**Part A: Kiritaki information**
**1. Kiritaki details**
Kiritaki name: John Smith
Date of birth: 03/03/1979
Claim number: ACC000-TESTCLAIM-01
Address: 1 Example Street, Christchurch
**Update on treatment and behavioural outcome measures**
**Date of Action Plan and/or last Progress Report:** 15/09/2026
**Summary of input provided (eg number of sessions, modality of treatment, type of intervention, frequency)**
The kiritaki has attended six sessions of weekly individual psychological treatment since the last report, using a cognitive behavioural therapy approach with a focus on trauma-related anxiety. Sessions have included psychoeducation on the anxiety response, graded exposure to workplace-related triggers, and breathing and relaxation exercises practised between sessions.
**Functional goals**
| Goal | Progress | Status |
| --- | --- | --- |
| Reduce hypervigilance and startle response so the kiritaki can attend the workplace without significant distress (from 1 day/week to 4 days/week). | The kiritaki reported a steady increase in workplace attendance, now managing 3 days per week, with graded exposure exercises supporting this. He reported reduced startle response to loud noises. | Partially achieved – on track, target of 4 days per week not yet reached. |
| Improve sleep continuity (from waking 3–4 times per night to no more than once per night). | The kiritaki reported using the sleep hygiene strategies discussed and now wakes on average once per night, down from 3–4 times. | Achieved. |
**Outline any barriers which are impacting progress:**
The kiritaki reported that ongoing demands of managing his business independently have limited the time available for practising strategies between sessions.
**Reason for more sessions if needed:**
The kiritaki has engaged well and made measurable progress on both functional goals, but has not yet reached his workplace-attendance target. Continued weekly sessions are recommended to consolidate gains and support a full return to his previous work pattern.
**Mental injury assessment (Max. 16 Hours)**
Please indicate the proposed next stage:
☐ Treatment with approved mental injury cover (Max. 24 Hours):
☒ Treatment without approved mental injury cover (Max. 10 Hours):
☐ Treatment review (Max. 11 Hours):
If additional sessions are required for treatment without ACC approved mental injury cover, identify why a mental injury assessment is not indicated at this stage:
The kiritaki's presentation remains consistent with the difficulties identified at initial assessment and continues to respond to the current treatment approach, so a further mental injury assessment is not considered necessary at this stage.
**6. Provider declaration**
Provide the date of the last appointment with the kiritaki that informed this report: 20/10/2026
☒ I have informed the kiritaki that the information collected for this report will be sent to ACC to support cover decisions and treatment and rehabilitation needs. The kiritaki understands this.
☒ I confirm that the information contained in this report is accurate and aligns with ACC's report standards.
Date: 20/10/2026
**Psychologist name:** Dr Selina Kyle Date: 20/10/2026
