ACC8535 Cover and Wellbeing Plan - child and young person

**ACC8535** **Cover and Wellbeing Plan - child and young person** This report - is for a kiritaki (client) who was aged 17 years and under when this period of service began. - should be completed during the Cover and Wellbeing Plan sessions by the Lead Service Provider in collaboration with the kiritaki, and a guardian, safe contact or whānau where appropriate. Please refer to the Sensitive Claims Service Operational Guidelines and report guidelines on our website: www.acc.co.nz/resources. Return the completed report to sensitiveclaimsreports@acc.co.nz. **Part A: Kiritaki information** **1. Kiritaki details** Kiritaki name: Kalani Tofa Date of birth: 18/03/2010 Claim number: 10038947 Contact details/safe contact person: Kalani's father, Sione Tofa, mobile 021 472 8194; preferred safe contact channel is voice call only, after 17:00 weekdays. **2. Consent to access the service** Kiritaki aged 0–15 years Gillick competence has been confirmed: [ ] Yes [ ] No Child/young person assent obtained: [ ] Yes [ ] No Safe contact consent obtained: [ ] Yes [ ] No Kiritaki aged 16 years to 17 years, or where Gillick competence has been confirmed Kiritaki consent obtained: [x] Yes [ ] No Authority to act (if applicable) consent obtained or informed: [x] Yes [ ] No Any additional points to note: Kalani is 16 years old and provided informed consent in his own right at the consent conversation on 12/05/2026. His father, Sione, was present at Kalani's request and is the nominated safe contact. Authority to act for ACC correspondence was confirmed with Kalani and is documented on file. No Gillick assessment was required given Kalani's age. **3. Changes since the Early Supports Plan** a. Have there been any changes to the situation of the kiritaki or their identified needs since the completion of the Early Supports Plan? [x] Yes [ ] No If yes, please describe these in more detail: Since the Early Supports Plan was completed, Kalani has commenced Year 12 at a new school in central Auckland following a planned transfer from his previous school. He has also taken up part-time work at a relative's café on Saturdays. His sleep has worsened over the past four weeks, with increased nightmares, and his attendance at the new school has been intermittent. His maternal grandmother passed away in early April, which has been a significant additional stressor for the whole family. b. Are there any areas of risk? Are there any risks identified? [x] Yes [ ] No If yes, please describe the risk and any duty of care actions that have been taken. Kalani reports occasional thoughts of not wanting to be alive, occurring approximately weekly over the past four weeks, without active intent or plan. He denies access to means. No risk to others identified. Risk of harm from others is considered low; the perpetrator of the Schedule 3 events is not in contact with Kalani or his family. Duty of care actions taken: collaborative safety plan completed with Kalani and his father, including identification of trusted contacts (his father, his uncle Tagaloa, and his GP) and agreement to contact 1737 or attend Auckland Hospital ED if ideation escalates. His GP has been notified with consent, and an appointment is scheduled within the next 10 days for medication review and physical health monitoring. c. Are any other agencies currently involved in supporting the kiritaki? [x] Yes [ ] No If yes, please list the agencies involved: Onehunga Family Health Centre (Dr Lavinia Faleolo): primary care and medication review. Te Whatu Ora Auckland Child and Adolescent Mental Health Services: triaged, currently on the waitlist for specialist input, available for re-referral if risk escalates. New school's pastoral and counselling team: school-based monitoring and check-ins. **Part B: Cover determination** **4. Psychometrics** **Measure 1: HoNOSCA / HoNOSI** HoNOSCA / HoNOSI total score Name of measure: Health of the Nation Outcome Scales for Children and Adolescents Date administered: 12/05/2026 Section A total score: 18 Section A+B total score: 20 Comments on the HoNOSCA / HoNOSI results: The kiritaki's HoNOSCA Section A total score of 18 falls within the moderately severe range and is consistent with significant clinical impact across emotional, behavioural, and functional domains. The highest item score is on emotional and related symptoms (rated 3, moderately severe), with additional moderately severe ratings on overactivity and attention, peer relationships, family life, scholastic skills, and school attendance. Section B items indicate that knowledge and information needs for both kiritaki and whānau are present but lower priority. The Section A+B total of 20 supports cover determination under the Sensitive Claims Service. **Measure 2: Results of additional measures used** | Name of measure | Date administered | Respondents | Score | |---|---|---|---| | Child Report of Post Traumatic Stress (CROPS) | 12/05/2026 | Kiritaki self-report | 32 | | Parent Report of Post Traumatic Stress (PROPS) | 12/05/2026 | Parent report (Sione Tofa) | 25 | Comment on results: The kiritaki's CROPS self-report total of 32 is substantially above the clinical cutoff of 19, indicating clinically significant post-traumatic stress symptoms from Kalani's own perspective. The PROPS parent report total of 25 is also above the clinical cutoff of 16, indicating clinically significant symptoms as observed by his father, with consistency across observed avoidance, sleep disturbance, irritability, and concentration difficulties. The convergence of self-report and parent report supports the clinical interview findings and is consistent with the HoNOSCA results. **5. Link to Schedule 3 Events** Kalani's presenting symptoms include intrusive memories of the Schedule 3 events identified in the Early Supports Plan, nightmares with content directly related to the events, avoidance of locations and individuals associated with the events, hyperarousal symptoms including sleep disturbance and exaggerated startle, emotional withdrawal and reduced engagement in previously enjoyed activities, and a marked decline in school attendance and academic engagement. Onset of clinically significant symptoms is dated by Kalani to approximately six months after the events, with intensification over the past six months following the school transfer and the death of his maternal grandmother. Symptoms worsen following exposure to reminders (including specific places in his previous suburb and certain social media content) and ease when he is at home with his father and siblings or attending Sunday church with his extended family. Themes and content of his intrusion and avoidance symptoms map specifically onto the Schedule 3 events rather than onto generic adolescent distress. Psychometric scores (HoNOSCA Section A 18, CROPS 32, PROPS 25) are consistent with this clinical presentation and support the causal link to the Schedule 3 events. Non-Schedule 3 factors contributing to symptoms: Kalani has experienced significant non-Schedule 3 stressors in the past three months, including the death of his maternal grandmother in early April 2026 and the transition to a new school in February 2026. In the clinician's opinion, these factors have contributed to a worsening of his overall distress but are not the primary cause of his trauma-related symptoms. The themes, content, and triggers of his intrusion, avoidance, and hyperarousal symptoms map specifically onto the Schedule 3 events and not onto the bereavement or the school transition. The non-Schedule 3 stressors are best characterised as contributing to a reduction in his usual coping resources rather than as independent causes of the presenting symptoms. **Part C: Wellbeing Plan** **6. Treatment** a. Tailored treatment needs The symptoms impacting Kalani's functioning and quality of life include intrusive memories, nightmares, avoidance of reminders, hyperarousal, sleep disturbance, irritability, reduced concentration affecting his schoolwork, social withdrawal, and a passive wish to not be alive. These symptoms have led to inconsistent school attendance, withdrawal from his previous social network, and reduced engagement at home. The supports needed include trauma-focused psychological therapy as the primary intervention, ongoing GP input for medication review and physical health monitoring, and engagement with culturally aligned support to incorporate Kalani's Samoan identity and church community into recovery. Kalani has identified that the involvement of his minister and church youth leader at agreed checkpoints is important to him, and that he wishes for the option of bringing his father to one session per fortnight as a support person. The treatment plan incorporates a Samoan cultural support practitioner who will work alongside the Lead Service Provider for cultural support and at key transition points in therapy. b. Broad treatment outcomes: Kalani would like to be able to attend school consistently without trauma-related absences, sleep through most nights without nightmares, re-engage with peers and his previous activities, and feel safe enough to participate in his church community. He will know this has been achieved when he can attend school five days per week for at least four consecutive weeks, sleep through at least five nights per week without nightmares, and attend a church youth group event without prolonged dread or avoidance. c. What other non-ACC supports in the community will be involved in the treatment pathway for the kiritaki? | Name | Roles | Community organisation | |---|---|---| | Dr Lavinia Faleolo | GP, medication review and physical health monitoring | Onehunga Family Health Centre | | Reverend Faaolataga Vailaau | Spiritual support, fa'aSamoa cultural guidance at agreed checkpoints | EFKS Onehunga (Pacific church community) | | Sione Tofa | Identified support person (father) | Personal support | | Auckland Girls' Grammar pastoral team | School-based check-ins, academic accommodations | New school (note: confirm school name accurately) | **7. Treatment barriers** | Treatment barriers | Plans to address treatment barriers | |---|---| | Passive suicidal ideation requires stabilisation before commencing trauma-focused work | Phase one of therapy will focus on safety planning, stabilisation, emotion regulation skills, and routine establishment. Risk reviewed at every session. | | Sleep disruption limiting capacity for between-session work and school | Sleep hygiene work in early sessions; coordinate with GP regarding short-term medication for sleep if non-pharmacological strategies are insufficient. | | New school environment creating ongoing stress and inconsistent attendance | Liaison with the school's pastoral team to develop a flexible attendance plan, including agreed safe spaces, named contacts, and option for half-day starts during the first phase of therapy. | | Concurrent grief response to maternal grandmother's death | Brief bereavement-informed component integrated into early sessions; cultural support sessions with Reverend Vailaau to support fa'aSamoa grieving rituals. | **8. Recovery goals** Recovery goal: Reduce the frequency of trauma-related nightmares from four to five nights per week to one or fewer nights per week, by the end of Package A (approximately week 20). How will the outcomes of this goal improve kiritaki functioning? Reduced nightmare frequency will allow Kalani to obtain adequate sleep, which in turn will improve his daytime concentration, mood, and capacity to engage in school and family activities. He will be able to start the school day rested, and his daytime irritability and somatic symptoms are likely to reduce. How will this goal be achieved? Specify the services needed and how they will be used to achieve the goal. Phase one of trauma-focused psychological therapy will introduce sleep hygiene, imagery rehearsal therapy techniques adapted for adolescents, and grounding skills for use after waking. Weekly individual sessions with the Lead Service Provider for the first 12 weeks, with cultural support sessions with Reverend Vailaau at weeks 1 and 6 to integrate spiritual and cultural framing of recovery. How will progress towards this goal be measured? Weekly nightmare diary completed by Kalani and reviewed in each session. Re-administration of CROPS sleep and intrusion items at weeks 10 and 20. Who will deliver the services to support this goal and what is the expected timeframe to achieve this goal? Dr Hana Allen (Registered Clinical Psychologist, Lead Service Provider) over weeks 1 to 20. Reverend Faaolataga Vailaau (cultural and spiritual support) at agreed touchpoints. Recovery goal: Achieve consistent school attendance of five days per week, sustained for at least four consecutive weeks, by the end of Package A (approximately week 20). How will the outcomes of this goal improve kiritaki functioning? Consistent school attendance will support Kalani's academic engagement, peer connection, and vocational future. It will reduce his isolation, restore his sense of routine and structure, and reduce the secondary stress of academic catch-up. How will this goal be achieved? Specify the services needed and how they will be used to achieve the goal. Graduated school attendance plan developed in collaboration with the new school's pastoral team. Initial target of three days per week from week 4, increasing to four days per week from week 10, and full five days per week from week 16. Concurrent skills-based therapy focused on managing in-school triggers, emotional regulation, and peer reconnection. How will progress towards this goal be measured? School attendance records reviewed monthly. Self-report of trauma-related school absences logged weekly by Kalani. Who will deliver the services to support this goal and what is the expected timeframe to achieve this goal? Dr Hana Allen (Lead Service Provider) in collaboration with the new school's pastoral team over weeks 4 to 20. **9. Planned services and the providers who will deliver these** **Tailored Support to Wellbeing** | Service | Provider name/ACC ID | Provider discipline | Supplier/Supplier ID | Hours | |---|---|---|---|---| | Individual trauma-focused psychological therapy | Dr Hana Allen / NZP5147 | Clinical Psychologist | Awhina Rangatahi Services / S20194 | 22 | | Cultural and spiritual support | Reverend Faaolataga Vailaau / K20847 | Pacific cultural support practitioner | EFKS Pacific Support Network / S21073 | 6 | | Family liaison and parent coaching | Dr Hana Allen / NZP5147 | Clinical Psychologist | Awhina Rangatahi Services / S20194 | 4 | Total hours of Tailored Support to Wellbeing: 32 **Group-based Therapy** | Service | Provider name/ACC ID | Provider discipline | Supplier/Supplier ID | Hours | |---|---|---|---|---| | Rangatahi trauma recovery group, mixed gender ages 15 to 17 | Dr Hana Allen and co-facilitator Mariana Tupou / NZP5147 / NZP5206 | Clinical Psychologists | Awhina Rangatahi Services / S20194 | 14 | Expected start and end dates of Group-based Therapy: 04/08/2026 to 06/10/2026 **Other ACC services** | Service | Provider name/ACC ID | Provider discipline | Supplier/Supplier ID | Hours | |---|---|---|---|---| | Education support (homework and academic catch-up assistance) | TBC, sourced through Awhina Rangatahi Services | Education support worker | Awhina Rangatahi Services / S20194 | 8 | Total expected package duration of all services listed above: 20 weeks If other ACC services have been listed in the table above, please describe how these services will support the recovery of the kiritaki: Education support has been requested to assist Kalani with managing the academic catch-up required following his reduced attendance and the school transfer. The support worker will provide weekly study sessions during the first 12 weeks of the package, focused on prioritised subjects (English and Mathematics) and on building Kalani's confidence in re-engaging with classroom work. This sits alongside the school-based pastoral support and is intended to reduce the secondary stress of academic catch-up that may otherwise undermine progress on the recovery goals. **Part D: Other information and declarations** **10. Other information** Please provide the date of the last face-to-face meeting with the kiritaki/guardian/whānau that informed this report: Date: 21/05/2026 Please provide the proposed Progress Report submission date: Date: 04/08/2026 Date of disengagement by the kiritaki/guardian/whānau (if applicable): Date: Please provide any other information that you consider relevant to assist in determining cover or to assist in the recovery of the kiritaki: Kalani has expressed a clear preference for a male cultural support practitioner with experience in fa'aSamoa, which has been accommodated through Reverend Vailaau. His father has consented to ACC corresponding directly with him for plan implementation. Kalani has asked that no correspondence be sent to his mother's address (his parents are separated and Kalani lives full-time with his father); this is recorded with his consent. [x] I have attached a completed copy of the HoNOSCA / HoNOSI questionnaire [x] I have attached other documents, eg clinical reports, other psychometric results. List these: CROPS self-report score sheet dated 12/05/2026; PROPS parent report score sheet dated 12/05/2026; GP letter from Dr Lavinia Faleolo dated 06/05/2026; collaborative safety plan dated 14/05/2026. **11. Provider declaration and signature** [x] I have informed the kiritaki/guardian/safe contact/whānau that the information collected for this report will be sent to ACC to support decisions on treatment and rehabilitation needs. I have kiritaki/guardian/whānau authority for this. [x] I confirm that the information contained in this report is accurate and that I have followed the standards set out in the Sensitive Claims Service operational guidelines. Lead Service Provider name: Dr Hana Allen Provider ID: NZP5147 Supplier name: Awhina Rangatahi Services Supplier ID: S20194 Date: 28/05/2026 In the collection, use, disclosure, and storage of information, ACC will at all times comply with the obligations of the Privacy Act 2020, the Health Information Privacy Code 2020 and the Official Information Act 1982. --- **HoNOSCA score sheet** Report the ratings and result of the clinician version of HoNOSCA in the score sheet below and in section 4 of the Cover and Wellbeing Plan template above. HoNOSCA is for ages 4-17 years. Guides on the use of HoNOS measures can be found on the Te Pou website. **Date administered:** 12/05/2026 For each question, answer on a scale of 0 to 4. No problem = 0, minor problem requiring no action = 1, mild problem but definitely present = 2, moderately severe problem = 3, severe to very severe problem = 4. Rate 9 if not known (this is not included in any total scores). **HoNOSCA section A** 1. Disruptive, antisocial or aggressive behaviour: 1 2. Overactivity attention and concentration: 2 3. Non-accidental self-injury: 1 4. Alcohol, substance/solvent misuse: 1 5. Scholastic or language skills: 2 6. Physical illness or disability problems: 0 7. Hallucinations and delusions: 0 8. Non-organic somatic symptoms: 1 9. Emotional and related symptoms: 3 10. Peer relationships: 2 11. Self-care and independence: 1 12. Family life and relationships: 2 13. Poor school attendance: 2 Section A total score: 18 **HoNOSCA section B** 14. Lack of knowledge – nature of difficulties: 1 15. Lack of information – services/management: 1 Section A + B total score: 20 **Items for Clinician Review** [ ] Section 1, Contact details: confirm preferred safe contact channel; voice call only after 17:00 was stated verbally but SMS may also be acceptable, verify with Kalani's father. [ ] Section 3a, Changes since Early Supports Plan: confirm exact date of maternal grandmother's passing ("early April" was stated); record specific date for clinical record. [ ] Section 6c, non-ACC community supports: school name listed as Auckland Girls' Grammar, but Kalani is male; confirm correct school name during next session. [ ] Section 9, Other ACC services: education support worker recorded as "TBC, sourced through Awhina Rangatahi Services"; confirm named worker, ACC ID, and supplier ID before submission. [ ] Section 9, Tailored Support to Wellbeing hours: 22 individual + 6 cultural + 4 family liaison = 32 hours total recorded; confirm this aligns with the agreed Package A allocation for Kalani. [ ] Section 10: Progress Report submission date 04/08/2026 aligns with group-based therapy start; confirm this timing is appropriate. [ ] HoNOSCA and CROPS/PROPS scoring: item-level scores transcribed from clinician's hand-completed score sheets; cross-check against originals before scanning and attaching.