Disability Maintenance Instrument: Frequently Asked Questions
- What are the domains?
- Why are there so many questions?
- What if I have trouble interpreting a question?
- What are the rating categories?
- Social and Behavioural Assistance, Cognitive Assistance, Vocational Assistance, and Physical Assistance and Personal Care
- Communication Abilities
- Workplace Environment Assistance and Other Assistance
- Special Assistance
- Variable Assistance Domain
- What if a client doesn't 'fit' a rating category?
- What if a client fits more than one rating category?
- How do I know I've selected the correct rating/category?
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:
- Social and Behavioural Assistance
- Cognitive Assistance
- Vocational Assistance
- Physical Assistance and Personal Care
- Communication Abilities
- Workplace Environment Assistance
- Special Assistance
- Other Assistance
- Variable Assistance.
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.
|Social and Behavioural Assistance||Over the past three months, what level of assistance has this service provided to enable the worker to:
|Cognitive Assistance||Over the last three months, what level of assistance has this service provided to enable the worker to:
|Vocational Assistance||Over the past three months, what level of assistance has this service provided to enable the worker to:
|Physical Assistance and Personal Care||Over the past three months, what level of assistance has this service provided to enable the worker to:
|Communication Abilities||Assessors are ask to select the ratings category that best fits the worker's communication abilities for each item:
|Workplace Environment Assistance||During the past three months, which of the following types of assistance has your service provided or funded for the worker:
|Special Assistance||During the past three months, has the worker required any of the following types of special assistance in the workplace or preparation
|Other Assistance||During the past three months, which of the following types of other assistance has your service provided or funded:
|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:
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.
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.
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.
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.
- Select the 'Information' icon on the top right of the DMI screen.
- 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.
- 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.
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.
|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.
The Communication Abilities domain contains five items, some of which have further sub categories:
- Understanding language:
- understands complex language
- understands simple language
- difficulty understanding language.
- Expressive language:
- uses complex language
- uses simple language
- difficulty speaking.
- Speaks a language other than English.
- 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.
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.
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:
- not required in the past three months
- required once in the past three months
- required more than once in the past three months (but not every week)
- required at least once each week.
And finally you select one of the following rating categories to indicate how long assistance was required for on each occasion.
- Not applicable – has not occurred in the past three months.
- Assistance for less than 10 minutes.
- Assistance for between 10 and 30 minutes.
- Assistance for more than 30 minutes.
If assistance was required on more than one occasion, the length of time should be averaged.
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.
The Variable Assistance domain contains three parts:
- Part (a) concerns the frequency of variation in the client's assistance needs – select one of five rating categories which range from fairly stable and consistent to varying continuously.
- Part (b) involves the magnitude or size of fluctuations in assistance needs. There are three rating options:
Descriptions appear on screen.
- Part (c) asks if there is any evidence (such as a letter from a psychiatrist) within the past two years that the worker has an episodic condition. The response is a simple yes or no.
Figure 7: Assessment items in the Vairable Assistance domain.
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.
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.
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.'
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.
- Do I have evidence to support my decision?
- Has the evidence been collected over the previous three months or more?
- Is the evidence about support needs to maintain employment (not general support needs)?
- What is the evidence telling me about the amount of support provided? (Remember, 'support' means any employment-related assistance or intervention provided or funded by your organisation.)
- Based on all the evidence, does the rating category best describe the client's situation?
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.