Summary of session and breakout group discussions - PowerPoint Presentation

1. Summary of session and breakout group discussionsISSC Quarterly Conversation 29 July 202212 August 2022

2. 2Recap of what we covered

3. Priority areas that have emerged through previous engagements

4. Who are we are currently engaging withFour subgroups: Adults, Children and Young People, Men and MāoriConfirmed dates: 25 November 202231 March 202328 July 202324 November 2023Survivor SurveyProvider SurveyInternal Drop In SessionsThe four subgroups of the ISSC Evolution Working Group will run from July through to December 2022

5. 5Breakout group discussions

6. Kaupapa Māori Health Services

7. Kaupapa Māori Health ServicesWhat we heard:There was overall support for the direction that ACC is taking with this mahi to develop Kaupapa Māori Health Services.Credit to ACC for starting this journey and it will benefit those that don’t engage with ACC and that are missed. It is hard within the existing model for Kaupapa Māori practitioners to work holistically with whānau, there is excitement to see this being developed. This highlights the importance of having kiritaki at the centre.The current process limits encouragement of Kaupapa Māori providers to apply to work under the ISSC as its limited in scope and approach.If ACC wants to engage with kiritaki Māori, it is essential to have the right providers to support those kiritaki Māori and their whānau.Interested to understand how we get messages out there that ACC is here to help people impacted by sexual violence – how do we reach those people that don’t know?How can we get this message out to more people?Can there be a move away from a reliance on talk therapy, and consideration of other ways to lift wellbeing?How does this work (ISSC Evolution) intersect with the development of Kaupapa Māori Health Services being developed within ACC?We want to provide Māori who are injured with a choice in the services available to them. We’re developing a new pathway called Kaupapa Māori health services to deliver whānau-centred, tikanga-aligned care to injured people with a serious injury or sensitive claims. At the same time, we are looking to evolve the delivery of our Integrated Services for Sensitive Claims (ISSC) to ensure that it can continue to meet the needs of clients that access the service. Part of this will be ensuring that through the ISSC we can deliver a culturally safe experience to all who interact with us and the service. The evolved ISSC and newly created Kaupapa Māori health services will complement one another and extend the range of service pathways and offerings available to our clients and their whānau with a sensitive claim. ISSC Evolution and Kaupapa Māori Health Services for sensitive claimsKorero about the mahi underway to develop a new pathway called Kaupapa Māori Health Services to deliver whanau-centred, tikanga-aligned care for clients with sensitive claims

8. Towards investment in primary prevention A discussion about the actions ACC is leading under Te Aorerekura to invest in a Tiriti-based primary prevention model that strengthens protective factors.

9. Towards investment in primary preventionWhat is the change we are making?What we heard:What is primary prevention and how does it work?Most prevention work for ISSC providers is within the healing realm, for example safety planning for prevention of future violenceThere are issues for providers due to Territorial Authorities that specify which areas they cover – difficult when they need to reach clients outside their approved area.ISSC Providers want the ability to do more group work to help circumvent the shortage of providers in an area.

10. ISSC Supplier / Provider ModelA discussion about the current ISSC Supplier/Provider model and opportunities for improvement.Current State:ACC contracts with approximately 210 Suppliers who hold the contract (they vary in size and approach).Those Suppliers subcontract approximately 2,300 providers to deliver services. The ISSC Operational Guidelines sets out the requirements for the role of the Supplier vs the Provider. Providers are able to be a named provider on more than one Supplier contract. Suppliers:Hold the ISSC contract with ACC and are responsible for the provision of high quality and timely services to ACC’s Sensitive Claims Clients to support recovery from a mental injury, in accordance with the principles in the Sexual Abuse and Mental Injury Practice Guidelines for Aotearoa, March 2008 (the Massey Guidelines).Providers:Are subcontracted by a supplier (following approval from ACC) and become a named provider and will deliver the supports and therapy to clients with a sensitive claim.Suppliers can only use the services of an Approved Service Provider. Providers must be approved by ACC before they can start providing services.To hold a contract, a Supplier must have the ability to provide all Primary Services and Assessment to determine cover and entitlement decisions in an agreed geographical area.

11. ISSC Supplier / Provider ModelWhat we heard:Is working well and there is good communication.The current model works well when it’s going well but is really difficult when it’s not going well (in terms of the Supplier and Provider relationship).Hugely varied experience in terms of what suppliers provide to providers. For some there is no real connection with the supplier vs very hands on involved supplier.There are dramatic variations in the Provider- Supplier relationship.The size of an organisation can influence the experience of providers.There are pros and cons in every different model. The Supplier role is to take away some of the administrative burden for Providers. Balance and mix to get it right.There is uncertainty about where things are being duplicated – Suppliers sending things out to providers, and what ACC is sending to everyone. There needs to be better clarity and communication.The current business modelShould there be a cap on the number of suppliers providers can subcontract with under the ISSC?Being attached to one supplier (as a provider) is easier, but sometimes means you have to go outside of that supplier to get someone to do the assessment because there’s not a lot of choice.As a supplier you very quickly work out good providers and bad providers. Prefer it to be capped (number of suppliers that a provider can be attached to), maybe at 2-3. It would be good for providers to have a bit of flexibility.Concern raised about ‘restraint of trade’ if a provider could only be under one supplier. Some suppliers restrict providers from working for other suppliers, but as a contractor you should be able to work for whoever and whenever. Would need to consider people that work part time for more than one agency, you’d need to be able to work under different suppliers if you had more than one job.If ACC were to limit the amount of supplier groups – smaller suppliers would be impacted and lose providers.

12. ISSC Supplier / Provider ModelWhat we heard:Some suppliers have no clinical background. Wondered if suppliers are fully cognisant of their duty of care. It would be useful to have guidance in the contract around what support suppliers should provide to providers. This could be focused on duty of care as a supplier (connection, responsibilities, standards, reporting etc). Would like to see this be meaningful and valuable rather than a compliance exerciseAn effective supplier provides support to their providers whilst they are delivering services and supports to clients. It is Important that the suppliers have more than an administrative understanding of the challenges of survivors and the provision of clinical support (which is well informed, if not worked in the field previously). It is important to recognise that recent graduates are being encouraged out of the clinical programmes. Early career support is very important for new graduates. There is a concern about support for new staff - particularly in the larger and more hands-off suppliers.Difficulties in getting some providers approved under the ISSC contact for things like ‘breath therapy’.The Police vetting process when providers move from one supplier to another is taking too long.Suppliers and ProvidersSuppliers and ProvidersThere is a mismatch between expectations of the supplier and the ability of the supplier to meet those expectations. A supplier can do nothing more than a strongly worded letter to say that a provider is putting their contract at risk. There is nothing to stop providers from bringing more work through a different supplier group if there’s something going wrong or under investigation in another supplier group. As a supplier you can have no awareness of what’s happening. The Contract doesn’t have enough teeth when things go wrong for suppliers.Disparity between content and reports. See very brief early planning reports often coming from providers in different supplier groups. Struggle to give feedback on that and not clear how to handle that, they’re not direct suppliers so can’t really give feedback. More standardised education to providers about level of content needed, and the quality of what’s in reports is needed.The line between supervision and supplier information often blurs – When a supplier is a different discipline to the person it can provide interesting conversations. When suppliers can go to supervisors isn’t always clear when there’s ethical concerns.

13. ISSC Supplier / Provider ModelWhat we heard:Issue with the volume of emails from ACC to suppliers and providers when services are at capacity with full waitlists.Frustration that suppliers/providers do not get a response back from ACC on the back of referral emails.Suppliers and providers want to stop being inundated daily by referrals by ACC. Referrals can be sent out to many suppliers- duplication of effort. Concern raised about clients ‘slipping through the gaps’ and is there a way referrals can be done better?Have seen an increase in the number of incorrect Purchase Orders, delays in receiving purchase orders – this is causing frustration.Would like to see more flexibility for clients when they move so they can continue to engage with their provider rather than having to find a new provider in their new location.Is there the online capability to check which suppliers have space to take on new clients? Would like to see an electronic solution to manage capacity, which could reduce effort and administrative burden.Generic emails from ACC are frustrating and now often ignored. ACCOther matters raisedIssue raised about the delay in payments and the negative impact this is having on providers. People expect to be paid on time.Highlighted the pricing gap between private practice and ISSC contract, which is further compounded by inflation.Client Travel - reimbursement rates are not meeting the cost of petrol. Clients are having to change their sessions due to cost of living and reimbursement rates are not sufficient.Changes made by ACC in the Early Planning Report template has made it more difficult for suppliers, as providers can’t put much content in reports anymore. The template isn’t saying that you can’t provide more, it’s just saying that you don’t have to provide as much. As a result, some providers don’t provide any meaningful information that assessors can’t work with.

14. Workforce StrategyA discussion about what can be done to influence the capacity and capability within the Mental Health workforce to support the delivery of ISSC.What we heard:ACC needs to expand the workforce to provide support more quickly and efficiently.ACC needs to think more broadly than cognitive-based therapy as there are other forms of therapy for survivors available in New Zealand, but ACC does not fund them.Examples of professions to consider for the ISSC workforce include Mental Health Nurses, Occupational Therapists, Physiotherapists, Dieticians, Acupuncture, Art Therapists and Allied Health professions. Providers and suppliers may benefit from peer engagement to share ideas, experiences, and resources.Increasing efficiencies in the workforce would release capacity. For example, the frequency of appointments for some clients could be fortnightly rather than weekly. Make ACC onboarding and administration easier to release some capacity – police vetting is a barrier. Suppliers could also elevate their role in supporting providers with administration.Tertiary institutions and professional bodies need to support and promote this work.More robust processes may ease capacity constraints and provider availability. There is a need to work with NZAC to attract overseas providers.Providers need to have the right qualifications, skills and experience so that survivors receive high quality, trauma informed support services. Professional bodies have a role to play in this.There are capability gaps in the workforce, particularly around the support services available to children and adolescents, Pasifika, Māori and the rainbow community.There is minimal trauma / family and sexual violence training available in New Zealand. This contributes to pipeline challenges as this field of work can be intimidating and challenging.If ACC and suppliers collaborate to offer education and training, or apprenticeships, this work may become a more viable option for those considering it. ACC could support this with funding.Offering internships may also support the pipeline.ACC could establish a network of ‘preferred providers’ with appropriate trauma informed training, awareness of referral networks and participation in professional supervision.

15. Pre-engagement with ISSCA discussion about a proposed pre-engagement (the period between a survivor reaching out for help and ACC receiving an Engagement Form) future state and solution areas that can enable this.For the purpose of this work, pre-engagement begins when a survivor of sexual violence reaches out for help. It is not limited to ACC or ACC funded support. Pre-engagement ends when ACC receives an Engagement form from a therapist, so that the survivor can access ACC funded support.

16. Pre-engagement with ISSCWhat we heard:One ‘Front Door’General support for the proposed future state, but questions on how it can be done?A lot of people have expectations around ACC, the experience of clients differs vastly, based on their recovery partner and other various misconceptions.Due to the backlog/waitlists at the moment, and seeing how online has worked well during Covid, is there a way for ACC to allow online sessions (outside of TLAs) to help with this. Can ACC make it easier for this to happen? AwarenessNeed to flag that there would need to be above the line advertising (e.g. have you been harmed, you can get free help here).There is a lot of low hanging fruit, with partner agencies who are dealing with survivors to improve awareness ( e.g. Police)Challenge at the moment is that if you do increase awareness this will increase the pressure on an already stretched service.General feedbackWould not like to see a repeat of the Victim Support format where they are in control of the Victim Financial Assistance Scheme and administer entitlements. Would not want ACC replicating this approach.If ACC is the ‘front door’ to ALL sector services how does that work with ACC providing entitlements for only some Providers or some services?Confirmed in meeting that the details need to be worked through, but that we are not suggesting ACC is the front door. We need a sector wide solution. Who would be responsible for the ‘front door’ vs the ACC front door – concern about duplication. It is confusing for survivors when different ‘bodies’ have to be approached. How do they know what they want from these bodies if they don't know what they could be entitled to?What 'choice’ do clients have that is free and non-ACC (that provides longer term support that isn’t funded by ACC)?

17. Pre-engagement with ISSCWhat we heard:Workforce CapacityIssue is the front line, they instruct survivors to go to Find Support, it shows for example one supplier has 18 counsellors. Suppliers have to explain this isn’t right. It is important to get the information right up front. It would be useful to have co-ordinated waitlist management.Many suppliers do not operate waitlists. Supportive Wait timesHow can we ensure that potential ACC clients across the country will be able to equally access the same kind of support while waiting for therapy? How can ACC support providers to educate clients prior to needing service?WaitlistsMaking one change in isolation, there is a risk that there isn't enough workforce there.There is funding for more counsellors through other contracts, but there aren’t any in the area. Currently social workers are holding survivors until counsellors are available, but they are holding too many and it is a bottle neck. Can ACC make the registration process for professionals more user friendly?Group work or access to other pre-cover supports (yoga, physio, nutrition etc) would mean that some people don’t need to access that longer-term therapy. Would ACC fund more supports pre-cover? We appreciate the feedback we have received on a proposed pre-engagement future state and the solution areas that can enable this. We are now in the process of incorporating the feedback into the next iteration.

18. The language we use in ISSCA discussion about how ACC can change the terms and phrases used when we communicate with clients who have a sensitive claim.What we heard:Current communication with clients is very bureaucratic and official, not soft at all.Communication with clients, providers and suppliers needs to have a shared value set – and be less bureaucratic.It is very government authoritarian communication with clients from ACC, whilst providers are meeting clients with warmth, tenderness and nurturing.Currently missing the physical and illustrative communication versus being wordy.The communication tone and style via the ISSC service needs to be warm and nurturing and reflect how you want the service delivered.Provider communication with ACC has moved from a partnership to a transactional relationship overnight.Need to move towards a human centric system rather than an industrial model, which we seem to be moving more and more into. Not sure how valuable the glossary will be for a lot of clients – terminology may go right over someone's head. It’s like – I can drive a car, but I don’t need to know what is under the bonnet. I just need to know that I can trust someone – I take it, they fix it, and they communicate it simply to me.A proportion of practitioners and clients are illiterate – concerned how people can access and make sense of a glossary if its produced?The glossary would be beneficial to some to understand some terminology.Find Support needs to be updated – it has made it more difficult by having providers and organisations listed. It should just be organisations, otherwise we get clients asking to see a particular person, who may not have availability or be the right fit for the client's needs.Claim ‘declined’ (prior to a Supported Assessment) leads clients into a tailspin due to the wording – it would be better to have wording such as cover is ‘pending’.

19. Questions and AnswersDuring the session we had a question and answer session, we did not get through all questions, here are responses to the few questions we missed.Have any changes been made to the Police vetting process?No changes have been made to the current Police Vetting process for new Providers looking to be a named provider under the Integrated Services for Sensitive Claims contract. We are however in the process of updating the Service Provider Application form to make it easier for new providers to apply. The updated form is expected to be released in September 2022.How will ACC reconcile the gap between feedback it receives from clients and what their experience is vs how we can continue to increase efficiency for providers?Through the ISSC Evolution work the primary focus is on survivors and how ISSC can better support clients that come forward for help.Having this as the central focus is critical if we are to further evolve the service to better meet the needs of people. A part of this focus is looking at how we can continue to create efficiencies within the service to ensure that clients can be supported. When are the dates for the next Psychology Advisor Sessions?Monday 26 September 2022 12-1pm. Topic: Adjunctive TherapiesMonday 10 October 2022 12:1pm: Comorbid conditions co-existing with mental injuryFriday 2 December 2022 12-1pm. Topic: Children and Adolescents in ISSC.Can the update to payrates in the Integrated Services for Sensitive Claims contract align to updates made to other ACC contracts?This delay to other service contracts in ACC is due to when the ISSC contract was first implemented and the contract start dates for variations. We will look to see if it is possible in the future to have alignment across all ACC mental health contract uplifts.

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