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Disability Maintenance Instrument: Frequently Asked Questions

Chapters

The Assessment

What is a DMI assessment?

The DMI is a tool that 'measures' the support needs of clients, and matches this with an appropriate level of funding.

For the purposes of the DMI, 'support' or 'assistance' is defined as any employment-related assistance or intervention provided. This includes:

Basically the DMI is like a questionnaire – there are set questions (assessment items) that are 'answered' by selecting a rating category that best describes the client's support needs during the previous three months.

Before a DMI can be completed, the client needs to be assessed. The purpose of assessment is to gather reliable information about the client, so informed decisions can be made about their support needs. In other words, there needs to be some information and evidence about the client so that the most appropriate rating category is selected for each of the DMI questions.

Sometimes people think of assessment as having to complete a one-off 'test'. That's not the case with DMI assessments. DMI assessments are about gathering information and evidence about a client's support needs in the workplace, for the three months prior to completing the DMI. This means:

Who's responsible for undertaking DMI assessments?

There is no official requirement for assessments to be undertaken by qualified 'assessors'. Particular people in your organisation may be responsible for planning and coordinating DMI assessments (for example, developing documentation systems, distributing observation sheets, overseeing data collection, etc), however many people may be involved in the assessment process in some way.

For example, a support worker may be asked to fill in an observation sheet about a client each day for two weeks, to collect evidence for the DMI.

The DMI is directly linked to the funding a business service will receive to support its clients – so it's very important. If people are involved in the assessment process in any way, they need to understand the purpose of the DMI and their role in contributing to it. This will help to ensure information and evidence is collected:

How often are clients assessed?

A client's first DMI must be completed after they obtain an 'employment outcome'.

An employment outcome is defined as:

'… employment for at least 8 hours per week for at least 13 weeks.'

Clause 17, Standard Terms and Conditions of Funding

After this, a reassessment is required every two years. In other words, every two years another DMI is completed.

Note: You can request a DMI reassessment before the two year period is up, if a client's support needs change significantly. (See What if a client's support needs change after their DMI score is determined? for more information.)

It's important that DMIs are completed on time. Payments can be suspended if they aren't completed by three months after the due date. And if they aren't completed four months after the due date, the case will be exited from the system. If payments are suspended or the case is exited you will not be back-paid. This can have a significant impact on the business service, and possibly on the support a client receives.

Business services are responsible for monitoring DMI assessment and reassessment dates – so you should have a system in place to manage this information. However, to assist this process FOFMS has begun to auto-generate reminders to authorised personnel of upcoming dates. (Remember that these automated processes rely on case records being correct and up-to-date – including the names and details of authorised personnel.)

Do I involve clients in the DMI assessment?

Under the Commonwealth Privacy Act 1988, you are obliged to explain to the client (or their advocate) their rights regarding the collection and use of personal information.

With this in mind, you should have a policy of informing clients of the DMI assessment, its purpose, and the anticipated assessment process. You should also discuss the results of the DMI with the client.

How much a client is involved in the completion of the DMI is up to the professional judgement of those undertaking the assessment.

Example 1:

A client has difficulty understanding the concepts covered in the questions. In this case, the DMI process is briefly and simply explained verbally, but the client has no other direct involvement in the assessment process.

Example 2:

A client has excellent cognitive capacity and communication skills. During some on-the-job observations they are asked to describe any difficulties they have in performing their job.

Whatever the situation or capability of the clients, it's important to note that you must never ask clients to complete their own DMI assessment – it's not their responsibility, and could compromise the outcome.

What is the assessment process?

There are five key stages in the assessment process.

Five key stages assessment process diagram

  1. Determine assessment focus

The first stage may seem obvious, but it's extremely important. Before you start, you need to be very clear about what you are assessing.

Example:

If you are assessing the level of assistance a client needs to understand and follow simple instructions, the key words are 'understand' and 'follow' – that's the focus of your assessment. You need to collect evidence about the level of support the client requires to 'understand' and 'follow' simple instructions.


  1. Decide assessment method

The next stage is deciding on the best way to assess. In other words, how do you go about collecting accurate and reliable evidence?

Example:

You are determining the level of assistance a client needs to be punctual in starting and finishing work. You decide the best way to do this is:

Asking the client's work supervisor to observe and keep records is a good way of collecting evidence for this assessment item. The work supervisor will be well aware of when the client arrives and leaves for work, and will also be directly involved in encouraging punctuality. Similarly, checking administration records would also be useful, as they may reveal some punctuality issues.

You would probably not ask the client's parents or work colleagues for information about the client's punctuality. In this situation, they may not be reliable sources of information. You need objective, documented evidence – not hearsay or undocumented verbal opinions.

  1. Collect evidence

Once you decide how you are going to assess or collect evidence, the next stage is doing it. There are some important points to remember when you are performing an assessment or collecting evidence.

  1. Collate data

The next stage is bringing all of the evidence together, and drawing out the facts. This may mean counting how many times a client did something, or how long they took with something. Or it may mean interpreting descriptions about the client's needs.

If there are any queries or you find conflicting data these need to be clarified. This may mean going back to the source of the evidence, or collecting more evidence.

  1. Perform assessment

And finally, you need to make a judgement. This means looking at what the evidence is telling you, looking at the rating category descriptions for that particular question (assessment item) on the DMI, and then making an objective judgement about which rating best describes the client's needs. The judgement is official when authorised personnel authorise the assessment in FOFMS.

What if I believe a client's future support needs may be different?

Example.

A business service has a client with a history of mental illness. Occasionally the client has episodes of debilitating depression, which dramatically affects their capacity to perform adequately in their job. Recently a support worker mentioned that she 'can feel' another episode coming on.

What should the organisation do, in terms of the client's DMI assessment?

The DMI can only be based on actual support required during the assessment period (previous three months). It should not be adjusted to cater for 'predictions' about the future levels of assistance a person requires.

If a client's support needs change significantly three months after their DMI was completed, you can contact FaCSIA and request a DMI reassessment. Evidence to support the need for a reassessment must be provided. It must show that the client has experienced significant physical, emotional or behavioural change, which has directly affected work performance or hours of work, and the level of support required. (See page 41 for more information about reassessment.)

How do other business services assess clients?

It may seem overwhelming and time consuming to collect evidence against 126 questions (assessment items), particularly for smaller organisations. However, there are systems you can introduce to streamline the process. An example of good practice follows.

Widehills Industries started by focusing on the nine domains in the DMI.

  1. Social and Behavioural Assistance
  2. Cognitive Assistance
  3. Vocational Assistance
  4. Physical Assistance and Personal Care
  5. Communication Abilities
  6. Workplace Environment Assistance
  7. Special Assistance
  8. Other Assistance
  9. Variable Assistance

Then, against each domain they recorded sources of evidence they had already developed or maintained for other purposes.

For example:

Domain Source of evidence
Social and Behavioural Assistance Professional assessments

Workplace assessment

Work reports

Positive Behaviour Support plan

File note records

The mapping of existing sources of evidence was useful to locate relevant data for each domain. (Widehills Industries also modified its workplace assessment template to include categories that aligned with the DMI domains – another way of streamlining data collected).

However, because the DMI focuses on the three months prior to submission, Widehills Industries decided to also develop and implement a simple evidence collection tool, to gather data during this period. They created a 'tick sheet' system, where supervisors and other workplace personnel record assistance provided to the client by ticking or recording small amounts of descriptive information on the sheets developed for each domain. The tick sheets were different for each domain to collect the specific data required to answer the questions (assessment items) on the DMI.

Physical Assistance and Personal Care

Date and tick each time assistance is provided during the day, for each assessment item. For example, if assistance is provided three times in one day, place three ticks against the assessment item.

How much assistance has been provided to enable the worker to: 30.03.05 10.04.05 19.04.05 01.05.05 05.05.05 29.05.05 08.06.05 14.06.05 25.06.05 30.06.05
Manipulate objects and complete gross motor tasks (eg tasks involving dexterity of fingers) relevant to work placement tick
tick
tick
    tick
tick
        tick
tick
 
Move objects around and complete gross motor tasks (eg tasks involving movement and coordination of arms and/or legs)   tick
tick
tick
tick     tick
tick
tick
  tick
tick
tick
   
Lift and move objects in accordance with the requirements of work placement and within safety limits     tick
tick
    tick
tick
  tick
tick
  tick
tick
Move around the workplace or training environment freely and safely                    
Set up and arrange own work environment, equipment and materials   tick
tick
      tick
tick
      tick
Maintain required work pace without tiring         tick         tick
See clearly to perform work related activities (when wearing glasses or contact lenses if normally worn)                    
Attend to toileting and personal hygiene needs tick
tick
tick
tick
tick
tick
  tick
tick
tick
tick
  tick
tick
  tick
tick
Prepare and consume drinks and food at work or work preparation setting tick   tick
tick
tick     tick
tick
  tick  
Manage own medication while at work   tick tick   tick   tick tick    
Maintain personal comfort and pressure area care (if unable to walk)                    
Manage pain associated with physical injury or illness   tick         tick     tick
Transfer between wheelchair and other seating and/or load and unload from wheelchair transport                    
Any additional notes

Special Assistance

Record date and duration of assistance, for each assessment item.

Over the past three months, has the worker required any of the following types of special assistance? Date Duration
Physical intervention by staff to prevent injury to self or others (eg due to aggression or self-injurious behaviour) 06.04.07 10 mins
Non-physical intervention by service staff to prevent injury to self or others (eg verbal intervention, behaviour management strategies) 05.0407
02.04.07
01.04.07
10 mins
10 mins
10 mins
First aid treatment for episodic conditions such as epilepsy or asthma or incidents such as falls or other immediate threats to health    
Counselling or other intervention for SEVERE mental health-related episodes such as severe stress, anxiety, panic attack, delusions or suicidal threat    
Counselling for less acute issues such as grief, behavioural issues 08.04.07 20 mins

It would be time consuming to fill in the sheets every day over the entire three month period. So, to get a good sample of evidence, it was decided that a minimum of ten working days had to be covered for most domains over a three month period. The exceptions were:

which were monitored over the entire three month period.

When it's time to complete the DMI, Widehills Industries reviews the data collected on the tick sheets, as well as cross checking this with other relevant sources of evidence identified in their original mapping. With this evidence, they are able to complete the DMI satisfactorily. All tick sheets are then stored in the client's file, as evidence for audit.

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