Let’s talk about Functional Capacity Assessments

Since the dawn of the NDIS, the ‘Functional Capacity Assessment’ (or ‘FCA’) has become a staple of occupational therapy practice, but there is a general lack of understanding of what constitutes a FCA, which can be a source of frustration for clients, support coordinators and NDIS planners alike! So let’s talk about what a FCA is, why you need one, and what else occupational therapists have to offer beyond the FCA!

When completing my degree, the words 'Functional Capacity Assessment' didn’t really come up, and it was only after graduating and with the rollout of the NDIS that it kept popping up. This is not because occupational therapists were not doing these assessments, but more so that evaluating and working out ways to optimise 'function' were just staples of what we do, and subsequently our assessments were just called 'OT Assessments'. Fast forward to now, where in the last 2 years the FCA has really taken off, to the point where I often find people are requesting a FCA without really knowing what they are asking for.

Where a few years ago we could be guided by the needs of our clients and subsequently any of the assessments or treatment that we did was truly driven by client goals, we have now entered an era where it feels like nothing else matters but the FCA. When I receive a referral for a FCA, I tend to try and take a step back and ask some relatively simple questions:

• What are we actually trying to achieve for this client?

• Is there an alternative assessment or process that we could explore which meets the client needs?

• Is a FCA the most cost-effective method of achieving the goal?

Let's use a couple of examples to demonstrate this. These are completely made up examples based on some real referrals that we have received.

Scenario 1: James has been referred for a FCA by his support coordinator. He is 38 and has NDIS support in place for an acquired brain injury that is stable, as it is now 5 years post-injury. He has regular support workers in place and sees a physiotherapist once every two weeks. Based on the current supports he has in place, he will have a small amount of funding leftover in his 'core supports' budget and following the completion of the FCA requested, will have just enough 'capacity building' funding left to continue his regular physiotherapy sessions to the end of his plan. As James is having trouble with getting out in the community due to ongoing difficulties with his mobility, he would like to explore the use of a powered mobility device to support his ability to access the community independently.

• What are we actually trying to achieve for James? James would like to explore the use of a powered mobility device.

• Is there an alternative assessment or process that we could explore which meets James' needs? Completing assessment, showroom trials and practical trials of one or more powered mobility devices would be more suitable in working towards James' goal

• Is a FCA the most cost-effective method of achieving James' goal? No, James has adequate funding in both core and capacity building areas for his current needs, and a more effective use of funding would be to more directly service his goal of exploring powered mobility.

It is important to note here that assessing James' suitability and training him in the use of a powered mobility aid still has a focus on function and will encompass some elements of ‘functional assessment’, with the key difference being that the focus is on function that is relevant to James' goals.

Scenario 2: Stephanie has been referred for a FCA by her support coordinator to assist a NDIS 'change in circumstances' review. Stephanie has been living with Parkinson's Disease for the last 12 years, and is experiencing a recent progression in her symptoms. She is 52 and has recently separate from her husband and is now living alone with limited informal supports. She receives some gardening and cleaning assistance using her NDIS funding, and does not have the budget to increase this. She currently sees a physiotherapist once per fortnight, but following the onset of some challenges with swallowing, has been recommended to see a speech pathologist which she cannot afford to self-fund and her capacity building funding has limited flexibility to accommodate this. Stephanie has expressed that she would like to remain living independently, but is becoming more isolated and withdrawn as she does not feel confident to go into the community, and needs to spend a majority of her energy on maintaining the household.

• What are we actually trying to achieve for Stephanie? Stephanie would like to reduce her social isolation and increase her ability to get out in the community safely, as well as effectively manage her household tasks

• Is there an alternative assessment or process that we could explore which meets Stephanie's needs? No. Her goal is related to accessing the supports she needs to maintain and maximise her functional capacity.

• Is a FCA the most cost-effective method of achieving Stephanie's goal? Yes. Stephanie's goal is broad and encompasses her 'functional capacity' across multiple domains of daily living. The FCA is also clearly linked to a change of circumstances request to be submitted, with the goal of altering her NDIS plan to reflect her needs more accurately.

The common theme of these two scenarios is that in both cases, the assessments completed should be targeted to the individual goals and needs of the client.

In my experience, a FCA is ultimately needed when support is not adequately meeting a person's needs. The recommendations from these assessment mostly apply to the 'core supports' and 'capacity building' portions of NDIS support, and there may also be some assistive technology or home modifications ('capital support') recommendations as well, depending on what is needed. However, when the goal of occupational therapy referral is for assistive technology or home modifications, it is often a better use of time and funding to target these areas specifically, rather than complete a full FCA. Whilst a FCA can often be seen as 'all-encompassing' and generally favourable with the NDIS, it is not always the most effective answer, and there can often be a more cost effective and client-centred solution.

The reality of being an occupational therapist is that many of referrals we receive will need to be FCAs, but rather than being automated in our prescription of a standard assessment for all, we must pause to reflect on the 'why' in order to be client first, goal directed, always.

I am sure that we will be continually evolving in the complex space of the NDIS and FCAs for many years to come, I would encourage you to get in touch if you have any questions or would like to discuss anything around what has been raised in today's blog post. Whether you are a NDIS Participant, a support coordinator or an OT new to the field, I am always keen for a yarn!