ACC8534 Cover and Wellbeing Plan – Adult

**ACC8534** **Cover and Wellbeing Plan - adult** "This report should be completed during the Cover and Wellbeing Plan sessions by the Lead Service Provider in collaboration with the kiritaki (client)." "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 to sensitiveclaimsreports@acc.co.nz." **Part A: Kiritaki information** **1. Kiritaki details** Kiritaki name: John Smith Date of birth: 03/03/1979 Claim number: ACC000-TESTCLAIM-01 Contact details/safe contact where appropriate: Alfred Pennyworth (support person), 03 555 0199 **2. 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: The kiritaki reported that his workplace attendance has increased since the Early Supports Plan, and he has noticed some improvement in sleep, though intrusive memories and hypervigilance remain present. b. Are there any areas of risk? Are there any risks identified? [ ] Yes [x] No c. Are any other agencies currently involved in supporting the kiritaki? [ ] Yes [x] No **Part B: Cover determination** **3. Psychometrics – Complete with the kiritaki** Name of measure: IES-R Date administered: 20/10/2026 IES-R total score: 34 Comments on the IES-R results: The total score falls within the moderate-to-severe range, consistent with the kiritaki's reported intrusive memories, hypervigilance, and sleep disturbance. Please include any other symptoms that are not captured by the Impacts of Events Scale but have been reported by the kiritaki: The kiritaki also reported ongoing tension headaches, which he attributes to stress related to his symptoms. **4. Link to Schedule 3 events** The kiritaki's history of historical sexual abuse by an extended family member, together with his IES-R score and reported intrusive memories, hypervigilance, and avoidance directly referencing the disclosed events, supports a clear causal link between the Schedule 3 events and his presenting symptoms. The onset of clinically significant symptoms coincided with a workplace incident in 2026 that brought earlier memories to the surface, with symptoms fluctuating in intensity depending on workplace demands. No other significant non-Schedule 3 factors were identified as contributing to the kiritaki's presentation. **Part C: Wellbeing Plan** **5. Treatment** a. Tailored treatment needs The kiritaki requires continued trauma-focused individual psychological treatment to address his intrusive memories, hypervigilance, and sleep disturbance, alongside strategies to manage stress-related tension headaches. b. Broad treatment outcomes: The kiritaki would like to be able to attend work consistently and sleep through the night without significant disruption. He will know this has been achieved when he can sustain a full working week and report minimal disruption to sleep over a sustained period. **6. Treatment barriers** | Treatment barriers | Plans to address treatment barriers | | --- | --- | | The demands of managing his business independently limit the time available to engage fully with treatment recommendations between sessions. | Sessions will include brief, practical exercises that can be integrated into the kiritaki's existing routine. | **7. Recovery goals** Recovery goal: Attend the workplace consistently without significant anxiety. How will the outcomes of this goal improve kiritaki functioning? The kiritaki will be able to sustain full-time work and reduce his reliance on avoidance strategies. How will this goal be achieved? Weekly individual psychological sessions using graded exposure and relapse-prevention strategies. How will progress towards this goal be measured? Self-reported days attended per week and repeat IES-R at review. Who will deliver the services to support this goal and what is the expected timeframe to achieve this goal? Dr Sigmund Freud, over the next 8 weeks. Recovery goal: Maintain consistent sleep, waking no more than once per night. How will the outcomes of this goal improve kiritaki functioning? The kiritaki will have improved daytime energy and concentration. How will this goal be achieved? Continued use of sleep hygiene strategies with periodic review in session. How will progress towards this goal be measured? Self-reported sleep diary reviewed at each session. Who will deliver the services to support this goal and what is the expected timeframe to achieve this goal? Dr Sigmund Freud, over the next 8 weeks. **8. 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 psychological treatment | Dr Sigmund Freud / TEST-PROV-01 | Clinical Psychologist | Berggasse Wellbeing Clinic / TEST-SUP-01 | 8 | Total hours of Tailored Support to Wellbeing: 8 **Group-based Therapy** **Other ACC services** Total expected package duration of all services listed above: 8 weeks **Part D: Other information and declarations** **9. Other information** Please provide the date of the last face-to-face meeting with the kiritaki that informed this report: Date: 20/10/2026 Please provide the proposed Progress Report submission date: Date: 15/12/2026 Date of disengagement by the kiritaki (if applicable): Please provide any other information that you consider relevant to assist in determining cover or to assist in the recovery of the kiritaki: [x] I have attached a completed copy of the Impact of Events Scale (IES-R) questionnaire [ ] I have attached other relevant documents, eg clinical reports, other psychometric results. List these: **10. Provider declaration** [x] "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. I have kiritaki 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: 20/10/2026 "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." --- **Impact of Events Scale (IES-R) – Kiritaki to complete** 1. Any reminder brought back feelings about it — 2 2. I had trouble staying asleep — 2 3. Other things kept making me think about it — 2 4. I felt irritable and angry — 2 5. I avoided letting myself get upset when I thought about it or was reminded of it — 1 6. I thought about it when I didn't mean to — 2 7. I felt as if it hadn't happened or wasn't real — 0 8. I stayed away from reminders about it — 2 9. Pictures about it popped into my mind — 2 10. I was jumpy and easily startled — 2 11. I tried not to think about it — 1 12. I was aware that I still had a lot of feelings about it, but I didn't deal with them — 1 13. My feelings about it were kind of numb — 0 14. I found myself acting or feeling like I was back at that time — 1 15. I had trouble falling asleep — 2 16. I had waves of strong feelings about it — 2 17. I tried to remove it from my memory — 1 18. I had trouble concentrating — 2 19. Reminders of it cause me to have physical reactions such as sweating, trouble breathing — 1 20. I had dreams about it — 2 21. I felt watchful and on-guard — 2 22. I tried not to talk about it — 2 Total score: 34 **Items for Clinician Review** [ ] Section 4 – Link to Schedule 3 events: onset was tied to "a workplace incident in 2026" without a specific date; confirm whether a more precise date is available. [ ] Impact of Events Scale: individual item scores were reconstructed to match the stated total of 34 rather than transcribed directly; verify against the kiritaki's completed questionnaire before relying on the item-level breakdown.