Lead Supplier Manager ISSC: Tracey Hobson

Integrated Services for Sensitive Claims Supplier

Meeting

October 2015

Agenda

2Copyright (c) ACC

Welcome and Introductions

Quarterly Report findings

Tracey 45 minutes

Discussion points on the ISSC

Tracey 1 hour

Cultural Responsiveness

Bev 15 minutes

Clinical Components of the ISSC

Branch Psychology Advisor

1 hour

Close

Reporting on Trends

•The information is based on purchase orders generated for ISSC services since 24 November 2014 through until 12 October 2015

•The information also includes clients who have transitioned into the ISSC from previous ACC services

•Information is compiled from 165 Supplier Responses

3Copyright (c) ACC Author/Unit

ISSC Map – Number of Clients in each service from 24 November – 12 October

4Copyright (c) ACC Author/Unit

4617

839

7315

830

32

5

602

39

3059

373

4805

220

316

Comments from Suppliers about the strengths of the ISSC

• Beneficial to clients• client focussed• client led with more client input• more client choice• more supportive of clients • clients informed, engaged in process earlier• easy access for clients• continuity for clients• Timely responses and approvals from Sensitive Claims case owners• Good multidisciplinary approaches including collaboration as a result of

working together and positive team environment

5Copyright (c) ACC Author/Unit

Feedback from Quarterly Report

Comments from Suppliers about the emerging issues of the ISSC

• Delays in receiving supporting information and/or medical notes for Supported Assessments

• Supported Assessment delays including Supported Assessors being at full capacity

• Timely responses for approving continuity sessions• Service gaps, particularly for Supported Assessors (for e.g. in South

Auckland, Northland and Southland)• Electronic invoicing including purchase order approval issues and

payment delays• Delays in travel being approved• Limited social work hours• Template reporting issues and having to repeat same information across

different service stages• Some service stages have an insufficient number of sessions available to

complete therapy

6Copyright (c) ACC Author/Unit

Referral source into the ISSC – last quarter

Referral Sources Number of referrals

GPs, Primary Care 159

DHBs 63

Other government services (Police, Cyf, etc) 225

Community Services 146

Other suppliers 241

Schools 21

Family Whanau 76

Self referral 915

Total 1846

Discussion Points

8Copyright (c) ACC Author/Unit

9Copyright (c) ACC Author/Unit

Telephone Case Conferencing

• Purpose – why has this been introduced under the ISSC

• Why is this a good idea?

• Feedback received from clients and providers

• Any other ideas from the floor

Travel

•Assessor travel outside of the TLA’s

•Prior approval for all travel requests outside of the TLA’s

•Suggestions from the floor

Did Not Attend (DNA’s)

•When a DNA can be invoiced for – only for primary services for the client

10

Copyright (c) ACC Author/Unit

Cultural Components of the ISSC

•Cultural Advisor role and when to access cultural support

•Family / whanau sessions

•Questions from the floor

11

Copyright (c) ACC Author/Unit

Psychology Advisors section

What are we doing well?

Provider Reports

Generally we are seeing:•Good discussion of the client’s broader presentation, alongside the clinical and functional issues.•Good formulations looking at the bigger picture of the client’s life and considering all of the predisposing, precipitating, and perpetuating and factors involved in the client’s overall presentation.•Clearer statements of the causal links between the sexual abuse events and mental injuries.•Good discussion of risk factors.•Consistent reporting of outcome measures: WHODAS and PWI.

Common Questions:

Provider Reports:

Why do we need details of the sexual abuse history and context?

Details of the sexual abuse assist to:•Clearly establish that a schedule 3 event has occurred.•Contextualise the abuse in terms of the broader context of the client’s life. •Assist in clarifying any causal links between the sexual abuse and the development of a mental injury.

What details do we need about the sexual abuse?Generally we need to know:

•how old the client was at the time of the abuse,•how frequently the abuse occurred,•over what time period the abuse occurred, and •the nature of the abuse in broad terms.

How should I proceed in an assessment if medical notes are not available?You should:•Discuss in the report the decision to proceed without the notes and outline any consequent limitations to your report findings.•Acknowledge any independent accessing of clinical notes and collateral information (and attached where appropriate).•Consider NOT completing the report if you are aware of complex medical information likely to impact significantly on your report (e.g., you know the client has extensive DHB involvement for a psychotic disorder).

How much information is required in Early Planning Reports?

You should provide:•Clear details about why the client is seeking assistance now.•A full description of the client’s current living situation and life functioning.•Details of any prior assistance for sexual abuse-related or other clinical issues.•Clear rationale for why particular service selections are being made now.

Consider short term intervention versus proceeding to Supported assessment.

•Well-Being short term may include the broader support services and can be seen as an early intervention package and may be sufficient to prevent a mental injury developing.

•Remember that if further symptoms develop later in life, clients can re-present and be assessed regardless of any prior childhood pre-cover intervention.

Child and Adolescent Clients

If assessment is necessary consider broader diagnoses such as DSM5 Unspecified / Specified Trauma and Stressor Related Disorder, or consider a making a very clear formulation between the sexual abuse and clearly observable behavioural difficulties (e.g., sexualised behaviour).

What are your responsibilities as an assessor or provider?

Risk: Duty to protect

What are your responsibilities as an assessor or provider?The ISSC Operational Guidelines (p8) is very clear about this:Your responsibility is to:•Identify risks, if any.•Ensure that there is an adequate risk management plan for the client if necessary.•Any appropriate referrals or notifications have been made (e.g., to Police, Acute mental health services, CYFS).•Notify ACC of any risks, risk management plans, and referrals made.

What might this involve?:

Obviously this depends on a range of situational and client factors but likely some combination of responses such as:•Following through on the duty to warn others who can assist in reducing risk (e.g., Police, CYFS, family and partners if appropriate).•Referral to and involvement of others (e.g., Acute mental health services).•Increasing contact with the client to achieve stabilisation or until other referrals have been actioned.•Use of supervision to clarify and document actions.

Group Work

How do I become an approved provider for group work?You need to already meet all ACC requirements as a treatment provider.

In addition you need to be able to:•Show evidence that you have engaged in professional education about group processes.•Indicate the kind of group that you are intending to run (e.g., DBT group, anger management group, anxiety management group) and show evidence that you have training in this area.

Establishing endorsement to run a specific group.The process for approved providers for group work wishing to start a group for ISSC clients is:•Supplier submits a group proposal to Supplier Manager.•Group proposal is evaluated by clinical team and category.•Approval or feedback is sent to the supplier by the Supplier Manager.The following information should be included in the proposal:•Objectives and rational for the group including an outline of the content and focus.•Names of the facilitators.•Group duration-specific dates.•Measure for ensuring client safety.•An outline of how outcomes will be evaluated

How do I get a particular client onto a particular group?Ideally this would be:•Considered with the assessor during a Supported Assessment OR•Outlined in the Wellbeing Plan planned with the rational for the client’s inclusion in a particular kind of group (e.g., DBT group, anger management group, anxiety management group) being clearly outlined along with a discussion of the likely best timing for this to occur.This may also be considered at any case conference or at the time of a Wellbeing progress report.

Any final questions from the floor?

Thank you for attending