ACC8541 Wellbeing Plan

**ACC8541** **Wellbeing Plan** "This report should be completed by the Lead Service Provider in collaboration with the kiritaki (client) when planning their recovery from a covered mental injury and either:" "- the kiritaki has not previously had a Wellbeing Plan for their injuries, eg because their claim for the injuries was recently approved; or" "- the kiritaki is returning for treatment of injuries on an existing covered claim but requires a new Wellbeing Plan." "Please refer to the Sensitive Claims Service operational guidelines and report guidelines available on our website: [www.acc.co.nz/resources](https://www.acc.co.nz/resources). Return the completed report to sensitiveclaimsreports@acc.co.nz" **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. Current situation and impacts** a. Please describe any changes to the presentation of the kiritaki. The kiritaki's anxiety symptoms have reduced in intensity since the previous report, with a marked decrease in startle response and hypervigilance. He reported feeling calmer overall and sleeping more consistently. No changes to medication were reported. b. Please describe any changes to the life situation of the kiritaki since the previous report. The kiritaki reported increasing his workplace attendance, which has improved his sense of routine and purpose. No significant psychosocial stressors were reported since the previous report. Have there been any developments of risk to the kiritaki from themselves or others, or from the kiritaki to others since the previous report? [ ] Yes [x] No c. Have there been any changes that impact on the kiritaki accessing services since the previous report? N/A **3. Treatment** a. Tailored treatment needs The kiritaki continues to require support to manage residual anxiety symptoms and to consolidate his return to a full working pattern. Ongoing individual psychological treatment is needed, focused on relapse prevention and continued graded exposure to workplace-related triggers. b. Broad treatment outcomes: The kiritaki would like to be able to attend work five days a week without significant anxiety and to sleep through the night consistently. He will know this has been achieved when he can maintain a full working week and report minimal disruption to sleep over a sustained period. **4. Treatment barriers** | Treatment barriers | Plans to address treatment barriers | | --- | --- | | Limited time to practise strategies between sessions due to work demands. | Sessions will include brief, practical exercises that can be integrated into the kiritaki's existing routine. | **5. Recovery Goals** Recovery goal: Attend the workplace five days per week 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? Continued 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 DASS-21 Anxiety subscale at review. Who will deliver the services to support this goal and what is the expected timeframe to achieve this goal? Dr Selina Kyle, 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 Selina Kyle, over the next 8 weeks. **6. 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 Selina Kyle / TEST-PROV-01 | Clinical Psychologist | Gotham Wellbeing Clinic / TEST-SUP-01 | 8 | Total hours of Tailored Support to Wellbeing: **Group-based Therapy** **Other ACC services** Total expected package duration of all services listed above: **7. 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 the recovery of the kiritaki: [ ] I have attached other documents, eg clinical reports. List these: **8. 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 Selina Kyle Provider ID: TEST-PROV-01 Supplier name: Gotham 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." **Items for Clinician Review** [ ] Section 6 – Tailored Support to Wellbeing: total hours field left blank as no explicit total was stated in the consultation; please confirm the total against the 8 hours listed in the table. [ ] Section 2c – no explicit statement was made about access barriers; "N/A" was inferred from the absence of discussion rather than an explicit "no change" statement — please confirm.