The State Insurance Regulatory Authority (SIRA) is the New South Wales (NSW) government organisation that regulates the state’s workers compensation system. It’s a requirement of SIRA that all NSW employers have a return to work (RTW) program in place within 12 months of starting the business. However some employers aren’t complying with this; either they’re not aware of this requirement or they may not understand what they need to do to meet it. This article has been created to assist employers understand what it is they need to do, why it’s important and how to best meet this requirement.

Please note this information must be read in conjunction with that provided by SIRA, it does not replace it. SIRA’s website (www.sira.nsw.gov.au) contains detailed and valuable information which employers should make themselves familiar with.

What is a RTW program?

A return to work program is the formal policy that outlines your general procedures for handling work-related injury or illness. It represents your commitment to the health, safety and recovery of workers following an incident. It sounds quite simple, however unfortunately it’s not always the case. And when not done well it can have a detrimental impact on the employee and employer.

The program is required to be in place irrespective of whether an employee has been injured. It’s about having the plan in place for when it may be needed.

Why it’s important to have a return to work program

While creating a RTW program is something you must do, it’s important to understand why it’s a must and how it benefits your business. A RTW program provides clarity and a clear process for the business in the event of a workplace injury. Supporting an injured worker return to work can be a challenging and sometimes stressful situation; this will be compounded if you haven’t previously thought about how you’ll do it. Creating a program means you’ve planned for the situation before it occurs.

Having a program means the business has agreed who’s responsible for assisting the different aspects of an injured worker returning to the workplace. The person appointed is responsible for recovery at work. If your business reaches a certain size, a return to work coordinator needs to be appointed.

Helping your worker to recover at work may reduce the financial impact on your business and enables you to:

• maintain the skills and knowledge of an experienced worker
• reduce the cost of training a replacement worker
• demonstrate to all workers that they are valued employees
• maintain good employer-employee relationships
• reduce the length of time your workers are away from work
• avoid the cost of hiring new staff
• help to comply with your legislative obligations.

In addition to the workplace benefits, businesses need to know that SIRA is taking compliance breaches seriously. SIRA can issue fines of up to $2,000 to businesses found to not have the required program in place.

Resources to assist the process

Before the requirements of a RTW program are explained, it should be acknowledged that some businesses have found it a bit challenging to fully understand what they need to do. Therefore it’s important to know there are resources and supports available to you.

Guild Insurance (Guild) offers personalised support and guidance for those businesses who hold a workers compensation policy with Guild or Guild Early Learning. Our Injury Management Specialist, Julia Lock, will walk you through the process of creating a RTW program specific for your individual business. If you would like to take advantage of this invaluable offer of support, please contact Julia directly at jlock@guildinsurance.com.au. And further to this, when a business lodges a claim, Guild’s case managers will have a discussion with the business to be sure the RTW program is in place and created for the correct business category (as described below). If it isn’t, the case manager will refer them to Julia for assistance.

In addition to this, the SIRA website has a great deal of information about creating a return to work program, as well as various supporting documents to assist this process. The majority of the information needed can be found in their Guidelines for workplace return to work programs document, found here.

What’s required in the program?

The information below can be found in more detail in SIRA’s guidelines mentioned above.

There are two types of requirements depending on the size of your business. These are separated into 2 categories; Category 1 employers and Category 2 employers. The table below defines which category a business fits into.

Category 1 requirements

For Category 1 employers there are four parts to implementing a RTW program, and these are:

1. Appoint a RTW coordinator – this person looks after the tasks required under the RTW program, such as identifying suitable work opportunities and liaising with key people such as doctors and insurers. This person must be able to demonstrate knowledge and skills specific to this role as set out by SIRA.

2. Develop a RTW program – there are eight key areas which need to be covered in the program and they are:

   a. leadership and commitment

   b. workplace arrangements

   c. rights and obligations

   d. after an incident

   e. support for the worker

   f. recovery at work

   g. dispute prevention and resolution

   h. administration.

   Details on what needs to be done under each of these areas can be found on a checklist for Category 1 employers in the appendix of the SIRA guidelines document mentioned earlier.

3. Consult workers and unions – this step ensures workers are involved in the development of their RTW program. Effective communication between all parties, in a way which can be understood by all, ensures everyone is able to contribute to the process.

4. Implement the RTW program – the information gathered during the previous consultation step is used to finalise the program and implement it. Employers must make the workplace aware of the RTW program and review it at least every two years.

Category 2 requirements

For Category 2 employers there are three parts to implementing a RTW program, and these are:

1. Nominate the person responsible for recovery at work – this doesn’t need to be a return to work coordinator as with Category 1, but this person will manage workers compensation and recovery at work activities.

2. Develop a RTW program – employers can develop their own program or they can customise the Standard return to work program for Category 2 employers; this can be found in the appendix of their guidelines previously mentioned. Employers must consult with their employees when developing this program.

3. Implement the RTW program– this step requires the employer to inform workers of their rights and obligations under the program. The program should be reviewed at least every two years.

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There will be occasions when a speech pathologist needs or wants to end the therapeutic relationship with a client. However, this isn’t an easy thing to do. Knowing how to do this in a professional way that doesn’t cause any distress for either the speech pathologist or the client can be quite challenging.

Why do therapeutic relationships end?

There can be many reasons why a speech pathologist considers that the therapeutic relationship needs to end. It may be because the needs of the client won’t be met by that speech pathologist and they should be seeing someone else who has the knowledge and expertise they require. It may also occur because the relationship has become strained or difficult and therefore it’s no longer effective. A speech pathologist may inform a client that services are not able to continue if there are concerns relating to safety, or because the client has not complied with their obligations, such as payment of outstanding invoices, or other practice/organisational policies that the speech pathologist has provided to them.

Speech pathologists need to know they can end a therapeutic relationship. In some cases it may not just be that they’re able to end the relationship, it may be something they must do as it’s in the speech pathologist’s and/or the client’s best interests.

Provision of speech pathology services within consumer directed models of funding/care can be challenging. A client may have expectations that will never be met by any speech pathologist, they may not have had much contact with any allied health services in the past and have limited understanding of ‘how it works’. A speech pathologist has an ethical obligation to provide all the information a client will need to understand their communication, swallowing or mealtime support difficulties and how speech pathology may be able to assist them to improve their function or support them. This may mean that information needs to be provided in a variety of ways, with frequent checks of the client’s understanding and support to develop a positive therapeutic relationship.

Communication is key to maintaining positive therapeutic relationships. A speech pathologist has an obligation to ensure they have provided information in a way the client can understand and has discussed any questions or addressed concerns in a professional and respectful manner. Sometimes however, this still does not result in the development of a positive and beneficial relationship and the speech pathologist must consider how to proceed.

Tips for ending a therapeutic relationship

• If there’s tension or conflict arising within the therapeutic relationship, discuss these with the client early. Not doing this allows problems to escalate which makes them harder to manage and de-escalate later. Managing these problems early also allows the speech pathologist and the client to potentially improve the relationship, meaning it may not need to end.

• Records should be made of any discussions with the client (this includes phone calls and emails) about difficulties within the therapeutic relationship and suggestions to end the relationship. Unfortunately, there will be occasions when the client is unhappy with ending the relationship and they may feel they’ve been treated unfairly. The speech pathologist should keep of record of all conversations had as evidence they’ve addressed all concerns respectfully and professionally.

• Reasons for ending the relationship should be provided to the client so they understand why this action is being taken. Understanding the reason is most likely going to lead to them being accepting of the decision. However, what information is provided is at the discretion of the speech pathologist. For example, if a parent is non-compliant with home practice, the speech pathologist should provide sufficient information for the parent to understand why home practice is important and the lack of progress if none is completed, however, stating that the parent is very difficult to work with may not assist that understanding.

• Provide the client with information regarding other speech pathology services available in their area, keeping in mind specific requirements or limitations the client may have, e.g. other practices that offer school/home/residential facility visits etc.

• If a referral to another speech pathologist is made, the specific reasons why this speech pathologist is being recommended should be explained, such as this person has specific skills which would better meet the needs of the client. When recommending that a client see a colleague for their specific knowledge and skill, the speech pathologist must have personal knowledge of the colleague’s expertise. Speech pathologists should refer to information about referrals in Speech Pathology Australia’s (SPA) Policy and Procedure Manual found on the SPA website. Speech pathologists are reminded that they will breach client confidentiality if they share reasons for ending the therapeutic relationship with the new treating speech pathologist. If there are specific concerns regarding the behaviour of a client or family members, speech pathologists should seek independent legal advice about what can or cannot be provided to the next clinician.

Support and assistance can be sought from Speech Pathology Australia, they can be contacted on 1300 368 835.

Ending therapeutic relationships in Speech Pathology

Facebook has evolved greatly overtime, and so has our use of it. Gone are the days of it simply being used to chat with friends and share holiday photos. Professional use of Facebook has grown to the point where many people expect businesses to have a Facebook presence. With ever evolving algorithms and functions and various accounts settings, it can be difficult to stay on top of best and safe practice. Most concerningly, these changes can bring misunderstanding about the many risks and issues all businesses, including speech pathology practices, need to consider before creating a professional Facebook account.

Reasons for a Facebook account

Creating a business Facebook account because many other businesses or practices have one isn’t a good enough reason. As with all other decisions and plans made for your speech pathology business, creating a Facebook account needs to be well thought through with the pros and cons considered carefully. Risk management is especially important as issues can quickly escalate due to the nature of how the platform can easily share and distribute information.

Your speech pathology practice should have a process and policy for the following in relation to a business Facebook account and its usage:

• What information will be shared
• How responses to comments will be managed
• Who is responsible for managing the account
• How client permission, if posting information about clients, will be obtained and recorded
• Who is responsible for ensuring the content is appropriate for advertising speech pathology services

Did you know?

Facebook was created in 2004 as a social networking tool for college students. Now, there are over 2 billion Facebook users and almost 1.5 billion daily users[1].

94% of Australia’s social networking users have a Facebook account.  And these Facebook users have an average of 234 friends each[2]. 

Ethics of posting information about clients

It’s becoming more common to see speech pathology practices sharing information about clients on Facebook. Even when done with the permission of the client, or the client’s parents, it’s important to consider how ethical or professionally appropriate this is. When intending to post information about client progress on Facebook, first consider the following:

• Could the information be shared without identifying the client? Is there any real benefit in identifying the client?
• How many people will be able to see the information being posted (consider how many people follow your page and then their ability to share this further)? And who are these people? Is it possible that friends of the client could see the posts?
• If the client is a child, as they get older how may they feel about their health information being shared publicly?

Client permission isn’t always enough when sharing confidential health information. The reasons for and implications of this sharing need to be considered.

Blurring of professional boundaries

Using Facebook, and any other form of social media, can contribute to professional boundaries starting to blur. Social media encourages an informal means of communication which may be different to how you’d communicate with clients when face to face. This can alter the dynamics of the professional relationships between clients and clinicians. Professional social media use can also lead to clients contacting clinicians on their personal social media accounts. When using social media for work purposes, it’s important to maintain the professional separation and relationship with clients by not altering the way you interact and communicate with them.

Privacy

Privacy on Facebook is almost a contradiction. When using Facebook remember:

• Posts and comments can never be completely deleted, especially if someone has taken a screen shot of them.
• Privacy within groups can’t be guaranteed. It’s not uncommon to hear of people creating fake accounts to access private groups and share their information.
• If there’s something you don’t want to be seen by a regulator, client, colleague or competitor, never post it on Facebook.

Appropriate use of social media for advertising

Speech Pathology Australia has published a Code of Ethics – Advertising Policy which describes appropriate advertising of speech pathology services. The policy applies to all social media advertising (Facebook included) as well as any other forms of advertising that the speech pathologist has control over. The required level of professional language used and information shared in all advertising is also required when using Facebook.

Seeking advice

When using Facebook in a professional setting, consider the appropriateness of the conversations held in that forum, even if it’s a conversation with other speech pathologists in a private or “closed” community.

While peer support has many benefits, using forums such as Facebook groups to seek and provide specific clinical information can pose a significant risk to speech pathologists. The risks not only relate to confidentiality of sensitive client information, but also provision and use of advice that is suggested without access to adequate information on which to base decisions. In many situations/scenarios, very little information may have been supplied about the case being discussed. Even if a lot of detail is provided, which carries risk for maintenance of confidentiality, the advice you provide to a colleague could potentially be clinically inappropriate or incorrect. Following advice provided via social media groups that may not be appropriate for your client poses a risk for the treating speech pathologist.

Speech pathologists have an ethical obligation to provide quality and competent professional services which follow evidence-based practice principles. Although general advice provided through a discussion of general clinical scenarios on a social media platform may be appropriate, for a discussion regarding client specific information speech pathologists are advised to consider how they seek professional advice, such as working with a supervisor.

Facebook risks in Speech Pathology