Dietary education required (ie healthy eating and weight reduction) Standard diet/ weight monitoring Clinical Comments Physical disability 2-3 trained therapists/ trained staff at one time to treat Complex postural tone/contracture management Specialist interventions required to manage spasticity Routine physical issues 1-2 required to Moderate physical disability requiring some specialist interventions Higher function problems only No/low level of physical disability Clinical Comments Cognition Severe cognitive problems – intensive support required for over or orientation Complex cognitive/ neuropsychologist assessment required Highly structured environment required to enable functioning Moderate cognitive problems Routine cognitive assessment required by occupational therapy team Strategies may be required to enable functioning A environment may be required to enable functioning Higher function problems only No cognitive problems Clinical Comments Behavioural Highly challenging behaviours Interactive behavioural management programme required Mild/moderate behavioural problems generally managed well with a behaviour management care plan A structured environment may be required Some monitoring may be required Minimal/ no problems with behaviour – managed effectively Compliance with care A secure facility is not required
1:1 specialling for safety and behaviour management May be a danger to self or others Risk of wandering or absconding Significant problems in compliance with care A secure facility required Mild/moderate problems in compliance with care A secure facility may be required Clinical Comments Mood/emotion Severe lability Specialist evaluation required Active management and frequent crisis intervention required Mood disorder/adjustment issues under active management with planned programme No significant mood/adjustment issues Clinical Comments Communication Complex communication problems such as dysphasia combined with cognitive/perceptual problems Complex communication aid set up/provision required Specialist assistive technology required Moderate communication difficulties Able to communicate basic needs and ideas with/without aids Higher function problems only No communication problems Clinical Comments Complex disability management Complex disability management interventions required such as: Standard disability management required such as: None required
evaluation of low awareness state rehabilitation/ end of life care set-up of care programme care booklet training Clinical Comments Social/discharge planning Complex issues requiring extensive multi-agency negotiation Safeguarding concerns identified – high risk Active discharge planning requiring liaison with community social worker, district nurse, occupational therapist to arrange care package Potential safeguarding concerns – moderate to low risk No major discharge issues, taken care of by family/allocated social worker No safeguarding concerns Clinical Comments Family support Major family distress issues requiring frequent support or crisis intervention Routine family support needs (met by planned meetings) No significant family problems Clinical Comments Emotional pressure on staff Demanding situation requiring highly experienced staff/extra support for staff Somewhat challenging situation but manageable Minimal or no emotional pressure on staff Clinical Comments Vocational rehabilitation Specialist vocational rehabilitation needs such as: multi-disciplinary vocational assessment support for return to work Moderate vocational support such as: work visits or employer liaison support for other roles e.g. homemaker/ parenting No significant needs for vocational support Clinical Comments Medico-legal issues Complex medico-legal issues requiring interaction with the legal system such as: Standard medico-legal issues such as: Mental capacity evaluation No significant medico-legal issues
complex best interests decisions court of protection applications DoLs/PoVA applications Litigation issues Complex mental capacity/consent issues Standard consent/best interests decisions LPoA, advance care planning Clinical Comments Specialist equipment/ facilities Highly specialist equipment/facilities required such as: Bespoke assistive technology Highly specialist needs Bespoke orthotics Electronic assistive technology Assisted ventilation Moderate specialist equipment needs such as: Adapted wheelchair/seating Electric standing Treadmill/harness training Assisted cycling e.g. motor-med Splinting/casting No equipment needs Basic off the shelf equipment only Standard exercise facilities e.g. plinth, bike, tilt table, parallel bars Clinical Comments Therapy type/intensity Intensive coordinated therapy programmes required Up to 5 therapy disciplines involved in therapy More than 25 hours total therapy time per week High intensity staffing ratios required ie 2 or more to treat at one time Therapy teams specialising in complex neurological conditions Moderate to intensive therapy programmes required Up to 4 disciplines involved in therapy 20-25 hours of total therapy time per week Less intensive therapy Short rehabilitation programmes Rehabilitation may be required as part of a specific diagnostic (e.g. stroke) – treatment by a local specialist team
Access to specialist medical equipment for assessment /monitoring etc. M 2 Specialist medical / psychiatric intervention – for diagnosis or management/procedures (Requiring in-patient hospital care in (DGH or specialist) M 3 Potentially unstable medical /psychiatric condition (Requiring 24 hr availability of on-site acute medical / psychiatric cover) Type of medical / surgical intervention required: Medical Surgical Trauma Psychiatric Other…………………………… M 4 general medical / surgical problem (Requiring general emergency medical / surgical intervention, but can be managed in DGH setting) M 5 Post-acute care – with active acute trauma needs (Requiring acute step-down coordinated trauma care) Orthopaedic / trauma Neurology neurosurgery Vascular Abdominal / Cardiothoracic Plastics/ burns ENT / Max-fax Urology Rehabilitation Medicine M 6 Hyper-acute trauma needs - extended range trauma care (Requiring hyper-acute coordinated trauma care only available in MTC) CARE AND SUPPORT NEEDS Describes the approximate of intervention required for basic self-care or level of risk (For all centres: score both care and risk and use highest score) CARE: Standard rehab needs RISK: Cognitive behavioural needs C 0 Largely independent in basic care activities R 0 No risk C 1 Requires help from 1 person for most basic care needs R 1 Low risk – standard observations only But requires escorting outside the unit C 2 Requires help from 2 people for most basic care needs R 2 Medium risk – above standard observations OR managed under MHA section C 3 Requires help from ≥3 people for basic care needs R 3 High risk – above standard observations AND managed under MHA section C 4 Requires constant 1:1 supervision R 4 Very high risk
TI 1 Low level – less than daily (e.g. assessment / review / maintenance / supervision) OR Group therapy only TI 2 Moderate – daily intervention - individual sessions with one person to treat for most sessions OR very intensive Group programme of ≥6 hours/day TI 3 High level – Daily intervention with therapist PLUS assistant and/or additional group sessions TI 4 Very High level – very intensive (e.g. 2 trained therapists to treat, or total 1:1 therapy >30 hrs/week) T score (TD + TI) :…………. EQUIPMENT Describes the requirements for personal equipment E 0 No for special equipment Special Equipment Highly Specialist Equipment E 1 Requires basic special equipment Wheelchair/seating Pressure care Standing frame Off-shelf orthotic Walking aid Other…………………… Environmental control Communication aid Customised seating Customised standing aid Customised orthotic / brace Assisted Ventilation E 2 Requires highly specialist equipment (e.g. electronic assistive technology or highly customized equipment) E3 Requires extremely specialist equipment (ie Really fancy hi-tech trauma equipment only available in MTC!) State equipment type: TOTAL SCORE SUMMARY Needs scores Totals: Currently gets Reason for unmet need (E.g. Not available (NA), declined (D), or Other…) Medical / Surgical / Trauma / Psychiatric treatment M: Medical: / 6 M: NA D Other.. Basic care and support (Includes risk management) C: Care / 4 C: NA D Other.. Skilled Nursing care N: Nursing / 4 N: NA D Other.. Therapy TD: Therapy: / TD: NA D Other.. TI: TI: NA D Other..