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Disability Maintenance Instrument: Frequently Asked Questions

Chapters

The Domains

What are the domains?

The nine domains in the DMI are a way of categorising the questions. Each focuses on a specific behavioural or functional area where a client may require support. The nine domains are:

The following table show the nine DMI domains, and the questions included in them. Reading through them will give you an understanding of what each domain covers.

Domain Description
Social and Behavioural Assistance Over the past three months, what level of assistance has this service provided to enable the worker to:
  1. maintain friendly and cooperative relationships with others
  2. greet and interact with people confidently
  3. behave appropriately in interview, assessment, work experience or work situations
  4. control anger and frustration appropriately
  5. cope with work-related stress and pressure appropriately
  6. maintain a positive outlook and mood most of the time
  7. manage fear or anxiety about work issues
  8. display emotions appropriate to the situation
  9. cope with change in the work environment
  10. address attitudinal barriers, eg difficulty in dealing with authority figures and difficulty accepting direction
  11. maintain personal hygiene, grooming and dress appropriate to work environments.
Cognitive Assistance Over the last three months, what level of assistance has this service provided to enable the worker to:
  1. learn complex tasks (eg involving three or more steps) relevant to their current job after being shown or instructed in the task once or twice
  2. learn simple tasks (eg involving one or two steps) relevant to their current job after being shown or instructed in the task once or twice
  3. solve problems and make decisions appropriate to current work role
  4. understand and follow complex new instructions (eg involving three or more steps)
  5. understand and follow simple new instructions (eg involving one or two simple steps)
  6. remember tasks or instructions for the remainder of the work/ training day after being shown or told
  7. remember tasks or instructions several days after being shown or told
  8. concentrate on tasks without being distracted
  9. plan and organise work tasks.
Vocational Assistance Over the past three months, what level of assistance has this service provided to enable the worker to:
  1. undertake the full range of tasks required for current job
  2. understand the basic requirements of employment (eg attending work, reporting to supervisor, complying with instructions)
  3. demonstrate a level of work productivity and work quality acceptable in the workplace (including under supported wages system)
  4. work on task under the usual supervisory conditions for at least 30 minutes
  5. work on task under the usual supervisory conditions for at least 1 hour
  6. understand time and be punctual in starting and finishing work and scheduled breaks
  7. respond appropriately to instructions from work/work preparation supervisor
  8. use initiative appropriately in the workplace (eg initiate work tasks, move on to the next step, etc)
  9. asks for assistance appropriately if required
  10. comply with safety requirements in the workplace or work preparation sessions
  11. attend at least 95% of work or work preparation sessions
  12. give appropriate notification of any absences (eg due to sickness)
  13. contact employer by telephone
  14. adapt to environment conditions in the workplace (eg noise, heat, cold, humidity)
  15. travel to and from work independently (eg travel training or assisting with transport bookings)
  16. develop awareness and acceptance of own abilities and limitations in work activities and employment goals
  17. be motivated and enthusiastic about current employment.
Physical Assistance and Personal Care Over the past three months, what level of assistance has this service provided to enable the worker to:
  1. manipulate objects and complete gross motor tasks (eg tasks involving dexterity of fingers) relevant to work placement
  2. move objects around and complete gross motor tasks (eg tasks involving movement and coordination of arms and/or legs)
  3. lift and move objects in accordance with the requirements of work placement and within safety limits
  4. move around the workplace or training environment freely and safely
  5. set up and arrange own work environment, equipment and materials
  6. maintain required work pace without tiring
  7. see clearly to perform work related activities (when wearing glasses or contact lenses if normally worn)
  8. attend to toileting and personal hygiene needs
  9. prepare and consume drinks and food at work or work preparation setting
  10. manage own medication while at work
  11. maintain personal comfort and pressure area care (if unable to walk)
  12. manage pain associated with physical injury or illness
  13. transfer between wheelchair and other seating and/or load and unload from wheelchair transport.
Communication Abilities Assessors are ask to select the ratings category that best fits the worker's communication abilities for each item:
  1. understanding language
  2. expressive language
  3. speaks another language
  4. hearing
  5. other language uses.
Workplace Environment Assistance During the past three months, which of the following types of assistance has your service provided or funded for the worker:
  1. workplace assessment (eg assessment of worksites for physical accessibility and/or modification requirements)
  2. negotiating and arranging modifications to the workplace environment (eg building modifications, ramps)
  3. job modification or redesign to match the capabilities of the worker
  4. selection and procurement of adaptive equipment or technology
  5. training the worker in the use of adaptive equipment or technology
  6. training co-workers in the use of adaptive equipment and technology
  7. supporting co-workers to adjust to the worker's abilities and workplace support needs
  8. supporting the employer to accommodate the worker's abilities and workplace support needs
  9. not applicable – no workplace environment assistance.
Special Assistance During the past three months, has the worker required any of the following types of special assistance in the workplace or preparation setting:
  1. physical intervention by staff to prevent injury to self or others (eg due to aggression or self-injurious behaviour)
  2. non-physical intervention by service staff to prevent injury to self or others (eg verbal intervention, behaviour management strategies)
  3. first aid treatment for episodic conditions such as epilepsy or asthma or incidents such as falls or other immediate threats to health
  4. counselling or other intervention for SEVERE mental health-related episodes such as severe stress, anxiety, panic attack, delusions or suicidal threat
  5. counselling for less acute issues such as grief, behavioural issues.
Other Assistance During the past three months, which of the following types of other assistance has your service provided or funded:
  1. advising or counselling the worker's family regarding the worker's employment related issues
  2. assisting the worker in employment related matters involving other agencies (eg declaring income to Centrelink)
  3. liaising with other agencies and treating professionals regarding the worker's disability, medical or psychiatric condition
  4. providing recognised pre-vocational training (eg training towards a recognised vocational certificate or New Apprenticeship)
  5. transporting the worker to and from work, training or other employment related appointments
  6. interpreter assistance for interviews and/or work orientation (eg sign language interpreter or other language interpreter)
  7. English language and/or literacy training for the worker
  8. assisting the worker with career planning, development and progression
  9. not applicable – none of these items of assistance have been provided or funded by the service in the past three months.
Variable Assistance The Variable Assistance Domain has three categories. Based on your assessment, observations and other evidence collected over the past three months, indicate the worker's assistance needs in the following categories:
  1. the frequency of variation in the worker's assistance needs
  2. fluctuations in assistance needs
  3. evidence of any episodic conditions.

Why are there so many questions?

In total, there are 126 questions (assessment items) in the DMI.

At first glance, it may seem unnecessary to have so many – and a huge task to collect evidence for each of them. But it's important to keep in mind that the aim of the DMI is to measure the level of support a client requires to do their job.

There are many tasks or situations where a client may need support in the workplace. The questions (assessment items) aim to capture that information, so that a reliable and complete 'picture' of the client emerges. Each question (assessment item) is designed to cover a specific task or functional area that may affect the level of assistance a client may require.

What if I have trouble interpreting a question?

The questions (assessment items) in the DMI deal with a range of behavioural and functional areas where clients may require support. Functional areas are usually easier to interpret and 'assess', as they deal with what a client can do – the tasks they can perform.

Example:

What level of support is required to assist a client with toileting and personal hygiene? (Physical Assistance and Personal Care, assessment item C)

In this instance, the question is clear and measurable – does the client need assistance with toileting. Those supporting the client would be able to identify and describe the type of support the person requires for this task, such as assistance with clothing, reminders to wash hands, turning on taps.

However, behavioural questions can sometimes appear more difficult to interpret and 'assess'. They deal with who the client is – their emotions, personality, moods, behaviour. We all have 'good' and 'bad' days, different types of personalities, different values, different cultural backgrounds, etc.

Example:

What level of support is required to assist a client to cope with work-related stress and pressure appropriately? (Social and Behavioural Assistance, assessment item E)

This question may be open to some interpretation, as it's dealing with an area that's more difficult to measure. Does it mean discussing stress reduction techniques with the client? Asking how they are going if they appear stressed? Discussing and implementing time management techniques? Or noting how many moments of anger and frustration the client displays?

If you have any queries about questions (assessment items) in the DMI, particularly ones relating to behaviour or communication, there are some options.

  1. Select the 'Information' icon on the top right of the DMI screen.
  2. Select the 'View Rating Definitions' link on the DMI, to have a look at the rating categories in more detail. This may clarify what you need to look for, or how to measure a question you're finding difficult to interpret.
  3. Contact FaCSIA for assistance. It's better to discuss a query than take a guess or simply make something up. Misinterpreting a question could have an impact on the rating category selected, which in turn could impact on the final score and funding for the client.

What are the rating categories?

Each question on the DMI needs to be 'answered' by selecting a rating category. The rating categories are there to describe the different levels of support a client may need for a behavioural or functional area.

There are different rating categories used throughout the DMI domains. You only select one rating per question, unless asked otherwise.

The following information explains the rating categories used for each of the domains. Reading through them will give you an understanding of each one. If you have access to the DMI, you can also select the 'View Rating Definitions' link on the DMI itself, to have a look at the rating categories in more detail.

Social and Behavioural Assistance, Cognitive Assistance, Vocational Assistance, and Physical Assistance and Personal Care

The Social and Behavioural Assistance, Cognitive Assistance, Vocational Assistance, and Physical Assistance and Personal Care domains have the same rating categories.

Rating category Description
No assistance provided Worker consistently achieved this with no prompts, training, counselling or other support during the past three months.
Some assistance provided Worker required up to three or four prompts, reminders, counselling, additional training sessions, or other support during the past three months.
Moderate level of assistance provided On average worker required weekly prompts, reminders, counselling or training sessions, or other support during the past three months.
High level of assistance provided Worker required frequent (eg daily) prompting, reminders, counselling, training, or other support during the past three months.

Figure 3: Assessment items in the Social and Behavioural Assistance domain.

Figure 3: Assessment items in the Social and Behavioural Assistance domain

Communication Abilities

The Communication Abilities domain contains five items, some of which have further sub categories:

  1. Understanding language:
  1. Expressive language:
  1. Speaks a language other than English.
  2. Hearing.
  3. Other language use issues.

For each of the above, there is a selection of descriptive ratings to choose from. Only one rating is selected for each, except in the 'Other language use issues' item – more than one rating category can be selected here.

Figure 4: Descriptive ratings for the Communication Abilities domain.

Figure 4: Descriptive ratings for the Communication Abilities domain

Workplace Environment Assistance and Other Assistance

In the Workplace Environment Assistance and Other Assistance domains, more than one rating can be selected, depending on what applies. When you select categories for these domains, you need to consider whether your business service has provided or funded any of the listed types of assistance to the client.

Figure 5: Assessment items in the Other Assistance domain.

Figure 5: Assessment items in the Other Assistance domain

Special Assistance

When you rate the five items in the Special Assistance domain there are three steps. First, you need to select the yes/no rating to indicate whether assistance is required. If 'yes' is selected, you then select one of the following rating categories to indicate how often the assistance has been required:

And finally you select one of the following rating categories to indicate how long assistance was required for on each occasion.

If assistance was required on more than one occasion, the length of time should be averaged.

Example:

A client required assistance on two occasions during the previous three months. The first time was for a duration of 5 minutes, and the second time was for 25 minutes. The average would therefore be 15 minutes – select the 'Assistance for between 10 and 30 minutes' category.

Figure 6: Assessment items in the Special Assistance domain, with three levels of categories.

Figure 6: Assessment items in the Special Assistance domain, with three levels of categories

Variable Assistance Domain

The Variable Assistance domain contains three parts:

Descriptions appear on screen.

Figure 7: Assessment items in the Vairable Assistance domain.

Figure 7: Assessment items in the Vairable Assistance domain

What if a client doesn't 'fit' a rating category?

Example:

You are involved in a DMI assessment for a client with a significant hearing impairment. You are not sure how to respond to some of the questions.

For example, the client is not taking any medication, so what rating should you select for the question about the level of support required to manage own medication while at work? (Physical Assistance and Personal Care, assessment item J)? Or in the same domain, assessment items K, L and M which seem to only relate to clients in wheelchairs, ie pressure area care, transferring from wheelchair to other seating, managing pain associated with physical injury.

Remember that all questions in the DMI need to be answered, even if, like in the example above, they appear to be completely irrelevant to the support needs of a particular client, or the descriptive ratings – such as those used in the Communication Abilities domain – don't describe the client's situation or abilities exactly. So what should you do?

You need to select the rating that most closely describes the client's situation. In the example above, select the 'no assistance required' rating for the questions (assessment items) mentioned, as this best describes the situation – the client has no need for assistance in these areas. The same goes for descriptive ratings – select the rating/s that best describe the client.

What if a client fits more than one rating category?

Some of the questions in the DMI allow you to select more than one rating – such as in the 'Other language use issues' of the Communication Abilities domain. But for many of the questions you are only able to select one rating.

Example:

A client interacts with people she knows, such as her work colleagues in the organisation, very well. However, she tries to avoid talking to people from outside the organisation, such as contractors.

On the one hand, it could be said that the client requires little or no assistance in greeting people confidently (Social and Behavioural Assistance, assessment item B); but on the other hand she requires a significant amount of support and guidance in greeting people from outside the organisation.

In the previous question, the message was to always select the rating that most closely describes the client's situation. The same message applies here. In this situation, you would need to look at the evidence that's been collected, and select the rating that best describes the client's support needs in maintaining their employment. If they need to deal with outside contractors as part of their employment requirements, then yes, they require support and guidance in greeting people. How much? Go to the evidence collected, look at what the evidence is telling you, and select the rating that best describes the situation. If, however, the majority of the client's interaction is with people they feel comfortable with, the best rating would be 'no assistance required.'

How do I know I've selected the correct rating/category?

If you have followed the process correctly and applied the principles and guidance contained in this manual, you'll select the best rating category for each assessment item.

Ask yourself the following questions.

If you can confidently answer 'yes' to these questions, you have selected the correct rating category. If you can't, you need to go back and look at the evidence. If there's insufficient evidence, you may need to collect some more.

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