HELP – Personal Helpers and Mentors Program

Eligibility Screening Tool (EST) - Contents:

Detailed help information for each EST Form question is available via the section links below.

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Client Information
Demographics
Carer
Institutional Details
Alcohol/Drugs
Mental Illness
Functional Information
Employment
PHaMs Employment

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Question 1: Agency ID

Defined as:

A unique system generated identifier that identifies a particular service provider.

Guide for use:

This identifier is automatically generated when the service provider’s funding agreement details are entered into DSS’s Online Funding Management System.

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Question 2: External Person ID

Defined as:

A unique system generated identifier that identifies a particular applicant.

Guide for use:

This identifier is automatically generated when application is first started.

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Question 3: Date of application

Defined as:

The date the applicant first seeks assistance from your organisation for the PHaMs service.

Guide for use:

Record the date that a person first applies for PHaMs (dd/mm/yyyy)

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Question 4: Has the PHaMs Service “Consent to the collection, use and disclosure of information” form been signed?

Defined as:

Whether the applicant has provided informed consent in writing, using the PHaMs Consent to the collection, use and disclosure of information Form, for data to be provided to DSS for PHaMs purposes.

Guide for use:

The PHaMs service consent form should be completed with the applicant (or legal authority/person responsible for applicant) prior to commencing the assessment for eligibility.
Select ‘Yes’ if you have provided information to the applicant about what information is collected, who can access the information and how the information will be used, and they have given in writing their consent.
Select ‘No’ if the applicant has been asked to give written consent but has refused, or if written consent was not given. Note: This would make the applicant INELIGIBLE for PHaMs.

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Question 5: Does the applicant’s functional limitation prevent them from being able to make an informed decision to participate in the service?

Defined as:

Whether the applicant’s functional limitation prevents them from being able to make an informed decision to participate in the service (including in conjunction with a third party where appropriate).

Guide for use:

Select ‘Yes’ if the applicant’s functional limitation prevents them from being able to make an informed decision to participate in the service (including in conjunction with a third party where appropriate). This makes the applicant INELIGIBLE for PHaMs.
Select ‘No’ if the applicant is able to make an informed decision to participate in PHaMs (including in conjunction with a third party where appropriate)
People whose functional limitation prevents them from being able to make an informed decision to participate in the service (including in conjunction with a third party where appropriate) are not eligible for PHaMs services.

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Question 6: Statistical Linkage Key Determination

Defined as:

SLK is a system generated alphanumeric code used to symbolise a record.

Question 6a: What is the applicant’s date of birth?

Defined as:

The date of birth of the applicant.

Guide for use:

Record the date using the DD/MM/YY format. Thus, if the date if 2 July 1970, this would be recorded as 02/07/1970.
To be eligible for the PHaMs service, an applicant must be 16 years of age or older (unless applying for support from a designated Remote service site).
Young people – aged 16 to 24 years – are included as one of the PHaMs special needs groups.

Question 6b: Is the applicant’s date of birth an estimate?

Defined as:

Date of birth estimate flag.

Guide for use:

Select ‘Yes’ if date of birth has been estimated.
Select ‘No’ if the applicant’s actual date of birth was specified in question 6A.
To be eligible for the PHaMs service, an applicant must be 16 years of age or older.
It is important to remember that in some CALD and Indigenous cultures actual date of birth may not be recorded and transient or homeless applicants may not have access to such records. For example, an applicant may know they were born in July and that they are 45 years old.

Question 6c: What is the first name and surname of the applicant?

Defined as:

The first and last name of the applicant.

Guide for use:

Type the first name of the applicant into the space provided.
Type the surname of the applicant into the space provided.
It is important that service providers and applicants are aware that an applicant’s name is not stored at all and is used to generate the SLK. It cannot be viewed by the Australian Government, service providers or any third party.

Question 6d: What is the sex of the applicant?

Defined as:

The gender of the person requesting services from PHaMs.

Guide for use:

Asking the sex of the applicant is usually unnecessary and may be inappropriate, or even offensive. It is acceptable to assume the sex of the applicant through observation, their first name, or on the sex nominated by the applicant themselves.
If an applicant is transgender, record whichever sex the applicant identifies as. Applicants should feel comfortable and not stressed with completing the EST process.

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Question 7: What is the applicant’s current/usual residential setting?

Defined as:

The setting in which a person usually resides. Usual meaning 4 or more days per week.

Guide for use:

Select only one option.
Record the type of residential setting in which the applicant usually resides at the time of the assessment interview.
Private residence: A largely self-contained dwelling (house, flat, apartment, unit or other dwelling) intended for occupation by one or more usual residents. It includes dwellings rented from public housing authorities and community organisations, and dwellings owned, being purchased or being rented privately.
Domestic-scale supported living facility: refers to community living settings in which service users reside in a facility that provides support in some way by staff or volunteers. This category includes group homes, cluster apartments where a support worker lives on site, and community residential apartments. This setting may or may not have 24-hour supervision and care. Independent living in a retirement facility should be recorded under the ‘Residential aged care facility’ category.
Residential mental health service: refers to a specialised mental health service that employs mental health-trained staff on-site, provides rehabilitation, treatment or extended care to residents in a domestic-like environment, and encourages the resident to take responsibility for their daily living activities.
- If an applicant is residing in a residential mental health service at the time of application, they would be INELIGIBLE to participate in PHaMs.
Psychiatric or acute care hospital: refers to an establishment either devoted to the treatment and care of inpatients with psychiatric, mental, or behavioural disorders, or an establishment that provides at least minimal medical, surgical or obstetric services for inpatient treatment and/or care, and which provides round-the-clock comprehensive qualified nursing service and other necessary professional services.
- If an applicant is residing in a psychiatric or acute care hospital at the time of application, they would be INELIGIBLE to participate in PHaMs
Specialised alcohol or other drug treatment residence: refers to residential services such as drug and alcohol units within and outside of hospitals.
- If an applicant is residing in a specialised alcohol or other drug treatment residence at the time of application, they would be INELIGIBLE to participate in PHaMs
Prison, remand centre or corrective institution: refers to establishments for people who committed, or are suspected of having committed, a criminal offence, or it is likely that they will re-offend without adequate treatment or containment.
- If an applicant is residing in a prison, remand centre or corrective institution at the time of application, they would be INELIGIBLE to participate in PHaMs.
Residential age care facility: refers to a nursing home or an aged care hostel.
Supported accommodation facility: refers to settings in refers to settings in which applicants reside in an accommodation facility which provides board or lodging for a number of people and which has support services provided on what is usually a 24-hour basis by rostered care workers. This setting includes hostels for people with disabilities. This category should be used for larger supported accommodation facilities (usually 7 or more people) that provide 24-hour supervision or care. Smaller supported accommodation facilities (i.e. less than 7 people) which may or may not have 24-hour supervision or care should be recorded under the ‘Domestic-scale supported living facility’, while aged care hostels should be recorded under the ‘Residential aged care facility’ category.
Boarding house/private hotel: refers to a self-contained unit within a boarding house with separate cooking, bathroom, and toilet facilities. Aged care hostels should be recorded under the ‘Residential aged care facility’ category.
Public place/temporary shelter/homeless/couch surfing: includes non dwelling, living rough and informal housing for a short-term. The applicant may also be considered to be homeless if they have no regular place of residence, such as those staying temporarily in the homes of friends or family, or if they are living in insecure accommodation.
A couch surfer is someone who is unable to, or chooses not to, have their own accommodation (rental or otherwise) for various reasons and moves between places. It is a form of lodging where an individual relies upon friends and relatives for short periods at a time.
Caravan: Includes caravans in caravan parks, vacant land or elsewhere.
Other: Where the residential setting is known but is not specified in the classification above, please select ‘Other’ and provide further details in the space provided. Note: Please ensure any of the responses listed here do not belong in any of the above categories.

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Question 8: Is the applicant of Aboriginal or Torres Strait Islander origin?

Defined as:

Whether or not the applicant identifies themselves as being of Aboriginal and/or Torres Strait Islander origin.

Guide for use:

Select only one option.
This question should be asked regardless of your perception based on appearance or other factors.
If applicant does not wish to answer please select “Does not wish to identify”.
Indigenous status does not include ‘South Sea Islander origin’. People of ‘South Sea Islander origin’ should be recorded as “Neither”.

Question 8a: Is the applicant a member of the Stolen Generation ?

Defined as:

Whether or not the applicant identifies themselves as a member of Stolen Generation.

Guide for use:

Select only one option.
If ‘Yes’ has been answered for Q8 Indigenous, Please answer ‘Yes’ or ‘No’.

Question 8b: Is the applicant a Stolen Generation family member?

Defined as:

Whether or not the applicant identifies themselves as a Stolen Generation family member.

Guide for use:

Select only one option.
If ‘Yes’ has been answered for Q8. Please answer ‘Yes’ or ‘No’.

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Question 9: Place of residence

Postcode

Question 9a: Where does the applicant usually live?

Defined as:

Whether the applicant’s usual residence falls within the allocated site boundaries, outside boundaries or if the applicant is homeless at the time of application. Usual residence meaning where the applicant lives for 4 or more days per week.

Guide for use:

Select ‘Within site boundaries’, if the participant is currently residing within the boundaries of the particular site.
Select ‘Outside of the postcode boundaries’, if the participant is currently residing outside of the boundaries for the site
Where an applicant is from outside your catchment area, you may service up to 10% of clients out of area without asking DSS for approval. If you have over 10% out of area, you should ask your funding agreement manager for approval to increase the number of out of area clients
Select ‘Homeless’, if the applicant has no regular place of residence e.g. staying temporarily in the homes of friends or family, or “living rough”/on the streets.

Question 9b: If ‘Within site boundaries’ or ‘Outside of site boundaries’ what is the applicant’s postcode?

Defined as:

The postcode of the applicant’s usual residential address. Usual residential address means 4 or more days per week on average.

Guide for use:

If options ‘Within site boundaries’ or ‘Outside of postcode boundaries’ have been selected, please provide the postcode in the space provided

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Question 10: Does the applicant usually live alone or with others?

Defined as:

Whether the applicant lives alone or with other persons, can be either related or unrelated persons.

Guide for use:

Select only one option.
Record the living arrangements and people with whom the applicant usually lives.
Live alone: refers to living without any other individual, but includes living in a boarding house or hostel.
Lives with parent(s): refers to living with one or both biological or adoptive parents, with or without siblings or children and/or any other related or non-related person, or with a foster family.
Lives with partner/spouse and children: refers to living with a spouse or partner with or without biological or adopted children, or the spouse/partner’s children, including under shared (part-time) child custody arrangements.
Lives alone with children: refers to a person living only with biological or adopted children, including under shared (part-time) child custody arrangements. This may include a situation where a boarder is present in the home.
Lives with other related person(s): refers to a person living with other relatives such as brothers, sisters, grandfather, grandmother, uncles, aunts, grandchildren and so on.
Lives with unrelated person(s): refers to people living with other unrelated persons including living in shared accommodation with flatmates, and living in a supported group home, or living with a boarder present in the home. It also includes communal living arrangements such as in a boarding school or other institution
Other (please specify): refers to living arrangements not specified in the other categories, for instance, living with a spouse/partner and also living with parent(s).

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Question 11a: In which country was the applicant born?

Defined as:

The country in which the person was born.

Guide for use:

Select only one option.
Where the country of birth is known but is not specified, please select ‘Other’ and list the country in the space provided
Alternatively, if the country of birth is unknown, please select ‘Other’ and type ‘Unknown’ in the space provided.

Question 11b: Did the applicant arrive in Australia under Australia’s Humanitarian Program?

Defined as:

Humanitarian entrants are defined as people who are subject to substantial discrimination amounting to gross violation of their human rights in their home country, are living outside their home country and have links with Australia (http://www.immi.gov.au/visas/humanitarian/)

Guide for use:

Select only one option.
Select ‘Yes’ if applicant arrived in Australian under Australia’s Humanitarian Program

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Question 12: What cultural or language barriers need to be considered in delivering services to the applicant?

Defined as:

Culture and identity are central to CALD and Indigenous perceptions of ill health. These perceptions can influence why and when they will access services.

Guide for use:

This question must be answered.
More than one option can be selected from options 2-5.
If ‘None’ is selected, please move to question 14.
Cultural values, beliefs or assumptions: A value that is shared and influenced by a group of people from the same culture. The social justice model of the Cultural group and what is acceptable to this culture as compared to mainstream society.
Cultural behaviours: behaviour that is reflective of one’s belonging to a culture. Eg in Indigenous- Men and Women’s Business and Sorry Business. This influences the level of contact with the mainstream services as to what is appropriate for them
Verbal communication or spoken language: this relates to the ability of an individual to speak, hear and understand a particular language.
Written communication:Communication that occurs through a written representation of the language needs to be culturally and linguistically appropriate.

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Question 13a: Does the applicant speak a language other than English at home?

Defined as:

The primary language spoken by the applicant at home other than English

Guide for use:

Select only one option.
If ‘Yes’ is selected, please Move to question 13b
If ‘No’ is selected, please move to question 14.

Question 13b: If yes, please select a language

Indicate the language spoken most often if there is more than one

Defined as:

The primary language spoken most often by the applicant.

Guide for use:

Select only one option.
If ‘Yes’ has been answered for Q13, record the language reported by the applicant as the main language other than English spoken by that person in his/her home (or most recent private residential setting occupied by the person) to communicate with other residents and regular visitors.
Where the main language is known but is not specified in the drop down menu, please select ‘Other’ and specify the language in the space provided.
Where the main language is unknown, please select ‘Other’ and write “unknown” in the space provided

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Question 14: Does the applicant have a carer who provides care and assistance on a regular and sustained basis?

Defined as:

Whether a person has a formal carer or an informal carer, such as a family member, friend or neighbour, who has been identified as providing care and assistance on a regular and sustained basis.

Guide for use:

This question is about the presence of a carer. A carer is someone who provides a significant amount of care and/or assistance to the person.
Informal carer: is a family member, friend or neighbour who provides regular and substantial care and assistance to another person without payment for their caring role (other than a pension or benefit.)
Formal carer: is a carer or assistant who is a paid worker or volunteer arranged by a formal service, or is paid directly by the care recipient to provide personal care.
Regular and sustained: in this instance means that care or assistance has been ongoing, or is likely to be ongoing, for at least 6 months.

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Question 15: Caring for children

Question 15a: Does the applicant have primary (or shared equal) caring responsibility for children?

Defined as:

Whether the applicant has caring responsibilities for children.

Guide for use:

Select only one option.
Select ‘Yes’, if the applicant has primary or shared equal caring responsibilities for children.
Select ‘No’, if the applicant does not have primary or shared equal caring responsibilities for children. Then proceed to question 16.
If care is shared equally between two or more parties (such as the care of a child by two parents who live with the child), this should be included.

Question 15b: How many children does the applicant have primary (or shared equal) caring responsibility in each of the following age groups?

Defined as:

How many children for whom the applicant has caring responsibilities for and their age range.

Guide for use:

If ‘Yes’ has be answered in 15a, record the number of children cared for by the applicant in each age group listed in the table.
Multiple responses may be reported when the applicant has children in different age ranges.
Older dependent children: refers to a child aged 15-24 years who attends a secondary or tertiary educational institution as a full-time student and who has no partner or child of his or her own usually resident in the same household. This definition also includes dependents of any age that may be fully dependent on the applicant for a particular reason e.g. severe intellectual disability.
This information refers to the number of children, by age, for which the applicant has primary care responsibilities

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Question 16: Does the applicant have primary carer responsibilities for another person?

Defined as:

Whether the applicant has other caring responsibilities.

Guide for use:

More than one option can be selected from options 2-5.
If ‘None’ is selected, please proceed to question 17.
Include people for whom caring responsibilities are equally shared.
Where carer responsibilities for other persons are known but are not specified, please select ‘Other’ and specify in the space provided

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Question 17: Has the applicant been institutionalised for 3 or more months in the last 2 years, including as a resident in a residential mental health service, an admitted patient in a psychiatric or acute care hospital, prison, remand centre or corrective institution?

Guide for use:

If ‘Yes’ is selected, proceed to question 18.
If ‘No’ is selected, proceed to question 19.
A period of three months can be cumulative or consecutive

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Question 18: What was the applicant's previous institutional setting?

Defined as:

The institutional setting in which the applicant resided for 3 or more months in the last 2 years.

Guide for use:

The question will only be activated if ‘Yes’ was selected in the previous question.
More than one option can be selected.
Where the previous institutional setting is known but is not specified in the options provided, please select ‘Other’ and specify in the space provided.
Residential mental health service: refers a to specialised mental health service that employs mental health-trained staff on-site, provides rehabilitation, treatment or extended care to residents in a domestic-like environment, and encourages the resident to take responsibility for their daily living activities.
Psychiatric or acute care hospital: refers to an establishment either devoted to the treatment and care of inpatients with psychiatric, mental, or behavioural disorders, or an establishment that provides at least minimal medical, surgical or obstetric services for inpatient treatment and/or care, and which provides round-the-clock comprehensive qualified nursing service and other necessary professional services.
Prison, remand centre or corrective institution: refers to establishments for people who committed, or are suspected of having committed, a criminal offence, or it is likely that they will re-offend without adequate treatment or containment.

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Question 19a: Has the applicant ever been institutionalised or long term care, as a child?

Defined as:

Whether an applicant has ever been institutionalised, or in long term care, as a child (from 0 to 18 years of age).

Guide for use:

Select ‘Yes’ if the applicant has ever been in foster care, an orphanage, a boys/girls home or a corrective facility during their childhood, up to 18 years of age.
If ‘Yes’ is selected, record the type of institution from the drop down menu shown.
Where the type of institution is known but is not specified in the drop down menu, please select ‘Other’ and specify the institution in the space provided
Where the institution type is unknown, please select ‘Other’ and write “unknown” in the space provided.
If ‘No’ is selected, please move to question 20.
Foster Care: is provided to children unable to live at home due to risk of abuse and neglect. Children are placed with appropriate caregivers who are assessed, trained and supervised by a community services organisation. The majority of children referred to foster care services are the subject of protective services intervention. A small percentage of clients enter the system on a voluntary basis.
Orphanage:Is an institution devoted to the care of children whose parents are deceased or otherwise unable to care for them. In the absence of a parent, grandparent or legal guardian willing to care for a child they become a ward of the state, and orphanages are a way of providing for their care and housing.
Boys/girls home: Places where children were placed to live because they:
- Were in State care, because the State considered their parents unfit;
- Had parents who were dead, in prison, missing or otherwise unable to care for them;
- were given up by their parent/s because the parent/s could not provide for them. Sometimes parents worked and used the Home as a form of child care. If they could, they paid maintenance to those running the Home;
- were children of sole parents, particularly girls, who were removed because of “moral danger”
- were aboriginal children forcibly removed from their parents under the Aborigines Protection Act of 1909.
Corrective facility: Means any penal or correctional facility, jail, reformatory, detention centre, work farm, halfway house, or residential community program centre.

Question 19b: Does the applicant identify as a Forgotten Australian?

Defined as:

People who were raised in institutional care (out of home care, including entrants from the child migration program and Indigenous children) last century, predominately between 1930 and 1970.

Guide for use:

Select only one option.

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Question 20: Is the person currently restricted in their ability to fully participate in the community (i.e. residing in a psychiatric facility, detained in some way, on home detention or have movement restrictions) that would impede active and full participation in PHaMs?

Guide for use:

Select ‘Yes’ if:

The applicant is restricted in their ability to fully and actively participate in the community e.g. if they are currently held in prison, a remand centre, home detention or other corrective institution or residing a psychiatric facility.
The applicant has been released from detention/incarceration or if they are subject to any form of judicial order and the conditions attached to their release or order restrict their ability to fully and actively participate in the community.

An applicant is INELIGIBLE to participate in the PHaMs service while they are restricted in being able to fully and actively participate in the community.
Select ‘No if there are no restrictions on the applicant, that would affect them fully participating in their community. Weekly reporting to a criminal justice team or equivalent is not considered a restriction on participation.

Question 21: Is the applicant participating in a state/territory funded service or program that provides them with community support similar to PHaMs (as opposed to clinical or forensic support)?

Guide for use:

Select ‘Yes’ if:
- The applicant is receiving a state/territory funded service or program that provides them with community support similar to PHaMs (as opposed to clinical or forensic support).
Select ‘No’ if the applicant is not participating in a service that provides them with community support similar to PHaMs.
An applicant is INELIGIBLE for PHaMs if they are participating in a state/territory funded service or program that provides them with community support similar to PHaMs. The applicant is precluded from entering PHaMs until the period of state/territory support ends. This is to ensure that PHaMs compliments, rather than replaces state and territory funded services

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Alcohol/Drugs

Question 22: Does the applicant misuse alcohol or other drugs?

Defined as:

Whether the applicant regularly misuses alcohol and/or licit, illicit, prescription or over the counter drugs.

Guide for use:

More than one option can be selected from options 1-3.
If ‘Yes’ is selected, proceed to question 23.
If ‘No’ is selected, please proceed to question 24.
Information would be primarily sourced from the applicant, although additional sources such as family, carers, and friends could be used.

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Question 23: Is the applicant willing to address issues relating to their alcohol and other drugs misuse during the course of participation in PHaMs ?

Defined as:

Whether the applicant is willing to address issues related to their substance misuse.

Guide for use:

To be asked only of applicants who have been identified as having alcohol or other drug misuse and answered ‘Yes’ to Q22.
The response of ‘No’ should be selected in instances where the applicant is unwilling to address their substance misuse
Applicants need to be prepared to address their drug and/or alcohol issues as part of their ongoing goal setting and achievements. This willingness should be reflected as a part of the applicants Individual Recovery Plan
Applicants with drug and/or alcohol co-morbidity who are unwilling to address their substance misuse are INELIGIBLE for PHaMs
Willingness to address substance use issues is a condition of eligibility for PHaMs

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Question 24: What was the source of referral for this applicant?

Defined as:

The source from which the applicant was referred to the PHaMs service.

Guide for use:

Select only one option (note: listed in alphabetical order).
Where the source of referral is known but is not specified in the options available, please select ‘Other’ and specify in the space provided.
Alcohol or drug treatment services: Includes both residential and non-residential services. Includes drug and alcohol units within and outside of hospitals.
Centrelink: Includes those referrals by Centrelink.
Community Health Centres: Includes primary health community clinics, health centres and Health Services, Metro Access Services, GP Access Services, Day Clinic, Metro Homelink Teams.
Disability support services: Includes support services provided to people with a disability. These services might provide accommodation support, community access, community support and respite services.
Employment Services: This includes employment agencies such as Australian Wide Employment Services, CRS Australia (Commonwealth Rehabilitation Services), ITEC Employment, Jobfind Centre, Max Employment, Salvation Army Employment Plus, Job Network Centres, Disability Employment Services.
Family member, friend or carer: Refers to family members, friends and carers, whether or not that person accompanies the applicant, at the time of the application
General practitioner: Includes vocationally registered general practitioners, and vocationally registered general practitioner trainees.
Hospital: Includes public and private hospitals, hospitals specialising in dental, ophthalmic aids and other specialised medical or surgical care, satellite units managed and staffed by a hospital, emergency departments of hospitals, and mothercraft hospitals. Excludes psychiatric hospitals, psychiatric units and drug and alcohol units (i.e. the above two categories) located within or operating from hospitals, and outpatient clinics.
Housing/Homelessness support services: Includes housing services, such as those provided through the Supported Accommodation Assistance Program (SAAP), designed to assist people who are homeless or at risk of being homeless.
Personal Support Program: Includes referrals from the Personal Support Program (PSP).
Police, courts or correctional services: Includes those services provided by police diversion (when a person detained for a minor drug offence is formally referred to treatment by the police in order to divert the offender from the criminal justice pathway) as well as court diversion (i.e. the diversion of an offender into drug education, assessment and treatment at the discretion of a magistrate), which may occur at the point of bail or prior to sentencing.
Psychiatrist in private practice: Physicians who specialise in psychiatry within the private practice setting.
Psychologist in private practice: Clinical psychologists who provide mental health care within the private practice setting.
Self: Refers to the applicant approaching the PHaMs program of their own accord.
Specialised mental health care services: services of which the primary function is specifically to provide treatment, rehabilitation or community support targeted towards people affected by a mental disorder or psychiatric disability. Such activities are delivered from a service or facility which is readily identifiable as both specialised and serving a mental health function.
The information refers to the formal way the applicant was referred to your organisation or how the applicant found out about your organisation.

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Question 25: Does the applicant have a diagnosed mental illness? If no, go to Question 30

Defined as:

Whether the applicant has a diagnosed mental illness.

Guide for use:

if ‘Yes’ is selected, proceed to question 26.
if ‘No’ is selected, proceed to question 30.

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Question 26: What diagnosed mental illness(es) does the applicant have?

Defined as:

Confirmed diagnoses of mental illness at the time of assessment for PHaMs.

Guide for use:

If ‘Yes’ has been answered for Q25, this question is mandatory.
More than one option can be selected.
Where the diagnosis is known but is not specified in the classification above, please select ‘Other’ and specify in the space provided. Note: Ensure response placed here does not fit into any of the available categories.

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Question 27: What is the date on which the most recent diagnosis was made?

Defined as:

The date on which the applicant’s most recent diagnosis was made.

Guide for use:

This question is mandatory if the applicant has answered ‘Yes’ to question 25.
Record the date that the most recent diagnosis was made. Thus, if the date was 21 August, 2006, this would be recorded as 21/08/2006.
Select ‘Yes’ if the date recorded has been estimated.
Select ‘No’ if the date recorded is correct and has not been estimated.

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Question 28: Is the applicant currently receiving treatment for one or more of the diagnosed illnesses?

Defined as:

Whether an applicant is currently receiving treatment for one or more of the diagnosed mental illnesses.

Guide for use:

This question is related to questions 25 and 26, and is only required to be answered if a diagnosed mental illness has been recorded.
If ‘Yes’ is selected, go to question 29.
If ‘No’ is selected, go to question 13.
Currently means that the treatment must be no older than 12 months.

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Question 29: Who was the applicant treated by?

Defined as:

The health care provider who is currently providing treatment to the applicant.

Guide for use:

More than one option can be selected. This question is mandatory if selected ‘Yes’ for previous question.
The treatment must be no older than 12 months.
Specialised mental health services include accredited social workers and occupational therapists approved as Medicare Providers under the Better Access to Mental Health Care Schedule.
Where the health care provider is known but is not specified in the categories listed, please select ‘Other’ and specify in the space provided. Please ensure response does not apply to existing categories.

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Question 30: Is there other supporting evidence of a mental illness, as verified by, for example, a referral letter or direct communication (e.g. telephone or face-to-face) from a health care provider?

Defined as:

Whether there is supporting evidence of a mental illness from a mental health care provider, as verified by, for example, a referral letter or direct communication (e.g. telephone or face-to-face) or a current prescription for Mental Illness medications.

Guide for use:

Select only one option.
This question is mandatory only if ‘No’ has been answered for question 25.
If option 1-4 is selected, go to question 33.
If ‘None’ is selected, go to question 31.
The evidence must not be older than 12 months to assist in determining eligibility.
Specialised mental health services are those that specifically provide treatment, rehabilitation or community support targeted towards people affected by a mental disorder or psychiatric disability. Such activities are delivered from a service or facility which is readily identifiable as both specialised and serving a mental health function.
Supporting evidence (i.e. no older than 12 months) from a Psychiatrist, Specialised mental health service, a General Practitioner, or a Clinical psychologist is sufficient to establish the existence of a mental illness for PHaMs.

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Question 31: Is there evidence that the applicant is receiving a Disability Support Pension for psychiatric impairment?

Defined as:

Whether there is evidence that the applicant is receiving a Disability Support Pension for psychiatric impairment only.

Guide for use:

Select only one option.
If ‘Yes’ is selected, proceed to question 33.
If the applicant does not know, or cannot provide the appropriate supporting information, that they are receiving a Disability Support Pension for psychiatric impairment, select ‘No’ and proceed to question 32.
Evidence that a person receives Disability Support Pension is not sufficient. The person must have evidence that they were granted Disability Support Pension for a psychiatric impairment. This will usually be through the applicant’s grant letter or a letter from Centrelink. Centrelink will not give this information out over the phone, the participant must obtain this information from Centrelink to provide to the PHaMs worker. A PHaMs worker may assist the participant with this process.

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Question 32: Is there any of the following types of evidence to indicate that the applicant has a mental illness?

Defined as:

Whether there is another type of evidence that the applicant has a mental illness.

Guide for use:

This question is mandatory and must be answered if no selected for question 31.
Select only one option.
If option 1 is selected, evidence of a referral must not be older than 12 months.
Family, carers or friends are able to informally refer an applicant to PHaMs (where the applicant may not have had previous contact with specialised mental health services or other relevant service providers), where they are concerned that the applicant may have a mental illness. No formal referral is required.
Applicants are able to self-refer to PHaMs if they feel they need or want help. They do not necessarily have to admit they have a mental illness. No formal referral is required.
Select ‘None of the above’ if the applicant cannot provide any evidence of the option types listed.

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Question 33: How often does the applicant need personal help or supervision with activities or participation in the following life areas?

Defined as:

The need for support:

Personal Capacity Activities

Interpersonal relationships-i.e. forming and maintaining social and interpersonal relationships with family, friends, and other people, and interacting with other people in social situations.
Learning, applying knowledge and general demands-solving problems, making decisions, paying attention, organising daily routines and handling stress.
Communication-for example, participating in conversations and discussions, and expressing ideas clearly.

Community Participation Activities

Working and employment-undertaking activities to obtain and retain paid employment or self-employment.
Education-i.e. participating in school, college or any educational activities.
Social and community activities-i.e. participating in social and recreational activities, and engaging in religious, political and other community life.

Independent Living Activities

Domestic activities-undertaking activities such as caring for children and for other family or household members, shopping, preparing meals, housekeeping and maintaining a home.
Transportation and mobility-activities in getting around, such as moving around or leaving your home, accessing public transport; driving your car.
Self care-activities in taking care of yourself, such as maintaining reasonable levels of hygiene, standard of dressing, nutrition, managing diet and fitness, administering medication and managing general health.

Guide for use:

This question records information about a person’s need for support in each of the life areas because of a severe mental illness. Select only one category of support need frequency (always; most of the time; sometimes; never) in each life area.
In assessing the applicant’s need for support, the assessor should consider the ways in which the applicant’s mental health condition, and their thoughts, behaviours and emotions, may affect how well they can undertake their daily activities or participation in community life.
The ‘need for support’ is broadly defined, and can include any kind of support from another person or service, whether they are currently getting that support or not. The need for support should be ongoing (have lasted or be expected to last for 3 months or more). It does not include support such as medication, money or equipment.
For an applicant with episodic or cyclical mental illness, please assess the support needs taking into account the frequency of episodes over the past six months and the level of support needs during these episodes.
Where the applicant has a physical impairment co-occurring with mental illness, the rating should represent the functional limitation that is present as a result of the mental illness. Prompt questions and examples are included in Appendix (Glossary for Functional Assessment) to assist assessors when considering how to assess and rate functional limitations against each life area. The questions are designed to elicit information about some of the applicant’s interests in each life area, their concerns and support needs. It is recognised that distinguishing the cause of the functional limitation may not be possible for service providers to ascertain. In these circumstances service providers may use their judgement or rate the functional limitation irrespective of the cause.
The paper version of the EST can be used to record the discussion with the applicant, and as the basis for completing the electronic EST.
Where a life area includes a range of examples (e.g. domestic life includes caring for children and other household members, shopping and preparing meals), if a person requires support with any of these activities, then the highest level of support should be recorded.
The need for support in a particular life area may, or may not, be directly relevant to services that could be provided in the PHaMs service.
Some areas may appear less appropriate for an individual person than other areas, since they are intended to cover all possible applicants.
Some areas may not apply at all to the applicant, e.g. education may not apply if the applicant is not at a school, college or in another educational setting. In this case, the assessor should rate the applicant in this life area as ‘Does not need support in this life area’.
The data item is used as an assessment tool. It can also be used as a framework into which the results of other assessments and information already collected by your organisation can be mapped.

Additional information to help complete the functional assessment

The following information, and in particular the Glossary, is provided to enhance the reliability of ratings and improve consistency between assessors and their ratings.

Impact of mental illness on activities and participation
To help assess the impact of mental illness on a range of activities and participation it may be useful to initially ask the applicant to describe the kinds of mental health problems or issues that they have. Given the importance of a person’s thoughts and feelings, the assessor should ask the applicant how their mental illness, and their thoughts, behaviours and emotions, may affect how well they can undertake their daily activities or participation in community life.

Prompt questions for each life area
A series of prompt (guidance) questions are included to assist the process of assessing functional limitation in each life domain. The questions help in developing an open dialogue with the applicant. They can assist in guiding decision-making by the PHaMs assessor by eliciting information about:

the applicant’s involvement or participation in each life area.
how well they are coping and what problems they may have in this life area.
whether they currently receive support from others, and
what support they need that they are currently not receiving.

Because each life area covers a very wide range of activities, and each applicant will come with their own experiences and background, the exact wording of the prompt questions are expected to be varied by the assessor to suit each individual applicant.

GLOSSARY FOR FUNCTIONAL ASSESSMENT

Personal Capacity Activities

Interpersonal relationships - i.e. Forming and maintaining social and interpersonal relationships with family, friends, and other people, and interacting with other people in social situations.

Learning, applying knowledge and general demands - Solving problems, making decisions, paying attention, organising daily routines and handling stress.

Communication - For example, participating in conversations and discussions, and expressing ideas clearly.

Community Participation Activities

Working and employment - Undertaking activities to obtain and retain paid employment or self-employment.

Education - i.e. Participating in school, college or any educational activities.

Social and community activities - i.e. Participating in social and recreational activities, and engaging in religious, political and other community life.

Independent Living Activities

Domestic activities-undertaking activities such as caring for children and for other family or household members, shopping, preparing meals, housekeeping, budgeting and maintaining a home.

Transportation and mobility-activities in getting around, such as moving around or leaving your home, accessing public transport; driving your car.

Self care-activities in taking care of yourself, such as maintaining reasonable levels of hygiene, standard of dressing, nutrition, managing diet and fitness, administering medication and managing general health.

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Question 34: Functional Limitation Score

Defined as:

The applicants functional limitation score derived from the answers to Question 33.

Guide for use:

This answer is automatically generated by the system upon completion of every sub-question within Question 33.
If the applicant receives a functional limitation score of less than 3.0, they are deemed INELIGIBLE for PHaMs.
If changes are made to the response in Question 33, the functional limitation score will be recalculated.

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Question 35: Is the applicant’s need for support with activities or participation in life areas because of mental illness?

Defined as:

The need for support with activities or participation in life areas is because of a mental illness.

Guide for use:

Select only one option.
The PHaMs worker must make a decision about whether they think that on the balance of evidence, the persons functional limitations result from their mental illness.
Sources of information that could help inform this decision could include, but are not limited to, the applicant, carer, family as well as formal informants involved in the referral process.
If the response is ‘Yes’ the person is eligible provided they also meet other eligibility criteria.
PHaMs is predominantly about recovery from mental illness and as such is not able to support people with other permanent disabilities. Where a person has dual diagnosis, the functional limitation must be related to the mental illness to be eligible for PHaMs. Where a worker cannot distinguish this they can assume it is from the mental illness.

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Question 36: Does the applicant have any other significant disabilities?

Defined as:

Whether the applicant has any significant disability (e.g. underlying health condition, impairment, activity limitations, participation restrictions and environmental factors) other than mental illness.

Guide for use:

More than one option can be chosen between from option 1-6.
If ‘None’ is selected, please move to question 37.
If the disability is known but is not listed as an option, please select ‘Other’ and specify in the space provided (e.g. Vision, Hearing, Speech or Deafblind – dual sensory).
Disability groups are a broad categorisation of disabilities in terms of the underlying health condition, impairment, activity limitations, participation restrictions and environmental factors.
The examples provided below for each disability group are intended to be a helpful guide rather than a prescriptive definition.

If an applicant fails to meet one or more of the eligibility criteria, they will be considered ineligible for the PHaMs program.

Intellectual (including Down Syndrome): Effects appearing in the developmental period (age 0-18 years) associated with impairments of mental functions, difficulties in learning and performing certain daily life skills and limitations of adaptive skills in the context of community environments compared to others of the same age. Includes, for example, Down Syndrome and Cri-du-chat syndrome.

Specific learning / Attention Deficit Disorder (Other than Intellectual): A general term referring to a group of disabilities, presumed due to central nervous system dysfunction rather than an intellectual disability, covering significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical skills.

Autism (including Asperger’s Syndrome and Pervasive Developmental Delay): A pervasive developmental disorder involving disturbances in cognition, interpersonal communication, social interactions and behaviour (in particular obsessional, ritualistic, stereotyped and rigid behaviours).

Physical: This includes ongoing organic conditions/diseases such as heart disease, cancer, diabetes, or physical disabilities such as limb amputations, paraplegia, muscular dystrophy, cerebral palsy etc. Organic conditions/ diseases or physical disabilities may impact on a person’s ability to function independently.

Acquired brain injury: Characteristically, multiple disabilities arising from damage to the brain acquired after birth. Results in deterioration in cognitive, physical, emotional or independent functioning. Can be as a result of accidents, stroke, brain tumours, infection, poisoning, lack of oxygen, degenerative neurological disease etc.

Neurological (including epilepsy and Alzheimer’s disease): Applies to impairments of the nervous system occurring after birth, includes epilepsy and organic dementias (e.g. Alzheimer’s disease) as well as such conditions as multiple sclerosis and Parkinson’s disease.

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Question 37: Is the applicant currently in paid employment?

Defined as:

Paid employment includes persons who performed some work for wages or salary, in cash or in kind and persons temporarily absent from a paid employment job but who retained a formal attachment to that job.

Guide for use:

Select only one option.
Select ‘Yes’ if the applicant is employed and being paid.
Select ‘No’ if the applicant is not in paid employment.

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Question 38: If yes, how is the applicant employed; (Full time, Part time or Casual)

Defined as:

The status of the applicants paid employment.

Guide for use:

If ‘Yes’ has been answered in Q37; record the applicants employment status.
Full Time Employment is where employees work an average of 38 hours per week and usually have ongoing employment.
Part time Employment is where employees work an average of less than 38 hours per week. They are usually hired on an ongoing basis and work set hours.
Casual Employment is where employees are paid on the number of hours they work. They usually are not guaranteed a certain amount of hours of work but can work regular hours.

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Question 39: Is the applicant currently employed in a voluntary capacity?

Defined as:

Volunteering is an activity which takes place through not for profit organisations or projects and is undertaken to be of benefit to the community and the volunteer.

Guide for use:

Select only one option.
Select ‘Yes’ if the applicant is employed in a voluntary capacity.
Select ‘No’ if the applicant is not involved in any voluntary capacity.

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Question 40: Does the applicant receive an income support payment from Centrelink?

Guide for use:

Select only one option.

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Question 41: If yes, what is the payment type?

Defined as:

The type of income support payment applicant is receiving from Centrelink.

Guide for use:

Select only one option.
Where the payment type is known but is not specified in the drop down menu, please select ‘Other’ and specify the payment type in the space provided.

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Question 42: Is the applicant being considered for PHaMs Employment?

Defined as:

Whether or not the applicant is being considered for PHaMs Employment.

Guide for use:

This question is mandatory and must be answered.
Select only one option.
Select ‘Yes’ if applicant is being considered for PHaMs Employment.
Select ‘No’ if applicant is not eligible for PHaMs Employment and move to Question 47.

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Question 43: Is the applicant currently registered with an Employment Service Provider?

Defined as:

Whether or not the applicant is register with an Employment Service Provider. Employment service providers are agencies that provide various kinds of support to job seekers.

Guide for use:

Select only one option.
Select ‘Yes’ if applicant is register with an Employment Service Provider.
Select ‘No’ if applicant is not registered with an Employment Service Provider and move to Question 45.

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Question 44a: What kind of Employment Service Provider is the applicant registered with?

Defined as:

The kind of Employment Service Provider the applicant is registered with.

Guide for use:

If ‘Yes’ has been answered in 43, select the kind of Employment Service Provider the applicant is registered with.
Where the kind of Employment Service Provider is known but is not specified in the drop down menu, please select ‘Other’ and specify the service provider type in the space provided.

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Question 44b: Please enter the name of Employment Service Provider?

Defined as:

The name of the Employment Service Provider that he/she is employed with.

Guide for use:

This question is mandatory and must be answered.

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Question 45: Is the applicant willing to register with an Employment Service Provider?

Guide for use:

If ‘No’ is selected, applicant is not eligible for PHaMs Employment.
If ‘Yes’ is selected, go to question 46.
Being registered with an Employment Service Provider or willingness to register with an Employment Service Provider is a condition of eligibility for PHaMs.

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Question 46: Please enter applicant’s Centrelink Customer Reference Number (CRN)

Defined as:

The Centrelink Reference Number (CRN) is a unique identifier assigned to people and certain organisations that have one or more recognised relationships with Centrelink.

Guide for use:

This question is mandatory to be eligible for PHaMs Employment and must be answered.
This identifier is assigned by Centrelink. The CRN consists of nine digits and one alphabetic character, generated and validation by an internal Centrelink Algorithm.

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Question 47: Is the applicant eligible for PHaMs Program?

Defined as:

Whether the applicant meets all eligibility criteria for the PHaMs service.

Guide for use:

The answer to this question will be determined and automatically generated by the system. It will be either ‘Yes’ or ‘No’.

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Question 48a: Acceptance into PHaMs Program

Defined as:

Whether an applicant who was considered eligible for PHaMs was accepted into the service by the PHaMs service provider.

Guide for use:

Select only one option.
If ‘Yes’ is selected, record the date when the applicant was accepted into PHaMs.
If ‘No’ is selected, record the reason why the applicant was not accepted from the drop down list. If the reason is not specified in the list, select ‘Other’ and provide further details.
The PHaMs service provider will need to determine if the PHaMs service can assist the applicant and whether the service provider has the capacity to support the eligible applicant.
In some cases the service provider may decide it cannot assist an eligible applicant, for example if the service is unable to source an appropriate worker for the applicant, or because services to treat complex needs - such as alcohol or drugs misuse, homelessness or dual diagnosis - are not available or accessible to the applicant.

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Question 48b: Was the applicant accepted into PHaMs Employment?

Defined as:

Whether an applicant who was considered eligible for PHaMs Employment was accepted into the service by the PHaMs service provider.

Guide for use:

Select only one option.
If ‘Yes’ is selected, record the date when the applicant was accepted into PHaMs.
If ‘No’ is selected, record the reason why the applicant was not accepted from the drop down list. If the reason is not specified in the list, select ‘Other’ and provide further details.
The PHaMs service provider will need to determine if the PHaMs service can assist the applicant and whether the service provider has the capacity to support the eligible applicant.
In some cases the service provider may decide it cannot assist an eligible applicant, for example if the service is unable to source an appropriate worker for the applicant.

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Question 48c: please select the reason?

Defined as:

Reason why applicant not accepted into PHaMs or PHaMs Employment.

Guide for use:

If ‘No’ is selected, record the reason why the applicant was not accepted from the drop down list. If the reason is not specified in the list, select ‘Other’ and provide further details.

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Question 49: Date at which the assessment was finalised

Defined as:

The date on which the PHaMs worker finalises the assessment process.

Guide for use:

Record the date that the assessment was finalised.
The date of finalisation must refer to the current eligibility assessment. If an applicant has been assessed for eligibility for PHaMs on a previous occasion, the application date should refer to the current eligibility assessment.
Once this EST Assessment has been ‘Finalised’, the record cannot be modified.

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Personal Helpers and Mentors (PHaMs) EST Data Guide (2013)

Eligibility Screening Tool (EST) - Contents:

Client Information

Question 1: Agency ID

Defined as:

Guide for use:

Question 2: External Person ID

Defined as:

Guide for use:

Question 3: Date of application

Defined as:

Guide for use:

Question 4: Has the PHaMs Service “Consent to the collection, use and disclosure of information” form been signed?

Defined as:

Guide for use:

Question 5: Does the applicant’s functional limitation prevent them from being able to make an informed decision to participate in the service?

Defined as:

Guide for use:

Question 6: Statistical Linkage Key Determination

Defined as:

Question 6a: What is the applicant’s date of birth?

Defined as:

Guide for use:

Question 6b: Is the applicant’s date of birth an estimate?

Defined as:

Guide for use:

Question 6c: What is the first name and surname of the applicant?

Defined as:

Guide for use:

Question 6d: What is the sex of the applicant?

Defined as:

Guide for use:

Demographics

Question 7: What is the applicant’s current/usual residential setting?

Defined as:

Guide for use:

Question 8: Is the applicant of Aboriginal or Torres Strait Islander origin?

Defined as:

Guide for use:

Question 8a: Is the applicant a member of the Stolen Generation ?

Defined as:

Guide for use:

Question 8b: Is the applicant a Stolen Generation family member?

Defined as:

Guide for use:

Question 9: Place of residence

Postcode

Question 9a: Where does the applicant usually live?

Defined as:

Guide for use:

Question 9b: If ‘Within site boundaries’ or ‘Outside of site boundaries’ what is the applicant’s postcode?

Defined as:

Guide for use:

Carer

Question 10: Does the applicant usually live alone or with others?

Defined as:

Guide for use:

Question 11a: In which country was the applicant born?

Defined as:

Guide for use:

Question 11b: Did the applicant arrive in Australia under Australia’s Humanitarian Program?

Defined as:

Guide for use:

Question 12: What cultural or language barriers need to be considered in delivering services to the applicant?

Defined as:

Guide for use:

Question 13a: Does the applicant speak a language other than English at home?

Defined as:

Guide for use:

Question 13b: If yes, please select a language

Indicate the language spoken most often if there is more than one

Defined as:

Guide for use:

Question 14: Does the applicant have a carer who provides care and assistance on a regular and sustained basis?

Defined as:

Guide for use:

Question 15: Caring for children

Question 15a: Does the applicant have primary (or shared equal) caring responsibility for children?

Defined as:

Guide for use: