ACC266 Psychological services action plan

ACC266 Psychological Services Action Plan This form is completed by the provider with details of the psychological services to be provided. Provider Details Provider name: Dr Rachel Edwards Signature: Address (fax number/email): Aurora Psychology Wellington, Level 3, 42 Willis Street, Wellington 6011; fax 04 384 2298; r.edwards@aurorapsych.co.nz Date of action plan: 22/05/2026 Claimant Details Claimant's name: Sophie Ellis Phone number: 027 384 6291 Claim number: 10094523 Date of birth: 14/05/1996 Date of injury: 18/11/2025 Case Manager Details Case Manager name: Pip Henderson Branch: Wellington Psychological Service Details Assessment findings confirmed? [x] Yes [ ] No Note: Case Manager approval needs to be obtained before the provision of further psychological consultations If no, please provide reasons: Findings not previously recorded in assessment: Number of sessions required (max 10): 10 Date to be completed: 28/08/2026 Specific outcome to be achieved: Significant reduction in post-traumatic anxiety symptoms following Sophie's motor vehicle accident on 18/11/2025, reflected in a PCL-5 score reduction from 52 at initial assessment to below 33 by completion. Full and sustained return to independent driving for daily commuting and personal use. Return to full-time work hours without trauma-related avoidance behaviours impacting attendance or productivity. Restoration of consolidated sleep with reduced nightmare frequency and improved daytime functioning. Functional objectives to be achieved: Functional objectiveDate to be achievedHow objective will be measuredResume driving independently for daily commute (40 km return)28/08/2026Self-report driving log; PCL-5 driving-related items below clinical thresholdReturn to full-time work hours (40 hours per week, 5 days)28/08/2026Employer attendance record; self-report of trauma-related impact on workSleep continuity of 6 hours or more per night, sleep onset under 30 minutes, on 5 or more nights per week14/08/2026Sleep diary; PSQI reduction from 14 to below 8Resume social activities at 1 to 2 outings per week14/08/2026Self-report; behavioural activation log reviewed in session Cognitive Behavioural Therapy to be provided: [x] Relaxation training [ ] Assertiveness training [x] Stress management [ ] Anger management [x] Problem solving training [ ] Social skills training [x] Coping strategies [x] Goal setting [ ] Pain management [x] Other: trauma-focused CBT (TF-CBT) with in vivo and imaginal exposure components, and cognitive restructuring for trauma-related cognitions General Comments: Sophie has shown strong engagement and motivation through the initial assessment sessions. Sleep disturbance and driving avoidance remain the most disabling symptoms. Treatment will follow an evidence-based trauma-focused CBT protocol, with in vivo driving exposure introduced from session 4 and graded according to a hierarchy developed collaboratively with Sophie. Her partner has committed to attending one psychoeducation session in week 3. Sophie has been provided with safety planning and crisis contact information. A review point is scheduled at session 5 to assess progress against functional objectives; if expected gains are not being made, a revised plan will be submitted for case manager approval. Claimant Signature Claimant signature: Date: 22/05/2026 Case Manager Approval Only required if plan differs from assessment findings or IRP Case Manager signature: Date: The information collected on this form will only be used to fulfil the requirements of the Accident Compensation Act 2001. In the collection, use and storage of information, ACC will at all times comply with the obligations of the Privacy Act 1993 and the Health Information Privacy Code 1994. Items for Clinician Review Provider Details, Address: address stated with two possible level numbers in the audio ("level 3" or "level 4"); verify the correct level for Aurora Psychology Wellington before submission. Psychological Service Details, PCL-5 baseline: PCL-5 score stated verbally as "fifty-two"; confirm this is the documented score from Sophie's most recent administration rather than recalled from earlier in the assessment process.