ACC8531 Early Supports Plan - child and young person

**ACC8531** **Early Supports 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 Early Supports 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](https://www.acc.co.nz/resources). Return the completed report together with a signed _ACC8532 Consent for cover timeframe extension – client_ (if applicable) to sensitiveclaimsreports@acc.co.nz." **Part A: Kiritaki information** **1. Kiritaki details** Kiritaki name: John Smith Date of birth: 15/06/2012 Claim number: ACC000-TESTCLAIM-02 Address: 1 Example Street, Christchurch Contact details/safe contact where appropriate: Martha Kent (guardian), 03 555 0287 [ ] Female [x] Male [ ] Another gender [ ] Prefer not to say Ethnicity: New Zealand European Is the kiritaki in the care of Oranga Tamariki? [ ] Yes [x] No Are there any formal guardianship/custody orders in place? [ ] Yes [x] No [ ] Don't know Name of guardian/whānau: Martha Kent Is the guardian/whānau listed above a legal guardian? [x] Yes [ ] No [ ] Don't know Relationship to kiritaki: Mother Phone numbers: 03 555 0287 Address (if known): 1 Example Street, Christchurch Are there any reasons why ACC should not contact the legal guardian? [ ] Yes [x] No **2. Consent to access the service** **Kiritaki aged 0–15 years** Gillick competence has been confirmed: [x] Yes [ ] No Child/young person assent obtained: [x] Yes [ ] No Safe contact consent obtained: [x] Yes [ ] No **Kiritaki aged 16 years to 17 years, or where Gillick competence has been confirmed** Kiritaki consent obtained: [ ] Yes [ ] No Authority to act (if applicable) consent obtained or informed: [ ] Yes [ ] No Any additional points to note: **Part B: Event details** **3. Event details** 1. Historical sexual abuse perpetrated by an adult known to the family, occurring over a period of several months, at an approximate frequency of once every few weeks. In your opinion, is it likely that one or more of the events is listed under Schedule 3? [x] Yes [ ] No Did any of the events happen in Aotearoa New Zealand? [x] Yes [ ] No Does the kiritaki have any other active ACC claims? [ ] Yes [x] No **4. Kiritaki current situation** a. What presenting concerns is the kiritaki or guardian/safe contact requesting assistance with? The guardian reported concerns about the kiritaki's disrupted sleep, irritability, and reluctance to be alone with unfamiliar adults, and is requesting psychological support to help him process the disclosed events. b. Describe the current presentation of the kiritaki. The kiritaki presents as a generally sociable 14-year-old who has become more withdrawn at home since the disclosure. His guardian reported that he continues to attend school and maintains friendships, though he has been more irritable with family members. Protective factors include a supportive guardian, stable housing, and an established peer group. c. Since the events, has the capacity of the kiritaki to engage in school or other usual activities been impacted? [x] Yes [ ] No The guardian reported that the kiritaki's concentration at school has been mildly affected, though he continues to attend regularly. d. Have the events impacted the ability of the kiritaki to function in the workplace? [ ] Yes [ ] No [x] N/A e. Describe any cultural or spiritual needs relevant to the kiritaki. None reported. f. Are there any areas of risk? Are there any risks identified? [ ] Yes [x] No g. Are any other agencies currently involved in supporting the kiritaki? [ ] Yes [x] No h. Has the kiritaki previously accessed assistance for their mental health or behavioural difficulties? [ ] Yes [x] No i. Does the kiritaki need support from an interpreter? [ ] Yes [x] No **Part C: Planning and service requirements** **5. Planning and service requirements** [ ] **Support for Next Steps** [ ] **Short-term Support to Wellbeing** [ ] **Cover determined using this Early Supports Plan** [x] **Cover and Wellbeing Plan** [ ] **Specialist Cover Assessment** [ ] A Function Assessment is to be completed as part of the Specialist Cover Assessment. [ ] **Tailored Support to Wellbeing Package** [ ] Social rehabilitation: [ ] Treatment: [ ] Other: [ ] Vocational rehabilitation: **6. Planned services and the providers who will deliver these services** | Service | Provider name/ACC ID | Provider discipline | Supplier/Supplier ID | Hours | | --- | --- | --- | --- | --- | | Cover and Wellbeing Plan assessment sessions | Dr Sigmund Freud / TEST-PROV-01 | Clinical Psychologist | Berggasse Wellbeing Clinic / TEST-SUP-01 | 4 | **7. Short-term Support to Wellbeing recovery goals** **Part D: Cover determination** **Only complete Part D if you are providing information for cover determination.** **8. Psychometrics** **Measure 1: HoNOSCA / HoNOSI** Comments on the HoNOSCA / HoNOSI results: **Measure 2: Results of additional measures used** Comments on results: **9. Link to Schedule 3 events** **Part E: 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: 01/08/2026 Date of disengagement by the kiritaki/guardian/whānau (if applicable): Please provide any other information you consider relevant to assist in determining cover or to assist in the recovery of the kiritaki: [ ] I have attached a completed copy of the HoNOSCA / HoNOSI questionnaire (only if completing Part D) [ ] I have attached other documents, eg clinical reports, other psychometric results. List these: [ ] I have attached an ACC8532 Consent for cover timeframe extension – client (if applicable) [ ] I have attached an ACC6300 Authority to collect medical and other records (if applicable) **11. Provider declaration** [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 Sigmund Freud Provider ID: TEST-PROV-01 Supplier name: Berggasse Wellbeing Clinic Supplier ID: TEST-SUP-01 Date: 01/08/2026 "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** **Date administered:** **HoNOSCA section A** 1. Disruptive, antisocial or aggressive behaviour: 2. Overactivity attention and concentration: 3. Non-accidental self-injury: 4. Alcohol, substance/solvent misuse: 5. Scholastic or language skills: 6. Physical illness or disability problems: 7. Hallucinations and delusions: 8. Non-organic somatic symptoms: 9. Emotional and related symptoms: 10. Peer relationships: 11. Self-care and independence: 12. Family life and relationships: 13. Poor school attendance: Section A total score: **HoNOSCA section B** 14. Lack of knowledge – nature of difficulties: 15. Lack of information – services/management: Section A + B total score: --- **HoNOSI score sheet** **Date administered:** **HoNOSI section A** 1. Problems with disruptive behaviour/irritability emotional regulation: 2. Problems with activity levels, joint and/or sustained attention: 3. Non-accidental self-injury or lack of self-protective behaviours: 4. Problems with feeding and eating behaviour: 5. Problems with developmental delays: 6. Problems with physical illness or disability: 7. Problems associated with regulation and integration of sensory processing: 8. Problems associated with sleep: 9. Problems with emotional and related symptoms or emotional regulation: 10. Problems with social reciprocity: 11. Problems with age-appropriate self-care and environmental exploration: 12. Problems with family life and relationships: 13. Attending care, education and socialisation settings: Section A total score: **HoNOSI section B** 14. Lack of knowledge – nature of difficulties: 15. Lack of information – services/management: Section A + B total score: **Items for Clinician Review** [ ] Section 5 – Planning and service requirements: "Cover and Wellbeing Plan" was selected, so Part D (sections 8–9) and the HoNOSCA/HoNOSI score sheets were left blank per the form's own conditional logic; confirm this is the intended pathway before submission. [ ] Section 3 – Event details: the abuse frequency was described only as "once every few weeks" over "several months"; please confirm whether more precise dates are available. [ ] Section 4c – school impact was described as "mildly affected" without a specific example; consider adding a concrete example if available.