Sensitive Claims a new way of working

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Sensitive Claims a new way of working

• Dr Peter Jansen, ACC Clinical Directorate

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Agenda

• Development of ACCs Clinical Framework
• Implementation development of pathways, whats
  different, timeline for change
• Future treatment or support package option
• Opportunity for discussion

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The Opportunity

• Opportunity to improve on care according to the
  current evidence
• Opportunity to make better / faster decisions by
  using an evidence-based guideline
• Clients need to be rehabilitated to the best
  extent practicable
• Services must be provided at a sustainable cost
  to New Zealanders

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• Best Practice Guidelines for the Assessment and
  Treatment of Mental Injury as a result of Sexual
  Assault or Sexual Abuse, 2008
• Massey Guidelines
• www.acc.co.nzgt Publications gt
• search ACC4451

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Why have Guidelines?

• Difficulties inherent in the diagnosis of mental
  injury caused by sexual abuse
• Identification of effective therapeutic
  approaches
• Improve information collection, decision-making
• Treatment timing and duration
• Lack of consistency and demonstrable outcomes
• All these factors contribute to this area being
  complex and one size does not fit all.

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Objectives of the project

• To examine the processes and tools available to
  determine mental injury consider their validity
  and reliability
• To gather information on different therapies and
  approaches being used in the rehabilitation
  process, assess their effectiveness and risks
• To examine the main tools and processes used to
  determine progress and outcomes to consider
  their validity and feasibility
• To develop evidence-based, best-practice
  Guidelines

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Underlying principles

• Guidelines must
• address the unique needs of New Zealanders
• be acceptable to a wide range of health
  professionals working in the sexual abuse area
• Guidelines not discipline-specific and avoids
  clinical paradigms
• not be prescriptive by adhering to one particular
  modality or intervention 
• provide a "whole of life" perspective on the
  effects and treatment of sexual abuse

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Key messages

• Sexual abuse is a complex life experience, NOT a
  disorder or life sentence
• It is NOT inevitable that clients will suffer
  from severe, long term effects following sexual
  abuse
• Relative, shorter-term therapy more beneficial
  than long term therapy
• Ending therapeutic relationship DOES NOT mean all
  expectations met and client is free of
  challenges. Clients should be able to use skills
  obtained through therapy to cope and manage
  emotional needs

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cont.

• Other Staging, relapse prevention, contact vs.
  non-contact abuse, boundaries, Offenders, outcome
  measures, assessment tools, etc
• Also coverage on treatment of children
  adolescents treatment issues for Maori and
  Pacifica other groups with particular needs
  (i.e. older people, intellectual disabilities,
  Gay and Transgender)

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ACC Clinical Framework

• Released 16 July 2009.
• Based on the Massey Guidelines
• Reflects the most current approach to the
  treatment of injured clients
• Demonstrates most recent evident-based practice
• Sets the scene for future use of objective
  outcome measurements by treatment providers.

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Framework Principles

• 1 We support the rehabilitation of injured
  clients
• 2 Treatment must focus on empowering the client
  to manage their injury
• 3 Measurable treatment effectiveness must be
  demonstrated
• 4 Goal setting is a means of improving function
  and return to work
• 5 Treatment must be based on the best evidence
  available
• 6 Decisions about claims are made within the
  bounds of legislation
• 7 We share responsibilities for injured clients
  with the wider community
• 8 We will develop the capabilities of staff
  members to support the rehabilitation of injured
  clients
• 9 We will use all the available expertise in
  making decisions

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Purpose of treatment

• Restore the clients health through a
  rehabilitative approach
• Achieve appropriate quality of life and return to
  maximum extent practicable
• Return the client to work, or enable them to stay
  at work during treatment

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ACCs role

• Make timely decisions on cover
• Ensure services are goal orientated, evidence
  based, clinically justified and use resources
  effectively.
• Achieve optimal rehabilitation outcomes,
  including a return to normal functioning and
  return to work
• Informing providers of our expectations for the
  management of injured clients and the outcomes
  required.

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Expectations we have of Providers

• Recommendations from the Guidelines will be
  adopted and implemented by providers from all
  disciplines ("Best Practice" concept)
• Provide information on progress to ACC
• Ensure SCU clients receive most appropriate
  treatment to facilitate rehabilitation
• Tailor your assessment and treatment processes
  accordingly
• Work collaboratively across the sector, and with
  ACC

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Next Steps Client pathways

• The main focus of todays discussion

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Draft Pathway

• The generic (or the basis of the) pathway is a
  step-wise one
• Assessment for cover includes clinical triage
• Therapy, including
• - Usual care
• Variations and exceptions
• - Expected treatment
• Additional assessments
• Support packages
• Completion ie recovery

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What this means

• 1. The goal of rehabilitation is to restore the
  function of those who are injured.
• 2. Effective decisions on rehabilitation and
  treatment takes account of resources.
• 3. ACC is accountable and responsible for
  conditions caused by the injury.
• 4. Interventions are funded according to evidence
  shaped to manage the risks presented by the
  client.

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contd.

• 5. Clients with pre-existing injuries or other
  health issues will be managed in collaboration
  with other agencies.
• 6. Counselling has a focus on empowering the
  client to manage their injury
• 7. A good therapeutic alliance is a means of
  improving function. Key elements
• goal setting
• collaboration, and
• a good therapeutic relationship.

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contd.

• 8. The effectiveness of counselling or other
  treatments should be demonstrated using outcome
  measures.
• 9. When available, outcome measures should be
  used that are
• reliable, valid and responsive to change
• related to rehabilitation goals
• relevant to the clients injury
• needed by ACC to make decisions about claims

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contd.

• 10. Regular use of outcome measures provides a
  justification for treatment decisions
• continuing, changing or ceasing treatment
• referring the client to another provider.
• 11. ACC has a skilled team to manage sensitive
  claims, and will continue to develop the
  capability of this team.

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The Pathways Triage and treatment
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2nd Assessment
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Re-entry
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What is different?

• ACC 45s will include a Provisional diagnosis or a
  statement of problems and issues based on
  symptoms eg cognitive, emotional and behavioural
  symptoms diagnosis
• Clinical Psychology triage
• AD Pathway
• Streaming of claims to appropriately qualified
  health professional for assessment and goal
  setting/treatment planning
• Assessment/provider split
• Short term interventions and support packages

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contd.

• Self management plans for clients
• End of treatment review by original assessor
• Case closure at time of exit
• Change of provider for more intensive or
  different treatment where goals not achieved
• Multidisciplinary Team Panel assessments for
• All re-entries
• IA/Lump sums
• Insufficient progress against goals and outcomes
• Provider request for complex clients
• Long term clients
• Variation to the DATA contracts to support the
  pathway

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Support packages

• ACC is looking for alternative interventions
  which best support the client with a mental
  injury as a result of sexual abuse
• This work will follow from the implementation of
  the Pathways
• We welcome your ideas

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Timeline for change

• Workshops 7 August 18 August
• Variation to DATA contracts sent out 1 September
• Pathways implemented 14 September
• New clients only
• Staged transition plan for existing clients from
  1 January 2010
• Training opportunities
• Development of support packages
• Share updates with you via ACC News

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Discussion

• Questions?

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In summary

• Imperative for change
• Clinical evidence
• Best practice Guidelines and Framework
• Results deteriorating
• Solution
• New client pathways
• Focus on client outcomes, value for money
• Stronger working relationships across mental
  health sector

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Feedback

• Workshops held 7 August 18 August
• Summary of workshop feedback
• Ongoing ideas for improvement
• Via respective sector representative body
• peter.jansen_at_acc.co.nz
• Upcoming training opportunities