that both prompt additional questions on the extended behaviour assessment. Those two questions are does the client experience feeling aggression, agitated or found themselves wandering or are there any reported changes in the client’s behaviour? So if yes is selected additional questions are prompted that go into those topics a little bit further.

And then onto the last slide on the threshold questions. The PHQ4 as Carla mentioned is a validated tool that’s embedded in the questions. The first two questions cover anxiety related signs and symptoms. If a score is three or more for those first two questions – and we’ll get into the scoring and what that means later – that will trigger the advanced psychological assessment. And then for the last two questions which cover signs and symptoms of depression if the score is three or more from those two questions that will also trigger the advanced psychological assessment. So we’re looking at the validated tool split in half. It’s not the score for the whole validated tool. It’s based on what the questions are covering.

Now let’s quickly run through the list of additional questions. I won’t read it through word for word but this is to give you a flavour of what they look like. As I mentioned earlier we will shortly be going into some response guidance on the questions that are new in the IAT. So a lot of these questions will be picked up there as well. So we’ve got the validated tools. The advanced assessment medical assessment. So that’s covering things like recent GP visits and health checks, recent hospital admittance. The extended cognitive assessment. That’s looking at both short term and long term memory problems, impaired judgment. So similar topics relating to cognition. The extended behaviour assessment. So that’s going further into any behavioural or personality concerns and getting a picture of that if there’s anything that needs to be noted.

The advanced psychological assessment. So that’s going further into what was covered in the PHQ4. And then finally the geriatric depression scale. That’s a validated tool that’s also prompted through the PHQ4 questions.

[Visual of slide with text saying ‘Clarifications’]

Shall we have a quick look at some of the clarifications? I think I saw a couple of questions pop up. 

Kathryn Foley:

Yeah. So there was a question about:

Q:         Is a GP Cog Step 1 and 2 recognised by the Australian Medical Association and the Geriatrics Association?

Not sure that we can answer that. We’ll take that on notice.

Some comments there about the carer stress tool. Some people requesting that that’s quite a useful tool.

Q:         Can it still be used as part of assessments?

James Robertson:

Just flagging there, so the carer profile is very comprehensive. So I’m not familiar with the exact questions in the carer stress tool so I don’t know if this is the case. But have a look through the carer profile questions. You might find a lot of the questions addressing what was in the carer stress tool in slightly different wording or even in the same wording. So that might address some of those concerns that I did see pop up there on the carer stress tool.

Kathryn Foley:

Great. Okay. Other than that I think that’s probably it for the time being. 

Q:         Is there a summary on which tools are for RAS assessors?

Carla Scalia:

Yes. The validated assessment tool does highlight which are which, noting that if you’re a RAS and you can see a tool you can use it. If you’re in the IAT and it’s not displaying you’ll be unable to use it. But we will pinpoint it in today’s session as well.

Kathryn Foley:

Excellent. All right. Let’s keep going then.

James Robertson:

Okay. Pre-population. Our favourite word. So looking at this from the assessment context, so not triage like we were discussing before, the assessment questions, they can be pre-populated with the relevant screening and triage information. Again it’s an option that you select at the start of the assessment. So if you are thinking about not pre-populating be cautious because you can’t undo that, and you can edit anything pre-populated. So in my view information that you’re not quite happy with that you want to tweak is better to be edited rather than starting from scratch again and it hopefully helps the client’s assessment experience as well.

Separate to that, to pre-populating from previous stages in that assessment journey, you can also pre-populate from the previous assessments. So it doesn’t matter if it was an NSAF or an IAT previously. If there is any like for like questions that can all be pre-populated across as well.

We’ve covered the reasons why pre-population is important. So again just emphasising we’re keen to avoid asking clients to repeat their stories multiple times and it was one of the goals of the Royal Commission. Recommendations from the Royal Commission was to try and streamline the assessment experience so pre-population has been flagged as a solution to help with that as well.

[Visual of slide with text saying ‘New question topics in the IAT’]

Okay. So getting into the new question topics in the IAT. One thing that we’re really keen for trainers to flag to learners is their knowledge of the NSAF is critical for understanding the IAT. You’ll shortly see how much of the NSAF is being repeated in the IAT. So in that sense it’s not a brand new assessment tool. There’s probably about 30/40% of the questions that don’t directly correlate with the NSAF but a lot of it is like for like. And it might be a couple of minor wording changes or a question sitting in a different section but it’s more or less the same as the NSAF.

So what we’ve got on the next few slides is just emphasising that point about what’s new in the IAT. So we’ll just cover those at a topic level rather than going into all the questions in the IAT. So it’s more to give you a flavour than specifically what questions are new.

Once we’ve gone through the new topics in the IAT we’ll be using those new topics as the focus area for our response guidance section as well. So assessment details, reason for assessment. All the questions are the same. In the carer profile all the questions are the same which led me to think that that carer strain index point might be addressed but we’ve flagged that one earlier so we’ll double check that. But the question on other people living in the same household, so that’s a new question that’s included in the carer profile.

Then in the function section there’s a number of new functional areas that are covered in the IAT that we’d previously covered in the IAT. I’ve mentioned light and heavy housework here because it was only covered as housework but this is split separately. Then there’s take medicine, use a telephone, use other communication devices, use online services, wheelchair mobility, climb stairs and grooming, and upper body strength were the new key functional areas in the IAT.

The DEMMI modified continues. Medical and medications. It’s questions on medical treatments, impact of health issues on normal activities and that advanced medical assessment that’s new.

Physical and personal health and frailty. The three key areas here that are new in the IAT, unintentional weight loss in the last three months, fatigue over the last four weeks and illnesses. Then in social it’s the two validated tools that Carla covered before. So the Good Spirit Good Life and the Duke Social Support Index. So we’ll go into those further shortly.

Cognition. Validated tools are the new inclusion. So the GP Cog and the additional KICA Cog focusing on regional and urban. The behaviour section. It’s the extended assessment that’s new. Psychological, the PHQ4 and the advanced psychological assessment is new. But the GDS continues, carried over from the NSAF.

Home and personal safety. So this is a new section but a lot of the questions are coming from other areas from the NSAF. The new question topics though, characteristics of home and characteristics of garden. That’s a new set of questions that’s focusing on different things that were not covered in the NSAF. For financial or legal it’s a new section and all of the questions are more or less new as well. So those topics are listed there. And then support considerations. No major changes to that section.

[Visual of slide with text saying ‘Quick break’]

Shall we have a quick break or power through?

Kathryn Foley:

I think we just power through. Yeah.

James Robertson:

[Visual of slide with text saying ‘Response guidance for new assessment questions’]

Okay. We’ll keep going. So let us cover the response guidance for those new questions that were not included in the NSAF. Again the IAT user guide is a great source if you want more information than what’s flagged on the slides here. Again there’s a fair bit of detail here. We’re not expecting you to memorise everything that we cover. So we’ll move through fairly quickly and hopefully the slides will be a handy resource to come back to. In regards to how the slides are structured here we’ve got the section and new question topics similar to what we had for triage. But because we’ve only listed the topic rather than the question itself we’ve also included the question on the right hand side as well and then everything else is the same including that IAT user guide reference.

So Carla and I will tic tac through these. I’ll do the carer profile and function and then pass over to Carla. The question that’s changing in the carer profile, how many people excluding the client live in the same household as the client? There’s a text box for a number response. Two things to consider here as part of responding to this question. Don’t include people that live elsewhere but stay in the same household for a specific purpose from time to time, so those that are caring for a family member who might stay over a few nights of the week but they’ve got their own house elsewhere. So they wouldn’t be counted as a person in this question. And please also make sure you’re excluding the client. So it’s asking for how many people aside from the client live in that household. So if they live alone the answer is zero.

Then we go into the functional questions. What I’m going to do here is just explain the structure of the functional questions. There’s four questions that follow the same structure for each functional area. I’ll explain how they work and the consistent response options and then we’ll just skip through these topics and may call out a couple of examples where we’ve had a few questions about what’s actually covered by that functional area. But in terms of what the questions cover, those four questions, the first question will always be are they able to undertake that task and the response options will be yes, no and somewhat. So these follow that same structure from the triage questions. The second question will always be who helps? So no one, informal carer, aged care service provider or other. The third question will always be is the need being met? So this is considering it from the client’s perspective and if necessary considering other considerations as well. 

In terms of the definitions here completely unmet is obviously when the client’s needs are not being met at all. Partially met is some of the client’s needs are being met or the client’s needs are only being met some of the time. Completely met is if it’s being sufficiently met and it’s all managing okay. And then finally the client does not require assistance. So that’s flagging if there’s no need to be met.

The fourth question included in each of the function sections is the free text. So that’s where you can add any additional information. That free text will be included at all times. For those of you that participated in the trial you may remember these questions were only being prompted in certain circumstances. So there’s a bit more flexibility to include additional information with the design of the IAT post 1 July.

So I’ll skip through these fairly quickly and just call out a few definitions of functional areas that we’ve had raised as questions. We’ve covered the distinction between light and heavy housework so I won’t cover that again. Taking medicine is pretty straightforward. Using the telephone. We did have questions about if this relates to mobile phone devices. A bit of assessor judgment is required about what’s answered here in this question versus what’s answered in the other communication devices. So if it fits well answer yes for mobile phone devices for this one if it comes up as part of that conversation. In regards to what’s covered in other communication devices these are things like tablets, iPads – sorry they’re the same thing – computers. So anything that communicates to the outside world that’s not a telephone.

The other one that I’m going to flag is grooming as well. The difference between grooming and bathing and showering. So grooming relates to personal care, cleaning your teeth, shaving, brushing your hair, etcetera. So we’ve got some examples there in the key guidance and some more in the user guide as well.

And then finally upper body strength is the last key one. So the example used in the user guide is considering their ability to lift and carry a weight, around five kilograms, a heavy cat. So that’s the example we use there.

Okay. I’ll pass over to Carla to cover the next section. 

Carla Scalia:

Great. Thank you James. So medical and medications is the next section within the IAT, the screening question topics. I’ll move through these at a canter. Hang on. I think we’ve skipped one. Hang on. Sorry guys. There we go. That’s the first one there. Beautiful. All right. So a new question within this section is you’re asked to identify if the client’s in receipt of any medical treatments. You’ll get a number of response options to choose from noting that you’re selecting which ones the client currently has. We know that some of these terms may be unfamiliar to you so the user guide provides a definition of each and what they mean. So the user guide is a great source of information. It will certainly help you when answering this question.

The next new question you’re getting in this section is impact of health issues on normal activities outside or inside of the home during the past four weeks. So you’re identifying if the client does have any health issues that do impact on their ability to move around inside or outside of the home. You’ve got four response options here. Not at all, slightly, moderately, quite a bit. As mentioned before this is a threshold question so this is where you’ll actually see how these work. What that means is if you select moderately or quite a bit and you’re an ACAT assessor you will be prompted with additional questions being the advanced medical assessment questions. If you are a RAS assessor and you’re clicking moderately or quite a bit to this question nothing more will happen in the IAT. You won’t be required to answer any further questions. Noting though that it’s very much recommended that you detail any concerns that the client has within your assessor notes and it’s those assessor notes that you’ll be using to determine whether you think the client will be required to be referred for an ACAT assessment after the assessment’s completed. 

So like I said it is a threshold question. Moderately, quite a bit is what the answers are which trigger the next set of questions for ACAT assessors. And this is what ACAT assessors will see. So you’ll move into the advanced medical assessment section of the IAT which will be triggered. As you’ll see on this slide in the top right hand side you see that little red clinician icon. We’ve put these in the slides just so it’s easy for you to see that these questions will only be visible to ACAT assessors. So the first question that ACAT assessors will be faced with is they’ll need to identify if the client has been in receipt of any recent GP visits and health checks. It’s a yes or no response. Health checks can include cancer screening, mammograms, flu vaccinations, etcetera. Again the user guide will provide you with information of that.

And then what you do once you’ve identified whether it’s a yes or no answer is you’re putting in any free text as required to summarise that answer obviously if it’s required. If you’re ticking no there’s no need to go with your free text. If you’re identifying yes then you will need to put in further information. 

You’re then asking the client or identifying if they’ve been admitted to hospital in the last 12 months. You’ve got three response options. No, yes planned or yes unplanned. Again the IAT user guide provides a bit of a summary of what each of those means. It goes without saying though that as we said in the face to face if they’re having a bit of a surprise trip in the ambulance to the hospital and it wasn’t scheduled in you can assume that that’s very much unplanned and that’s how you’re answering that question there. Noting that there is a free text field that you’ll need to complete once you identify the response based on whether they have been admitted to hospital over the past 12 months.

And that ends that section for you. You’ll then move into the physical and personal health and frailty section. There’s three new question topics in this area. The first one is around a client’s illnesses and identifying if they have any illnesses. Again there’s a list of response options which you’ll have the option to choose from. Again noting that the IAT user guide provides definitions and explanations of each of these if needed.

You’re then identifying if the client has unintentionally lost any weight in the last three months and you’re given three options to pop in for the client into the IAT. We did talk about it in our face to face sessions that this category can be really tricky possibly for a client to identify themselves. I think there’s many of us on this call today that wouldn’t know exactly how much we weigh. We wouldn’t know what five kilos of weight loss would necessarily look like. And so the user guide has some really great prompts for you to use when you’re asking the client and trying to identify an answer, things about asking them about how their clothes are fitting, if they’re a bit loose, if rings are a bit loose. That may be able to guide you in identifying which category the client falls into. It is important to also flag with you guys that we’re talking about unintentional weight loss. So if that client’s hitting a Jenny Craig diet hard and they’re doing a great job of it that’s awesome. It’s not required to be covered in this question because they’re on a diet or a weight loss program. Just noting that it’s unintentional.

Next question you’re asking the client is how much of their time in the past four weeks did they feel tired? Every time we raise this slide, hits us in the feels. I think this is a question that all of us could answer all of the time. Noting that the question is flagging fatigue over the last four weeks. And the user guide does talk about fatigue as a feeling of constant exhaustion, burnout or a lack of energy. So it is more than the client telling you that they’re just feeling tired. You are looking for signs of fatigue in regards to identifying which response option that you’re to flag for the client.

You’re then moving into the social section of the IAT where you’re faced with the first of your new validated tools which is the Good Spirit Good Life. As we flagged before your Good Spirit Good Life is a tool that’s used for the assessment of older Indigenous Australians and it will only display if the client’s demographics have been identified that they are a First Nations person. I should also note with you that if for whatever reason you’re in the middle of an assessment and the demographics haven’t flagged that their client is First Nations and they identify as being a First Nations person as you’re conducting the assessment what you can also do is you can go into the support considerations tab of your IAT, go to your client diversity section, and if you use the radio button that identifies that the client is Aboriginal or Torres Strait Islander, it should turn on the tools for you as well. So that is an option for you to note too.

There are two versions of the Good Spirit Good Life. You’ve got a participant version and a carer version. The participant version is the version that’s used within the IAT. I won’t read out the themes that are covered in the questions but it’s quite a comprehensive tool to use with First Nations clients if suitable. The tool contains 12 questions. Number of response options being all of the time, most of the time, sometimes, not much and never. And assessors are encouraged to use the client’s answers to support their needs as well as identify areas of concerns and goals that they wish to achieve.

Part of our key guidance we do flag with you as it’s really important is just to ensure that you’re utilising the use of this tool with a really solid informed understanding of country and protocols. So just because the client identifies as being a First Nations person does not necessarily mean that this tool will be suitable for use. You will be able to have the option to complete the DSSI if you think it’s more suitable to use. But it is important to note that please only use it if it’s actually suitable for the client and we do strongly suggest the involvement of Aboriginal health workers and elder care support connectors at the time of assessment to ensure that your assessment is as culturally safe and appropriate as possible. We do cover this tool in the validated assessment tool element which has been released last Friday. We’ll give you some information in there about the tool. There’s a video in there. There’s a scenario for you to practice so that you can sort of learn about this tool in a little bit more detail.

The next tool you come across in your social section is the DSSI or the Duke Social Support Index. This is a tool that assesses the client’s social support over two sub-scales. So you’re assessing the client within their level of social interaction and then you’re going on to assess the client’s satisfaction with their social supports. There’s a couple of different versions of the DSSI floating out there. The 11 item version is the one that’s used within the IAT.

So basically this tool is divided as I said into two sections. The first section or a sub-scale as you’d call it, so the social interaction sub-scale has four questions. Within those four questions you’re asking clients questions around how many people they feel close to and can depend upon, how frequently they communicate with friends and how often they socialise with groups of like-minded people. And then the next section of the tool contains seven questions and they’re questions around the themes of how the client’s feeling connected and listened to by others, are they satisfied with their friendships, do they have a sense of social purpose.

If yes/no answers are given by the client further prompts will be required because the response options are on a frequency scale so you’ll need to get the client to give you more than just that yes or no answer. And again responses to the questions in this tool should be used to consider the level of social support the client may or may not have for the sake of making recommendations. 

There was some feedback within the trial around this tool that assessors did find some of the questions within this tool a little challenging to ask given the level of vulnerability expected from the client. I think it’s very similar in some of the nature of the questions. So the geriatric depression scale, some of those questions can be quite confronting to ask. It is important to note that I’m just flagging it for you because as trainers you may get assessors coming to you with some questions hoping to get some helpful guidance from you about asking some of these questions, when it might be appropriate to ask these questions or to use this tool. So please be mindful of that as well as outlined on that slide. We do cover it again in the validated assessment tool element with regards to the scoring and understanding those questions. But again some of the human element nuances of the questions asked can be a little bit tricky and that’s where your expertise will certainly help in guiding assessors through that process.

The next tool you’ll encounter is the GP Cog which as we said there’s two steps within this tool. You’ll find it within the cognition section of the IAT. We’ll cover step one first. So your GP Cog is a reliable, valid and efficient instrument that screens for signs of dementia and cognitive impairment. The GP Cog Step 1 focuses on responses from the client. So this is a tool that you administer with the client. Step 2 is with the support person but we’ll unpack that a little bit later. There’s five questions within the GP Cog Step 1. Before you indulge in these five questions that you ask the client you need to read out a script where you’re asking them to recall a name and address. And once you think that the client has understood that request, that requirement, you then move through the five questions which involve the skillsets that you can see on the slide around time orientation, clock drawing, information and then recall. And you’re asking that client to recall the name and the address that you asked them to remember at the beginning of that tool.

This tool is a – basically all of these questions within this tool are threshold questions. So what that means is that if the client gets an incorrect response to any of the questions within the GP Cog Step 1 the GP Cog Step 2 and extended cognitive assessment questions will be prompted for ACAT or clinical assessors. So it’s really important to note that again if you’re a RAS assessor and you’re doing this tool with a client and you’re marking any questions incorrect you won’t be prompted to complete any further questions. But it would be really important to note that if there’s incorrect responses being answered to questions that could very much indicate that the client is experiencing some cognitive impairment and a GP referral or a referral up to ACAT may be a requirement. So please keep that in mind. That’s where you pop that into your assessor notes details.

Just some key points to note with this tool. Assessors should read out each question as it’s presented and unless specified each question should only be asked once. Noting that again our validated assessment tool element will sort of guide you in understanding the GP Cog Step 1 quite extensively.

You then move into Step 2 which again is also located in your cognition section of your IAT. So the Step 2’s undertaken with the client’s support person or carer and it’s to be used if again as we said as an ACAT any of those questions are incorrect. It may be suitable also to complete the GP Cog 2 if the client is unable or unwilling to complete the GP Cog Step 1. So that’s also important to note. The Step 2 is only available for clinical assessors. So RAS you won’t be able to use this tool. It will only be available for ACAT assessors if needed.

The GP Cog Step 2 has six questions and the questions involve asking the client if they have trouble remembering things, finding the right words when talking, if they need more help managing money and financial affairs, if they’re needing more assistance with transport or managing medications.

Again as identified before if there’s many yes responses to questions this may indicate that the client is experiencing cognitive impairment and again a GP referral may be appropriate. Just some key guidance that was flagged. Is probably best to if you can ask these questions out of view or earshot of the client noting sensitivities. You are seeking guidance about the client’s cognitive wellbeing and abilities, if they’re questions that you may wish to ask outside of their view just for the sake of maintaining dignity and respect. And again our validated tool element gives you some hints and tips on how to engage in completing this tool with clients and their support people.

The last new validated tool you’ll find within the cognition section is the KICA Cog Regional Urban. As discussed it’s very similar to the KICA Cog. There’s just a few nuances in questions. So you’ll find within the KICA the first question is is it pay week or pension week? The KICA Urban Regional just says what month is it? So it’s tweaked a little bit. Instead of using the word pannikin you’re using the word cup. Some of the images are a little bit different as well. So again it may be more suitable given the context that the client lives within to use the KICA Cog Regional Urban as opposed to the KICA Cog.

As mentioned before it’s not a tool that will display by default. It will only display if the First Nations status of the client is selected in their demographics or in the support consideration section of the IAT if those tools aren’t displaying for you. I’d like to note at this point too that when it comes to your First Nations clients obviously it will turn on these additional tools for them. That doesn’t necessarily mean that you’re to assess them through the three validated tools. We certainly don’t want clients being over assessed here. So what you can see on the screen is the three tools that you have access to in the cognition section for First Nations clients. So you’ll be able to have the option to complete the KICA Cog, the KICA Cog Urban Regional or the GP Cog Step 1, noting that you’re only to select one tool for completion if it’s required. So the completion of the validated tools are not mandatory. They’re screening tools for you to obtain extra information. If you feel you’ve obtained that information when completing the IAT and you don’t feel the validated tools are going to give you any further information you don’t need to use them. They’re not required. They’re not required to engage in. But you will need to identify whether it’s a yes or no for use of each of those tools. And I should note that if you say select the KICA Cog for completion you won’t have the option to select the KICA Cog Urban Regional or the GP Cog Step 1 for completion. You pick your one tool, you go forth, and that’s all you need to complete for the client where applicable.

The tool contains 16 questions. You need to ask them verbatim. Again like I said it’s very similar to the KICA Cog tool. Just a few nuances. You’ll still need your five items to assist with the questions and there’s a set of pictures within the tool which are embedded in the IAT for you to show the client to be able to engage in that process with them as well. The tool is scored like most of the validated tools within the IAT. They do produce a score. As outlined in the validated assessment tool element a score of 33 or less out of 39 indicates cognitive impairment. And again you may need to use that score to determine supports where applicable, or again as a RAS you may need to refer up to an ACAT assessment.

Sorry guys. Jumping around here a little bit. Just last but not least, again it’s really important to note that the tool should only be used with a really strong understanding of country and protocols. Again involve those Aboriginal health workers and elder care support workers where possible for the sake of making sure that your assessment is culturally safe. And as I said, I keep banging on about that validated assessment tool element, but the information’s all there. I know that we’re skimming through this but that tool will give you a lot more intel to help you with the completion of these tools.

James Robertson:

Okay. Let’s jump into the extended behaviour assessment which is new for ACAT assessors with that little icon in the top right hand corner in the background. So there’s six areas that are explored in the extended assessment. All of them have the same response options. So let me cover those response options now before we go into the six topics. So for each question in the extended assessment you’ll get these five options. Unable to determine. This will be selected if it’s unclear based on the conversation or you’ve received conflicting information. Never is never. They never displayed that behaviour. Occasionally is if they have displayed that behaviour only on a few occasions. Regularly is if they often display that behaviour. And always is if they’re always displaying that behaviour. So that might be rare. I can’t imagine there would be many people that always display verbally aggressive behaviour. So I imagine even at the most extreme ends regularly might be the one that’s selected.

So let’s get into what each of the six areas cover. Verbal aggressive behaviour. So when someone yells, screams and/or threatens.

I did just see a question pop up about the ACAT assessor icon. Top right hand corner of the slide you’ll see a person with long hair that’s red. That’s the icon that we’re referring to. And then to the right hand side of that there’s the page reference in the user guide.

So we’ve covered what physical aggressive behaviour covers. The next one is verbal aggressive behaviour.

Sorry. We covered verbal. The next one is physical. This is when someone bites, scratches, hits, pushes, shoves. There’s a few examples there but physical aggressive behaviour I think is pretty clear. The response guidance, as I said, it’s all the same for those five options. So use those same frequency scales that I mentioned before for each question.

The next one is resistive behaviour. So what this means is if the client resists, opposes or withstands help or caregiving tasks from those around them. And same again for those response options.

Then we’ve got agitation. So this is where a person experiences extreme emotional disturbance. And then you’ve got your five response options there.

Hallucinations and delusions. We’ve got a summary of what hallucinations means in the key guidance on the right hand side. I get to the first word when I’m reading it out and struggle to read each of those words so I’ll let you just read through that one. And then delusions, they’re false or erroneous beliefs that usually involve a misinterpretation of perceptions or experiences. Don’t forget your notes field as well. If it’s relating to one or the other feel free to flag in the notes field at the end of the behaviour section if you need to provide a bit more information.

Wandering is moving around without a definitive destination or purpose. Same response options again and same frequencies.

That’s the extended behaviour assessment for the ACAT assessors. Then moving into the psychological section. So we’ve got the PHQ4 and the advanced psychological assessment. So let’s jump into the PHQ4. So this is a brief tool, very brief, four question tool. It’s aim is to screen for core symptoms and signs of depression and anxiety. Obviously it’s not a diagnosis. It’s a screening tool. So it’s signs and symptoms.

There’s two questions that relate to depression and two questions that relate to anxiety. They’re asking for the client’s experience over a two week timeframe. So the two questions on anxiety is if they’ve had feelings of nervousness, anxiousness or been on edge over that timeframe. And the second one is not being able to stop or control worrying. We’ll go into those response options shortly. For the signs and symptoms of depression the first question is little interest or pleasure in doing things over that two week timeframe and the second one is feeling down, depressed or hopeless over the timeframe.

In regards to the response options it’s the same for each. So no, not at all, several days over that two week timeframe, more than half the days over the timeframe, and then nearly every day. The scores that are applied based on those response options, so zero would be for no, not at all. One point would be for several days, two points for more than half the days, and then three points for nearly every day. So you might recall when I was talking through the threshold questions earlier a score of three or more in the first two questions or the last two questions are what triggers the advanced psychological assessment for ACAT assessors. So we’re not looking at a score of three across all four questions which you could easily hit if it was several days for each question. It's three for the first two and three for the last two.

In regards to guidance on administering this tool we do know from the trial experience that it is quite a sensitive tool to administer. Please don’t feel like you need to read out questions word for word or a Q&A style approach. It can be conversational. You can adapt questions to things that have been mentioned previously, make other prompts or suggestions where needed. The validated tool learning element in the online learning goal, it’s got some really helpful advice on conversation tips for discussing possible mental health challenges. This advice is included as part of the PHQ4 content but a lot of it will be relevant to other sections of the IAT as well. So that’s one area that is well worth a look through and to point that out with learners because it will be helpful elsewhere in the tool.

And then into the advanced psychological assessment. So this is again for ACAT assessors only. The first question relates to if the client has experienced stressful events over the past three months. This is from the client’s perspective. We’ve all got different interpretations of what a stressful event is so please look at it from their perspective. It’s a yes/no response.

Then there’s the ability to provide additional details on those stressful events if they’ve been flagged.

Then we’ve got the next question on disturbed sleep or insomnia. The same response options are flagged here as what I covered before for the extended behaviour assessment. So please use those same frequency scales that I read out before to help answer the question. And then just another point to flag here that came up in the face to face sessions, please still indicate disturbed sleep or insomnia if it’s for a purpose. So for example if they’re waking a number of times during the night because they need to go to the toilet frequently, that’s still regularly and it still has an impact on the person’s wellbeing so it’s needing to be flagged here as well.

Anxiety. Again the same frequency scales.

Symptoms of depression. As you can see it’s going a lot further into what was covered in the PHQ4 in the earlier questions.

Apathy. So this is where people experiencing apathy might stop caring about everyday tasks, hobbies, personal interests or showing interest in personal relationships.

Loneliness. So in regards to this question please look at it from the client’s perspective only. So loneliness is not the same as solitude. Some people are quite happy spending a lot of time by themselves and they get enough fulfilment out of that circumstance. So we’re looking at the person’s feeling from their circumstance. So if they’ve got an ache of wanting greater social connection than what they’re currently experiencing that suggests they’re experiencing loneliness. If they don’t then they’re quite happy doing their own thing and being someone that enjoys solitude.

The next question is the opposite. So the next question is where a client lacks engagement with others, has minimal number of social contacts and is deficient in fulfilling quality relationships. So this is looking at clients who may live a life of solitude and flagging if that’s the case. So here it’s indicating if they’re not doing much in the community or social activities with family etcetera.

So that’s the psychological section. We move into the home and personal safety section. I did see a couple of questions come up on the characteristics questions that will be addressed here. So there’s two questions. The first is characteristics of the client’s house and the second one is of the garden. So this is based on what is the characteristics, not what the need is, particularly for the garden question where it does look at sorts of tasks that are required. So the first one’s a bit more straightforward looking at the design of the house, single storey, multi-storey. So you pick which option fits best. Then for the garden question it talks about the tasks required. So the response options here, mowing and/or gardening required, gardening only, no garden. Please note this is just talking about the characteristics. It’s not a precursor for any recommendations or anything like that. We’re looking at the environment that they live in.

Okay. Moving into the new section on financial or legal. I’ve bumped ahead one. So financial or legal issues. The first question is are there any issues being experienced by the client? We’ve got a summary on the right hand side there of what constitutes a financial issue and what constitutes a legal issue. It’s a yes/no question.

The next question is is the client capable of making their own decisions? This relates to financial or legal decisions. It’s a yes/no question.

Power of attorney. Another yes/no question. So does the client have a power of attorney in place? There are questions a little bit later covering other roles that are similar to power of attorney. So if they’re not a power of attorney the answer’s no here, but if they have someone else fulfilling a similar role which varies across the country depending on the jurisdiction you’re in there will be the ability to answer that in the next couple of questions.

The next one is who makes or assists the client in making health decisions. So this is where you can start to indicate some of those other role types. We have been advised that there is a lot of nuance here around the country about the certain roles. So it’s not covered by the first three, particularly number two and three in the response options. Option four, person responsible or appointed guardian, is your generic option to pick if it doesn’t fit within.

So the same structure for both health and financial decisions. So who makes or assists the client in making those decisions?

The next question is do you have enough financial resources to meet emergencies? Yes or no.

And then the final question relates to the client’s employment status. So here we do agree with some of the feedback that we’ve heard that the response options don’t appear complete because they have been tailored for the circumstances of a lot of clients that you’ll be dealing with. So please don’t forget the other option if they are indeed in a paid employment situation or they’re volunteering. We’ve got definitions of the difference between home duties, retired for age and retired for disability in the user guide. Essentially the differences are if they’ve never worked then home duties would be the most appropriate answer. If they have worked in the past but retired because they’ve reached a certain age then that’s retired for age. Or if they had to give up working because of a disability that would be the third option.

[Visual of slide with text saying ‘Clarifications’]

Any clarifications that have come through that we can answer Kathryn? 

Kathryn Foley:

So we’ve got a few questions that have come through. We’ll try and group them together. So there’s a few questions about the use of the tools.

Q:        Do we use GP Cog for all clients or only clients who have memory issues? And what happens if there’s no carer and lives alone for GP Cog 2?

Carla Scalia:

So the first question in the cognition section will ask you has the client got a formal diagnosis of dementia from a geriatrician or a neurologist. If the client does have a formal diagnosis you don’t have to complete any validated tools. Policy guidance that we’ve received is that if the client has an official diagnosis you don’t need to engage in any of those tools because the official diagnosis trumps. Obviously in the case of all validated tools they are there for you to get further information if you need it. So if you think that the GP Cog 1 is going to assist you in further understanding the client’s cognition for the sake of developing their support plan go ahead and complete. If you feel that the questions would not give you any further information you’re able to identify no and move on. I hope that answered the question.

Kathryn Foley:

Great. Okay. And on the same theme. 

Q:        Are any of the tools mandatory or do we pick which ones are applicable and we’ll use those tools?

And I think we’ve covered that.

Carla Scalia:

I do believe if they are prompted as a threshold question they do become mandatory for completion. Is that correct James?

James Robertson:

If still appropriate. Yeah. So there’s always the judgment needing to be made if it’s appropriate based on the assessor’s experience and also the client circumstance. But they’re helpful for completing a more holistic assessment.

Kathryn Foley:

And that sort of goes to the theme of this question as well.

Q:        With regards to external assessment tools non-VATs – in the validated assessment tools in practice training it documents if VATs are not included in the IAT or are not in IAT validated tools used at assessment a record of the completed tools should be uploaded in the assessor portal as an attachment to the client record and referenced in the support plan.

So that’s great feedback. That’s giving us back what we’ve referenced in the training which is good.

Okay. And then I think the other themes that have come through – so there’s been a few detailed questions about the different characteristics. So someone’s commented about regional specific.

Q:        Is the maintenance of fire breaks included in there?

We haven’t heard that one before so we’ll take that one on notice. Then I think there’s just a question about confirming the process for RAS.

Q:        So I’m not sure if this is obvious but is it my understanding if a RAS hits a threshold question that they feel needs more exploring write up in notes to add to decision regarding if complex assessment is needed? 

Kathryn Foley:

You’ve absolutely nailed it there. So that’s great. And I think that’s then linked to another question.

Q:        Will it be clear in the IAT assessment when the RAS assessor asks the threshold question and gets a response that would trigger further questions but it doesn’t for the RAS assessor?

And that’s exactly it, that they should write it up in the notes that it reflects the need for a comprehensive assessment.

Carla Scalia:

And we did flag in the face to face just because there is a threshold question that’s reached it may not require an ACAT assessment either. There may be situations where RAS are well within their means and capabilities with the supports on offer that can support the client at that time without the need to refer up to an ACAT. So just need to make that clear that yeah, reaching a threshold question, put your notes in, but the stock standard answer doesn’t necessarily equate to an ACAT assessment. There’s more involved in making that decision. And if you feel that the supports you can put in place is enough to support the client and they agree with that that’s okay.

Kathryn Foley:

All right. In the interests of time we might hold over the rest of the questions and keep going with where we’re up to.

Jaems Robertson:

Okay. So we were up to the support plan content but it might be best to cover that tomorrow. Just to flag the last slide here it’s the resources that we’ve got available on the assessment questions. So the user guide we’ve referenced throughout. One thing we haven’t mentioned is there is also a fact sheet on the IAT versus the NSAF. But in regards to the rest of today’s session just noting that we’ve got 20 minutes left what we might do is a summary of the training scenario that we’re asking participants to do between today and tomorrow’s session. We’ll just give a bit of an explanation on what that scenario entails and how to complete the scenario and then we think that will put you in a really good position for tomorrow’s session.

We did have some content on the support plan changes that we were hoping to cover as part of today’s session but we think best to do it justice tomorrow and cover as part of that session instead. So I might skip through a few slides and then get to our training scenarios. So we will go back to those slides tomorrow. So over to you Carla.

[Visual of slide with text saying ‘Training scenarios’]

Carla Scalia:

All right. Sounds good. So part of the feedback from the IAT trial was that you guys found the scenarios really useful. But something a little bit more robust to kick the IAT tyres was suggested and so we’ve taken that feedback on board and we’ve run with it and that’s what we’ve done. We’ve developed some training scenarios for you. So in your resources you will see two scenarios. I don’t know whether you can see this. I’m holding up two images at the moment for two documents. There’s a scenario in there for Maria Galotti which is a home support assessment and then you’ve got an IAT scenario in there for Jamal Obi who is a comprehensive assessment scenario. 

What you’ll find is when you move into the IAT element that’s available to you in MAClearning the last lesson of that element is called the IAT in practice. There’s a lovely interactive at the end of that lesson that you’ll be able to engage in as an assessor and you can pick RAS or ACAT. And within whichever pathway you choose you’ll be presented with five scenarios that you can download and use to play with the offline version of the IAT at this point in time. So what we’re going to get you to do between now and tomorrow if you can find the time, which would be well worth it – if not definitely flag it on your to do list – is to grab either Maria’s scenario or Jamal’s scenario, download the offline form of the IAT and use that scenario to move through the questions, move through the response options and just start to become familiar with the IAT.

It is important to note that the offline form is a draft version. I did see some comments pop up with people saying that they’ve noticed that the offline form is different to the IAT user guide. Absolutely noted. We’re aware of it. We updated the IAT user guide before that form has been updated. The form is in the process of an update so once it’s updated we’ll give you the new form. But for the time being even in its draft form it’s a really good tool to use to just slowly become familiar with the IAT, the questions within it, the response options in it and have a practice run. The scenarios that we’ve developed are pretty comprehensive but they don’t cover absolutely everything. If you find there’s an area of the IAT offline form that you can’t really see any information in the scenarios to guide you through be fabulous and use your amazing imagination, make it up.

Kathryn Foley:

Use those secret powers.

Carla Scalia:

Absolutely. Like I said it’s just a practice run to help guide you and then once the training environment becomes available we’re hoping that these characters are going to be in the training environment for you to be able to still go and use your scenarios but practice in the online environment. Feedback is that assessors have found these scenarios to be really great. We’re hoping that you’ll find them as such as well. Noting that these scenarios will become available for use in the BAU training for your assessors. So any new assessors that come into the workforce from the 1st of July will also have access to these scenarios and hopefully will help them navigate the IAT and be their little training wheels as they’re moving around the form. So that’s really just the breakout activity for you.

Q:        Were the scenarios recommended for Maria and Jamal?

Yes. So I was going to say a bit more clarification on that question. To complete? Yep. So absolutely. So Maria for your RAS, Jamal for your comprehensive. Noting that if you’re already engaging in the IAT element at the moment and you’ve chosen another scenario to have a go at feel free to use that one too. That’s not a problem. They’re just there as a practice run to help guide you.

Resource section. Yes. Maria and Jamal are available in the resources section of MAClearning. The other scenarios you’ll find in the IAT element within the transition goal. That’s where you’ll find the rest of these scenarios sitting. So that’s a matter of like I said have a bit of fun with it. 

Kathryn Foley:

[Visual of slide with text saying ‘Thank you’]

Great. And we have just been advised that the link to the offline form in the training in the element is not working. But it is working in the resources section. You can still get the offline form there. We are fixing it right now so please download the offline form from the resources section and we are fixing the one in the element as we speak. So thank you to all those people who notified us of that error.

All right. So big day. We might stop sharing the screen. And thank you to everybody who has joined in. It’s been a marathon effort kicking through today with all this information. Big thanks to James and Carla for walking us through all those slides and explanations. We hope you can dive into the information overnight, have a look at that scenario and then we can come back to you tomorrow, wrap up with support plan and walking through the training materials and answer any questions. We’ve taken down all the questions that you’ve given us so we won’t forget those. So we will see you all online tomorrow. Thank you. Bye.